"Healthcare is now about combining the digital pieces with a personal touch"

Q. Zane, you’re a veteran in the healthcare tech space having been part of large enterprise class technology platform providers and startups that have had spectacular success. How would you describe the current state of digital health?

Zane: It’s a fascinating time and digital health has seen a lot of amazing innovation where people are taking on areas that may need better health care experiences and better clinical and financial outcomes. There are a number of places where there’ve been significant movements in a positive light for many disease states. That’s a real big positive.

On the other side, what we’ve seen is almost a bigger silo of data and information that’s really creating too many small pockets of information with not enough views of the larger picture and a lack of integration.

For instance, I know I like to go to concerts and drink wine. That’s what I do for my health care. I don’t do health care to do health care and I don’t think anybody does that, either. I think, they really do it to live their lives. So, it’s a missing component of what’s really occurring. We just see more and more of these little islands of information and more siloed elements and while in those individual spaces, there are better experiences and better outcomes, we’re missing this broader picture for people.

Q. How did you come to Quantum? What does Quantum Health do?

Zane: I came to Quantum Health because it’s really about creating a different and better health care experience with better financial and clinical outcomes and really looking at hard ROI within the boundaries of the medical spends, today. What really attracted me, in addition, to that core piece there, was the people and the business model. That is the only one I’ve seen, particularly in digital health, that’s really around bringing together the plan sponsor, the member, and the provider.

Those three components were what attracted me to Quantum Health because I saw this as a platform by which we could deliver what I call the connective tissue between a clicks and mortar world. It’s increasingly important for people to recognize that it’s not going to just be a digital health or virtual care world, only. It’s a connection back to that physical piece.

How do we create that singular experience for the member and simplify it? That’s what I saw in Quantum Health. That’s the opportunity as we move forward.

Q. Who are your main customers today – employers, plans, or providers? Who or what would you consider competition?

Zane: We are mostly a large self-insured employer. We scale both, up and down. But if you think of a Delta Airlines, a Target, an Allstate, a Honda, then, those are some representative clients. We’re serving over two million members today, in that space and that’s where we got our start.

Increasingly, we’re seeing that the health plans themselves are interested in navigation, although it leads directly to the competitive environment where the biggest competitors are still the health plans themselves. That’s because they think of themselves providing that customer-first experience. Unfortunately, what they’ve done is optimized around business processes.

What we are able to do around navigation is be on the journey with the member by taking all the data sources in whether it’s claims data, PBM data, or that provider information. Every single one of these interactions in health care is a health signal and is calibrated in our Artificial Intelligence to help us create the next best action. It’s really about the next best action for that member and helping them in their journey in the context of their health plan.

What benefits they can be accorded will depend on what’s in-network or out-of-network. So, how do we get them to the right side of care?

When you’re on a real health care journey, you know how difficult it is to actually navigate the health care system. Quantum really guides that person through the journey and it turns out that they’re actually doing the right thing, making the experience better, and helping people navigate to the right places. So, our Net Promoter Scores are in the mid-70s which I just haven’t seen in any other business ever and we’re getting hard ROIs as well. So, doing the right thing turns out to be really, really good for the sponsors and/or for a large self-insured employer. It’s a win, win, win across the board. However, “do nothing” still remains our biggest competitor. Stay with the payer.

Increasingly, there are more people entering into navigation. Unfortunately, it isn’t about just putting a little digital app on the front-end and doing some lightweight pieces. We’re seeing digital applications making a difference. Our front-end, for example, is great and we’ll continue to hone that but it’s really all the data science and ultimately, a personal touch that comes with it, which matters.

I often mention this in my executive meetings. Every single day, I get multiple notes from members that say “thank you for X” — either better clinical outcome, better financial outcome, or better experience — but it’s always tied to a person and what we call our health care lawyers. I’ve never got a response that said, “thank you for writing that software” and that’s what health care is. It’s intensely personal. It’s about how you connect the technical part with the personal part that makes such a huge difference.

Q. In the context of healthcare, the other big competitor is, “Who pays?” because healthcare is all about following the money. Who pays for the solution as a self-insured employer?

Zane: Sometimes, employers hire us and pay us a per member per month fee on behalf of their members so we become the front-end both, for the interactions with their members and our engagements with our providers to get paid. Literally, we created a model for a single flow for that member, the workflow for that physician’s office and that’s how we often garnered a number of those health signals. Then we also delivered value back to either the member or the provider on those signals, along the way.

That this is coming from the sponsors themselves creates great experiences for the employees — better health care experiences, better clinical and financial outcomes — and sponsors, too. We’re seeing significant ROIs then, on the amount of fees that they’re paying. That’s the thing when you talk about what the state of digital health is. If you’re not driving value, there’s just no way you’re going to be in the game in the long run.

Q. In the context of the markets and data silos, you’ve been a senior executive at one of the big EHR platform companies and in startups. Give us a State of the Union on this interoperability. Is it getting better or worse? What’s the unfinished business here?

Zane: It’s getting better but what people have to realize is, it can’t be a one-way street on data. That goes for everyone involved in the conversation. From an EHR perspective, we have to think about what’s in it for those EHR companies and the value they’re going to get back from the connections that they receive. People may look at that and say, that’s a bit of a jaundiced view. They received Dollars as part of the federal programs and incentives to go drive that. So, I do think there’s a responsibility from those EHR companies to be open.

I’ve long been a proponent of health care data. It should be mine as a person, not mine as a EHR company. You ought to own your own electronic health record and I, mine. Whether I choose to share it or turn it off, should be my prerogative and I should have the ability to do so.

EHR companies have come a long way but there’s more to do. The hold-up though is still the notion of what’s in it for them on data-sharing from these other technologies. That’s often lost in the mix. What you have seen in digital health has been more cooperation around democratizing the data and saying, “If I have data to share, I’ll share that with our partners.” If you have data or digital health from our ecosystem, you’re sharing it with us because we can provide better experiences for our members. The digital health community has done a fantastic job in data sharing. I’ve seen it at Livongo, where we’ve shared Apple data, Fitbit data, claims data, and others as part of that conversation. We have an incredibly robust ecosystem and partner program at Quantum Health where we can connect in multitudes of ways and share information which is an important part of that responsibility.

There’s a lot of work to do around the data. Your ability as an individual to be able to turn that on and off and understand where your data goes is critical. Most people don’t appreciate that once they flip the switch for their PHI to be put into an Apple health kit, for instance, then, that data is no longer your PHI anymore. It’s literally part of the Apple ecosystem. Some of those pieces are areas of importance for us to continue to track and follow through on. There’s a lot more to do from the EHR perspective. However, at the digital health level, this notion that your data, should you press a button, will be forever out there, persists.

Q. Digital health companies are in their own ecosystem and the consumers are somewhere in the middle with very little control over their data. If companies cannot access the data easily from an EHR system, what is the true value of a digital health solution?

Zane: It can be much more robust to have the EHR data in those digital health elements. I’d say that there is a ton of information in these digital health organizations that are clinically relevant for those EHR organizations and the providers, and quite frankly, I don’t think digital health has actually stepped up to the plate to embrace the provider meaningfully.

Actually, Quantum is one of the lone exceptions out there in terms of, “Hey! There’s an opportunity to give back here.” There’s a reason why our provider scores are so high and it goes beyond the understanding of the benefits paid. That’s because you actually get some feedback from the first time, from the digital health community so, I do think there’s actually more that digital health community can and should do to close the loop. It’s painful and hard work, but it needs to be done. That’s part of the responsibility of being in health care.

You can get a lot of value in those disease-specific condition states. With those digital health applications, you gain a lot through the claims data and the PBM data, etc. and it would be beneficial to have more access on the EHR side. That’ll come and I really believe that that’s on the right trajectory. Everybody in the ecosystem has to remember you have a responsibility to close the loop on behalf of the member, and that includes leading back to the providers themselves. Doing that in a way that’s useful to the provider, rather than a burden is just one more thing that we put on their plate that they have to sift through.

Q. Livongo’s successful exit may have paved the way somewhat for a few of the large, recent exits — One Medical with Amazon, Signify, CVS, and perhaps Cano Health. Can you share your thoughts on the M&A environment of the marketplace today in light of how many digital health companies are actually struggling?

Zane: The macro financial markets are very tough and challenging for fundraising for digital health solutions and while that may continue for the next 12 to 18 months, it’s going to have implications. There will be people that run out of funding and those whose business models just haven’t shown profitability in those pieces. That will have ramifications on the marketplace. Those with deep balance sheets are going to be in the best position to scoop some of those pieces up. So, you’ve got that dynamic.

You alluded to the amount of M&A activity. You’re going to see more because of the financial challenges that I spoke to start with and the Amazon One Medical and Signify CVS combinations which prove a thesis that I’ve long believed that this ultimately requires personal service. Technology is critically important. You can deliver great experiences through that, help people practice more at the top of their license, whether that’s truly a professional license or just at the top of their game. But at the end of the day, it’s the personal touch that matters. Both those combinations are big signals that it’s the delivery of care integrated into the digital aspects that people are betting on the future and thinking that it’s again back to it’s going to be a digital only world is just not how health care is delivered.

The big value is always in the cases that are the most expensive and in the top 1% driving 50% of costs. But you’ve got to know the whole phone book to be able to dial in and say, “This person is the one that’s going to be on this journey. How do we engage with this person early and often and get them the right kind of information before all the choices have been made?”

That requires the digital pieces, along with the personal touch pieces. So you’re going to see much more M&A activity for those who have deep pockets on a go-forward basis.

Q. There are big tech firms like Amazon actively getting into the core health care services space. What’s your take on the role of big tech in the healthcare ecosystem going forward?

Zane: This might be the part where I’ve been around the block for too many times and so I’m a bit cynical. I’m not a cynic by nature and those that know me well, know I’m an optimist and I’m a half full kind of a person. But I’ve seen IBM and Trident Healthcare trying to get in health care four times. I’ve seen Google try to get in at least twice. I’ve seen Microsoft in it at least three times back in the day, McDonnell Douglas, American Express, and GE.

So, there’s a lot of dead bodies on the side of the road. Health care is a humbling experience for me every day. There’re reasons why your podcast is so wonderful, because what you do is, you turn this gemstone of health care and depending on what lens you look at it through it just gets a different viewpoint every time. That’s one of the fun parts of my own personal career and that is being able to turn the gemstone and see it through a couple of different ways. I’m humbled every day as I get to learn and try to say that I want to make a difference.

There’s a role for big companies and they may be the beneficiaries of a downturn in the financial market side because they have such strong financial statements and they are able to acquire some technologies that they otherwise would not have. So, this is going to be a little different. While I’m, on the one hand, cynical because I’ve seen large companies not be successful, I’m, on the other hand, hopeful that they’ll provide the kind of capital that’s going to be necessary to see some of these technologies reach their full potential. I can be, on the one hand, pessimistic, and on the other hand, optimistic, and say that’ll happen. I look at the company I used to be associated with this arm and Oracle joining that fray and on the one hand, I’m optimistic that contemporizing in the Cerner platform and truly getting to a cloud-based environment and doing some of the things that Oracle is uniquely capable to do would be super beneficial for Cerner. But on the flip side, I’ve seen where large companies think they know it all, and the smart people have come to save the people that are unworthy. I have concerns about those kinds of scenarios.

I’m not being critical of the Oracle or others that have tried and failed. It’s too big a market to ignore 20% of GDP. We’re going to see big-tech players in this space and the ones that will be successful are the ones that say, “I know how to scale. I know how to think about technology. But I’ve got to embrace everything that is health care and understand that there’s different dynamics at play here from the payer models to, you know, the consumer models, the providers and all the elements thereof.” If you think you invented it at your shop, you’re probably wrong. That’s what I would say. Again, I say every single day, I get to learn something.

Q. This year has been a bad one for health systems financially speaking and with labor shortages. Do you think this will slow down the pace of digital transformation? What is your advice to the health systems and digital health startups trying to play in this environment?

Zane: You’re right. I sit on the largest safety net hospital in Missouri, and they’ve prudently managed through what has been a very challenging time. Many of my health system clients have had some significant challenges and a number of health system clients are utilizing Quantum’s services.

They’ve got to be focused on value received and on making their own employee base feel loved and cared for. Often, the health professionals provide the love and care and it’s really important for the health systems to return that because it’s just been an unbelievably taxing time to be a health system provider and any kind of health system worker over the last couple of years.

For me, it’s just thinking about the employee population and then the value, the places they can go to the first dollar value place. How can you, as a health organization, not be subjected to what’s going to be a downward trend around value-based care? As people come after the big spend items, they’re going to have to think about how they’re providing unique value and how they’re going after first dollar. So, it’s a tricky time if you’re in the digital health. If you’re the digital health providers, you better be delivering a heck of a lot of our hard ROI or you’re just going to be out of business.

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