Integrating Healthcare Technologies of the Future – Andy Flanagan, CEO of Iris Telehealth

Dr. Rishi Desai: Hi, I'm Osmosis chief medical officer, Dr. Rishi Desai. A new report from the Kaiser Family Foundation shows that while the overall number of telehealth visits in the U.S. is declining now, telehealth visits for mental health remain much higher than at pre-pandemic levels. With us today is Andy Flanagan, CEO of Iris Telehealth, which focuses on expanding telehealth psychiatry services. Thanks so much for being with us today.

Andy Flanagan: Thank you, Dr. Desai. Appreciate the time.

Dr. Rishi Desai: Call me Rishi. I understand the formality, feel free to—

Andy Flanagan: My pleasure... to show respect.

Dr. Rishi Desai: That's very kind of you. I'd like to understand a little bit more about you and what got you interested in the healthcare space. Do you mind taking us back to when you first got started?

Andy Flanagan: I'm the youngest of five, and one of 26 grandchildren in a classic Irish Catholic family. I've seen everything, and we're very close-knit. Healthcare has always had a place in my life, if you will, wanted or otherwise. 

I started out my career at Xerox, and healthcare is something that was part of what I was drawn to, and I followed that professionally ever since. I think I've been on almost every side, except this is the first time I'm really leading a medical group per se, from the PC model, but being as close as I am, I'm having a field day, I love it.

Dr. Rishi Desai: At what stage did you did you first take a step into the healthcare space? Was that sort of in high school, college, after college, what was that first step?

Andy Flanagan: In my very first job, I worked for Xerox Corporation, and I was calling on materials management in hospitals, which was in the bottom basement corner filled with paper. Usually, the person had barely enough room to get to their desk. That's how it started. And I've seen the interplay between the business of running the hospital and delivering care play out at scale, in micro settings, in incredibly well and incredibly dysfunctional manners.

I was always drawn to trying to help solve that problem. I'm not a clinician and that wasn't my story. I don't think I had the chops in that regard to go through that part of the journey, but I feel like I've been able to fulfill my personal do good while I do well model by always having healthcare in the middle of what I do. I started a software company that was focused on optimizing cooperative purchasing for hospitals, and many of the large GPOs were customers back in the day. It's always been something I've tried to understand better.

Dr. Rishi Desai: Tell me a little bit about Iris Telehealth. The name itself is very intriguing as well. What got you to land on that name?

Andy Flanagan: Well, Iris is a messenger, a God from mythology, and it seems fitting for healthcare, and drawing on mythology at a certain level. But really, we view ourselves as just that—as conduits of care. We've always been digital. Our founder, Dr. Tarik Shaheen, a child psychiatrist, he started out as a sole practitioner, delivering telehealth himself, consults with his patients. Then that led to providing that service to others. And here we are today.

But our culture is strongly grounded in what we would all recognize as the human condition. One of our values: suck less every day, and people above all else. Live your work, love your work. It really aims to just trying to be self-aware. That's it. Iris really embodied a lot of those aspects, no endpoint in mind, just part of the journey.

Dr. Rishi Desai: Walk me through how Iris is different than many other telemedicine services that offer psychiatric consultation or help.

Andy Flanagan: Sure. First of all, we need 1,000 more companies helping, so we don't view this as a zero-sum game. As we said earlier, our empathy for the patient journey—and the lack of access—is paramount. Our story here is that we're focused on serious mental illness. 

We employ primarily psychiatrists and PMHNPs. And we're in community mental health and federally qualified health centers and community mental health centers and emergency departments of health systems and medical-surgical floors. We view our job as really kind of sort of stabilization. We're there when escalation occurs. Our role is to provide that incredibly important moment in time when there aren't resources and the clinicians and the staff need somebody who's trained—for psychiatrists to help.

So we're just part of the care team. We think we differentiate ourselves number one, by thinking of ourselves as the medical group in serious mental illness. We, of course, provide resources for stress, anxiety, and depression, because our patients experience those as well. But we're really focused on strengthening the delivery network. We really believe that there's a risk that our delivery network, it's attrited, if you will, and patients are cherry-picked out of the system, if you will, based on them being profitable, or some kind of lower medical expense ratio. 

And the hospitals are left and the PCPs are left with problems. What can they do with limited resources? So, we want to help health systems and community mental health centers and clinics, and form leverage technology like telehealth, and we see them being integrated. We are technology agnostic: Further differentiation, we don't have an app, we don't have a cart, we don't have a camera. And we want people to leverage the technology they have, and get the most value out of it for the precious dollars they spent on that technology.

Dr. Rishi Desai: I came across a model a while back where three hospitals in North Carolina were competing for patients. But what they realized is that with certain patients, patients were bouncing between the three ERs, and they all three hospitals were losing money on these on these patients. 

They pooled their resources to take care of these folks in the outpatient setting. And many of them had mental health issues. And like what you're saying, it didn't matter at that point in terms of competition. What they were doing is collaborating to create kind of a situation where the patients get better care, and all three of the hospitals did better as a result. 

In a scenario like that, I'm just trying to imagine, how would Iris Telehealth plugin? What concretely would happen for those patients in a scenario where Iris Telehealth was involved versus if they were not involved?

Andy Flanagan: I love this question, because it's really at the heart of the end game here. We ultimately quietly talk about ourselves as a navigation company. And this is a little bit esoteric. We don't say this out loud, we just talk to it. But because we are working with the federally qualified health center, the FQHC, the CMHC, and the hospital in the same county, the same city, the same zip code sometimes, we are uniquely positioned to understand that journey of that single patient. 

As we talk about value-based care, we're not worried about the contracting side of it. We're thinking about the pillars and the structure and helping our–we call customers partners–helping our partners figure that out, because you said it perfectly. If we can focus on the patient for a moment in time and continuity of care, then diverting that patient from the ED early to a CMHC, or to a surge resource like we might provide, or to a different hospital service line–psychiatric service line where someone is available–everybody wins. The patient wins. The family win. The insurers win. The payers, the clinicians, everybody. 

For us, that means that we have to step in to build the technology and the tools, but also think about patients as individuals by diagnoses to say what typically is happening to see if we can predictably–or at least quickly respond–if we can't do it predictably.

Dr. Rishi Desai: When I was thinking about your company and what you do, on one level, I was thinking, oh, my gosh, this is great, because you're helping those with serious conditions. You said that just a few minutes ago. And on the other hand, I was thinking, "Wait a second, those were serious conditions. They may be least able to manage a telepsychiatry service, they may not have the wherewithal to find the internet to use it to know how to..." 

So walk me through that, like logistically, how does that work for someone, let's say, with an extreme case of schizophrenia, or Alzheimer's, or depression... how do they take advantage of these services that require a certain level of ability?

Andy Flanagan: This is a wonderful question, Rishi, because this gets at the heart of some of the most painful stories. First of all, technology should be viewed as part of the journey. Telehealth itself is not the end game. It's just a facilitation of another method. we need to have an omnichannel strategy for this particular individual, this consumer, this patient, this person that you're describing.

The resources are available to help that patient. There are people that will go into the community and support the homeless population that has food insecurity, and they're living under a bridge, and they've no telephone. The problem is that they don't know which person they should call, which person they should go find. And this is where technology can play a role to say, 8 out of 10, they came into a food bank, we checked in, we see they're well, they took their prescription with them. These are data points we can track to say the absence of data is data. 

And with the fragile community you're describing–which I've experienced in my personal life, in my family, these are very personal stories that we should understand happen to everybody, in various points of time–we need to think about it that way, bring the full story every time. The technology creates a web membrane  if you will, a mesh system for us. And that's what it'll take to get to the endpoint of those most difficult patients that you just described.

Dr. Rishi Desai: You have an interesting corporate culture as well. And one element of it is this acronym that I love, SLED, which stands for suck less every day. Do you mind just explaining to folks kind the origin of sled and that means practically for your company?

Andy Flanagan: Yeah. it's funny, I mean, every time at a surface level, we talk about this all the time inside of our company. And I'll give you the examples. But externally, when I explain this, I always laugh. And it's because it's cheeky. It's the sort of thing that nobody ever wants to talk about. Nobody wants to admit I had a bad day, or I had a bad moment, or I could have done better, whatever. 

Inside of our company, we talk about this, We talk about sledding. Let's go sledding every day. And we say it that way. And what we keep saying, what we're sending the message, is that it's okay for me to make a mistake. It's okay for me to be human. There's space here to say I'm feeling down. This isn't a good day for me, or, boy, I could have done that better or wasn't as empathetic to my peer, or so and so had a tough time, and I didn't reach out. I could have done that.

So no matter where the bar is, it can be better. And that optimism is embedded in forgiveness. It's embedded in ownership. I own me, and that includes me owning the fact that I say, I don't think I did that very well. And if I can do that as a CEO, everybody can do it. We spent a lot of time talking about that because this is a tough business. We are a medical group. We're delivering care to some of the toughest patient journeys in the country with low reimbursement and technology disadvantages. So, everyone, they have their lives, they finish working during the day and they go home. We want them to go home and say, "I did good today. And even if it wasn't my best day, I really made a difference in the world. And that's okay, I paid a fair wage. I did well, I did good." 

We try and remind each other that that's the story. This is the journey we're in, and it creates a lot of self-confidence. We're going fast, and I want people to make decisions. This is a highly empowered environment, but we all know we're worried about, will I get in trouble if I make this decision? And the answer is no if you're sledding! Just learn from it, right?

Dr. Rishi Desai: Yeah, no, that's awesome. I like that. I'll probably try to start adopting that not just professionally, but within my family, because I think that's a really wonderful way to uphold your own life and also teach kids as well, how to not worry about being perfect. 

The next thing I want to learn about is the future. I mean, you've described kind of the problem very clearly. I think, as you said, it touches everyone's life: Yours, mine. And then at the same time, we're hearing things, like there's new words that are in the public lexicon, like Metaverse, that wasn't a word that people use two years ago, three years ago. What does the future hold for Iris Telehealth and really just telepsychiatry services even more broadly? What are you seeing? What do you imagine will be different five years from now potentially, from where things are now?

Andy Flanagan: First thing I think about is what's going to disappear, and the word telehealth is going to disappear. It's just care, just like online banking was the thing. You know what I mean, like the internet, I have a website. No one talks about any of that anymore, right? Much less, I have it on a CD. I'm gonna age myself. I can keep going, Rishi, like we could do this all day long.

So, it's okay. Number one, the future is simplification and integration. That's really the story. For the listeners that are coming out of medical school, or they're early in their careers, and everything they know in their personal life, and they go to work, and they're like, "Yeah, none of that is here." Like "What? I have to do it this way? "

I mean, that's gonna change in our lifetimes. The future for our company is that we're going to continue to be invested in ourselves as a medical group and get better, or joint commission accredited. And we're going to lean into that we're working on creating the next generation Medical Group. That means helping clinicians have a work-life balance. I mean, I don't know how clinicians do that, but that's our aspiration. And we believe that they have that here. And that's why our engagement scores are so high, but you gotta fight for that.

We're planning to fight for the clinician experience and the patient experience, and along the way, our technical and our value-based care teams, they're refugees, corporate refugees, from big companies–the leading tech companies you know–and our journey for them is, hey, you're in a protected area, go solve the problem. What problem? You know, the problem. Like, I don't know the problem. You know the problem. Talk to our clinicians, go talk to the patient. Just keep solving problems. 

And that's what I mean, it's kind of like sucking less every day, like innovation wise, solve the next most adjacent problem first. Don't swing for the fence, just make it incrementally better every day. And in the course of five years, look how far we've come. That's our future. And I believe in it, it's sort of a daily story, just spend a small percentage of your time thinking what could be better each day, and you've done a lot.

Dr. Rishi Desai: Actually, that's a good segue for me, because you've talked about the patients and how they struggle and thinking about their lives and their lived experience. And then you just touched on providers and the fact that a lot of them have to work incredibly long hours, and you're striving to make a better work-life balance for them. What have the last two years through COVID taught you? You've led this company and seen growth, what have you noticed in terms of how providers are managing their own care? And how do you guys support that?

Andy Flanagan: I would say, for the first time in a long time, and I have providers in my family, I respect the work they do, trauma nurses, I'm amazed. I would say for the first time, it's okay for the clinician to be vulnerable, for the clinician to have a tough day, and be public about it. The clinician burnout now is that real, we're seeing it. But it was always real. Now all of a sudden, like it's not like it just happened. 

It's the recognition, just like the stigma associated with behavioral health, mental health issues is dropping. The space, the personal space for clinicians to be humans as well, it's growing. We've leaned into that. We kind of have always done that. And I think it's the benefit of having a founder that is also a psychiatrist, right, that he really envisioned what the world was like, and what was sound clinical care, but also what was a good practice of medicine personally. That's my view.

Dr. Rishi Desai: Now, we're teaching companies, and so we're always looking at things through the lens of like teaching or filling in knowledge gaps. In your experience, what are some things that you've encountered–maybe their myths, or just misunderstandings–that you'd like to clear up for the audience, maybe just educate us on so that we're all a little bit smarter?

Andy Flanagan: I want to go back to technology because that's really my sweet spot. The problem that they see is being worked on. You don't know by whom, or how fast. It's like the metaverse–don't know what it is, here it comes. Didn't know what telehealth really was two years ago. Telehealth is going to disappear, the very best of it will be integrated, and the rest will be discarded. And it's going to happen again. We're starting to see this with EMRs, where patient engagement platforms and Cures Act is opening about the portability of data. 

It's slow. We're cautious as a country as a world. But I do think that progress will continue to be made and so their voice is important, just like yours on this podcast. We're going to continue to get better. I know that that seems impossible when you have these huge behemoths like Epic and Cerner who are just so big, they can't be touched, and they don't care. They do care and there are people inside those companies that do care. It's just such a big thing. It moves slowly.

Dr. Rishi Desai: I appreciate you saying that because I think another thing that is sort of this low-lying concern for a lot of folks is feeling commoditized. Like, hey, if now I'm going to be part of this platform, am I essentially sort of a medical version of an Uber driver, or a Lyft driver, where we're now I'm sort of seeing patients through a platform and they control really everything that they want to control, and then I sort of do their bidding. I appreciate you saying that.

And I guess that might be a good point to ask my final question, which is like, what advice do you have for folks that are going into medicine? Maybe they're going to clinical medicine, maybe they're interested in the business side of medicine, or improving it in some, like you said, tangible, but adjacent way, maybe a small improvement, but really right next to where they're already working? What advice do you have for folks that are looking at you and looking at your career, and maybe aspiring to do something like that?

Andy Flanagan: Yeah. I guess the first thing is that there's a business model for almost anything. You're right about Uber. There are plenty of telehealth companies that are using that business model as an example. And there are high-quality medical groups doing the same thing. You can find any career you want, you will always be highly valued because of your clinical experience, at whatever level, you decide to stop right out of medical school, or after years of practice. 

The second thing is to just have empathy for the corporate side of the equation because they haven't had the benefit of all those years of experience. We talk about people having superpowers. Everybody has a superpower, Rishi. And you just have to be diligent enough to keep asking and looking to find it. And when you find it lean in, and we want people to identify their superpower, and flex it, like, own it. We're all people, it's okay, like, I'm good at one thing, not 50 things.

That's my one thing, let's make sure that I'm on the field, I have the bat when it's up for that one thing to be decided. That's the story with the clinician. We expect that I had a CMO that I recruited out of a very well-respected health system that you actually have been a part of in your path. And I wanted him because of his clinical knowledge and his emergency experience, department experience, and he was going to practice part-time, and I wanted that too. 

And he wanted to become a business person. He wanted to know everything that business people knew. And it took me 6-9 months to get through coaching and cajoling and counseling and listening and talking to get him to understand that his superpower was far stronger at 100%, than at 50% and 50% business. There are tons of people that will know the business side–better than me, better than you–coming out of, you know, business school and some of these strategy houses. And boy, when he embraced him for everything he had, he soared. It was awesome.

Dr. Rishi Desai: That's amazing. I love it. I think a lot of times there's this tendency to kind of work on your weaknesses, improve your weaknesses, and there's I think value there. But less often do I hear people talking about kind of leaning into your strength in that's what I'm hearing you say?

Andy Flanagan: Yeah, that's exactly what I'm saying. Yeah.

Dr. Rishi Desai: That's wonderful. Listen, I want to thank you for taking the time to tell us your story and your inspiration for creating Iris Telehealth. I think that's fantastic. And for teaching us, that was wonderful. Thank you.

Andy Flanagan: Likewise, I appreciate the time. Thanks, Rishi.

Dr. Rishi Desai: Well, I'm Rishi Desai. Thanks for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together.