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