"Health systems and plans are now willing to take a leap of faith for digital patient experiences"

Welcome to the big unlock podcast where we discuss digital transformation and emerging technologies in healthcare. Here are some of the most innovative thinkers and leaders in healthcare and technology talking about how they are driving change in their organizations.

Paddy: Hello, everyone, and welcome back to my podcast. It is my great privilege and honor to have as a special guest today Leah Sparks, CEO, and co-founder of Wildflower Health. Leah, thank you for joining us and welcome to the show.

Leah: It’s great to be here. Thank you.

Paddy: Very good. So, Leah, for the benefit of our listeners, tell us briefly about Wildflower health, the company, its evolution. What got you started on this? Maybe a little bit about your background as well.

Leah: Yes, sure. I started this company about 7 years ago when I was pregnant with my first child, at that time I had worked in healthcare for about 10 years. I had started my career at McKesson and then worked for a startup that was sold to a big PBM. Although I knew the healthcare system from the business side, but I never had to navigate it first hand till the time my husband and I decided to start a family. And I was appalled at how difficult it was as an actual healthcare consumer. Every encounter that I had outside of those directly with the clinicians such as navigating my health benefits, determining which hospitals were covered, where to deliver, navigating my high risks during pregnancy; it was all fraught with a very low tech transactional, not consumer-friendly experience. And I contrasted that with what I was experiencing as a pregnant woman consumer shopping for strollers and registering for my baby shower. I thought that if we could bridge this gap, we could not only enhance the experience of healthcare but also move the needle on quality and outcomes. Since as you know, maternal health is not as good as it should be, it is just like most other categories of health in the United States compared to our peer countries. So that was the original inspiration. However, I always knew that we didn’t want to just start and stop with pregnancy, although our initial focus was pregnancy. Over the years we have found that it is more than just starting a family. People enter the healthcare system and become engaged with it when they start a family. And we have begun to focus on the Chief Health Office of the home, who could be anyone in the family but is usually a woman according to our data. We use our technology to help her navigate healthcare, not just during pregnancy, but across a variety of ages and stages in a way that is deeply connected to the health care system. So, it is not a direct to consumer experience. It is a healthcare integrated experience using technology to make healthcare better and move the needle on outcomes. We can certainly share more about how we do that.

Paddy: Thank you for that background. Now, your company would be what we term today as a FemTech company, if I am not mistaken. Now your background and what led you to start the company is very typical of a lot of entrepreneurs that I talk to who see a need that comes out of a personal experience of some kind. Did you also see this to be a marketplace need and if not, what marketplace need were you’re trying to address with this idea?

Leah: Yes. And I will just say a word about FemTech, which is the term in vogue right now for women’s health technology companies. I would say that women are the primary users of our platform. Since women are making 80 percent of the healthcare decisions, they are influencing the whole population. It is not just about women, it is a cascading impact on a range of people and almost like a different way to think about population health. But to get to your question about market place need today, I think it is about engaging women as the Chief Health Officer of the home. Our health system clients particularly, who see this first hand in their patient interactions completely get that. But, like you talk about in all your podcasts, how do we get digital adoption? In the beginning, we focused on a very narrow use case that we knew could get adoption in the healthcare system because it was so simple. Often this is a theme in digital transformation when one starts from simple use cases and grows from there. In the beginning, seven years ago, our focused use case was helping health plans like the payers, whether it is Medicaid, commercial payers or employers to quickly identify and intervene in high risk pregnancies, to move the needle on medical costs, that would have otherwise costed thousands of dollars. Then we proved that we could do that by using a digital solution to engage women every day, identify risks faster, get them the right care with their OB or with a nurse or a care manager. We reduced rates of preterm birth and NICU admissions. So, a very simple use case could get us a simple one-year ROI that helped us to grow from there. While it is important to have the aspirational vision of engaging women as the Chief Health Officer of the home and having a different way to engage your consumers and population, but also having some simple use cases that can help get you started with often, skeptical healthcare purchasers.

Paddy: Right. So, who are your primary customers today? Who do you work with is mostly health plans, health systems, or a combination of both? Where do you see the response being the most positive and encouraging for your solution?

Leah: It’s a great question. In the first three or four years of the company, it was exclusively health plans, both Medicaid and commercial. And then a few years ago, we started getting interest from health systems, especially as we extended our model beyond maternity into a broad range of women’s health and family health. The health systems were interested, not just because they wanted to have a great experience for maternity, but because they wanted to have lifetime loyalty with their patients. Today we work with 20 large health plans. Our contracts cover over 50 million covered lives. We work with a lot of health systems that encompass 130 hospitals and their affiliated outpatient practices. Today about 60 percent of our customer base is payers and 40 percent is providers. What is interesting about this is that there are synergies between the two, because women or families don’t want to navigate health plans separately from their providers. On our technology platform, we bring the two together so that a woman in Seattle can seamlessly go to her OB and get access to an application that can help her navigate her delivery, pull in her health benefits and other resources. Those are powerful use cases which make us excited that we have been able to straddle these two historic silos and help them work better together.

Paddy: Just one more question on the split between the health plan and the provider side of your business. Did one naturally come about as a fallout of the other? In other words, did your relationships with health plans kind of naturally lead you to the providers through those health plan relationships or did it develop organically and independently?

Leah: It was organic and independent. It was more about the product capabilities. Our first client was Dignity Health who cold called us and was interested in our product after surveying the market and found us the best fit for what they were trying to do. So, it was really organic. Over time, particularly in the past 18 months, our clients, both health plans and providers have become interested in how they work together on our platform. It has been an interesting evolution.

Paddy: That’s great. First, congratulations on all the progress that you’ve made in a relatively short time. And of course, it’s a fast-moving marketplace and there are a lot of companies out there in the digital health space broadly speaking. So, you know, in this one moment of the proliferation of digital health programs and interventions, how do you actually build a business case? How do your customers decide which ones have merit? In other words, how do you actually go about establishing that business case with your clients? Who pays?

Leah: The health plans and the health systems license our software. It is a software-as-a-service business model where they pay for the licenses to access. I do think that the risks in healthcare are high. It is hard to experiment on things that do not have an obvious ROI. One of my board members, Aaron Martin from Providence St. Joseph Health had a great comment in our board meetings that for digital health companies to be successful they need to have a short story and a long story. The short story needs to be about how you can save or make money using a solution in 12 months or less. The long story then can be more aspirational and strategic about how are you going to survive in healthcare in the future? Our short story has been successful on the payer side by focusing on the opportunity to reduce costs in maternity. About 25% of the dollars spent on maternity care are costs due to complications, 70% of which could be prevented or mitigated or lowered in some way. We have some nice case studies with clients saving up to 40 thousand dollars per high risk woman who uses our platform, which is very compelling and helps tell an obvious business case. On the health system side, they think about this as a lifetime loyalty family health program. Over a dozen health systems have shown that their patients have a higher return rate to their system when using our platform. There is a higher rate of return visits, from pediatrics to adult health or even tracking family members when added to the platform, that are bringing the health system a short-term ROI of the product. In both cases, payer clients and provider clients, there is still a long story of the need to transform engagement with their target consumers, members, patients and how they are going to be relevant in the future of healthcare.

Paddy: Right. And Aaron Martin, whom you mentioned earlier on, has also been on my podcast. And I do recall this comment that he made about the short story and the long story. In fact, a related comment that comes to mind also is one of Mike McSherry of Xealth, which is also Providence Ventures Portfolio, a company he mentioned that for digital health solutions to be successful in today’s marketplace, they have to be “doctor prescribed”. In other words, you know, you can’t go directly to a consumer and expect them to adopt a solution which is not tried and tested or proven or recommended or evidence-based or any of that unless the doctor prescribes it views. So, I agree with that. Has that been your experience as well?

Leah: I agree. That is ideal but not always possible. It is hard for health plans to get all their physicians to prescribe solutions to their members. We have partnered with Xealth for this. I completely agree and our company is focused on getting integrated with the clinician and physician workflows to make our technology available there through partners like Xealth and in other ways. There have been several companies trying to get into healthcare with their directly consumer brands, and that has been a struggle as well. We have done a lot of research on women in particular, who tell us that they want plain digital health technologies that are truly connected to healthcare through a channel and brand that they can trust. And they don’t necessarily trust all the array of consumer health brands out there. But if their clinician, doctor or health plan tells them something and sends it under their brand, they have a different level of trust and expectation from that technology. I think it is critically important, but a huge challenge given that many outpatient practices are trying hard to survive in the current environment. And now they are supposed to be seamlessly recommending technology to their patients, so it is a challenge. 

Paddy: Right, and you mentioned trust and I think importance of trust cannot be overstated in the context of healthcare because the relationship between the doctor and her patient is a very special one. My understanding, again, we’ve seen the data in a lot of digital health companies that go back a few years, started out with a B2C model and didn’t really work. And a lot of them are pivoted to B2B models on healthcare is more likely B2C, some would say. And part of that is because the trust factor is not something that you can simply bypass and go directly to the consumer. And digital health interventions at the end of the day are complementary to trust and the relationship between trained and experienced and qualified physician and the patient or the health care consumers. Now when you look at your own journey, what have been the biggest challenges to adoption and growth for your own solution?

Leah: Well, I think it is the healthcare system, even when you have a pretty open and short ROI like we have. But even when you build a good base of clients like we now have, it is still slow. People are slow to make decisions since the stakes are really high. There are a lot of security requirements. It is a sluggish industry. There are a lot of reasons why some of this is acceptable because it is risky to introduce new technology to patients and clinicians. Some of the sluggishness is the fact that we have very large institutions making decisions, and sometimes which is an unnecessary bureaucracy. These are challenges that every single digital health company will face, except for the few that may be trying to go to consumers directly who again have a different set of challenges to face. We were on the first wave of digital health startups and have now matured as a company but one thing that has changed in the last seven years since I started is that healthcare systems and plans have become more willing to take a leap of faith. They feel the pressure even more today than they did seven years ago to embrace digital, especially great digital experiences for the patient. I do see a little bit more risk taking and willingness to experiment than I saw seven years ago. It is hard for me to quantify that, but I sense it and see it in the meetings that we have.

Paddy: You know, I will share a little bit of research that my firm did. We kind of have a maturity model for digital health adoption and digital transformation, if you will, among health systems. A vast majority of health systems are still kind of focused on their electronic health records systems and whatever they can get out of it before they go out and do something more innovative. But there’s a lot of health systems at the other end of the spectrum, the leading health systems. I agree with you. They are setting aside budgets. They are experimenting and, in many cases, making investments in some of the promising startups and getting invested in the success of these, which I think is really encouraging and to a point with all these long sales cycles and so on. You do need that support so that you can sustain and continue to grow while you build out your footprint. In that context, I want to ask you, Leah, where do you see the big electronic health record systems, which kind of dominate the marketplace as far as providers are concerned. And the big tech firms you know the Microsoft, the Googles of the world, where do you see them relative to your own success? Do you rely on them? Do you compete with them? Is it both? Can you talk a little bit about where you fit in the broad scheme of things?

Leah: Yeah, we do integrate our solutions with the EHRs, we pull out data. We are beginning to take data and show it on top of the EHR to like OB before our first appointment. The EHR is incredibly important. They are like scaffolding for our future digital transformation for healthcare. I would caution thinking of EHRs as consumer engagement. It is not consumer engagement. They have done well and is an amazing transactional infrastructure. But there still needs to be a consumer layer for the health care system that puts it in context. If you look at the Wildflower apps, they look more like Instagram or Facebook than a patient portal. They have articles and images and you can scroll through them and they are personalized based on reading variables in EHR. You don’t have to go look and see, “oh, I had this test result. What does it mean?” It can be pushed to you and say, “Hey, you had a positive gestational diabetes test result. We’re going to start sending in reminders that aligns to your provider’s care plan to check your blood glucose every day”. So, it’s translating it and making it personal for the user, which is a very different and important use case than the EHRs offer. I think the challenge for our business is not competing with the EHRs. It is just the distraction within health systems who are spending so much time trying to get that right, which I understand they often need to do first, they can’t get to the last mile, which I would say is putting a consumer layer on top of it. As it relates to the technology companies, I think that they’re all trying to figure out what their big play is in healthcare. And of course, they’ve been doing this for years. I remember Microsoft HealthVault, which has now been sunset in Google Health. And I think they’re still figuring out the model. They’re probably closer now than they used to be. We would certainly love to collaborate with big tech companies. But I still see them a bit sitting on the periphery and figuring it out. And they have a lot of smart people who no doubt will figure out in force. Amazon’s making a lot of headway there. I’m hopeful that some of these innovative tech companies we have in the country, like also Apple, they will bring something really important and meaningful and transformational to the healthcare system. I think they’re well poised to do it.

Paddy: You know, you mentioned last-mile solution. I’ll actually go one step further and I see that healthcare really has a last-mile problem because there aren’t enough last-mile solutions, but there’s way more of the technology platforms, all of whom are waiting for solutions to be built on top of that, like the Wildflower Health’s of the world. And clearly, digital health companies such as yours, are differentiating yourself through better user experience. So, this whole notion of human-centered design to build out the user experience, that is something that digital health startups have really taken to heart and seem to be doing an outstanding job. Of course, you need the back-end integrations with the EHR systems to get real-time access to the data and so on. Which brings me to the other question about data really. Is your experience for your customers driven primarily through traditional data sources, or have you also figured out incremental and additional data sources that you can creatively combine with some of the traditional data sources to drive the experience? Can you talk a little bit about that?

Leah: Yeah, today our experience is driven by a combination of what the user tells us about and what we can read when it’s available from the EHR and then other data sources. So, we are currently expanding the level of data that we integrate through other partners. In an ideal state, we would be able to pull in labs and pharmacy data and claims data in addition to the EHR data when it’s available. It’s important that people understand what the EHR data is, that even where we integrate with the EHRs, not all the patients have signed up to use it. We may have had the patient authenticating to pull it in and EHR is only associated with that current provider. You can’t get if she’s a brand-new patient, without an active health history. So, if you’re really going to use healthcare data, you’ve got to work with a variety of sources. Don’t underestimate the power of user data. The data we can get from trackers, from what women are clicking and tapping on, what her mood is in other things like that, you cannot get any conventional traditional healthcare data source. And so, we really believe to truly have a personalized consumer experience. It’s a combination of what we can read when it’s available in the healthcare system and what she’s telling us either directly because she’s answering a question in our device or tracking something or just by what we can detect, what images, what she likes the most. What article does she read? Which article does she click? And that combination, we think, is what true personalization looks like in healthcare. And we’re certainly not there yet. But that’s the journey we are on at Wildflower Health.

Paddy: That’s a fascinating story. Well, what would you like to see? I guess this is my last question for you. What would you like to see from healthcare organizations to accelerate the adoption of digital health innovation? You’ve talked about the sales cycle, and I don’t know how much anyone can do about that, but what would you really like to know? What’s your top one or two things on your wish list, if you will?

Leah: Oh, gosh, it’s a great question. I think the number one thing on my wish list would be for my clients and the people who work with Wildflower, I have so much respect for them. They put their necks out in their organization to work with a young, innovative company. And it’s not easy to do that. I’ve been in their shoes and I’ve been a company, so I really applaud that. And I completely understand that you have to fulfill what Aaron Martin calls that short story, that one-year ROI. But I would really encourage the healthcare system as a whole, not to lose sight of that long story. Where are we going? What is the opportunity here? What does an amazing health care experience look like? That is not siloed. That’s not transactional and doesn’t make me feel like I’m just a cog in the wheel. That’s personalized. That’s as good as what I experience when I go on Pinterest. They know exactly what I want to see in my feed. And to really have that vision as an industry is something that I think we’re all missing, including, many of the startups. And it’s hard when we’re slogging today, trying to get to the next step. But I think that’s something I would really encourage as an industry to continue to really envision to accelerate this transformation.

Paddy: That’s fantastic. Well, Leah, it’s been such a pleasure speaking with you, and I greatly appreciate the time that you’ve taken to talk to us and look forward to following your company and all success to you and your team.

Leah: My pleasure. Paddy, it’s great to be here.

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