Joe Coldebella:
Hello and welcome to another episode of The Broadband Bunch. I’m Joe Coldebella and we are joined by broadband advocate and telehealth expert, Craig Settles. Craig, welcome to The Broadband Bunch.
Craig Settles:
Thank you very much for having me. I appreciate it very much.
Joe Coldebella:
Oh no, we always enjoy bringing you on the show. You’re a frequent contributor to The Broadband Bunch and it’s always appreciated. Before we dive into the topic of telehealth, which I know is extremely important to you, could you give our listeners a little bit of background about yourself?
Craig Settles:
Sure. I have been working in the area of community broadband since 2005, and I have… Before that, I spent 20 years working in marketing for high-tech companies like Microsoft and also some telecoms such as AT&T, and AT&T Wireless. And so I have a fairly broad broadband technology marketing. And when I was doing that, it was a lot about using the skills and the experiences of the market, the target market to really find the answers for what makes sense for them from a market perspective.
So when I look at community broadband today, I’m also wanting to bring the people who have the issues, the lack of connectivity, and so forth, getting their understanding of what they need. And that’s the starting point I think, of any kind of successful broadband project.
Joe Coldebella:
Okay. And obviously, as someone who’s been involved with broadband since 2005, or community broadband since 2005, it’s probably been pretty incredible in terms of just since the pandemic happened, how much broadband has become front and center, especially in the area of telehealth. I was wondering if you could just give some thoughts on that.
Craig Settles:
Yeah. So the understanding of what the value of broadband is becoming very front and center during the pandemic because that’s when people realized, “Oh well, we don’t have good broadband for our students and we’re having students go to McDonald’s parking lot to get their homework assignments.” We also discovered that the broadband infrastructure, the internet, high-speed internet, we found out in the pandemic that one, we could work from home, but if we’re going to work from home, we’ve got to increase the impact that broadband has within the home and within the neighborhoods.
And the third thing that came out of the pandemic was the understanding that there’s a thing called telehealth. I can use the internet to not have to go to the doctor’s office. I could go to my doctor to take on my kids or help with my personal health issues and so forth. A lot of understanding of the mental health aspect and basically what broadband and telehealth can do to make mental health. Again, front end center. We knew that these activities and these technologies existed, but we didn’t have a big understanding of how much we needed these types of things.
For example, with mental health, the value of the broadband element is that it allowed people to not have to go to a therapist. You don’t want the neighbors to know that you’re having mental health issues. That’s a big issue. But with broadband and using telehealth in the home, we were able to get more people engaged with mental health at a very trying time for mental health treatments and understanding and so forth. So there was a lot of awakening that happened with the pandemic.
Joe Coldebella:
I couldn’t agree more. Just as I was doing research for our conversation that prior to the pandemic in 2019, there were less than a million patients using telehealth. And the primary reason they gave in terms of their hesitancy was the quality of telehealth. They didn’t know whether or not it was going to be a viable place to get healthcare. And then obviously the pandemic happened and we went from under 1 million folks to… In the year 2020, 50 million appointments were through telehealth online.
So it’s incredible how fast we were able to pivot because you’re exactly right. It’s one of those things where we didn’t know that we needed it until we needed it.
Craig Settles:
Exactly.
Joe Coldebella:
So just in terms of me doing some statistics, so definitely I think you’d agree that telehealth has entered the mainstream, but what’s interesting is that I think it has its niche. So 15% of all visits are now done virtually, which sort of makes sense in the sense that one adoption hasn’t been totally front and center, but it’s one of those things where it’s slow. And then the interesting thing about that is that those who do use telehealth, 89% of those folks have a positive experience.
So it’s really interesting that we’re at this crossroads where people are looking at telehealth as an opportunity to use it as a healthcare vehicle. But Craig, unfortunately, there are some folks being left out of the equation. And ironically, those folks are probably the ones that need it most. I know that we’ve talked about some of those folks, those in urban communities, low-income folks, folks in the rural areas, senior citizens, folks with disabilities, and veterans. Craig, if we could focus on one group, what do you think we need to do to help these underserved communities and look to telehealth as a viable alternative to traditional healthcare?
Craig Settles:
Well, I think near the top of the list is that we need to understand, well one, what is telehealth? Because of the pandemic, it became popular to have a doctor’s visit because I don’t want to go to the doctor at this time, so I will get the basics. What’s this cough I have? I may have had some sort of accident and I’ve got to worry about the healing process and so forth.
So the main thing was can we use it for basic healthcare that is delivered over the internet and what will it take to make this all work, right? Now, this is where the broadband element comes in because you can’t have telehealth without broadband. And as people, again, as they learn during the pandemic, broadband wasn’t up to snuff in a number of markets. If we’re looking at urban organizations and people, if you look at the rural areas, you would see a lot of people saying, “Oh, our broadband is pretty bad.”
I know that if we were understanding that there’s now this telehealth thing there, but we can’t even get to it. So you’ve created two points off, we’ll call market agitation where people are saying, “We need broadband in a big way and we need the benefits of telehealth because then I can get healthcare delivered to my home, to my apartment, and so forth.”
So bringing those two and marrying the two now opens up these various ways to make things better for the entities and the organizations and the individuals that end up being targeted. It’s interesting to note that the NTIA, which is an organization, I cannot remember their… They’re an acronym.
Joe Coldebella:
They’re a government organization that helps with the distribution of broadband funds. Correct?
Craig Settles:
Right, yes. And so they have targeted seven markets that they feel are most in need of broadband. And if you look at those, you will also see that these are many of the same markets that will be benefited from telehealth. We have low-income communities in urban areas. We have the rural areas. The list that you went through in the beginning. Veterans, people who have disabilities, and so forth. Definitely the elderly. The ability to be able to provide healthcare and broadband for people who are getting older and their alternative may be going to the assisted living facility.
As I said, when you marry these two, you see opportunities for delivering both of those technologies. So if you follow the NTIA’s list of markets, you can see exactly where the money and the resources need to be spent to assist both broadband adoption and telehealth adoption.
Joe Coldebella:
Well, I think you raise a great point there that adoption is the big problem. And is it one of those things where these folks are a little bit slower to adopt because they don’t know that the benefit is there? Isn’t one of those things where we almost need to market it to these folks as we’re sort of reinventing the doctor’s office visit when people traditionally think that going to the doctor’s office, hopping in the car, or transportation, going to the doctor’s office. But what if we rejiggered the direction we take healthcare and make this the initial reinventing of the doctor’s office first and foremost to get adoption?
Craig Settles:
Right. Now, what makes sense is you can’t throw the technology out there and assume that people who have never used digital technology are going to be able to understand and use these tools effectively. So you’re going to need to find a way to almost take a small section of your technology telehealth to provide a specific service and delivering that service, you have people saying, “Oh, well if I can do this, I can work these things over here. And all of a sudden now it makes it easier to have the telehealth adoption.”
So for example, if I understand that my barbershop is doing hypertension screening, which is a huge problem in African American communities and a certain amount in the Hispanic and Latino communities, it is such a major issue that people will stop and listen to what you’re saying. So, well, now I can get my screening when I go get my haircut.
There have been barbers who have talked about providing telehealth services to their customers and looking at the results. There is a huge number of people who say, “Oh, I need to deal with this now.” And now I can say, “Well, I can do telehealth in the barbershop, but maybe I can do the same and more at my home if I understand how to use the computing devices, the telehealth software, and just digital technology in general.”
You can extrapolate to other markets, you can extrapolate to other age groups. You can basically start small and create that aha moment and people will lower some of the barriers that they have to government programs when you have minority groups, not from this country, and they may be very reluctant to deal with the government, especially when it comes to healthcare. So the barbershop or the bodega or the community center in the rural areas, those locations and the people that are responsible with those, your barbers, your pastors, your merchants and so forth, there is credibility in those various communities that NTIA has targeted.
Now, you give telehealth in bite-size nuggets so that people can see a value and they understand that there’s more value in having more technology, getting devices, getting wireless connectivity, and so forth, and then engaging with their doctors and healthcare providers and so forth.
Joe Coldebella:
So is the idea to create, I guess, not traditional channels for healthcare services, say at the local library or the community center, so that way you get the adoption for people to proactively seek out healthcare as opposed to waiting for things to get worse and then going to, say, an emergency room not getting the quality care that they deserve?
Craig Settles:
Exactly. So we have a situation where policymakers will air very badly when they assume that just because the technology is free, everybody is going to, will want it, right? And the reality is very, very different. There have to be some research and community groups and activity groups and so forth that will educate the folks to what digital can mean. And then by, again, making it into bite-size nuggets, then that they will be the removing of these barriers because you’re not going to affect those barriers with billboards and ads, and social media, and so forth.
You have to have very one-on-one kinds of activities and they have to be done by those people, the unofficial leaders in the various communities. And those are the people that need to become the ambassadors for telehealth and digital technology in general.
Joe Coldebella:
Okay. Because ultimately what that’ll do is that’ll give folks in these communities access to better care. Right?
Craig Settles:
Mm-hmm.
Joe Coldebella:
Because as we start out and you work these folks into learning more about their healthcare options, then they have access… Plus they also have access to folks that they might not have in their community because some of these communities may have one or two facilities, but the healthcare workers don’t have the expertise. So telehealth gives them an opportunity to get a higher quality of healthcare.
Craig Settles:
Right. I think that what is really important and valuable is the preventative types of healthcare. Right?
Joe Coldebella:
Exactly.
Craig Settles:
Because there are lots of cases where low-income folks have hypertension, they have obesity, they have various healthcare issues, and they let it go because they can’t get to a doctor or they can’t afford a doctor. So those people end up in the ER or they end up in the hospital and it’s worse for the individuals and it’s more and more costly for the system that delivers the healthcare. And so if you can get people comfortable with putting their blood pressure from a device that will be sent automatically to a healthcare provider or whoever the city is partnering with as they roll out telehealth, those preventative measures will have a huge impact.
It has the unintentional benefit of driving broadband adoption because if I can get a hundred people who get really excited about it, I can get my blood pressure checked, I can maintain and lower my diabetes issues, and so forth, and everyone says, “Oh, this is great.” And now I can say, “Well, I can get the FCC’s ACP program, the Affordable Connectivity Program where I can get a subsidy on a computing device. I can get free internet access.” At that point, it’s an easier sell to that hundred people than using a bunch of marketing tactics and so forth that work in the suburbs, but they don’t work for low-end communities.
Joe Coldebella:
No, I think that makes a lot of sense and what the community should do is embrace the technology, and then once the technology is embraced, then folks would bring it into their home and insist from local leaders and government officials to say, “Hey listen, connectivity is vitally important not only for my community but for myself just to help with bringing healthcare to me so then I’m proactive as opposed to reactive to things that happen to me.” I think that’s a great point, Craig.
Craig Settles:
Exactly. I think that we have an excellent opportunity to provide what I call training wheels for government broadband programs, and grant programs. We have programs set up by the FCC. You can have a number of different agencies or programs that you are a part of and that can make you eligible for the ACP program. So if communities are smart, you would use that program and figure out how to form partnerships and partnerships with the unofficial leaders of the community.
You can try different approaches, different programs, and so forth and figure out what makes the most amount of sense. Because everyone is getting all revved up because of all the billions of dollars that are going to be available from the NTIA. But it’s going to be a year easily, maybe two or three before all these programs start to get revved up and money starts to flow.
So you can use the ACP program now to figure out, as I said, create training wheels, marketing training wheels, figure out things that are going to actually work, and then you’ll be ready when you create your plan, your digital equity plan, digital inclusion plan and so forth down the road because all of these ACP, I call them pilot programs, you can say with a certain amount of certainty if we reach a thousand people with this type of program because we’ve tested it out. And I know that I can get 10,000 more people engaged in the program, then I’m ready for the NTIA and their big bucks programs.
Joe Coldebella:
No, that’s a great point. And one of the things as I did some studying for this, I would think about augmented reality or virtual reality or the different things in terms of technology that telehealth is bringing to rural communities, to underserved communities, to people of color is that ultimately right now we’re at the stage where we need to get adoption before we even think about those bigger issues. I wonder if you could comment on that.
Craig Settles:
Yes, there are a number of programs that are involving different universities and schools and hospitals and so forth where they’re using and they’re testing the next wave of technology, artificial intelligence, the internet of things. All of these technologies, I would say they’re out at two or three years before they are mainstream because when we’re bringing technology into organizations and in communities, there are the people who are the first adopters, and then there are the rest of the folks.
And before you can get the other bulk of the different markets to get them engaged and actually have a cost-effective program and products, you’ve got to do this testing and experimenting and pilot programs and so forth. So you want to encourage these types of activities, the things where you have artificial intelligence that can figure out that the person in the house hasn’t taken their medicine, but they haven’t eaten in two or three days.
These are possible technologies, but they need to be refined. And then there has to be a certain amount of buildup to when it becomes affordable for middle and low-income communities and so forth. But you have to be engaged with these kinds of programs now. I think that the people who say, “Oh, that’s down the road. We don’t have to worry about that. Right now we have the stuff here.” And that’s fine, but there need to be folks who are encouraged and motivated to figure out the next killer apps because three years is not a whole lot of time when you really look at the situations that we’re looking at.
Joe Coldebella:
Absolutely. It’s really interesting too because the question of adoption is really fascinating. I know we touched on it earlier in terms of what’s the possible avenue that we could take to make adoption much quicker. I was reading this report by the McKinsey group, and just looking at the adoption of telehealth, it was really interesting in the sense that for most areas of healthcare, the adoption pretty much was anywhere from eight to 15% because I think breaking that habit for folks to not visit their primary physician in person is going to be difficult.
But one area where there actually was tremendous adoption that was in mental health where it was close to 50% of folks has taken that step. And it could be because when you go to a doctor for your primary care, you’re examined physically. But in terms of mental health, it’s one of those things where I think it might be the perfect area for us to focus on, especially getting telehealth adopted by the masses.
Craig Settles:
Right. I think the big value of telehealth in the mental health picture, there are many folks both culturally and socially who are reluctant to tell anybody that I’m going to have a consult with a psychoanalyst, right? There are certain communities where their fear of what the neighbors will say, is an intense barrier. So if I can make it so that people can go on the computer, that’s fine, that’s good. That’s a way to break that barrier and then people can use it more and so forth.
I would caution that as a community or a hospital, whoever, if you are wanting to establish a mental health program that involves telehealth, it’s great when you have it in people’s homes. But there are a number of cases and sometimes where you have the most serious need for mental health in cases where you’ve got five people in the house and then no one has space. The computer is not in everybody’s room. They have just one in the kitchen or the living room or what have you. So you don’t have that comfort of just a one-on-one situation.
So you have to provide alternative locations where you can deliver telehealth that makes it easy. Maybe it’s in the neighborhood. Maybe it’s a community center. Maybe it’s a church. But that element of privacy has to be respected because broadband, gives you speed, it gives you access and these are great things. And then obviously to a certain event that you have the privacy as well. But you have that, call it space or spatial issues and you have to address that as well.
Joe Coldebella:
No, that’s a really great point. And it’s one of those things where telehealth in itself is just starting out. So it’s going to be interesting to see how all communities figure out the problem. As sort of winding down here. I want to do something a little different in terms of how we end up our podcast. I want to make you the telehealth Czar Craig and I want you to give out some advice on three different areas and I would love to get your opinion on them.
The first area is if you could share with healthcare organizations one thing that they could do moving forward to make telehealth more acceptable, and more adoptable. What would you tell those folks?
Craig Settles:
You have got to create relationships and partnerships with the people building the network because the people that are building networks generally do have not a whole lot of expertise in telehealth and healthcare issues in general. They’re just laying out the pipe and where the pipe goes is based on a number of things having probably nothing related to healthcare delivery.
So the medical and the physician community, and the healthcare community has to make their presence known in the beginning. If you hear that your community is going to apply for different NTIA grants, make sure as a healthcare provider or a public health person, you are part of the mix from the beginning. I cannot emphasize that enough.
To the government folks though, I think that as one person in Chattanooga said, we often want to come in as policymakers and tell people what they need. And that is the worst. That is the absolute worst. The politicians and the administrators have got to step aside, take their egos with them, and then they’ve got to make it extremely easy for communities, people, and individuals to explain what they need.
You also have to respect that because if you just say… You just give it as lip service. Oh yeah, we had this needs assessment. We had a focus group and now I’m going to do what I want to do anyway. Well, What’s the point? That is not going to save your communities from being made further and further behind. So the needs assessment is a community-driven thing and that has to be the first rule I would give to the government. And I’m not saying local government agencies.
Joe Coldebella:
No, that’s great as well. I heard a great line at an event I attended in Cleveland and the speaker on stage said, “Hey, listen, we always say, hey, let’s give these underserved communities a seat at the table.: But she’s like, “No, that’s not what we should do, it’s actually we should go to their table because this is just one issue of many that are in these communities.” It behooves us for the broadband community to go to those areas and extend an olive branch, so to speak, and go to their areas instead of them coming to our areas.
Craig Settles:
Exactly. You have to get those folks comfortable because I hear a lot of rumblings from folks in the community, who hate the word best practices because that’s like consultants speak for, “Just listen to what we have to say.”
Joe Coldebella:
Right. Yeah.
Craig Settles:
Right? It’s just like, “Holy mackerel.” You got to change your way of operating because governments have years, years of experience doing the same thing. And they often screw the local communities, the people that they’re trying to help. So you got to stop that. You just got to stop that.
Joe Coldebella:
All right. Well, as the telehealth czar, what would you tell communities to get the healthcare organizations, to get the folks who bring the broadband to communities and the government organizations? What would you say to them to get more alignment from those folks?
Craig Settles:
I think they’ve got to be more forceful and they probably already are, right? But they might want to be more assertive and really pound the table. Because governments don’t like to be wrong. They want people to do what they say. And so you just have to be as forceful in your position. But I think also numbers. There’s nothing that makes government people happier than having numbers.
Joe Coldebella:
The idea being the squeaky wheel gets the grease.
Craig Settles:
That’s true. But the thing that happens with this community, because they’re making this, ACP program work for them is that they measure everything, everything. How much time does it take from the first meeting to the final meeting with the different groups? Right? They break down the different neighborhoods. How much time is it going to take for folks to understand this or to survive this particular program or process or what have you? Right? It’s crazy.
They’ve created seven phases of the program and they made everyone else understand that these phases are the phases that make sense, but it also shows how you actually get people through these phases faster. And so the point is, you are never too small of a community to where numbers can definitely help you. So figure out… Then that way when you come to the table or you have people come to your table that’s when people understand, “If I do this, I got a 10% better chance of getting people to adopt the technology. If I do this program over here with these particular neighborhoods or ethnic groups or what have you, I will get 40% response and adoption.
But that bridges or helps the bridge, the healthcare folks, the government folks, and the community. And the community will hopefully get more of what they need as a result of that. So numbers. All about numbers.
Joe Coldebella:
It’s all about numbers. Well, this has been an awesome visit, Craig. If folks want to get ahold of you, where can they go to reach out and chat with you?
Craig Settles:
Sure. It’s craig@cjspeaks.com. Guaranteed you get me that way. I have a website, cjspeaks.com. I’m also on LinkedIn and Twitter, but not so much.
Joe Coldebella:
Okay.
Craig Settles:
LinkedIn is kind of my social network of choice.
Joe Coldebella:
Awesome. Well, hey, this has been a great visit, Craig. Thanks so much. Hopefully, we’ll check in with you a little later just to get an update on all the things that you’re doing, but thanks so much for joining us.
Craig Settles:
Sure.
Joe Coldebella:
Hey, that’s going to wrap up this episode of The Broadband Bunch. Until next time, we’ll see you guys later.
