Month: February 2022

Our goal is to have clinicians be able to use tools that help get individualized medicine to the point of care

Season 4: Episode #112

Podcast with Jackie Gerhart, MD, VP of Clinical Informatics and Phil Lindemann, VP of Data and Analytics, Epic

"Our goal is to have clinicians be able to use tools that help get individualized medicine to the point of care"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Jackie and Phil discuss Epic’s Cosmos research database that covers over 130 million patients across 800 health systems in 50 states – the largest single healthcare dataset of its kind. They discuss the role of database in driving the Epic Research initiative, specifically in public health, and explain how they ensure privacy protections and safeguards for the data.

Jackie and Phil also discuss Epic’s recent expansion into newer market segments such as retail healthcare and health insurance, and Epic’s new CRM product, titled Cheers.

Epic is one of the largest healthcare IT companies today and has a significant influence in healthcare operations across the country. Jackie and Phil discuss how the Cosmos dataset could power new innovations and research, and also highlight advocacy efforts with regulatory agencies to reduce coding and documentation burdens on clinicians, at a time when the healthcare industry is facing a shortage of workers.

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Show Notes

01:38Can you walk us through a high-level overview of the Cosmos platform?
04:37Tell us a little bit about what you know from the COVID surveillance standpoint? What was the platform able to accomplish for you and how you've used this massive dataset?
08:17How do you make sure the privacy and security aspect of it?
12:23 There are other health systems doing their own rollout. They've got their own data, they're going to use it, and mine the data for insights they can get and they're going to serve their own patient populations. How is Cosmos data different from others?
17:29 Who gets access to the data sets? What about the private sector? Do developers get access to private or academic researchers?
19:34 So, for digital health startups, the pathway to get access to the data is to either build a product or a final product with one of your customers, which would be a health system or an innovation group. Is that the way it is that?
20:43 Tell us about your new CRM platform – Cheers. How does Cosmos fit into that story?
23:42 Epic, which traditionally has been seen as a health system focused software company, is now branching out. You talked about the work with retailers like CVS, you've announced a partnership with Anthem. How does Cosmos fits in all of this?
28:37 What is your view on how your platform can help alleviate the acute shortage of workers, which has been identified as the number one issue for healthcare CEOs in a recent report by the American College of Healthcare Executives?

Jackie Gerhart, MD is the VP of Clinical Informatics at Epic where she works with healthcare executives to advance clinical care and improve clinician well-being. Her current work focuses on the value patients can get from their data and how that information can advance evidence-based medicine and improve outcomes. She leads the clinical team that works on Epic Research studies. She also works on healthcare policy at the local, state, and national levels. Jackie also has an appointment as an Associate Professor of Family Medicine at UW School of Medicine and Public Health and still practices medicine at UWHealth. Jackie earned her MD at Mayo Clinic School of Medicine.


Phil Lindemann is the VP of Data and Analytics at Epic, where over the last 18 years he has worked with various products to define their development roadmap and strategy. He leads the team that works on Cosmos. He has worked on health tech solutions spanning machine learning, data visualization, data quality standards, and real-world evidence generation during his time at Epic.

Q. I am here today with Jackie Gerhart and Phil Lindemann, Senior Executives at Epic. It’s a pleasure to have you on the show. In your roles, your core areas of focus are Cosmos and Epic Research. Can you tell us more about this?

Jackie: I’m Jackie Gerhart. I am a Family Medicine Physician by background, and I’m one of the multiple clinicians at Epic that help make sure that their software is a joy to use. I work with other clinician executives at organizations that provide health care to ensure their workflows are going well and that their clinicians are satisfied.

Phil: I’m Phil Lindemann and I work with our data and analytics teams. What that’s all about is figuring out how to take, at this point, 170,000 different items created by Epic or other systems we work with, make sense of that and serve that back up to users within Epic. So, whether that’s Artificial Intelligence, Seth’s team from your previous conversations, or doing dashboards or even what we’ve been spending a lot of time on — Cosmos.

Q. Who or what is Cosmos? There’s an Epic Research program that is also associated with the Cosmos dataset. Why don’t you walk us through a high level overview of the platform?

Phil: What we’ll do is, I’ll give a little foundational information on Cosmos, and then, Jackiewill tell you what we’re doing with it. So, Cosmos really started as a collaboration with the Epic community a few years ago, where we tried to bring together the information from all of these health systems. The question was –What kind of insights or discovery could we do? So, fast forward a few years and we’re now over 130 million patients across 50 states with over 800 hospitals and 10,000 clinics. All of that data feeds into a central location to be available to researchers and ultimately, come back into the Epic system. When you’ve got that much data together, can you imagine what you could do with it? Jacqui, would you like to talk about Epic research here?

Jackie: Absolutely. Epic Research started right around the same time as the pandemic. It was actually something we had planned beforehand and serendipitously, it came at the same time when we were able to get good information out, quickly. That’s really the goal of Epic Research — to help search the Cosmos to find information or insights that might have taken years to find if following a traditional research process. So that data could have been in a medical journal and maybe, less out in the public eye as the Epic Research platform is. Our goal was to make a website that would enable the generation and pushing out of good insights quickly among the public and in the hands of those that can actually make change and take action from it. We’ve worked with the COVID 19 task forces throughout different government agencies, and our customers to try and ensure that anytime we see something new, we try and extract that data.

Q. Can you tell us, from the COVID surveillance standpoint, what was the platform able to accomplish for you? Do talk about some of the use cases so we understand how you used this massive dataset.

Jackie: Our goal is to get good information out quickly, but we really span the spectrum of trying to write anything that will help the news articles, peer-reviewed journal research etc. out within a day or two. So, I’ll start at the academic end with the peer-reviewed research. We worked with customers like Penn and Yale on an article that was later peer-reviewed and published in the Green Journal, the Journal for Obstetrics and Gynaecology. This was specifically looking at mothers that had had COVID and during what trimester they got COVID and whether changed the outcomes of their babies in terms of low birth weight, preterm birth, etc. That was one of the first studies that was published on pregnancy including a COVID infection and it was able to get out much more quickly than maybe what we would have been able to do and impact those that had COVID, were pregnant and wondering what was next.

At the other end of the spectrum, from a COVID perspective, we also worked with the government. Early on, we first looked at surges, but now, we’ve also been doing that with the CDC for the vaccinations. The goal is to get a vaccine approved and there is a process in which safety is paramount. You’re also looking where the bang for the buck is and whether the benefit is better than the risk that you would take as a patient. We’ve been able to provide a lot of information about patients that have got vaccinated, highlighted the safety implications and the risks to help impact legislative findings. Specifically, we worked on the 5–11-year-olds, and the passing of the EUA for them to get vaccinated. Then, there was the passing of the EUA to get booster shots for Moderna and Pfizer. So those were the COVID examples.

For me, the ones that were most impactful were those that helped drive change — One was in the middle of COVID and the other was related to Cancer screenings. During the pandemic, a somewhat unwelcome side effect was that multiple different clinics were closed so patients couldn’t get their Mammograms or Colonoscopy done. We noticed the screenings plummeted. So, the question was — how would the decreased screening rates of Cancer impact the likelihood that somebody had a missed Cancer or that it was going to be diagnosed at a later stage? We found in our most recently published article, and we’ve been following this over time, that the rates haven’t really caught up, yet. One would think with the clinics opening, perhaps people would be back to get their screenings. But it’s not happened, yet so that leaves some room for improvement.

Q. With such massive datasets, how do you make sure patient privacy is secure? With 130 million patients, you’ve got to have at least one or two of them asking this question.

Phil: Absolutely. When you look at something the size of 130 million — we’re unaware of any other EHR-based data source that’s this big in the US or the world – so, that’s a big undertaking. Talking of privacy and security, the first thing we ensure is no free text, no unstructured data for there’s a chance it could have information. It’s a very simple rule then, that any information that’s brought into Cosmos must have a structured location at an Epic site. This goes way back into our ability to build these integrated medical records such that no matter where you go in the world, Epic is the same code base, even though it might be configured slightly differently in some places, in different scenarios. But the meds are stored in the same location, as are the doctors, so that it made it easy for us to bring all the data together. Still, this is a very hard task, but it was much, much easier than trying to deal with different databases in different ways that things had grown up over the years.

The most important thing from a privacy and security point is, before data even leaves the healthcare organization, 16 direct identifiers are removed from the record, and this is before it arrives in the Cosmos database. Any users interacting with the data are only ever seeing de-identified data through aggregate controls or if the results are few, then, the platform says “there’s fewer than 10 results” rather than show the exact number. There’s certainly a lot of things that we do with the software to protect it.

But another special sauce when you have so many health care organizations and shared trust is the “rules of the road” that they’ve all agreed to. That contains things like — the data can’t be sold, access to the data can’t be sold, the data can’t leave the secure portal etc. These contribute to the shared trust because we’re operating under this general rule of the road and those are governed by the health care systems, themselves. So, they elect a Board that grows more organizations that join Cosmos. They help maintain that the rules of the road will evolve and stay within the spirit and goals of what Cosmos was intended for.

Q. That’s a very important clarification about no free text. I certainly wasn’t aware of that. Now you’ve mentioned this is the largest dataset of its kind in the world, but there are also other similar initiatives, like Truvada or even Mayo Clinic that’s rolling-out their own data for their patient communities. In all cases, the data comes from EHR systems – some of it yours, some, not. Other than the fact that Cosmos is Epic data, and I’m assuming only Epic data, how else is it different?

Phil: The only Epic data is, when you think about what we know and what we’ve learned about healthcare, by making the actual data creation systems. We’ve created the medical record in the models. We know what those screens look like, the interactions occurring there, and we understand how data is created. Knowing the origin of data is really important for a researcher who’s making sense of it once it arrives. So, from a quality standpoint, that’s one of the things that we see as magical.

What Cosmos is — All the data comes from a uniform source where we actually understand how it was created. We go back to the source to see what’s happening in that workflow. From a data quality perspective, one of the things we do when an organization on-boards the Cosmos is run all of their data, even an individual lab result, through a series of data quality checks. And it’ll be fascinating because we’ll find out that they’ve had a particular lab value which doesn’t look anything like that same lab value in Cosmos which we’ve worked with. We may think it was mapped incorrectly but what that means is that same mapping is what’s used to interoperate that chart across wherever that patient goes. So by joining Cosmos, these groups actually raise the overall ability to interoperate data and health care in an identifiable state. So, it’s exciting that there’s some pleasant side-effects when they do join Cosmos from a data quality perspective. That’s just a mild differentiator yet it’s important.

But you know, there’s a lot of these groups that are doing irrigation-type things – some, our own customer and that’s great – but many, have unique models out there of what they’re trying to achieve. Lots of people can do analyses, research but we have some of the highest quality data that can drive high quality research. The real sort of North Star for us is, how do we bring that information back to the fingertips of the clinicians and building tools that are directly within Epic? And actually, Jackie you may want to talk about some of the things we do.

Jackie: I’ll back up and add to your initial question about, what’s our differentiator — why use Cosmos? For me, having used it in research, it’s really the size and the representativeness as well as the speed at which you can get those insights into the hands of those that can act on them. A couple of instances specifically in working with the CDC is that, for example, we’ll be sharing data about hospitalizations for kids. They get information from their public health registries and multiple different areas but that will be delayed at times and getting that relayed to those that can use it consequently also gets delayed. But that delay is greater than the delay we have with Cosmos. As soon as a clinician or a patient enters information into the record and it goes into Cosmos, it can be surfaced to have decisions made on it. One example concern using MIS-C, which is an inflammatory syndrome in kids. We were told by folk at the CDC that we had data that was a good month ahead of some of the sources that they had. And this made a difference especially when we were dealing with something like the Omicron. So, speed and size matters.

It is really hard to do research on a representative dataset, especially one that represents the US population. So you can imagine that why Epic customers and Mayo Clinic etc., have their own data sets. Often, when you’re using one organization’s data, there’s a certain type of patients that might go there. That might be the population that happens to be in Minnesota, or the population that happens, to your point, to seek Cancer care. And so they might have a sort of larger representativeness of a certain specific type of question that they’re looking to get answered. But overall, when researching general broad questions, really having the scale, age, sex, race, and ethnicity and as that social vulnerability index breakdown that really matches the US population, it’s really a huge step from our research perspective.

Q. Let’s look at the other end of the spectrum — Who gets access to the dataset — private sector, developers, academic researchers?

Jackie: I wanted to follow up on what Phil was mentioning about how he put it in front of the physicians/clinicians. Who gets access, you ask? One of the main goals here, in addition to research, is to put the data and insights in front of a clinician at the point of care so clinicians that are using Epic software, can use tools that help them to really get individualized medicine to the point of care. So Epic users will be able to use the Cosmos dataset. And one of the main intentions is to bring evidence-based medicine directly to the exam room. Phil, do you want to talk about the other users that use it for research purposes?

Phil: Just so there’s a general understanding — the health care organizations that participate in Cosmos are the ones that actually get to touch the data. That’s about 1,000 users across all the different organizations, today. Now the nice thing about it is, they can work on sponsored work for other industry partners. So we really see it as a way to drive research to some of those groups that are participating in Cosmos. They work with an organization, derive some insights whether that’s a paper or an algorithm, but we really do see this being an ability to create lots of different things off of the Cosmos dataset. While its ok for insights to leave Cosmos, that raw underlying data is only touched by the Cosmos researchers in the Cosmos system.

Q. So, how does one get access – does a digital health start-up listening to this podcast for example, either build a product or partner with one of your customers, a health system or an innovation group, and thus, potentially get access. Is that the way it is?

Phil: We should preface it by saying it’s early days for us. We’re still figuring out how these models will work but when we thought this through, we felt Epic certainly can work and do many of these things. When you unleash this on the research community and have them interrogate the data and do the queries, they’re the ones that can work with the digital health start-up, ask the questions and derive the insights to inform their product and then, build them.

Q. Awesome. Now that you are taking Cosmos out into the market and you’re looking at newer users, tell me, how does Cosmos fit into the Epic and the CRM platform, Cheers, story?

Jackie: So, Epic has many health care organizations that we work with and in the concept of bringing in more patients the right care, in the right way, at their timeframe, we’ve really been looking at ways to try to open it up to health care organizations to have that ability to give patients what they need, when they need it. The differentiator for us is that we are deeply embedded in health care so, we’ve worked many times on things such as, MyChart in the patient portal and so forth, but it really goes beyond that. That was the impetus for Cheers as a CRM application.

It’s really the CRM that is specifically tailored for health care so that we get advice from our current customers who are looking to implement something like that, apply that directly into the research and development of the product before they take it. Phil, I think there are a couple of other things you wanted to add for that.

Phil: It’s funny we finally did name our CRM, but it’s something that we have had for over a decade that we’ve been using and learning. It’s something that our health plan customers do and our diagnostic laboratories use it. We’ve had a lot of experience building and integrating it into the various facets of the organization to understand our patients better. But one of the real insights for us as we started working with customers that were more in the retail space — So CVS, Walmart — was that it really helped inform our roadmap of where it needed to go. A few years ago, we added a Campaign Module to that. But you know how the naming process is always an art any time you’re naming a product. This year, finally, we concluded that Cheers would be it. So, a great announcement came with that.

Q. The name is only one part of it. You have a CRM product now and that in itself is a big deal. You’re working with retailers like CVS, have a partnership with Anthem, something going on with Humana, too. So, where does Cosmos fit into all this?

Phil: Just to drill down a little bit more on the on the payer relationship, we’ve always had teams and customers that have been working in this larger ecosystem, and we’re starting to expand, to build solutions, to reduce some of that friction. The payer space was a big one where we were seeing groups move to value, which was good. They were asking for more information so there was a lot of back and forth with the payer than we’d done, before. This wasn’t just simply “submit the claim and get paid”. It became much less transactional and back and forth. So we thought of working on something that would have a shared benefit for the payer and the health care system to really reduce some of that friction. And developed a payer platform and a series of things like the pre-op you mentioned. At this point, we have five of the six largest payers participating on that platform, and it’s about a hundred million patients that those represent.

So it’s really taken off, continues to grow and has another roadmap. That’s probably another podcast worth of discussion for you to have that team come and talk. Nevertheless, it’s a big part of what we’re doing to help ease the movement of that information — just the right information — because obviously, it’s got different viewpoints from the payer and the health care system

Q. Epic Research, Jacqui, there’s also been some interesting work done on public health and safety by helping identify practices like human trafficking. Want to touch on that briefly?

Jackie: Sure. So, we have a few different websites at Epic. One is Epicresearch.org which shows all the studies that we do on Cosmos. Then, the Epicshare.org. And then, just overall Epic.com. When you’re looking at different studies and outcomes that our customers have or if they’ve piloted something and then, worked on that initiative, you can access those websites and read the success stories.

The one that you’re specifically referring to was where one of our customers — Henry Ford Health System — did a training and used the software to actually ask the right questions at the right time and help identify more of the human trafficking victims. Their exact program involved three things – a. increasing the screening so that the folks that were seeing people come through the emergency room were able to identify certain behaviours or cues, b. having those people be trained so that when those cues were identified, they knew how to act and c. ensuring that they were getting support to those patients, as well. We have these things that, I call, clinical programs, where when a customer does something really amazing and it could be scalable or put across the rest of the app community, we package it up and put it on one of our websites and have it made available to anyone that wants to try to do it in another hospital.

Q. That’s so great. I want to touch on just one other topic. Today, we’re in the midst of a brand new crisis that we didn’t expect — an acute shortage of health care workers. Technology is one of many solutions to alleviate that and you’re one of the biggest technology providers in the health care/health system space. What is your view on how your platform can help alleviate the crisis identified as the number one issue for health care CEOs in a recent report by the American College of Healthcare Executives?

Jackie: I love how you started with there’s so many pieces to that puzzle because that is the issue. There’s just so many reasons that healthcare professionals and clinicians, especially amidst a pandemic, are struggling to determine what their path and calling is to be able to provide health care. On the non-technology spectrum, we’ve really been encouraging and working with outside groups, whether that be CMS regarding ENM coding to try to decrease the number of things that people need to document, either in flow sheets for nurses notes or in billing types of situations for physicians.

We’ve done a lot of things with partnerships — we have is that 25 by 5 initiative, which is Vanderbilt, Columbia; I believe now even the AIMIA (the American Medical Informatics Society or Association); and then, the National Library of Medicine — are all going together to reduce documentation burden by 25% by 2025. So, it’s all about really leaning-on and collaborating with others in that community to learn their success stories.

Beyond that, in the software there are a couple of different things. I did mention how we have websites where we share customer success stories. One of the most recent ones that was published from UC Health describes how their project saved 64,800 hours of nurse-time annually, thanks to the processes within EHR and documentation changes. This also reduced clicks by 50%, lowered the number of flow sheets that the nurses need to fill out, and the length of those flow sheets was shortened by about 65%.

Those are some direct examples, but we’re really thinking of it on a broader innovation scale as well. One of the key areas we’re innovating in, is Voice. So, like how you might use Siri or Alexa, for clinicians we have the Haptic where you literally ask your phone a query. The application on your phone, Haiku, curates what you’re looking for, so you don’t need to spend time looking for it in the chart. So “show me my next appointment” “Show me Janet …. ABC,” or the different pieces that may take time looking up –We’re reducing that piece.

The other promise of Voice is, if it’s intelligent enough to be able to listen to a clinician’s conversation with a patient, is it possible to get it to document it too? How can action be taken so that clinicians don’t have to sit at the computer? The computer will never replace the empathy and the social cues that a clinician can pick-up on during a patient-visit. So, it should be used to enhance and elevate the time that you’re able to see those. Voice technology is one of the ways that can happen.

Q. These are great examples. And you know, the irony of technology is that sometimes technology can actually increase the burden on users. I’m sure it comes as no new news to you that, you know, that the EHR has been, fairly or unfairly accused of increasing burdens. But it’s so encouraging to hear that you’re working on reducing coding requirement, improving documentation and workflow. That’s a story that needs to be told a little bit more; perhaps on another podcast because it is such a hot button issue today in the context of the shortage of workers and the burdens on them. I’m afraid we’re going to have to leave it there today. It was fantastic talking to both of you and wish you all the best with Cosmos and cheers and all the other work that you’re doing. Thank you once again for coming on my podcast!

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 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.

Besides the act of healing, everything else should be automated away in healthcare.

Season 4: Episode #111

Podcast with Andrew Le, MD, Chief Executive Officer, Buoy Health

"Besides the act of healing, everything else should be automated away in healthcare."

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

Andrew Le started Buoy Health after he realized healthcare consumers were relying on Google search and other sources to make decisions about their care. After seeing bad outcomes from consumers relying on inaccurate information or failing to seek timely care, he decided to build an AI-powered service that helps consumers manage their health in a more informed way.

Andrew believes that everything, besides the act of healing, can be automated away. He takes pains to clarify they are not trying to replace a doctor but replacing what today is a very rudimentary system with a search engine that narrows things down for a whole host of different things.

In the conversation, Andrew and Paddy discuss a range of topics from the long sales cycles for digital health startups, their expansion plans for their core product, the trust deficit with big tech firms and consumer data, interoperability challenges, and much more. Take a listen.

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Show Notes

00:22Tell us about yourself and how you started Buoy Health.
03:44You're in the AI-enabled digital healthcare space. What’s your definition of AI and how did you apply that to starting and running your business?
05:54Is your AI application directly used by consumers?
07:48 As a consumer, I’d need to download the app and pay to use it. Are these sources of revenue for the company?
08:41 You didn't mention providers. Any particular reason why providers are not a target market for you?
10:29 How long did it take you to figure out that providers are not going to be thrilled about this?
15:42 Do you think that the acute shortage of labor in healthcare is the next forcing function for your business or any AI-enabled business that reduces the workload on caregivers, clinicians and, consumers and expedites in getting to the right decisions and treatments?
20:11 What are the biggest challenges that you have encountered as an entrepreneur in building this business from data aggregation, management, quality, and analysis standpoint?
23:19 While data, AI and advanced analytics can make a difference in care. How does your company, who is into the data aggregation and analysis business, address it?
27:51 Can you share some learnings from your entrepreneurial journey for all your friends and colleagues in the digital health world, especially those who are looking to start a company now?

Andrew Le, MD is the Chief Executive Officer of Buoy Health. Since founding Buoy out of Harvard Innovation Labs in 2014, Andrew has led the company through two successful funding rounds, raising over $67 million, with prominent healthcare investors including Optum, Cigna, Humana, WR Hambrecht + Co., and F-Prime. In 2020, Andrew was named by Business Insider as one of 30 healthcare leaders under 40 to watch, a Digital Innovator by Employee BenefitsNews, one of Boston Business Journal's Top 40 Under 40 leaders and recognized as a TEDMED Hive Innovator. Andrew holds a Doctorate of Medicine from Harvard Medical School and graduated magna cum laude from Harvard College.

Q. Tell us a little about yourself and how you started Buoy Health.

Andrew: I am a doctor by training, and I started Buoy back when I was in medical school at Harvard. I was going to be a Neurosurgeon. Then, on my last rotation in the ER at MGH in Boston, I saw these patients who were Google-ing their symptoms or reading something online and just making a bad guess as to what kind of care they should be seeking. That led to a lot of bad outcomes. Here’s a real story — I saw a woman with a jammed finger, followed by a man who had ulcer in his foot from a history of poorly controlled diabetes that’d also become infected. We had to amputate it that night. When I told the lady she was fine to go home, she pulled out these printouts from the internet telling me why she thought the finger was broken and why she’d been waiting in the E.R. for six hours! I told the next patient, had he come earlier to the hospital, we could have saved his leg. He pulled out sheets of information from WebMD telling me why he had waited and didn’t think we should amputate.

Unfortunately, my dad got sick; he had a mini stroke but didn’t go the doctor. I have two younger sisters who are both doctors, and when I asked him why he didn’t call any of us for help especially since he had access to unlimited free telemedicine and he had in fact, paid for all this, albeit in a different way, he said – “you guys are working” and so, he Google-ed it. I don’t trust what I find at Google, so, for me that was just kind of this emotional tipping point.

Three months after graduating, I took a sabbatical from school and became obsessed with this idea that consumer-driven healthcare, shopping, and healthcare wasn’t real. It wasn’t possible because it’s predicated on this idea that a consumer or a patient or a member had to be clinically trained to figure out what the ailment was, what kind of treatment they’d have to pick, what doctor they should see to get the treatment, and where to get the outcome that they’re looking for. That is not part of our educational system.

So, we decided to build a product that could solve that knowledge gap, help people figure out what’s going on with their bodies, understand what treatment will lead to the right outcome for them. So, that’s the journey we’ve been on.

Q. You’re known as a company that is in the AI-enabled digital healthcare space. What’s your definition of AI and how did you apply that to starting Buoy Health and running it?

Andrew: AI in the most basic sense to me is the ability for a non-human entity — in this case, obviously a computer — to deduce something as if they were a sentient, intelligent being. So, all the definitions you threw out there that fall under that very broad umbrella. I think it’s an often-used buzzword today for statistics, data science, and the ability to turn data into insights. It’s as simple as that and an over-hyped, over-used term.

Our application of AI is as simple as communicating with a computer program that communicated back to you in a way that a clinician would. The net result of that communication which is like texting someone is that Buoy actually tells you what’s most likely going on. As I mentioned before, it shares what the best possible treatment is for what’s going on, helps you make a really educated self-diagnosis, enables self-triage, and self-navigation into the right care at the right time.

Q. So you use it primarily for triaging based on inputs that patients or consumers may put into the tool and match it up with data on the back end that throws up a set of potential recommendations or as used by a physician? I imagine it’s not used directly by a consumer.

Andrew: No, it’s used by the consumer. I very purposely did not say that we diagnose. We’re not trying to replace a doctor but we’re really replacing what today, is a very rudimentary system for narrowing down what’s going on with you. So, we have a search engine that narrows it down for a whole host of different things.

So, in this situation, you’re answering questions thrown at you by a computer program in real-time. The entire engagement takes 2-4 minutes at the end of which thousands of possible questions are getting re-ranked. Then, we show people three possible matches. They get to see the reasons for and against each match, which then helps them conclude and decide on the most logical match for them. Based on that their clinical situation, benefit design, insurance information, and if we’re working with that, then, their particular employer or payer – all these helps us show them the services that are in-network for them or subsidized by their payer or employer. And thus, we get them into that.

Q. That brings us to the fundamentals of the economic model of the business. The payer could be either the employer or a commercial or a Blue Cross-kind-of-a-payer, or a consumer. As a consumer, I’d need to download the app and pay to use it. Are these sources of revenue for the company?

Andrew: The main source of revenue from the company is from the self-insured employer and the payer. We don’t charge consumers for accessing Buoy. You can go on buoy.com right now and it’s totally free for you to use. If you get it through your employer or your payer also, it’s free to use. The employer or the payer is paying us to essentially configure Buoy to their particular network design, their set of point solutions or particular services that are in-network for them to then, drive them into that right care at the right time.

Q. I noticed that you didn’t mention providers; you’re going to the employers and the payers. Any particular reason why providers are not a target market for you?

Andrew: It’s a really good question, because that’s where we’re headed next. From an original kind of company perspective, we started out working with some health systems and when we saw the data coming from our deployments, the use case directed us toward helping consumers navigate a complex health system.

What we found was that when we’d ask people upfront what kind of care they were looking for and then we saw where they ended up going, we noticed we were de-escalating 50% of ER visits, 48% of urgent care and 42% of primary care. It was astounding how, if you removed uncertainty and fear from the equation, it often de-escalated peoples’ care. Health systems, in no fault of their own, are in a transition right now from fee-for-service to value-based care. They’re somewhere along that spectrum, let’s call it 80:20, so when you show someone that data of us actually potentially reducing the number of people that come in that 80:20 equation, the math starts to play out right.

Q. This is a classic conundrum for digital health solutions, and I’m curious — how long did it take you to figure out that providers are not going to be thrilled about this?

Andrew: I would say about a quarter. We had the benefit of having some investors on the payer side, who helped us know that that would be the eventual landing spot of where we would be very valuable if we were able to change behaviour and move people into the right care. So, it was one of those things where we were de-escalating care and a couple of potential prospects told us that that wasn’t interesting. So, it was an immediate shift for us — moving to self-insured employers and payers.

However, going into this year, as a business, we have 30 million consumers that come on to Buoy.com every year. We work with three of the largest payers and hundreds of self-insured employers and so, the next opportunity for us is to drive consumer-driven healthcare, make healthcare shoppable with our technology where the shopping decision is taken out of your hands or out of the domain of a doctor who shops on your behalf or a doctor who guides your shopping decision. It’s our chance to actually bring services directly onto providers, onto Buoy so as to enable this three-sided marketplace where the marketplace’s core function is to do a really complex match between that consumer and exactly what service they should be going to. The focus then, is less on health systems, more on digital health solutions.

The next stage of the business for us entails talking to, partnering with many of the companies from among 1900 digital health companies founded in the last two years, bringing them onto Buoy, and helping them find the right patient.

Q. Even though you’ve decided to move on from providers, you’ve said it’s 80:20. So, only 20% of healthcare is on some kind of a value-based model but that percentage is expected to grow. Do you think that ratio will change enough for you to approach health systems, again? If yes, is that a year or a quarter of a year or five years away?

Andrew: I think that with the success of digital health on the value-based side over the last couple of years, it’s a forcing function for the rest of healthcare to move in that direction. So, I don’t think that we are a decade away. But I will caveat and say we’re not a year away either. Healthcare moves at the pace that it moves but COVID was a massive accelerant for its digital version. There will be continued momentum in the direction of value-based care, but legacy, or let’s call it ways of making money, are hard to unwind.

Q. That’s a great segue to my next question. You mentioned forcing functions – so, one was the pandemic and now there’s an acute shortage of labour in healthcare. A report in this month’s American College of Healthcare Executives publication states this as the number one priority challenge for healthcare CEOs today. Is it the next forcing function for your business or any AI-enabled business that reduces the workload on caregivers, clinicians and, consumers and expedites the right decisions and treatments?

Andrew: Absolutely. It’s been an underlying and an unstated problem for many years but it’s quite acute now – this access to care for an average person is very hard. If you have a family member living in Boston, you’ll know the average wait time there is 49 days to see your primary care doctor. It was like this 5 years ago but I don’t know nor do I want to look up the number today. Access then, has always been a problem, and now is bigger due to this massive burnout of healthcare workers across the entire spectrum of different types of clinicians and workers. I mentioned my siblings in the healthcare field and many friends and former classmates of mine are here too and they feel a massive amount of strain which explains that shortage.

When I think about the future of our company and that of digital health, we must focus on the labor that exists out there today and what will emerge in the future. How do we make sure that they’re doing what they’re cut out to do – heal people? The catchphrase is “practice at the top of their license,” but the way I think about it is clinicians and humans specifically, are good at healing. So that pat on the back, the treatment rendered in a kind, compassionate way, is a job that’s tough to replace by anything automated. So, everything besides the act of healing should be automated away.

When I think about this, I like the fact that when we visit the doctor, they’re not just healers, they’re also our shopper. They offer us options – “A, B or C. What do you want to do?” If we can allow the clinician to be the healer to do what they do best the moment they actually need it and automate the amount of other work that fills their day — from the documentation, billing, post-care rundown perspectives — there’s a treasure trove of what should be automated by technology.

Q. There is a considerable interest in automation technologies – RPA, voice recognition etc. – and it will only increase. What are the biggest challenges that you have encountered as an entrepreneur in building this business from data aggregation, management, quality and analysis standpoints?

Andrew: I would say the biggest problem is around the silos of healthcare data. I don’t think my insight here will be unique or interesting but it’s real. Everyone sees the data that is really owned by the patient, as being theirs. And there’s a lunge to not want to share that in any form or fashion, in the guise of HIPAA and patient privacy. That is a real challenge.

Patient privacy and data ownership from a compliance perspective, makes a ton of sense and that’s correct. But, if a patient who owns their data consents to having their data moved across places for better care and an enhanced healthcare experience then, that should be made easy. It isn’t the case, today. Obviously, considerable digital health investment has gone into businesses to make healthcare more interoperable, liberate that data — clean it, make it more actionable, and drive more insights — so, I’m hopeful, over time, it gets easier for consumers to tangibly hold their data.

Q. Let’s talk about the flip side of that, too. Consumers must have access to their data but if it falls into the wrong hands, there can be all kinds of unintended consequences ranging from the mild to the severe. While data, AI and advanced analytics can make a difference in care, how does your company, undertaking data aggregation and analysis, address it?

Andrew: Our view — and I’ll come back to your point, because it’s an interesting counter to what I said — is that, at the end of the day it is the trust with the patient that matters. If we’re a company trying to drive better decision-making at a consumer level, empowering people to get the right care at the right time, making healthcare more efficient, and if the consumer doesn’t trust us with their decision, then, we must ask why do we exist? So, when it comes to how we treat their data, protect it, regulate access — any action, whether real, intended, or not — it’s that trust that’s crucial for us.

When it comes to secondary consequences – here’s the segue to your earlier point – we ask “what if the consumer doesn’t know how their data is being used?” And this is controversial. I’ll say, it’s been proven to be true across tech and industry where the products themselves are addictive and a means of gathering data and then, monetizing it in a way that may not be best for that person.

However, healthcare is different. People don’t use healthcare for purposes of selling vanity. The intent is to use it to go back to their baseline and get healthy, again. If it turns out that this company is not using their data correctly, then, there’s no way that that company will be able to exist for very much longer. There’s going to be a flight to quality. People won’t access the site that’s selling their data. So, it’s important to have a bit more trust in the consumer to not let that happen. The intent in the healthcare context is just different from other contexts where unfortunately, consumer data has been misused. So, that’s my optimistic hope.

Q. You do make an important comment about healthcare data being a little different. The bar is higher and there are serious consequences for misuse of the data and the breach of trust. So, as a start-up in digital health, what’s your advice as an entrepreneur for those who want to start their own companies here?

Andrew: There’s so much to learn when starting a company that can be applied from other industries. The piece of advice I’d give most often to people going into healthcare — into digital healthcare, specifically — is what’s different about healthcare, is that outside of direct-to-consumer services where someone is paying, these sales cycles here are so long, regardless of whether you’re selling to pharma, employers, payers, health systems etc. So, the learning is slow because by the time you get someone to say no — which in and of itself is a learning — it takes 12-18 months.

When you are raising capital and trying to prove something, it’s crazy how much you have to guess correctly in order to make it to the next stage. That is a reality which entrepreneurs have to embrace. In other words, the questions to be asked are — How can I speed up my learning in some innovative way? Do I have to raise enough money to last through 2-3 sales cycles? — It’s just a stark reality that I think is not talked about when trying to apply tech, how it works and how to start a tech company relative to healthcare in the digital health landscape.

I hope that doesn’t discourage anyone from getting into healthcare for we need the innovators, people who can dig in for the long haul and investors who will have the faith that eventually, it’s all going to work out. Andrew, it’s been a pleasure speaking with you. I wish you and your company the best and thank you again for being on the show.

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 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.

Virtual maternity care can help address access to care and health equity

Season 4: Episode #110

Podcast with Anish Sebastian, Co-Founder and CEO, Babyscripts

“Virtual maternity care can help address access to care and health equity”

paddy Hosted by Paddy Padmanabhan
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In this podcast, Anish Sebastian, Co-Founder and CEO of Babyscripts, shares how they are reinventing the standard of prenatal and postpartum care by enabling improved virtual and remote maternity care. Babyscripts focuses on the delivery of pregnancy care through the power of technology and remote patient monitoring and addresses the critical shortage of obstetrical providers in the U.S. 

Anish calls the pandemic ‘a watershed moment’ for telemedicine and digital health adoption. He highlights how technology presents an interesting dynamic for pregnancy, and how connected devices can improve access to care at a central level, thereby impacting maternity care in the country.  

The digital health landscape is a chaotic marketplace today. Anish concludes with advice for digital health start-ups who want to make a mark in the industry. Take a listen.

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Show Notes

00:36Tell us about yourself and how you came to start Babyscripts?
02:59What you consider as some of the milestones you've had as a company? Also, tell us how the pandemic impacted your business?
06:24You and your co-founder are both men in a women's health business. Does anyone ever ask you about that?
08:42 What kind of demographic do you mainly serve? Who’s paying for your customers – plans, providers, or employers?
11:54What are the big elements of your platform that go towards providing this comprehensive care?
14:12 What are some of the big challenges you encounter when you're aggregating the data from a large population and trying to make sense of it?
16:06 Is your product or solution embedded in a clinical workflow or is it a separate standalone app?
17:23 Interoperability is an unfinished business. Is it getting better?
19:46 What is the hardest part for you as a start-up with an innovative solution, but also one that is not a part of the core technology and applications infrastructure for health systems today?
22:59 What has been your experience in the last several years and what would you advise to someone who's looking at starting a digital health company today?
26:47 For your peers and other digital health founders, can you share few things that you've learned?
anishsebastian-profile

Anish Sebastian co-founded Babyscripts in 2013 with the vision that internet enabled medical devices and big data would transform the delivery of pregnancy care. Since the company’s inception, they have raised over $37M.

As the CEO of BabyScripts, Anish has focused his efforts on product and software development, as well as research validation of their product.

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.

Behavior change is where value is derived in digital health

Season 4: Episode #109

Podcast with Kyle Kiser, Chief Executive Officer, RxRevu

“Behavior change is where value is derived in digital health”

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this podcast, Kyle Kiser, CEO of RxRevu, discusses how they have built a data network to provide real-time patient-specific prescription pricing information to providers at the point of care.

Pharmacy Benefits Management is a concentrated space with a handful of players. The PBM model is changing into something more holistic and more focused on managing patients, not just around pharmacy benefits specifically, but managing the total cost of care, using pharmacy benefits as a tool to achieve the goals. RxRevu has focused on building trust in their tool to drive prescription behavior change among providers. Kyle also emphasizes the need to have the tools in the hands of the right users to drive impact.

Kyle advises digital health startups to spend time on understanding where the value accrues in terms of finding customers. While it may look chaotic from the outside, the incentives in the healthcare value chain drive rational decisions for each entity. He urges startups to understand incentives and builds business models within them. Take a listen.

Our Podcast Partners:

Show Notes

00:35Tell us how you came about starting RxRevu and what’s your journey been like over the last few years?
02:07What is the main value proposition here? Who are your main customers -- health plans providers, employers?
04:38What's the differentiator from your perspective for your company? 
06:56 If PBMs and health plans are your customers, do they feel a threat of disintermediation in any way? Do help us understand.
09:16 Give us an example of how you make an impact. What is the kind of savings we’re talking about using the tool delivering real-time information?
13:56 What's the biggest challenge you encounter while trying to do this real-time dynamic integration of the data?
17:02 What’d be your advice to the digital health startups like yours?
20:30 How important are the clinical workflows for you? Is yours a standalone solution that can be launched from inside of the EHRs?
22:46 What would be your advice for digital health startups or their VC firms who are coming up with an innovative solution and want to enter the market today? What are the one or two big themes that you think are important for 2022?
Kyle_Kiser_Profile

Kyle Kiser is Chief Executive Officer at RxRevu, the industry leader in Real-Time Prescription Benefit services. In this role, he focuses on creating more seamless, cost-effective prescribing experiences for patients and providers. Since 2013, Kyle has helped develop innovative Prescription Decision Support solutions, which allow providers to select appropriate medication options for their patients. By partnering with physicians, health plans, IT vendors, and health systems, RxRevu is driving data transparency and better patient care nationwide.

Kyle has helped grow RxRevu from a vision to a reality and has been at the forefront of some of the most transformational initiatives in the healthcare industry. In particular, he has focused on projects that lower the cost of care, improve health outcomes, and enable informed decision making at the point of care. His focus on interoperability has allowed partners to improve prescription workflows and millions of patients’ lives. Kyle has helped develop incentive strategies for the country’s most innovative employers and led product launches with the nation’s largest payers. Prior to joining RxRevu, he was a senior leader at Welltok, Catapult Health, and Principal Wellness Company.

Q: Let’s start with a short background – tell us how you came about starting RxRevu. What’s your journey been like over the last few years? 

Kyle: I come from an employee benefits background and my family was into brokerage consultancy. As a kid, when I got into trouble, I’d come home from school and must stuff enrolment packets. It was that sort of a beginning. I was always in the payor-oriented side of the business and over time, when I looked at that world, I didn’t really necessarily see the opportunities to impact the system in the ways that I wanted to. You think about the options available to brokers and consultants to solve some problems for employers but ultimately, it’s just passing the cost along with the patient. You can try and distribute the out-of-control spending as best you can. So, I wanted to impact the cost curve by finding a different way to work within the existing system. 

Q: RxRevu focuses specifically on the pharmacy-benefits side of employee-benefits, as you mentioned. So, what is the main value proposition here? Who are your main customers — health plans, providers, employers? 

Kyle: We’ve built a data network that connects to the point of decisions. So, when providers order care, it could be in the form of prescriptions or something else. We connect to the systems they use to make those orders and bring into their consideration real-time, patient-specific, pricing information. We also connect to a network of payers, provider organizations, and PBMs for the data, and to the EHR systems to form that decision with that new cost value. 

Q: Let’s start with a short background – tell us how you came about starting RxRevu. What’s your journey been like over the last few years? 

Kyle: I come from an employee benefits background and my family was into brokerage consultancy. As a kid, when I got into trouble, I’d come home from school and must stuff enrolment packets. It was that sort of a beginning. I was always in the payor-oriented side of the business and over time, when I looked at that world, I didn’t really necessarily see the opportunities to impact the system in the ways that I wanted to. You think about the options available to brokers and consultants to solve some problems for employers but ultimately, it’s just passing the cost along with the patient. You can try and distribute the out-of-control spending as best you can. So, I wanted to impact the cost curve by finding a different way to work within the existing system. 

Q: RxRevu focuses specifically on the pharmacy-benefits side of employee-benefits, as you mentioned. So, what is the main value proposition here? Who are your main customers — health plans, providers, employers? 

Kyle: We’ve built a data network that connects to the point of decisions. So, when providers order care, it could be in the form of prescriptions or something else. We connect to the systems they use to make those orders and bring into their consideration real-time, patient-specific, pricing information. We also connect to a network of payers, provider organizations, and PBMs for the data, and to the EHR systems to form that decision with that new cost value. 

Q: You’re in a technology-heavy, data-intensive business, making these real-time connections between different data sources and potentially surfacing opportunities for reduced costs and perhaps, alternates to medications etc. Am I right? 

Kyle: Yes, that’s right. What we bring to the workflow is price information and any formulary restrictions that may exist — prior authorization, the quantity limit, a step therapy, alternative choices or lower cost options etc. These come in two forms – a different drug or a different pharmacy. The goal there is to help a prescriber. For instance, when they make a prescribing decision, we enable them to consider some other options that might have lower out-of-pocket costs for the patient either by switching drugs to something that’s more in relationship with the rules on the patient’s formulary or to a different pharmacy that would have a lower price-point compared to the patient’s preferred pharmacy. 

Q: Let’s talk about the concentrated PBM space. There’s a handful of players now and the number is shrinking. However, we’re noticing the emergence of a new category of startups like yours for instance, who are trying to approach this differently. What’s changed? What’s the differentiator from your perspective for your company? 

Kyle: PBMs are our customers, so, regardless of who’s managing the pharmacy benefit, we want to make sure we’re working on behalf of the risk-bearing entity and connecting them with whoever’s making their decisions. That’s the focus and the difference about what we’re trying to accomplish broadly around PBM consolidation and the model itself though there are changes ahead. The fact that many of them are being absorbed into the bigger healthcare conglomerates suggests that the PBM model is becoming more holistic and focused on managing patients; not just around pharmacy benefit specifically but managing the total cost of care with pharmacy benefits as a tool to do that. Bending the cost curve in general is going to require a lot of tools around care management, benefit management and really drive different behaviors on the front- and back-end of that. Pharmacy benefits are a component of that, but not necessarily the whole story and in that context, the consolidation of the markets evidenced is true.

Q: If PBMs and health plans are your customers, do they feel a threat of disintermediation in any way? Do help us understand.

Kyle: That’s true. We work with PBMs and health plans and in many cases, those are the same entity. It’s true that we’ve built a network that has different functionalities based on what problem we’re trying to solve. In some cases, it’s about simply specifying the cost and offering some lower cost choices. In some cases, it’s based on what we know about the patient. So, we put forth some sites or pharmacies that might be better options for them. One example for this is we work with health systems to ensure that we maximize the opportunities for them to fill those medications because we know that more integrated care is going to drive a better outcome especially, if we can send a patient downstairs to fill the prescription. We can make them more adherent and consequently, empower the provider encounter in a different way. That’s valuable. 

We’re in the position to do so since we’re focused intensely on provider-ordering as the point of intervention and a lot of those conflicts resolve there. The health plans and PBMs are rarely in conflict with regard to preferences, because, PBMs work on behalf of the health plans to manage risk, and both are incentivized to enforce the formulary, find the lowest-cost pharmacy, maintain interest in adherence and manage a better patient experience. We look for such opportunities where stakeholders align well enough for us to try and drive a different outcome because ultimately, finding that path of least resistance is how we make a bigger impact on the system. 

Q: Give us an example of how you make an impact – either by picking a therapeutic category, a client of some kind or what is the kind of savings we’re talking about using the tool delivering real-time information? 

Kyle: Let’s talk about behavior change, specifically since that’s ultimately where value is derived. We’re approaching five million transactions a month now through the tool that represents about $3 billion in annual prescription spent on the pharmacy-side of the world. Those are exciting numbers but what it really comes down to is how do you convert that into a different behavior at the point of prescribing those results at a lower cost option for the patient? 

We did a side-by-side comparison for the business in Florida and when competing with this other company we realized that we were delivering six times the behavior changes as the sort of standard solution. That really comes down to a few things – one, where we’re returning transactions at a rate of about 95%; that means out of all the opportunities we have had to price medications, we’re pricing successfully in returning value that’s relevant. So, 95% of that is 15% higher than the rest of the industry. In that, 15% are the complex things. 

It’s not that hard to price the medications of the capsules. However, what’s challenging is pricing the sort of non-standard forms – creams, inhalers, self-injectables, and things that don’t fit neatly into the other types of drug forms. What I can attribute the behavior change to is we’re working really hard to make sure that the most valuable encounters are successful pricing to service the lower cost alternatives because those are relevant opportunities to impact the patient’s outcome. They’re relevant to the provider, positive experiences and valuable to the users, our paying customers, the payers PBMs. 

Our goal is to create a relevant value for every provider that uses the tool. Technology providers love the data and incorporating it into their decision-making process. Initially, it wasn’t working very consistently because there were only so many payers of the PBMs that were capable of doing this but that’s changed over time. We’ve added the intelligence layers to ensure that it works at an even higher rate and ultimately, it’s the trust in the tool that’s driving more behavior change. So, that’s how we think about success — how do we ultimately convert these things into different behaviors at the point of care and a different outcome? 

Q: This entire platform is built on the premise of real-time data aggregation and intelligence on top of it to deliver recommendations at the point of care. Is that right? 

Kyle: Yes. The only change is less aggregation and more connectivity. Health insurance and health care pricing is quite dynamic, and variable based on location and the insurance coverage phase. So, all the aggregation opportunities become less valuable than the real-time connectivity opportunities. What’s important is our ability to transact in real-time based on what’s happening this second — the price at a pharmacy or at a health system or at this clinic today, based on what one knows, where one is, and one’s insurance plan. That’s the type of insight we must deliver and why this tool will be valuable. 

Q: What’s the biggest challenge you encounter while you’re trying to do this real-time dynamic integration of the data — Is it the technology? Is that resistance from those who have the data? 

Kyle: One of the biggest challenges is convincing providers that it’s real. The providers have, for so long, been at the receiving end of some unmet expectations with these types of tools for two reasons– one, because the data exchange was not happening in real-time so, it was inaccurate, outdated, and providers just stopped paying attention, looking at it or trusting it. Second, to capture the market before the technology arrived a lot of things were misrepresented as real-time, patient-specific, moment in time-specific pricing to indicate price transparency via tools that weren’t so. 

Both cases eroded provider trust in tools so they began to ignore them and one of our biggest hurdles to climb early on was just around convincing the providers that our tool was different, reliable and they could have a different expectation around this. We’ve overcome those hurdles today, because we partnered really closely with provider organizations like the U.S. Health Presbyterian in Mexico, Providence in the Northwest etc., to listen to providers and understand their side of the story. It helped us evolve our pipeline and communicate the value of the tools that we had better. 

Q: Let’s talk about the overall digital health landscape. You’re one of the emerging digital health companies, recently raised a Series B round and demonstrated some success. But there’re digital health companies developing innovative solutions and making a difference, but the flip side is, they’re confused about how to really evaluate partnerships. What’d be your advice to these startups? 

Kyle: I feel that the answer will be variable based on the type of company. As a sort of general, broad swath, scale matters. We experienced that early on and overcame that issue because in a lot of cases, the functionality only mattered if the right end user was engaging with it and only that could drive impact. 

Now, that’s hard to do in healthcare, especially when you’re talking about provider tools, point of care tools, coaching tools etc., because it’s a challenging B2B sales cycle to overcome if it doesn’t have scale which is, engaging with the users that matter most. Without scale, there may not be a great outcome. So, I’ll talk about how we’re reaching 300,000 providers and five million transactions a month because that’s an opportunity for us to drive value at a much larger scale compared to the early days. That’s the first point. 

I don’t think that necessarily correlates with venture capital, though. We’ve tried to be judicious about how much, when, and from who we pursue those investments and have ultimately decided that finding strategic partners that could help us drive value through who they are, what they do or what they know what was most important. That led us to on a health system path. We focused on provider systems, healthcare systems as strategic investors with a couple of notable exceptions and found a lot of value from those we brought to the table. Ultimately, for us, being very provider-centric and understanding the challenges they faced, how we could help them overcome those challenges was important. Having a web app where we could sort of test and iterate on those things was critical, too. So, the venture capital dollars are the lifeblood for many in this industry. Our perspective was just to ensure we were providing the right types of investors that could add specific and tactical value to our approach. 

Q: What about the EHR vendors? Our healthcare clients like to see single interfaces for all the technology tools. So, how important are the clinical workflows for you? Is yours a standalone solution that can be launched from inside of the EHRs? 

Kyle: Yes, we’re an embedded component of the EMRs where the data network that powers the price transparency features in Epic. We see a lot of value in such partnerships since they’ve helped us drive scale in a significant way. Frankly, these partnerships have considerable important inputs on the right ways to design such solutions because they’ve been serving those users for a long time. Like it or not, they’re some of the best chances we have in platform companies and health care. So, we want to be in those workflows ultimately, because that’s how you drive provider adoption and engagement. However, the minute you ask providers to do anything but their standard, it’s less likely that you are to actually be able to deliver something of value. 

Q: Scale is very important and though it’s still early days for digital health, and there are mergers and acquisitions, many companies will undergo some kind of an evolution. Do you think there’s also the prospect of a shakeout when some of these companies don’t reach scale? 

Kyle: Absolutely. I agree with that entirely. That’s part of the thrill and risk associated with entrepreneurship, right? Not everyone’s going to succeed and that’s the reality of any market you enter. 

Q: Can you share some advice for digital health startups or their VC firms who are coming up with an innovative solution and want to enter the market today? Specifically for those already in the game, what are the one or two big themes that you think are important for 2022? 

Kyle: If we were starting today, I would do a lot of the same things we’ve done, which is be entirely obsessive about the incentives that exist and understand where value accrues. Once you understand where value accrues, you know where your customer is. In our case, that was initially prescribing behavior. But because of the value we accrued for the payers, the PBMs, since they were looking to reduce their cost of goods by driving lower cost choices, we became naturally inclined to selling directly to providers. We wanted to engage those providers, users and monetize that effort. In our case, it was a multi-sided network opportunity because the incentives were not aligned necessarily, or the providers’ risk wasn’t to a significant enough scale or didn’t include pharmacy benefits. So, I think it’d be — be obsessed with the incentives in the healthcare value chain because while they look chaotic from the outside, at times, these are very rational decisions being made based on the incentives that are in front of one entity or another. And if you can understand those well enough, you can build a business model within it. 

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 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 Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.