Month: June 2022

We are building a consumer identity and engagement platform as the cornerstone of our digital strategy

Season 4: Episode #124

Podcast with Sara Vaezy, Chief Digital Officer, Providence

"We are building a consumer identity and engagement platform as the cornerstone of our digital strategy"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Sara Vaezy, Chief Digital Officer of Providence talks about her new priorities, the increased focus on patient acquisition through marketing and patient engagement tools, and the role of identity-based marketing programs that get tied with the returns on investment. Sara also discusses the digital health innovation ecosystem, the startup funding environment, and all the tough choices that health systems make in the context of an economic slowdown.

Sara talks about unlocking new business models and operationalizing digital in a multi-modal context to solve both consumer and health system problems that go beyond substituting a physical visit for a virtual visit. She also states that health systems are now going through a much-needed re-evaluation of the value generated by digital business models and partnerships. Take a listen.

Our Podcast Partners:

Show Notes

00:41 About your new role and immediate priorities.
05:18Why do you think health systems today are choosing to define the digital function in product management terms?
07:41Can you describe some of the trends you're seeing in healthcare today?
12:44 Compared to other industries, healthcare is certainly catching up. But historical factors determine how quickly you can transform the siloed nature of data – medical information, demographics, social profiles, and privacy concerns. What makes healthcare a little more challenging?
18:22With the hybrid care delivery model, patients receive some care at home and clinics too. How much of this have you implemented at Providence and how do you ensure a seamless experience?
22:48 There are plenty of digital health startups with thousands of good solutions, smart people, and some VC money. But the change in the funding environment could mean trouble for a few of them. What are your thoughts on this?
28:05 What do you see as a macro-outlook for the next 12 months? What kind of scenarios are you playing out in the context of digital health investments or even your own innovation programs?

About our guest

Sara Vaezy is the Chief Digital Officer for Providence where she is responsible for digital strategy, product innovation, marketing, digital experience, and commercialization for the integrated delivery network (IDN) which includes 52 hospitals and 1,085 clinics and serves over 5 million unique patients.

Sara is the architect of the Providence digital innovation model upon with the Digital Innovation Group (DIG) was founded, resulting in company partnerships and incubation of technologies that deliver value for Providence as well as other health system. The model has resulted in the commercialization of three incubated technologies into independent companies from within DIG— all of which are supporting Providence in delivering on its mission and vision of health for a better world.

Sara_Vaezy_profile-pic-tablet

Sara Vaezy is the Chief Digital Officer for Providence where she is responsible for digital strategy, product innovation, marketing, digital experience, and commercialization for the integrated delivery network (IDN) which includes 52 hospitals and 1,085 clinics and serves over 5 million unique patients.

Sara is the architect of the Providence digital innovation model upon with the Digital Innovation Group (DIG) was founded, resulting in company partnerships and incubation of technologies that deliver value for Providence as well as other health system. The model has resulted in the commercialization of three incubated technologies into independent companies from within DIG— all of which are supporting Providence in delivering on its mission and vision of health for a better world.

Sara is active in the broader healthcare industry serving as an NCQA Board Director, as a member of inaugural class of the Frist Cressey Ventures Collective, a Health Evolution Forum Fellow, World 50 Digital 50 member, and a Forbes Business Council Member. She has won numerous awards and has been recognized as a Business Insider 30 under 40 Transforming the Future of Healthcare (2019), Catholic Health Association Tomorrow’s Leader (2019), a Becker’s Rising Star in Health IT (2020), and a Becker’s Women to Watch in Health IT (2020 & 2022). 

She holds an MHA and an MPH in Health Policy from the University of Washington School of Public Health and BAs in Physics and Philosophy from the University of California, Berkeley.  

Q. Sara, tell us a little about your new role and your immediate priorities.

Sara: My role actually has three parts. The first, that of a Chief Digital Officer, is a bit of a misnomer because the first big part of the organization is the marketing and digital experience. This isn’t just digital marketing or just marketing of digital products but all organizational marketing and really like customer-facing, top-of-the-funnel customer acquisition all the way through in terms of getting our users to convert and acquire services from us. So, the organizational marketing and digital experience spans our marketing platforms, analytics, regional strategy, planning around marketing, website search, performance marketing, and our e-commerce activities both, on our own digital properties as well as on partner properties. Take for instance our payer partners and how we syndicate content and appointments and things like that to them. That constitutes the first big part.

The second part is product development. We have a product development shop with about 80 people that are building enterprise software primarily for health systems. Our core thesis is in terms of where they’re pointed at. We build customer-facing platforms that do not exist in the market today, and we build what we think are essential in terms of health systems having a role in driving the development of those platforms.

The third piece is, once we build, we commercialize. The last part of that is strategy that concerns not just where we build and what goes to our product development team but also spans taking these solutions to market, spinning them out into new companies and then, doing quite a bit of actual market development. In many cases then, we’re building platforms that don’t exist or which are new categories. We just need to educate the broader market out there as to what it is, why it’s important, and what we’re doing among other things.

To your question around priorities, we’ve done all sorts of things in the past — looked at a pretty broad scope of customers, studied consumer-facing solutions, whether they were more growth, mar-tech types of solutions, or even looked at access and convenience things that are behavioral health. We’ve also done work in health equity and in the last six months and in particular, this past quarter, we’ve really doubled down on just focusing all our efforts on driving the growth value proposition and the growth imperative for the organization.

In most industries, and I’m not talking about modernizing infrastructure here, but about digital transformation from a customer-facing perspective. The primary place where digital has a real role is in generating demand, aggregating demand, and capturing demand. That’s what we’re doing. We’re driving growth for the system through customer acquisition, customer retention through engagement, and capturing LTV. We’re changing the LTV equation for our health system and since it’s difficult to do, we’re focusing on that for we want growth, profitable growth all day, every day.

Q. Why do you think health systems are choosing to define the digital function in product management terms, today?

Sara: There are a lot of different answers to this. But here’s one which is that infrastructure and enablement only go so far. You really have to think about the problem that you’re solving for your user all up; in fact, the whole end-to-end experience. That’s what product managers do. They think about the entire problem and start from the customer backwards, hopefully. So, that’s one thing.

The other piece is in healthcare. I’d say that in any other industry, digital unlocks new business models. You must take that product management approach to ensure this else, you’re just enabling the same kind of core business. We have a lot of that, too, in healthcare.

However, unlocking the new business models or operationalizing digital in the context of new forms of access, for instance, is something we’ll get to in a little bit, but multi-modal care is not just about substituting a physical visit for a virtual visit. There’s a lot more to it than that if you really want to solve both, the consumer and the health system’s problems. That’s why it’s becoming increasingly prevalent. You need to think beyond infrastructure and really start thinking about new business models, new customer use cases, and that more transformative aspect of it.

Q. How are your patients and your target audiences driving some of your thinking? Can you describe some of the trends you’re seeing that may be of interest to our listeners?

Sara: There are a lot of different things that have especially happened or accelerated over the course of the last couple of years given both, COVID and greater familiarity with technology, in the context of our healthcare. I’ll just talk about a couple.

The first, is what I just mentioned earlier, multimodal. It’s just the notion of patients and users getting comfortable with both, the physical and the virtual and how these exist in a hybrid environment, together. But there are expectations that go along with this, for instance, the continuity of your data or your authenticated state as a given individual, and an identity that goes along with you as opposed to just these one-off transactional things that may or may not persist across the different mechanisms by which you encounter a system. This concept of “hybrid” is something we’ve seen over the last couple of years and read quite a bit about but, I think, there’s going to be increasingly more of that in different patient segments and use cases. I don’t anticipate that trend to go away.

Another piece of that is that’s tangentially related to the concept of identity. Identity-driven engagement and personalization drives engagement. What I mean by that is if you take the classic example of Pinterest, or any e-commerce platform, say, your home page on Amazon.com. That is going to look very different from my home page there because we are different people with different purchasing patterns, plus we live in different parts of the country. So, based on everything that Amazon knows about us, they are able to drive a completely different personalized experience for you versus for me. That is coming to health care. That’s coming in the context of how specific transactions may or may not be relevant to you. It may be a virtual one or a physical one, but it’ll become relevant to the context of outbound marketing. For instance, we’ve got good at being able to recognize, through some of our marketing platforms’ work, who is in the market for a specific service with us. That helps us undertake targeted outreach. So, we can say to them, “We’ve noticed that you’ve been engaging with us around content for knee pain or you’re being searching for orthopedic surgeons. How can we help you?” That there is personalized targeted marketing, outreach, and outbound marketing.

The third area is just around this as it relates to personalization. It’s just about engagement experiences, in general, that encompass knowing who you are and being persistent. There is a single place for all your information and it’s not just health system-centric, it’s marketplace-centric. We are building, for instance, what we call a consumer identity and engagement platform based on this general trend.

Identity is the cornerstone. It knows that I am who I am. It undertakes identity resolution, management, and identity verification, and then that identity powers a profile of me as an individual and in a single access channel, personalizes my transactions, my billing experiences, my third-party apps, and the services that are relevant to me. This happens on an ongoing basis, not just around an episode of care, but like between episodes of care. We’ve talked about this in healthcare for some time but as we solve the identity and the data problems, it begins to actually become real.

Q. While industries such as, ecommerce, personal banking, securities, travel, and hospitality are further ahead, healthcare is certainly catching up. However, some historical factors determine how quickly you can transform the siloed nature of data – medical information, demographics, social profiles and privacy concerns — related to this. Tell us, what makes healthcare difficult and maybe just a little more challenging?

Sara: Stitching together the data at an individual level and not just clinical data, is one of the key challenges. However, you must solve the problems around data before addressing the fragmentation problem. Stitching that together is difficult because all of the data elements exist in different places.

That example of marketing outreach that I gave earlier, required our team to stitch together Epic and web traffic data. So, it’s not just clinical stuff. It’s all about — how are they performing on our online properties? What are people searching for? How are they navigating their way around financial data? We can purchase data from other sources, integrate them, and then, layer on top of not just the data itself. It’s the models that actually tell you — Is this person in market or out of market for specific services? Stitching together the data or even getting the data out of these different siloes can be very difficult.

Our infrastructure is no secret. Healthcare, for example, is relatively antiquated in terms of the core infrastructure that it has, so, that’s a big problem. You mentioned security so I’ll say, we have an incredible cybersecurity team with folk from across the industry, ecommerce, and other places that have done this kind of work in the past. We’re very fortunate that we’re ahead but in many cases, that is a big barrier especially where security issues can actually hamper the ability to make progress around these kinds of things.

Second, it’s not just the fragmentation on the technology side of things but how it translates into the operationalized channels where care is delivered. That’s still a challenge for us especially nowadays with the worsening workforce crisis and increased burden on caregivers. It’s tough to actually operationalize some of these things in the context of where care is delivered.

However, that is not really a digital problem to solve though some exceptions remain. For instance, we are working on a decision support, similar to a customer service or self-service use case for something that we’re building and calling a conversational and navigation platform which is in one place. It surfaces up as our chat bot. In some places, the chat bot can be focused on all sorts of different problems – something complex as symptom-checking the differential diagnoses or even something very basic like resetting my password and administrative use cases.

What we’re working on is the inbox management problem for our caregivers. Out there, you can tackle it across different pain points. There’s a lot of work being dedicated to this once a message is generated. From triaging it and having different roles on a carrier team tackle different problems or different types of messages, what we’re working on is way upstream of that.

That begs the question, why are those messages being generated in the first place? How can we provide our customers, our users with tools and content to prevent those messages or some proportion of them, from being generated in the first place? There are ways to tackle that sort of in-person experience or even the stuff that gets generated around a specific encounter as well. But there’s a tremendous amount of data that’s required in order to be able to do that. So then, we get to come full-circle to the data problem.

Q. Let’s talk about care delivery. With the hybrid model, patients receive some care at home and then, come into the clinic, too. The communication process then, becomes critical so you don’t need to ask them for the same things, repeatedly. There may be an analogy in Retail – BOPIS (Buy Online Pay In-Store). How much of this was at Providence? How much of this have you implemented? How do you ensure a seamless experience? Have you had any successes that our audience could learn from?

Sara: We’re only at the very beginning stages of this journey but I’ll say that identity is the cornerstone here. You have to have identity that transcends beyond the clinical system of records, because not all of this sits within it. If you’re ceding your identity to just the EMR, then, that’s the first challenge that needs to be overcome. There’s that piece.

We built a simple patient identity platform which has over 4 million accounts now and it resolves all these for us in terms of pulling the identity out and doing everything we talked about. It also undertakes identity federation to third parties and services outside the system of record. That’s one very core element in terms of being able to do this more broadly. I think that’s key. That’s the first key.

The second is, starting to then think about how customers across both, the physical and the virtual actually go through a funnel and convert into buying a service. We, through a combination of our product development as well as our digital experience teams, incubated a technology called DexCare, which we spun out last year. That does three things with identity at its root. They’ve got their own SSL platform, which is around that whole demand aggregation piece. This ensures that your services are discoverable by users. Those services could be physical or virtual but you don’t want to artificially silo them and put people down one specific path without giving them the options that are most relevant to them. Equally important is navigating folk to what is most appropriate based on their intent, motivation, clinical appropriateness, and how the delivery system is structured, operationally.

The third piece matches the supply to the demand. This becomes very interesting in a hybrid environment because there, it’s either available or not. There are different types of services and when you start going into virtual modalities, these could be synchronous or asynchronous videos or chat-based, so, the complexity really increases from there.

So, we work with identity first to understand who the user is, to enable navigation to the options that are relevant to them, and then, to convert them to buy into a service by matching supply to demand. That’s another way by which we’ve actually operationalized it.

I’ve seen really tremendous results. Around 30% of the patients that come through our digitally enabled channel are new to the system, while around 80% of them are commercially insured and stay with us. We have relationships with them and that generates downstream revenue for us as well, so, it’s not just a one-off.

Q. Let’s talk about technology enablement. There are plenty of digital health startups with thousands of good solutions, smart people and some VC money. But, the change in the funding environment could mean trouble for a few of them. You’ve harnessed innovation from the marketplace, so what are your thoughts on what’s going on?

Sara: It’s definitely going to mean trouble for some and potentially, many. We’ve gone through an exciting but relatively undisciplined period and now that the financial tides are turning, we are going to have to become disciplined out of necessity.

The financial state and financial health of buyers and that of the health systems is not good right now. So, as we think about solutions to engage with getting value for those solutions, demonstrated value — demonstrated ROI and not vague, fancy hand-waving and lots of unjustifiable multiples — is going to be absolutely top priority. It’s all going to be about demonstrating value. So, we’re doing quite a bit of work to enhance what we do. We have operational metrics, for instance, that we’re on the hook for, but we’re getting crisper about our returns on digital investment as a system. That will be the number one change — Can you actually return something to the buyers in the form of some sort of demonstrated value?

The other thing is, often, in these types of environments and this happened in multiple cycles — the Great Recession, in 2008-09, or even during the dotcom boom — cash is always king. Hopefully, cash is a proxy for value and it’s presumably if you have cash, that you will probably have something good to sell to the market. I hope that that’s the case and that ultimately with this calling that happens, we’ll end up with solutions that are really meaningfully moving the needle for us.

Q. Cash is king, and it’s even better if the cash is internally accrued through a business as opposed to investor funding. But, how long can you make it stretch? Have you had to make difficult decisions with your portfolio of startups?

Sara: In our system, we are actively going through those discussions right now. I suspect every single health system in the country is going through that, too. Even for our internally-led efforts, we’re actually thinking — Do we really need to do this or not? Is this that important? Is it that foundational? The answer, generally speaking, is yes.

That’s because we’ve done the homework to say that this platform does not exist and so, it’s important enough from a differentiation perspective that we absolutely need to build it. However, we’re going to have to keep coming back to that. It’s like coming back to that and ensuring that our efforts are well-aligned and well-coordinated across the system. We are just in a position where we have to be extremely good stewards of our resources and any “messing around” is just unforgivable at this point.

Q. Does this mean that there’s a “flight towards safety”? Will you approach your EHR areas or your enterprise class technology vendors with deep pockets to ride out any cycle because they’ve got all this cash that they’re sitting on?

Sara: There’s always that. Now it continues to be a theme. That’s why we’re just going back to first principles and really saying it where it’s only absolutely essential. The definition of “absolutely essential” may change. But it’s not a foregone conclusion that these things are absolutely essential at this stage. Depending on how performance improves over the coming quarters, that definition may change and we’re prepared for that.

Q. What do you see as a macro-outlook for the next 12 months? What kind of scenarios are you playing out in the context of digital health investments, continued investment in digital health programs or digital health start-ups, or even your own innovation programs?

Sara: Similar to what we’re seeing in the venture-backed market, it will be all on focus. I suspect that the focus is going to be on a lot of dabbling in digital health and tech-enabled services. There’s a lot of dabbling going on everywhere.

I also think those days are over so, everyone is going to be forced to get more disciplined. The expectations, I think, are going to increase around the value that’s generated by new business models or digital models. So, there will be a lot of innovation efforts going away because they’ll be more “nice to have” than “essential” or maybe because they just aren’t able to articulate their value prop. They may have been extremely valuable but they may not have been able to communicate it or quantify it.

It is not to say I’m pessimistic, but I think, this will be a really tough time. Health systems are going through a turning point and it’s a much needed turning point. In how we do our business, how we serve our customers, and how we’re structured to do so, we’re all going to get leaner and meaner. That’s good; good for affordability and from a macro-perspective. It’s good but it’s just going to be a tough time. We will live to fight another day.

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.

We are going to settle into a significant amount of our healthcare interactions being digital in future

Season 4: Episode #123

Podcast with Susan Lucas Collins, Global Head of Healthcare, Twilio

"We are going to settle into a significant amount of our healthcare interactions being digital in the future"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Susan Collins, Global Head of Healthcare at Twilio, discusses how they are making a difference in the healthcare space through their platform using a combination of intelligent communication tools and real-time data on patients. Susan talks about how messaging tools can improve patient engagement and healthcare outcomes using behavioral economics such as nudge principles.

Susan talks about the need to transform digital experiences from merely being replacements for poor in-person experiences, the need to address underserved populations, and the use of communications and messaging platforms to address health inequities. Take a listen.

Our Podcast Partners:

Show Notes

01:57 What was the specific need that led Twilio to get into the healthcare market?
05:39Can you talk to us about a use case from your work to understand what Twilio product does?
10:37What kind of competitive space do you think you would like to put yourself in?
13:04 Do healthcare organizations and technology firms go with EHR first, or they go with best-in-class solution? How do you help your clients sort through these questions?
16:27We're seeing telehealth volumes level off a little bit as patients start coming back to the clinic. What are you seeing in your own volumes now and what does it tell you about how patient and provider preferences are changing?
21:08 Do you think the new technologies are really serving underserved populations? What are you seeing through the usage of your own tools and platforms?
25:00 What do you make of the current digital health startup environment? What should an innovative startup founder, who knew Twilio ten years ago, should be thinking about now?

About our guest

Susan Lucas Collins serves as Global Head of Healthcare for Twilio, a publicly traded cloud communications platform. Susan designed and established the company’s healthcare vertical, doubling Twilio’s healthcare business since her appointment. In her current role, Collins has established Twilio as the leading provider of CPaaS technology to iconic brands such as Epic, ZocDoc, Doximity, Doctor On Demand and MDLive as well as numerous health systems, public health agencies and health tech firms.

Previously, Susan served as EVP Global Field Operations & Strategy for startup Jawbone Health (now all.health), and led the healthcare business at Salesforce as General Manager, advising the firm’s largest customers on digital transformation and negotiating partnership agreements with leading health tech firms.

Susan Lucas Collins serves as Global Head of Healthcare for Twilio, a publicly traded cloud communications platform. Susan designed and established the company’s healthcare vertical, doubling Twilio’s healthcare business since her appointment. In her current role, Collins has established Twilio as the leading provider of CPaaS technology to iconic brands such as Epic, ZocDoc, Doximity, Doctor On Demand and MDLive as well as numerous health systems, public health agencies and health tech firms.

Previously, Susan served as EVP Global Field Operations & Strategy for startup Jawbone Health (now all.health), and led the healthcare business at Salesforce as General Manager, advising the firm’s largest customers on digital transformation and negotiating partnership agreements with leading health tech firms.

Q. Tell us about Twilio, your role and how you got into this.

Susan: Twilio is a specialist in communications and engagement. Historically, we have been way up high and to the right in all the magic quadrants for communications as a service. So, we’re a cloud platform that enables our customers, typically, to focus on where they bring value and let us handle the communications.

Recently, we’ve invested greatly in CDP (Customer Data Platform) technology. The idea is to not just have communications channels but make that a communication, engagement, and intelligence type of exercise where you really deeply understand somebody as an individual and personalize those communications in a way that is meaningful to that particular person. More importantly, be able to do that at scale and in an economical fashion.

Q. What was the specific need or gap that you saw in the market that led Twilio to get into this in the context of healthcare?

Susan: I would perhaps argue that there are different components of the equation when you talk about engagement. There’s always the data and the companies that are essentially repositories of that data. There are the medical reference systems in our space and CRM which is almost ubiquitous and certainly a critical component across many different industries. But being able to understand first-party data in a practical way and apply that specifically to communications around healthcare issues is the next frontier.

When I think about the strides that we’ve made, particularly during COVID – and you could argue that that was of necessity because we couldn’t see patients necessarily in person as we had historically done — you almost get to a really interesting place where we have digitally enabled the relationship that we used to have way back in the day when the doctor came to your home. They knew your family and your history. They probably brought you into the world and they might take you out of it at the end of the game. So, the notion of really understanding where people are in a more dynamic way is really interesting for health care.

You think about any of the chronic conditions that plague so many of us, and the way we really kind of snap at Chalk Line in a way and say, “This is Susan Collins. Perhaps she’s a compliant diabetic or maybe a pre-diabetic person.” You put Susan Collins on a little box and maybe enroll her in some sort of program. Perhaps, there’s even some care navigation and then, unbeknownst to you, three months, six months or a year later, something else happens in her life that you have no visibility into. Maybe her spouse is diagnosed with something serious, or they get COVID, or Alzheimer’s. All of a sudden, even though you don’t know it yet, she has become a rising risk patient because all of a sudden that spouse’s issue is taking up all the oxygen in the room. She’s not focused on her own health the way she used to be. Under our current approach, that’d be really difficult for our health system to have visibility into.

Technologies like CDP that use first-party data that understand what your activity is, today, as opposed to a questionnaire or survey you might have filled out a year ago, can really give you a lot of insight into the nature of that person’s reality. Now, that can change from day-to-day. I think that’s a really powerful concept but they’re only just beginning to scratch the surface.

Q. Let’s now turn to the core platforms and the products. For the benefit of our listeners, do give us an example, a use case, or a client case study from your work that helps us understand what your product does.

Susan: We think of the product as a communications platform as I mentioned, and that can look different in different environments. One of the nice things about taking a platform-approach to solving communications, engagement, and challenges in healthcare is that you don’t actually need to be able to look around a corner and know what’s coming.

If we think back to what seems like a really long time ago, but was only a little over two years ago before COVID, we had appointment reminder solutions and automated phone services that would tell you to not forget to pick up your prescription, for example. Chemically, somewhat generic in nature, but maybe some EHR would fire off a little notification that would send you an email about your appointment with a Dr. Smith on Wednesday at ten.

Now, we have had so much more experience in extending these systems in a more meaningful way to create dialog with patients and between patients and their providers — certainly of necessity through COVID — where there are basic things you couldn’t do before. Today, I can send you a text message before that appointment that says, “Hey! When you get here, don’t come in, stay in your car. Text “arrived” to this number and we’ll you know exactly where to go. You don’t come into the lobby. Don’t hang out in the waiting room. We’re going to put you right in a treatment room.” It’s a very basic use case now and used by hundreds of health systems.

All of the communications around vaccine availability, handling education around vaccines as well just indicates that we’ve come such a long way and maybe, I guess, better late than never. We’re starting to address some of the disparities in access and in understanding, and in trust in our health infrastructure, by giving people trusted sources of information about issues that were of concern to them.

For example, we work a lot with Penn Medicine and their Nudge Unit. They’ve done tremendous work in this space and recently through a mega trial run just before COVID — actually around flu vaccinations. They found that changing a single word in a text message, for example, “A vaccine is reserved/waiting for you” as opposed to “A vaccine is available for you” could change the uptake of that vaccine by 11%, which is really a staggering number of people when you start multiplying that across large populations.

We’ve become very sophisticated now around those kinds of use cases where you really deeply understand the audience you want to engage with. We’ve learned a lot about what the content needs to be, the delivery channel, how to accommodate people’s preferences, and how to reach people who are in communities that are historically underserved or have limited access to health care. It’s so heartening to see that progress after all these years in this industry.

You think of what SameSky Health is doing, for example, with a partnership to end addiction and see the tremendous strides they’ve made in communication with patients and how it’s an effective way to reach people where they are.

Q. You’re a communications platform and working at the intersection of technology and behavioral economics. In your space, who do you consider your competitors?

Susan: There are innumerable point solutions, out there and that’s been the approach that traditionally, health care has leaned into. There’s the text message solution for appointment reminders and such kinds of things. However, we think of ourselves much more holistically as a platform especially now, with the addition of Segment, an intelligent engine powering a platform that has a lot of omni channel communication capability.

At the risk of sounding a little arrogant, I don’t know that there are other true platform communications solutions that are cloud-based that we would consider competitors. Sometimes, it comes down to a little bit more of the customer use case and how broadly they think about communications. Is that a kind of a strategic thing that they’re thinking about across the health system or maybe a payer environment? Or, are they just trying to solve for prescription reminders? That must be considered.

Q. Twilio works with directly with clients like Penn Medicine and a lot of technology firms that embed your tool or solution within their own platforms. How does this landscape look to you from a competitive standpoint? How do you help your clients sort through going with EHR first or with the best-in-class?

Susan: We have solutions that work well for the health tech community. For example, EPIC, our vendor is an £800 gorilla in the space and they leverage our programable video product to create the embedded telehealth experience within their product. That was very widely adopted during COVID for obvious reasons. Likewise, we power every other brand that you’ve heard of in telehealth — over a billion minutes a month. That’s on the intelligence side.

For organizations that want an out-of-the box solution but who may not have the development resources or the bandwidth to stand those solutions up in the way that they prefer, those are wonderful options and we’re very proud to support them.

Then, there are other organizations that feel that they do not want to delegate the patient experience to someone else’s roadmap. They feel that often it may be a differentiator, a kind of bespoke patient experience that they want to create. It’s something that they feel strongly about owning a roadmap for. In those cases, they can likewise leverage our technology to build a very unique experience for their patients and providers.

Sometimes, there are workflow considerations and it’s a mistake to leave that to an afterthought. You really want to build something that’s efficient, particularly today, when providers are so challenged and burned out. They’ve worked so hard for so long looking for ways to make it easier and more efficient for them so, this is a meaningful exercise in lots of different organizations.

That said, I think, you can have your cake and eat it, too. In that respect many organizations try to start with an out-of-the-box solution. A World Health would be a great example of that. Powered by Twilio and highly configurable, but it does work out-of-the-box. Sometimes, they get a little bit of experience with that platform and decide they want to take it to another level, so, they might then build something of their own on Twilio directly. And that’s fine too.

Q. Let’s talk about patients. In the last couple of years, with the pandemic on, everything went virtual. Your own messaging volumes went through the roof. But, of late, there’s been a pullback. What are you seeing in your own volumes? What does it tell you about how patient preferences or even provider preferences are changing?

Susan: Some providers were quite surprised, to be honest because we’ve thrown so much technology at providers over even the last decade that meaningful use and the implementation of all the EHR at scale was a big lift for them.

You can argue, on the one hand, for standardization and best practice. You can also argue, on the other hand, that there’s an art to practicing medicine as well. Sometimes, providers may feel that that technology is dictating a particular approach. It was difficult for many organizations to navigate.

There was some technology fatigue as well. Then along comes COVID and the huge burden that that presented. So, we said, “Yeah, this solution is going to be more technology.” I’ve spoken with many physicians who are friends and who just went, “Susan, I just can’t take more technology. It’s really like my head is going to explode.” They then came back pleasantly surprised to say, “Turns out seeing my patient in the context of their home environment, maybe sitting in their living room, maybe with a spouse who hasn’t previously joined an appointment or an adult child who can dial in to a virtual visit has added a dimension to that experience that was not possible in our traditional model where I would just get in my car and drive to the clinic and have my appointment by myself.”

We’ve now had enough experience that we’re not treating digital as just a poor replacement for an in-person encounter. There will always be a need for face-to-face encounters in health care, but there are so many times when the convenience and the access that digital provides, has added to the experience. We can certainly bring other resources to the conversation. We can share documents, visuals, change the waiting room experience and make it more engaging. You do see some really innovative solutions being developed.

Sometimes, they’re just around the administrative function in health care, which we know can be substantial, and concern, for instance an easy way to pay your copay in a cashless environment. It happens everywhere else, in every other industry that you can think of. Now, we’ve brought that kind of ease and simplification to health care, as well.

It’s a very interesting time and while I don’t think we’re finished evolving in that way yet, I think we are going to settle into a pretty significant amount of our interactions being digital. It’ll be interesting to see what happens with reimbursement and workflow discipline among other things but we’re not going to go back to a time when even a simple question like “My kid’s skin in the ear has a rash” that can be handled easily over video will go away.

Q. Switching to underserved populations, I want to ask, are these new technologies really serving them? Your broad comments on that, specifically in terms of what you’re seeing through the usage of your own tools and platforms.

Susan: That’s definitely a huge problem to wrestle to the ground. It’s one that’s so important and honestly, a bit of a passion of mine to work on. We’re interested in and invested in the space along with others.

I do think we’ve started to think a bit more out-of-the-box, which is great and again, not treating digital as just a poor substitute for face-to-face, I’ll give you an example. We were talking about that Nudge unit from Penn Medicine. There is a great study on their website that they ran around handling hypertension and pre-eclampsia in pregnant women.

As you probably know, this very disproportionately affects women of color and can be an extremely serious problem. It often happens in the context of a busy young mom who might have other kids and a job she can’t get time off from. She feels okay so, getting her to come into the OB-GYNs office to get that blood pressure monitor can be a real challenge. The rates of compliance with those programs can be quite low, and you have all of the usual impediments to transportation, time-off, childcare etc.

It turns out that you can send to these women’s homes a very inexpensive blood pressure cuff that possibly costs 20 bucks at your local Rite Aid. You can send a text message that says, “Hey, you get us a reading.” It’s a simple thing and not particularly intrusive. It doesn’t really interrupt the course of her other activities during the day, and the compliance is sky high. The patient’s satisfaction in such cases is off the charts. It’s extremely cost effective and a text message is a fraction of a penny.

Solutions like that think a little about solving the problem in a way that’s very patient-centric. They get us the information and insight we need to serve that patient well. It really provides a lot of hope for the future. We’re just, again, scratching the surface in these kinds of programs but that’s an example of how you can really leverage technology effectively to serve folk who are historically maybe underserved or lack access to health care resources.

Q. You’re no longer a startup but there’s a vast ecosystem of startups that are just as innovative as you. However, they’re very early on in their journeys. Many are reliant on VC money to pull through but the VC environment has changed over the past few months. What do you make of this current environment? What should a startup founder in an innovative startup think about now?

Susan: There’s so much incredible innovation today, that it’s hard to keep track of it all. Actually, we do our best and we have programs at Twilio, such as a venture program and an incubator, for instance. So, sometimes, we have a little bit of a front row seat to some of these startups. One of the best parts of my job is actually seeing how people are thinking about change and improvements.

I think focusing on real problems is key. I have a very practical bent, so the theoretical is sometimes a little lost on me. When you can show, even in maybe a limited way based on resources and ability, how you can impact other humans’ experience of care, it’s likely that you will have a pretty receptive audience in the venture world. Certainly, there has been incredible growth in digital health investment and we’ll probably see a little bit of a pullback given the current economic realities.

However, I don’t think digital health is going away anytime soon. I don’t think the funding for digital health is going away either and we’re talking about 20% of our economy. It’s a massive market that everyone can relate to. All of us have had health care and we’re going to continue to need health care. So, it’s a simple thing to explain.

However, when we talk to founders, where we see sometimes a bit of a gap is that practical application proof points to a real good grasp of an MVP from a solution perspective and the ability to articulate that in a clear and concise way. That is always compelling. I’m not trying to take on the entire world at the outset, so my advice would be to have a very straightforward path to where you want to get to. Wherever you are on that path is where you are and I think, that’s okay. One bite at a time, right? It’s hard to think about and I’m just being really practical that it is wonderful.

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.