Month: October 2021

It is time to focus on a collaborative innovation model in healthcare

Season 3: Episode #100

Podcast with Unity Stoakes, Co-founder and President, StartUp Health

"It is time to focus on a collaborative innovation model in healthcare"

paddy Hosted by Paddy Padmanabhan
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In this 100th episode of the podcast, Unity Stoakes discusses about their life-long mission to improve people’s health and well-being worldwide and how the healthcare landscape has witnessed significant changes over the last ten years.

Unity maintains that by combining the powers of moonshot thinking, a transformer mindset, and collaborative communities, healthcare companies can reinvent the future of health. Health systems should lean towards early-stage innovation, experiment, and then really think about developing an innovation stack in the context of care delivery and better outcomes.

Unity advocates leveraging technology to build a cohesive health care segment where doctorpreneurs and clinicians can together transform organizations using the enormous capital and talent at their disposal. He also advises digital health start-ups to have a persistent and resilient mindset to thrive in the industry. Take a listen.

Note: StartUp Health has recently launched the StartUp Health Moonshots Impact Fund. For more details, visit here.

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Show Notes

01:29About StartUp Health.
03:44Can you talk to us about your new notion of moonshots?
06:54Can you talk to us about the funding environment?
12:44 What's happening to all the startups who are raising all this money?
16:38 Can you talk to us about a couple of your success stories?
20:10 What do you think are the big gravitational forces that are holding back innovation?
24:11 What do your portfolio companies say about their challenges as they build their products?
27:40 What’s the competitive landscape looks like now? Can you comment specifically on big tech and their role in this emerging opportunity landscape?
30:59 If you had something on your wish-list for health care regulators, especially in the digital health context, what would that be?
32:57 If there’s one thing you wanted health systems to do to accelerate innovation?
35:58 What is your advice to the digital health founders?

Q. Tell us about StartUp Health — the story and the one thing you’d consider a proud accomplishment.

Unity: My business partner, Steven Krein, and I co-founded StartUp Health ten years ago. We had a very basic concept that revolved around organizing a global army of what we call Health Transformers. These are the entrepreneurs and innovators reinventing or rebuilding the future of health. We thought, if we got enough of them together, it could transform or achieve some of the biggest health moonshots — big global challenges — of our time.

For the past ten years, we’ve been investing in and mobilizing a global army of entrepreneurs. We now have 400 companies from across six continents and 26 countries — all working on different aspects of health innovation in our portfolio — and we’ve mobilized this ecosystem and community of innovators to work on global challenges like delivering access to care to billions of people, reducing the cost to zero, ending cancer or even, curing diseases like Diabetes and Alzheimer’s.

But as I step back and reflect on what we’re most proud of, it’s just focusing on a vision around collaborative innovation. I think one of the great challenges of healthcare as an industry for the past 50 years or more has been its siloed nature. So, just focusing on a collaborative innovation model is ultimately what I’m most proud of and look forward to.

Q. Tell us about your new notion of Moonshots. What are these?

Unity: They’re connected to the UN’s Sustainable Development Goals around Health and Wellness and we set out to tackle 12 global health moonshots. Each of these can impact at least a billion people by 2040, and we expect to be working around delivering quality care to every human on Earth – note that there are five billion people without basic care right now — and reducing that cost to zero. So, rethink the business models around care the same way we’ve seen the tech world do with things like entertainment or travel or telecommunications.

We have a women’s health moonshot, a children’s health moonshot, a mental health and wellbeing moonshot and two years ago, we launched an addiction moonshot. More recently, a pandemic response moonshot was launched not just for COVID-19, but also to mitigate and manage future pandemics. We believe that all these moonshots are quite interconnected. For example, you can’t achieve longevity without focusing on curing disease or reprioritizing women’s health or children’s health. So, we take a very holistic integrated approach.

But the magic happens when you align a whole ecosystem and a group of innovators around a singular mission and then get them marching collaboratively towards it. Our thesis is that we can speed-up the innovation cycles and learn what’s working or not working. We can share that knowledge and those insights, tap into network effects and ultimately, speed-up progress, manage innovation cycles efficiently and more cost-effectively than ever done before.

Q. What about the funding environment? Twenty billion dollars in the first half alone and all indications are that this is going to be another blow-out year. What do you make of this?

Unity: A decade ago, when we started, there was less than a billion dollars being invested in digital health or early-stage health innovation. We’ve seen over $20 billion for the first half of this year, and after Q3, it’s closer to $30 billion. When you add a lot of the money flowing in globally, we believe that by the end of the year it will be closer to $40 billion. In some ways it’s exciting and surprising.

However, the big question we’ve had up until a pandemic or two years ago is — why isn’t more investment flowing into this sector when it’s a $10-13 trillion global market? In a lot of ways, we believe that there’s still not enough capital flowing in, even though it seems like we’re exponentially scaling.

There’re a lot of smart investors moving into the space in a lot of ways from outside of the healthcare market – SoftBank, Tiger Global, Sovereign Wealth Fund etc., not only healthcare companies but retail, consumer and technology, infrastructure, services, digital health, new diagnostics and med-tech and consumer health companies with direct-to-consumer business models, and everyone’s leveraging technology, data, design innovation, business model innovation. The scope is broad for what we’re seeing now. The past decade has been all about building ecosystems, attracting new streams of capital, bringing new innovators and entrepreneurs into the sector. And now there’s so many new entrants across sectors.

I would argue that Apple or even Dollar General have been doing a lot of interesting things over the years and they’re clearly becoming healthcare companies like some of the retailers — Walmart, Target, and Safeway. It’s just a really exciting time with some trends to watch out for especially with a new generation of innovation happening. I would equate it to being in the second inning of a wide, open market opportunity.

It’s an exciting time to be an entrepreneur and investor in this space as well as a strategic company thinking about their opportunity within the future of healthcare.

Q. There’s a lot of innovation and a Cambrian explosion of digital health startups but the landscape is highly fragmented and clearly not everyone will make it. What’s happening to startups who are raising all this money?

Unity: It’s a great question pointing to exciting trends of some of the newer companies – infrastructure companies –which, over the last 2-3 years, have been trying to be integrators of a very fragmented market. So, if you’re a health system, it can be really confusing when there’s a plethora of solutions trying to do business with you or provide some solution for your system.

But one of our companies, for example, Particle Health, is doing what Plaid did to the financial services market — created an integration layer, so, the financial services companies could plug into that. Particle Health is doing for the data layer something similar to what companies like Komura or Zeus have done — a platform approach that others can try to build-off of.

The tech domain has seen this for decades where Apple would have built a developer’s kit or an app store that others can build on. The same thing is now visible in healthcare. So, the fragmentation of the past decades has been good because there’s been thousands of experiments going on. I would equate this to 1990 for internet and web, when the business models were not clear. They were just figuring out this thing called eCommerce or CPM advertising models. It was very early and there was a lot of different innovation. Now, it’s clear there’s market opportunity, great innovation taking place and accelerating.

By developing new frameworks, things will hopefully speed up so others can start to build on top of these. That’s why the second inning is going to be even more exciting than what we’ve seen over the past 10 years. While there’s been a lot of exciting experimentation going on, what everyone’s looking for now is the impact — where are the results, where are the outcomes, how is this really helping patients or how is this really helping to reduce costs?

What we’re starting to see is like telehealth companies, which are demonstrating to a health system either how they can more efficiently or effectively deliver care during a pandemic or even post-pandemic. So, I believe, the outcomes of the next wave of innovation resulting from all these investments of the past decade, will start to have more quantifiable results.

Q. You’ve had a few significant exits, recently. Do share your success stories for a sense of what’s coming out of Startup Health?

Unity: I’m so proud of our 400 companies — our health moonshot companies. Some are familiar names — Devoted Health, City Block, Vertu Health. Most recently, Conversa was acquired by Amwell. Doctor.com was just acquired by Press Ganey. And then, we have an exciting blood diagnostics company out of Europe called Nightingale Health that went public on Nasdaq in Europe.

Getting back to your first question, I’m proud of the diversity of innovation that we have across our portfolio which spans region, country, business model and subsector. There’s a magic to that because when you cross-pollinate a big company with an innovative emerging company, you speed-up innovation. We saw this with Pfizer and BioNTech. I call it the Peanut-Butter-and-Jelly effect, where one-plus-one-equals-three or refers to creating something better. When we started a decade ago, it was just an idea, thesis, and a belief but now we’re tangibly seeing the fruits of our labor and the impact that these health transformers are making in very tangible ways in the market.

Q. Congratulations, on all those. Conversa CEO and Amwell’s have been guests here, so, it’s like I’m closing the loop with that story. I have two questions here — What about the gravitational forces that hold back innovation in health care? Also, despite some issues in healthcare – siloed data, the interoperability between various systems, the dominance of EHR vendors etc. — it’s interesting that health systems are getting into the act. What do you make of this?

Unity: The biggest challenge remains the siloed nature of healthcare, where everyone’s trying to protect their own sandbox, so to speak. However, as you start to expand beyond with new entrants coming in thinking of retail or tech companies as potential competitors rather than collaborators, structurally, one thinks that for decades there wasn’t enough talent coming into the space. A lot of the entrepreneurial talent was going to build just pure tech companies, photo sharing apps, social networks or going toward management consulting or Wall Street. Now, a lot of the best talent globally is coming into healthcare and that will make a significant impact.

Second, there wasn’t enough capital for early-stage investment and that’s starting to change. Now, there’s talent and capital. If we can break down the innovation and data silos and speed things up, that’ll be the next big thing.

One of the positives we’ve all learned from the global pandemic is really a mindset shift. There was an old framework that certain things around innovation had to take a certain amount of time or be impossible, perhaps. But when you do something like create a vaccine — that everybody thought would take multiple years — in less than a year and bring it to market, it shatters those frameworks and transforms mindsets. It’s really golden age of innovation potential for where we go from here because you’ve got the talent, capital, demand and the mindset shift of “How do we go bigger? How do we transform in a way that’s more significant than previously thought possible?”

The last big hurdle might be how to transform the regulatory frameworks so that it can keep pace with innovation. I am very optimistic about what we’ve seen even in the past 24 months, with how the structural elements that will speed-up innovation in the future have fundamentally changed in a post-pandemic world.

Q. What do your portfolio companies say about their challenges as they build their products, scale and grow sustainable businesses?

Unity: It’s interesting. I think it depends on the stage. I do think there is still a gap at the earliest stages of development. Let’s call it the pre-seed and seed stage where we’re seeing a lot of big $400 million rounds or $100 million rounds, or $67 million rounds. And there’s still a wide gap for the $500,000 rounds or $1 million round.

If you’re talking to the innovators that are just getting started, there still is a capital gap. That’s why, in the past year, we’ve seen multiple large early-stage pre-seed and seed stage funds, including the one just announced today from NFX Ventures, focusing just on early stage. The gap is really around capital.

However, the biggest challenge though, is really around a legacy mindset — around a notion — that the way things work, are the way things are going to be in the future. There’s lots of players within the legacy health care world that still have that framework, so, the opportunity is to demonstrate through real outcomes to basically prove to the market what’s possible.

Some tremendous things have happened over the past 24 months that are starting to bite away at this apple – a major multibillion dollar M&A activity with Teladoc and Livongo. And then, some regulatory, payment and reimbursement shifts have also happened recently, quickly for Telehealth. What these demonstrate to entrepreneurs, innovators and customers of those emerging companies is that the next decade will be different, way bigger and faster than what we may have thought just two years ago.

Q. What’s the competitive landscape like, now? Can you comment specifically on Big Tech and their role in this emerging opportunity landscape?

Unity: In many ways, every great company is trying to figure out how to become a health care company, be it automotive, transport or travel companies. It’s an exciting opportunity because a bunch of new entrants are coming in. The tech world may see this as competitive but really, there’s opportunities for collaboration. See how Amazon has entered this space or Apple versus Google. It’s all very different and they’re each attacking different aspects of health innovation to demonstrate the vastness of the potential and the opportunity. Now, I don’t think technology companies want to suddenly become health systems and health systems’ core focus is not on becoming technologists. So, alignment of their unique abilities will make great potential for collaborations. That’s what we’re starting to see.

One of the misnomers is, there’ve been many failed experiments over the years, from technology companies that were in the third, fourth or fifth iteration of Google Health or Amazon. But if you’re a trillion-dollar market cap company, there’re only a few ways to grow in future and health care is one of them. So, the real opportunity is to really lean-in into collaborative innovation and focus on the core that you may bring and that’s irrespective of whether you’re a startup or emerging innovation health care company or a great health system that has care delivery as your core. What can happen when you start to merge great technology players in with that will be most interesting.

Q. With regard to regulators and the regulatory landscape, if you had something on your wish-list for health care regulators, especially in the digital health context, what would that be?

Unity: If I could wave a magic wand, in terms of regulation, it would be to rethink the future frameworks with the pace of true innovation, in mind. This won’t erode the core of providing safety but will enable a rethink on the guidelines and frameworks in a way that exponential innovation can exist within the framework.

There are ways to do that by developing guiderails or innovation regulatory innovation kits that early-stage companies can build on. This has been seen in cases of drug development, where there are Phases 1, 2, 3 clinical trials and these take you through a process. If we can do the same with health tech innovation or digital health innovation and have frameworks that can move very quickly but give innovators a toolkit to work with at different stages of development, that would also be interesting.

Q. If there’s one thing you wanted health systems to do to accelerate innovation and enable your portfolio companies, what would that be?

Unity: I would study the concepts around the innovator’s dilemma and embrace transformation. There’ve been so many exciting developments around care delivery over the past few years and these new emerging companies — whether One Medical or others, that are working on full-stack innovation, integrating technology and data and thinking about the experience in a new way – are refreshing. The health systems of the future, then, should lean-in to early-stage innovation, experiment in tests and then, really think about how to develop what we in the tech world would call, an innovation stack within the context of care delivery and better outcomes.

I’d also focus on business model and design innovations and other types of frameworks that can be very innovative but may really not have anything to do with pure tech.

Also, I think one of the really exciting assets that so many health systems have, are their clinicians. And one of the great trends we’ve seen over the past few years is what we like to call the rise of the Doctorpreneur. These are clinicians that work with patients, serve patients, but they’re also innovators and they know the problems and they’re becoming entrepreneurs, themselves. So, I think leaning-in to those doctorpreneurs and clinicians within your teams, within your health system can be invaluable for transforming your organization.

Q. Finally, what’s your advice to the Founder who is entering the digital health landscape today?

Unity: It’s a long journey so, resilience and having a long-term mindset towards collaboration while navigating the daily ups and downs and challenges will help you be successful.

We hope you enjoyed this podcast. Subscribe to our podcast series atwww.thebigunlock.comand write to us at info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity

About our guest

Unity Stoakes is on a life-long mission to achieve the impossible: to improve the health and wellbeing of everyone in the world. By combining the power of moonshot thinking, a transformer mindset, and collaborative communities, he believes anything is possible. In 2011, Unity co-founded StartUp Health with Steven Krein, his business partner of more than 20 years, to invest in a global army of entrepreneurs, called Health Transformers, to embark on one extraordinary crusade: to achieve health moonshots, each of which can improve the lives of at least one billion people.

Unity has been a tech entrepreneur since the mid-nineties, previously co-founding OrganizedWisdom and helping build The Privacy Council, Middleberg Interactive, and Webstakes.com/Promotions.com, which he helped take public on NASDAQ with his business partner of 20 years, Steven Krein.

Unity has appeared on Bloomberg TV, CNBC, CNN, NPR, and USA Today, and speaks to entrepreneurs, world leaders, and CEOs around the world about the future of health. He is the publisher of StartUp Health Magazine and co-host of StartUp Health NOW, a weekly web series about Health Transformers.

Unity grew up on a farm in Oxford, Iowa, went to Boston University and currently lives in Berkeley, CA, with his wife and two young kids.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

The healthcare delivery model is changing from hospital being within four walls to getting distributed and virtualized

Season 3: Episode #99

Podcast with Amit Phadnis, Chief Digital Officer, GE Healthcare

"The healthcare delivery model is changing from hospital being within four walls to getting distributed and virtualized”

paddy Hosted by Paddy Padmanabhan
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In this podcast, Amit Phadnis, Chief Digital Officer at GE Healthcare reflects on how a geographical transition and a change in domain from IT networking to healthcare has worked out for him and shares his learnings from this shift. GE Healthcare is a leading global medical technology, pharmaceutical, diagnostics, and digital solutions innovator. 

While Phadnis admits that the potent combination of physics, electronics, electromagnetics, and AI will significantly transform care delivery, he discusses how these must be integrated into clinical workflows to change the healthcare delivery model. The majority of digital healthcare technologies provide patient-centric data aggregation, which aids clinicians and speeds up patient diagnosis and treatment. He views healthcare tech also driving beyond the hospital’s four walls to get closer to the patients virtually. The future of healthcare then, does indeed seem to be a robust partnership between the medical practitioners, computing, and analytics.

Amit also advises digital health startups to focus on the last mile of healthcare that is improved patient outcomes, decreased healthcare costs, and early disease detection. Take a listen.  

 

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Show Notes

01:06About your background and how you got to digital healthcare.
04:41What was your first impression when you started here? How has that changed over the past 5 years in GE?
07:01 How are you defining digital at GE healthcare?
15:31 What are the challenges with image data? How have you taken this and converted the aggregated data into advanced analytical insight?
23:38 How do you use data to build the infrastructure internally within GE healthcare?
27:12 How are you demonstrating value? How are your clients seeing the value?
33:08 Can you share one best practice for your peers who are on similar journeys or for startup founders who see an opportunity here in the world of data and advanced analytics to transform healthcare?

Q. Tell us a little about your background and how you got to digital healthcare.

Amit: I grew up in India and did my Master’s in Electronics and Communication from the Indian Institute of Science (IISc). Then, I started working in the fields of embedded systems, communication and networking before moving to GE Healthcare. When I joined GE Healthcare in 2016, I knew nothing about this space. But I was convinced because the whole digital transformation that they wanted to drive and the business was truly exciting. I discussed this with the entire leadership team and decided to take the plunge. Initially I was stumped to get a call for healthcare and then, I learned that the position would be in Milwaukee. Now, I’d been to the US many times before, yet I had no idea where Milwaukee was. When I opened Google Maps, I saw this tiny dot near Chicago and I concluded it was a suburb but, Milwaukee isn’t as near to Chicago.

So, I made two major transitions — one was from networking with Cisco into healthcare – and the second, from Bangalore to Milwaukee. The latter was more challenging but that’s how I ended up with my first role in GE as the CTO for the imaging business.

My focus has always been on digital transformation. And I’ll talk a little later about the Edison Platform, which we conceptualized here. Our CEO, Kieren Murphy at the time, told me that what GE is doing now is really relevant across healthcare. That’s when I picked up the Chief Digital Officer role for the company.

Q. There are CDOs being brought in from outside the industry in healthcare and it’s a good move since it brings a whole different perspective. What was your first impression when you started here? How has that changed over the past 5 years in GE, working with data aggregation, analytics, and advanced analytics?

Amit: Initially, I was taken aback by a couple of things. When you look at technologies like CT or MR or even anesthesia machines, bedside monitors, ICU equipment, there is deep and highly complex tech involved. It’s also a place where there is a fair bit of science – physics, electronics, and electromagnetics — that converges.

With GE Healthcare, I noticed that people who’ve been with GE for a long time really understand the space and the depths very well and that’s very important given how critical the work we do is, from a patient’s perspective.

When I joined GE Healthcare, everything seemed a little slow and there was too much process — a lot of attention towards testing, safety and compliance, privacy etc. When you come from a different world, it’s burdensome. So, it wasn’t a great experience to begin with ­­– the whole regulatory framework – but I started appreciating it over time. I realized why some of these are absolutely crucial. Over the 4-5 years that I’ve been here, I’d say, these are the strong pillars on which the industry stands.

Q. As a CDO, how are you defining digital at GE healthcare? What does that role mean to you?

Amit: If you look at healthcare products, the equipment generally is a combination of hardware and software. When some of this equipment was first made 40-70 years ago, it was always a combination, so software is not new to the healthcare industry.

There’s been a very strong realization that the data this equipment produces or other patient-centric data available within the health system, is a very important asset that can be used to significantly better the healthcare delivery models and outcomes for the patients. Everything revolves around what you do with data. That’s how I look at it from a digital perspective.

So how can we use this data and information produced by the equipment or what we capture for a given patient or cohorts of patients who have undergone similar journeys so that we can gain insights into what’s really going on? How can we learn about the disease status for a patient, a population of patients? How were they diagnosed, what treatment had they undergone and what was the outcome of that?

To learn all that, we need artificial intelligence. But our ability to take this data and information, convert that into insights, use applied techniques like AI to really learn from everything that has happened to better diagnose patients or create better treatments or more targeted treatments – that’s what precision health is all about. That’s how I look at it from a digital perspective.

Q. It’s a very comprehensive vision. Can you tell us a bit about Edison? How is it different from the other GE platforms? Which one’s more exciting?

Amit: I’ll probably answer the second question first. In that context, I’ll also talk about Edison. When you look at the platform, and this is a question that I’ve often got, there are two aspects to it.

One, the basic compute, memory and the rest of the OS, infrastructure etc. All platforms have that but that doesn’t define a platform. Its only what the platform is built on. When you look at the platform, its persona of the platform is defined by the domain it deals with. In this particular case, healthcare predicts that with industrial automation, when you look at that persona, it tends to be very different from industry-to-industry. So, when you look at healthcare, there are standards for data, for storing images, for communicating or connecting to different systems. There’s DICOM and HL7 and now FHIR, the nature of data is different. An image is a pretty big set of data. The way you process that information is different and so are the latency and timing requirements. When you look at all that, you also observe the real persona of this platform. And that’s what differentiates one platform from the other.

With regard to the healthcare platform, there’s a very distinct set of characteristics compared to industrial automation platforms. There may be intersections, for example, even on a healthcare platform you may actually look at the device, represent it and be able to manage it so that goes into the IOT and the industrial automation aspect of the platform. But specifically, when you look at what you’re trying to drive from the platform perspective, I’ll say that the Edison platform is targeted towards clinical workflows and applications.

That persona is very important, and that’s the basic difference between Edison and Predix. When we started that journey, the objectives were simple — GE Healthcare has about four million imaging devices in the field so roughly about and 350,000 or maybe 400,000 imaging devices and the rest are lifecare solutions, ultrasound machines. There are many devices and all produce a tremendous amount of information — we do two billion scans on our devices every year. So, you can imagine the amount of data that we produce.

One of the first things we had to do was, connect all these devices so that all the information could be ingested into a common place. Then, combine that information with the rest of the information available within the health system. I tend to look at it as a vertical axis and a horizontal axis for data. So, there’s the deep data from the device, which is vertical, and it’s combined with for example, horizontal information from within the health system or outside it — now more and more wearable devices, social media information, population health etc. Or there are EHRs and EMRs with patient information, also past imaging information in PACS and that’s horizontal. The Edison platform plays at the intersection of that vertical data and the horizontal information. So, this can all be combined.

One of our first objectives was to start aggregating information so that we could get a comprehensive 360-degree view of everything that’s happening (with a patient) along with all data that is available for them. So, we look at it as a longitudinal patient record. The platform provides supporting tools and services to process that information and create a workflow so that the insights gained either by analyzing the data or running algorithms on it, can be a part of the clinical workflow. It’s a very important aspect that we deal with, as far as healthcare is concerned, because at the end of the day, the solution generated has to fit in the clinician’s workflow, seamlessly. There are things that must be done on the platform and tools that have to be created from that workflow integration perspective. In a nutshell then, the platform is connected to devices and has the ability to ingest information from them, combine that with the horizontal information about the patient, use the processing tools, workflow tools and get insights, which may be converted into clinical workflows and through them to an outcome. That’s what the platform is and that’s how we break it down.

Q. Given GE has a certain heritage in the market with its medical technologies and diagnostic devices, there’s a lot of image data. How have you taken this and converted the aggregated data into advanced analytical insight? What are the challenges here?

Amit: One of the things we realized is when you look at the richness of the data, there is a tremendous amount of information already available, today. But 95% of that information is not used, and that’s a huge opportunity in healthcare because, as you make more use of the information that’s already there, you can get deeper insights and optimize the workflows.

Or you can be very specific and targeted about identification of the disease states. It can also be very targeted about therapies that would be effective for a specific biomarker or a specific disease state. What you start realizing then, is that, you can actually apply some of these insights at various levels across the enterprise, starting with the device.

A couple of examples just to illustrate the point here will be — On the CT and MRI — these are devices which are extremely sophisticated cameras — they’re really taking the picture of the patient and clearly offering insights into the patient, in general. The way the technology works is, when you scan a patient, you get a very weak signal from them. The job is to take that signal and convert it into an image so that the radiologist or physician can then check the image and offer a diagnosis.

In general, to create a better image, you need better hardware, physics, magnetics, more complexity in software etc. In the past, producing a better image would need next-generation hardware, software, all targeted towards processing that signal so that we get a better image because, the better the image, the more insights the clinician can get and the better the diagnosis, However, the image has a lot of noise. What we’ve done in the CT and MR is embed the algorithm to teach the clinicians how to differentiate between the signal and noise at the very raw level of the signal.

Q. What does that mean?

Amit: When you scan a patient, you might actually project “X” ray and then, on the other side, there’s a detector that transforms that projection of the “X” ray. Those transformations are very complex or in an MRI, you’re basically projecting a magnetic field on the patient and the body reacts – that’s to say, the hydrogen atoms react and you get a reflected signal back. It’s a very weak signal, and this is at a crude level.

So, a very weak signal means that there is a lot of noise around it. To convert this into an image requires a lot of transformations and substantially complex image-processing software. With AI, you teach the algorithm to “see” this pattern, which has this signal and this noise and the way to filter the noise. Since the signal is much better, the image will be enhanced quality-wise, too. So now, AI can be used to really create a much better signal before the software undertakes the processing.

We have been able to embed AI into the deepest levels of the product. So, for example, in the MRI machines, when a brain scan/neuro scan is to be done, one of the tricky elements entails the technician having to set the scan plane correctly. It’s a complex procedure that can take a while because it must get a 360-degree view. If it’s not done correctly, the image can be impacted. Using AI algorithms to do automatic scan selection correctly saves time, reduces variability from one technician to another, and lowers errors significantly while improving the quality of the image. So, it results in a significant amount of productivity as well as accuracy. That’s another example.

But then, we’re going all the way. So, we look at workflows and decide how to position the patient on the table. We check for use of the camera feed for analyses and then, do an automatic patient positioning. It’s a very good example of a workflow and we’ve done that, too. Then, the image is taken to the radiology department and interpreted there. When you interpret an image, you have to segment it, quantify or even take the measurements. And subsequently, you get into actual diagnostics.

If you see radiologists and how they work, they spend quite a bit of time segmenting the image, taking the measurements and it’s mostly repetitive, time-consuming and error prone. But you can use the algorithms to actually take a lot of the mundaneness out so this. It improves accuracy, focus, and enables faster diagnosis. So, we have done that. With AI, you can segment the image in 3-D, quantify it, take measurements and for some of the anatomies – the segmentation measurements can take hours depending on the complexity of the anatomies — you can reduce that time to literally 30 seconds. The last step is obviously clinical diagnostic processes and we’ve gone there to help with diagnosis using AI and that’s been the assist tool to the radiologists.

Q. Imaging, the world of radiology is a very high value, high impact-opportunity areas. GE Healthcare has assigned several multi-year contracts with health systems to help them with this. How do these relationships work? Since these are at-risk contracts with some accountability attached, how do you use data to build the infrastructure internally within GE healthcare? How do you demonstrate to your customers that your software delivers?

Amit: When it comes to data and the AI world, there’s no one company that is going to actually do it on all alone. There’s a vast ecosystem out there, a much bigger ecosystem outside of GE Healthcare than what we can do, inside. So, one of the first things we did on the Edison platform is that we opened it up. We publish the APIs, we encourage and run a number of accelerators. We work with start-up companies in India, China, and Europe. We’re working with significant number of companies here in the US too, to actually get their algorithms and their applications integrated on the platform so that we can take them to the providers and integrate them.

In many cases, we do a significant amount of integration work because, the value of the algorithm is enhanced significantly if it’s fitted well within the workflow. If it isn’t within the workflow, it becomes unusable even if it is a great algorithm. So, that’s what we’ve done.

Now through the pandemic, healthcare has witnessed a big change – something that would normally have taken 5-10 years — and that is, the basic delivery model of healthcare has changed from care being limited to inside the four walls of the hospital to it getting distributed and virtualized. And the cloud technologies have enabled this distribution and virtualization of healthcare delivery.

We work with multiple cloud vendors — AWS, Microsoft — and have a multi-cloud strategy. We are open to working with other cloud vendors, too. With AWS we have, a deeper sort of integration currently, and some similar work is being undertaken in some other application domains with Microsoft.

This entails taking some of the clinical workflows and applications that we are building to the cloud so that we can help the providers distribute care across geographies and take it outside of the hospital to the patient. When you do that, you must ensure data privacy, and HIPAA compliance. We encrypt information addressed in motion and are looking at technologies like confidential compute so that even the last mile between the storage and the compute infrastructure, is secure.

Q. How are you demonstrating value? How are your clients seeing the value?

Amit: Essentially, this is an area in which you can’t create a black box solution and deploy it. You need to work hand-in-hand with customers, providers, hospital systems and at times, with payers to really integrate things in a way that is visible to all, and everyone benefits from the accuracy, productivity, positional standpoints. Early engagement in terms of problem-solving is key for us.

Once we get into that dialogue, we need to really set a target. Stroke, for example, is an area where we want to really improve outcomes for patients. The stroke care pathway in general merits is a very detailed conversation about what the workflow is, how the clinicians do their work on a day-to-day basis, what the patient journey really looks like etc. Once you map that and then, get into very specific solutions around the pain points that we are trying to solve, that’s taken care of, on paper.

Post-analysis, you think an element can be reduced by 30% and another, optimized by 40%, reduce patient wait time can be lowered by X%. But you still need to create evidence around it. We’ve done two things — put in sufficient amount of telemetry to everything that we do from a software perspective or from a platform standpoint so that we can capture what’s happening when these applications are deployed. And that goes a long way in creating the evidence about “the before” and “the after.” We’ve also worked hand-in-hand with the health systems to be able to capture that information because a lot of that information gets registered in their systems, and we can work with them to see how we can actually look at the evidence and maximize what we get.

We’ve predicted something in terms of optimizations or operational efficiencies or accuracy or patient outcomes. But the next step is extremely important, and that’s how we work with the customer community.

Q. Increasingly, there will be more data versus more volume and velocity of data. All this can be aggregated, analyzed to drive health care outcomes through advanced analytics and AI. But have we been hobbled by interoperability challenges or self-inflicted problems, such as, algorithmic bias, data insufficiencies, issues related to the acceptance of AI in clinical decision making? Is the vision on the right track or are we further way from the goal?

Amit: I think we’re accelerating. What’s happened through the pandemic is, a lot of things that would have taken many years, actually got implemented very quickly. So, there is in fact, an ever-growing need and a push to deploy more analytics and use data more effectively and faster than before. However, for AI to be effective, the variety of data is very important.

What people have learned is that it is not just the quantity of the information which is important, but the variability of the information across different geographies. Different genetic makeup of the patients is extremely important. And that’s where people struggle, from the AI perspective.

Secondly, a tight integration in existing clinical workflows is noticed because you might have a great algorithm in place, but if it is not integrated in the clinical workflow, it is almost unusable. People underestimate the power that is required to actually do a deeper integration into an existing clinical workflow. That can be a significant barrier if you are not accounting for it right upfront when you actually start designing the full care pathway. Those are the things that need to be taken care of so information is available to us much more effectively through AI and that will change the healthcare delivery model for good, going forward.

Q. The pandemic has forced us to think, in creative ways, about how we can overcome challenges for the immediate future. It’s also laid the foundations for how healthcare might improve with all the virtualization. If there’s one best practice that you would like to share — with your peers or start-up founders, what would that be?

Amit: My learning is that you have to combine the power of computing and analytics with the knowledge of the clinical space. I would very strongly encourage people to form those partnerships with the clinical world. This is a work that needs to happen hand-in-hand with the physicians and the clinicians, and the health systems. So, if you are a startup company working in the AI space, joining hands in a larger ecosystem where you can actually get the domain knowledge, clinical knowledge and then, combine it with all the good things that are happening from connectivity, communications, computing, AI, — you will surely enable the best outcome as far as patients are concerned.

Second, I’d say, we can get very excited about technology, but we always need to focus on the last mile of healthcare, which is — what is the outcome as far as the patient is concerned? It has to improve the patient outcome, decrease the cost of healthcare as delivered to the patient, and help early detection-early treatment while almost going into wellness. But we can lose sight of our goals quickly by becoming very enamored with technology. Focus on the last mile to ensure that every effort put in eventually goes into the patient outcome.

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity

About our guest

Amit Phadnis is a GE Corporate Officer and holds the position of Chief Digital Officer for GE Healthcare, responsible for leading the company’s digital strategy. Amit oversees GE Healthcare’s complete digital portfolio, including Enterprise Imaging solutions and Clinical Command Centers. With his global digital team, he also works to enable the company’s vision for precision health by creating the industry-leading Edison platform, as well as its cloud, edge, device software infrastructure, data strategy, SaaS enablement, artificial intelligence, and analytics capabilities.

Most recently, Amit was the Vice President and Chief Technology Officer for GE Healthcare Imaging, where he drove digitization, software, digital and cross-modality initiatives across the Imaging business. Amit joined GE Healthcare from Cisco Systems, where he was the India Site Leader and Senior Vice President of Engineering for the Core Software Group, leading product development activities across routing, switching and wireless areas. Amit holds more than 25 U.S. patents in the Networking and Communications space. Prior to working at Cisco Systems, Amit held leadership roles at Motorola, Tata Elxsi and Silcom Automation Systems.

Amit has a master’s degree in electronics and communication from the Indian Institute of Science.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

Traditional care relationships cannot be replaced, but virtual care can provide extra support to patients

Season 3: Episode #98

Podcast with Darshak Sanghavi, MD, Global Chief Medical Officer, Babylon Health

"Traditional care relationships cannot be replaced, but virtual care can provide extra support to patients.”

paddy Hosted by Paddy Padmanabhan
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In this podcast, Darshak Sanghavi, MD, Global Chief Medical Officer of Babylon Health talks about how digital healthcare providers can deliver on the sales promise they make about bringing affordable and accessible healthcare to everyone. Babylon Health is the global end-to-end digital healthcare provider serving over a dozen countries and millions of people.

Darshak delves into the challenges around including the demographic segment that has never engaged with healthcare before and is underserved. He discusses how digital primary care is on the verge of possibly replacing about 80 to 90% of in-person visits.

Lastly, Dr. Sanghavi outlines what constitutes a longitudinal care experience. It’s not a ‘one-and-done’ approach but an effective engagement where systems are optimized to do the simple things and consumers find it easy to access them digitally. Take a listen.

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Show Notes

01:10Brief overview of Babylon Health.
02:26Can you share some insights on who you serve – payers, providers, employers, or all of them?
06:23 With regard to the population with low incomes, the underserved population, are they ready for digital engagement?
11:07 When we talk about digital front doors, what are some of the practices you've incorporated into your solution?
16:06 The healthcare system in the United States is still heavily dependent on the fee-for-service model. What's the one thing that will make us part of an accountable care market?
17:06 What are the big trends you're seeing in the market when it comes to digital health?


Q. Can you give us a quick overview of Babylon Health?

Darshak: I’ve been at Babylon Health since earlier this year. It’s a global, digital health company with a philosophy centered around delivering affordable, accessible, and quality care to everyone. This was their sales pitch, but it really got me most excited. It started in the U.K. and then, expanded to Rwanda, the Asia Pacific, Canada and now, the U.S. I’m the Global Chief Medical Officer and my responsibilities include thinking about how we can really deliver on that sales promise. In that context, we have a SPAC event coming up in the next few months and we’re looking forward to it.

Q. The United States obviously presents a big opportunity for Babylon. Can you share some insights on who you serve here — providers, employers, or all of the above?

Darshak: Our tag line is that we want to deliver healthcare to the palm of everyone’s hands, so, ultimately, the people we’re serving are really patients and members, worldwide. Now, the way we reach those members can vary depending on where they happen to live. Most of our members, at least in the U.K. and the U.S., principally, we are customers of their insurers. So, when the insurer says, they need somebody to help these members take care of themselves, in exchange for the premium the latter pay as compensation for service delivered, that’s when Babylon comes into the picture. Although we’re paid by the insurance, the ultimate person we’re serving is really the patient. The same thinking goes for Rwanda and all our other areas of business as well.

Q. So insurers bring you into members’ digital health services and you bring in technology, analytics, and capabilities to efficiently improve health care outcomes. As a consumer, my question is, while the primary care provider helps manage chronic conditions and the insurer also caters to similar issues via a program probably designed by companies like yours, so, who should I speak with? Whose protocol should I follow? Is this a dynamic you see in your work?

Darshak: We never want to get between people who are really satisfied with high quality care and intermediate that in any way. So, I’ll talk about how we’ve operated across areas. This varies from market-to-market. In the U.S., where people choose Medicare Advantage and when they sign up, they know what they’re getting into. Similarly, in the U.K., people elect to have Babylon become their primary care providers. When they choose us, we serve them.

Now, in places like the U.S., for example, we are in Missouri where we serve around 20,000 patients on Medicaid. We give them care but those individuals may not have really engaged with the health care system. These are the hardest to reach patients who are just not engaged in care. Can we go out and actually reach them? We contact them and of them, we actually engage with over 20% or so – a little more than enough to check our numbers — whereas traditionally, only about 5% of the individuals would be engaged.

So, while we really try to offer our services, we never want to supplant traditional care relationships. But we do want to reach people that are not engaged and if they actually do have a doctor, then we add it on as an extra level of care over that and support them in their journey as well. There’s a lot of things that you can’t always go to see your PCP for. When people have needs, we try to fill those.

Q. With regard to the population opting for Medicaid, these are groups with low incomes; in many cases, underserved and geographically spread out. Are such populations really ready for digital engagement? Can we really meet their needs? How do you overcome existing gaps?

Darshak: These are interesting questions or perhaps, the kinds that were raised when we had gone to Rwanda initially, several years ago. We know that these individuals won’t have access to technology and have low bandwidths so, we work around that. Getting back to your question, in the U.S. in particular, I’ll use an analogy. This notion that digital health is too complicated, or people don’t have access was actually tested at the beginning of the COVID pandemic. At that time, I worked for a very large national payer as a Chief Medical Officer overseeing an older population — millions of people. What we saw was, when we suddenly started to actually pay for that kind of care and allowed physicians and clinicians to use that, there was a massive increase from less than 1 in 1% to just over 15 to 20% of our members that were using digital services. These were older people and we’d previously thought they wouldn’t understand that. That’s exactly like it is with social media. But when there’s a value proposition, people will actually use that. I will say it’s not perfect. Some people may not have access to smartphone technology. They may not have access to bandwidth, but at least it’s better than what they have now, which is often no access at all. We started on that base and then, we tried to problem-solve incrementally to get more and more engagement.

Q. You’re operating as a virtual primary care provider on behalf of your insurer health plans. You also recently acquired a primary care physician group. Can you share the rationale for that?

Darshak: What we realize and maybe again, I’ll say one of the great benefits of Babylon, is that we benefit from years of experience, and we can learn from other parts of the world, as well. And one of the learnings we had from our experience in the U.K, was that while digital health care, particularly digital primary care, was incredibly accessible and people liked it, we could replace about 80 to 90% of a lot of in-person visits with digital care.

Now, what that means is we still have 10% that require some people. And we all know that. There are probably some conditions for which there’s no substitute for in-person visits. So, that’s what drove this sort of an acquisition of an IPA in California, which is incredibly high performing. The idea was to now partner with the provider organization and be sure that we now learned how to develop both, digital care in the U.S., and understand how to use that physical presence, as well. That’s going to be a scalable model for us, broadly speaking.

Q. So, acquiring this physician group was really to build the capacity to serve our larger population. Is that the right way to look at it?

Darshak: I’d say a couple of things. The first is that we recognize that we must develop both, the digital and physical presence. If we’re going to offer primary care, we want to do it longitudinally and in high quality. The second piece of it is, we believe that the digital tools we have, are highly scalable. So, we’d like to work with physician groups and then, transfer this technology to them. The point is to see if we can take existing practices and digitally supercharge them in some way. So, it’s not only for them to see patients who are largely virtual, but it’s for the physicians themselves to learn how to work in a digital-first environment, as well. And that’s done with the support of our partners.

Q. When we talk about digital front doors, it’s a hybrid model of care, where for some things one visits a clinic and for others, a physician comes home. These experiences can be very hard to pull together seamlessly from a consumer standpoint despite the vision, gadgets, and the technology. What are some of the practices you’ve incorporated into your solution? How are you approaching this issue of creating seamless experiences from a digital front door standpoint?

Darshak: There are a couple steps to being a seamless experience and to solving — at multiple points along that continuum. It starts as a seamless experience initially, in our view. We have something we call the health loop, where we talk about all the steps of what a seamless rehypothecation experience is. And the first step of that loop is engagement. What that means is how quickly can somebody be onboarding onto the app and getting it installed and actually getting registered?

Now, that seems like a fairly straightforward thing, but the amount of energy we put into that experience is enormous because, we’re checking insurance, birthdate, etc. So, when we talk about a seamless experience, we have a funnel approach. We think about that all along the way. And as I said, it starts with that engagement, that registration.

Then, it moves on to how do we actually acquire data. If we perform a health assessment, can that be done seamlessly? Or, can we try to create a personal connection with a call from one of our navigators? Then, we’ll think about how to initially book an appointment? What we’ve done is, and this is what I’m very proud of, the vast majority of our patients can actually have a virtual visit even the same day if they have a behavioral health concern within that first week. So, we think what’s also technologically important with our scheduling software is we have an enormous amount of quality control over the actual experience. We have over a thousand engineers, for example, all over the world that are helping us develop that plan. And then, we can pull that all the way through all the steps of what that seamless experience means.

Q. How do you keep score of how well you’re doing in a program like this? What are some of your key KPIs?

Darshak: One of our simplest measures probably, and this is the one we’ve started with and actually have a global scorecard on, is simply, patient satisfaction. It’s essentially like a promoter score from our patients. Are they pleased with the experience? And we consistently have, in the U.K., Rwanda and the U.S., for large pressure business, just extremely high satisfaction scores; some sort of a star system. That’s our North Star and it’s on our internal metrics of how we look at quality. As you can imagine, that’s one of the metrics and then, we have an enormous number of operational metrics that that underlines as well.

Q. Let’s talk about the competitive landscape. The digital health landscape has come a long way especially if you use the VC funding numbers as a barometer of growth. While new companies mushroom and it’s great from an innovation standpoint, few will survive this crucible of trial by fire. When you look at the landscape, your clients who are trying to parse through it and pick the platform or the solution provider, best suited to their needs, what are the challenges you see them grappling with when they’re trying to decide if it’ll be Babylon Health or somebody else?

Darshak: I’ll put it simply – in the digital health landscape, it’s so exciting to see all these companies competing. We welcome that competition. We think that’s only great for members who deserve the highest quality services. So, we are one of the only comprehensive digital health care companies that are not only talked about but are willing to essentially take full risk. That’s the mark, in my view, of somebody who truly believes in their company, knows they can scale. We take full financial risk on members. And that’s where we’re going most aggressively. That’s where our contracts are. And that’s why our revenue grows so much. We believe so much in our product that if we’re willing to do that and take that risk, I think that demonstrates to people it’s not just talk, but that we’ll deliver on that. And most importantly, it’s almost no risk for you as a client.

Q. The healthcare system in the United States is still heavily dependent on the fee-for-service model. That there are solution providers who are driving this push towards more of accountable care and at-risk models is welcome news. From your perspective, what will move the needle towards more of this? Will it come from innovative digital health providers like yourself or, from changes to the regulatory environment? What’s the one thing that will make us part of an accountable care market?

Darshak: We all do best when we have to operate within a defined budget and deliver based on metrics. I think that’s at its core. When we talk about value-based care, it’s all about us needing to give good quality, the budget. To me, that move towards full-risk, particularly on digital health, is the key that unlocks growth. Then, we don’t fight over regulatory issues like one’s Medicare, paying for home base, remote monitoring or if they’re doing cross-state license payments. When you offload that risk to companies that actually are digitally enabled and let them pursue what they think is best, I personally believe, that’s what the unlock is.

Q. I think this is the unfinished business and we’re all waiting for to play out over the next few years. What are your final thoughts, on one of the two or three big trends you’re seeing in the market when it comes to digital health — an option that consumers like me should be looking for?

Darshak: From the consumer standpoint, a couple of things. The first is, does your digital health company give you just a one-time experience? Like are they designed just around taking care of your coughs and colds and maybe your reproductive health needs? Or, are they truly giving you a longitudinal care experience where you want to develop a relationship with trust over time and actually take care of you at all of those periods? To me, that’s actually the direction in which we’re going. As a consumer that would be very important. I don’t want it “want it done”, I want to make sure that we push.

The second thing I would say is that how well are they optimized to do the simple things? Because, you know, it’s like the stories about those rock stars who say that in a bowl of M&Ms, they want to make sure that there’s no green M&Ms? That’s the same thing looking at the digital health care pack. How easy do they make it to make an appointment? Do they refill your medications on time? Do they do those simple things? And as a consumer, if they’re doing those things right, then, you can have some confidence you’re going to do the hard things right as well.

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to us at  info@thebigunlock.com

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

About our guest

Darshak Sanghavi, MD, joined Babylon in 2021 as the Global Chief Medical Officer. He is the former Chief Medical Officer of UnitedHealthcare's Medicare & Retirement, the largest U.S. commercial Medicare program with over $90B in annual revenue, where he oversaw all major national clinical and affordability programs.

Earlier, he was Chief Medical Officer at OptumLabs, running a large portfolio of industry-leading projects with dozens of academic, government, and industry partners. He was also a member of the Obama administration as the Director of Preventive and Population Health at the Center for Medicare and Medicaid Innovation, where he directed the development of large pilot programs aimed at improving the nation’s health care costs and quality. In this capacity, Dr. Sanghavi was the architect of numerous initiatives, including the $157 million Accountable Health Communities model, the 3 million member Million Hearts Cardiovascular Risk Reduction model, and the $1 billion Medicare Diabetes Prevention Program.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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THE HEALTHCARE DIGITAL TRANSFORMATION LEADER

Sign up to get Paddy’s Newsletter that is personally curated by Paddy along with analytical notes on the developments for the week.