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

Q. Tell us a little about yourself and how you came to start Babyscripts?

Anish: Babyscripts is about 6-7 years old now, so, we aren’t exactly the newest kids on the block. However, our goal from day one was to improve the provider-patient connection — that was critical to us. A lot of this was driven by some of our own stories – I have a twin and while twins can be fun, they’re also high-risk pregnancies. I was born in India not the U.S. and when talking to my family about my birth story, I realized that with such pregnancies, your probability of having a bad outcome is higher in some countries than in others that may not be as advanced. That started this whole confluence and possibly contributed to the formation of Babyscripts. As a company, we have one mission statement, vision and focus — better pregnancies. We want to try and improve the status quo of pregnancy care in the United States.

Births are like lotteries – you can’t control where you’re born, to whom or in what situation. In addressing pre-term pregnancies and maternal health, what are some of the important milestones you’ve had? How has the pandemic impacted your business?

Anish: What you just said about birth being a lottery, struck me. I totally agree. One of the variables that goes into it, unfortunately, is the zip code. We started Baby Scripts in Washington, D.C. and one could be literally a few miles apart, in a slightly different zip code, and their probability of having a good outcome versus a bad one could be dramatic. There are all kinds of issues with access to care, health equity etc. that play into it. At this most central level, we try and improve access to care through mobile, digital tools and internet-connected devices but it takes different shapes and forms with modules for low-risk pregnancies, high risk pregnancies, specific disease states — hypertension management and postpartum care management, mental health management. We make care as readily accessible by as many moms as possible and if this aspect is attended to, a lot of other things fall in place.

Technology can be a component around the pandemic, and it presents an interesting dynamic since it’s improved telemedicine digital health across health care. Interestingly, pregnancy is very unique in that it’s not an elective procedure, so, you can’t push it all back. There will be an outcome one way or another.

We’re driven by our users who are moms between the ages of 18 and 35 – a young, technology-friendly, digital-native population — that is the alchemy that just fuels prenatal and postpartum digital health adoption.

Our growth was as dramatic as that of our peers (digital health companies) and we went digital with our practices and customers very quickly, within weeks. It was a watershed moment for such innovation normally takes 10 years! It’s continued till today and we still see a lot of demand for it in the new normal.

 Q. You and your co-founder are both men in a women’s health business. Does anyone ever ask you about that?

Anish: That’s a running joke! Ours was a two bachelors’ start-up and when we formed Babyscripts, pregnancy was an area that was just not getting the attention it deserved. I like to point out, if you compare the statistics of what’s happening and the outcomes in maternity and strip the maternity element off it, it will become a national crisis because it’s very similar to what we’re seeing with mental health, diabetes or other chronic care management stuff. So, from a business standpoint, while it was an incredible opportunity, it goes beyond that.

I shared some of my background earlier, but my co-founder’s mother went through several miscarriages, so, there’s all kinds of kind of history there and all of that came a full circle with the company. Last year, my wife and I had a baby. And going through the pregnancy during COVID just added another layer to what we’re doing.

Q. So, what kind of demographic do you mainly serve? Who’s paying for your customers – plans, providers, or employers?

Anish: As far as our users go, the first level of segmentation is pregnant mothers or postpartum mothers. Our product goes to them the entire first year after the mom delivers the baby for that’s an important time. That’s the user there. We focus on the moms that have Medicaid and in the U.S. it’s a significant portion. Between 45-50% of pregnancies are Medicaid pregnancies and that’s a big number so a huge focus area with its own intricacies and challenges. That’s what we hone-in on. We have the benefit or luxury of knowing exactly who our user base is, in that sense.

About who’s our customer, we’re not a direct-to-consumer company. We knew that from Day One, so, we started working with providers, partnering and selling into health care and hospital systems which are, to this day, our major customer and partner bases. Over the last year or two, we have expanded and started working with managed Medicaid plans because I think there’s a lot of intricacy in how we’ve done our deployments to enable payers. Ultimately, the value of our work has been compounded by reimbursement policies, changing rules and regulations etc. which have opened more business models for us.

Q. In healthcare, you always must follow the money. But, in the world of data-enabled approaches to care, how critical is analytics to your platform or product? How do you approach comprehensive care?

Anish: That’s a good question! It’s a layered approach, right from the starting point at a very basic level for our platform enables remote or virtual maternity care. What that involves is, engaging and educating moms as they’re going to their pregnancy journey.

Our mobile app is a great place for moms to learn about their pregnancy – from how much coffee can I drink and till when can I travel to what floor is the labor and delivery in a particular hospital? We have a very specific provider base, and we customize their training and education.

Then, there’s all the remote monitoring of blood pressure, for instance. Collation of important data points as the moms go through a pregnancy is critical because it helps identify high blood pressure parameters and associated symptoms recorded, for example, with higher risks for pre-eclampsia after a certain gestational age. It helps us direct a doctor or nurse to attend to the mom-to-be and so, this is ultimately what makes us unique. It gives us a lot of leverage. It starts with the mobile engagement layer and then, we build intelligence layers on top of that by leveraging data, analytics, and insights thereby, helping providers stay efficient.

 Q.  What are the challenges you face when you’re gathering the data from a large population and a plethora of remote devices from different manufacturers – no two blood pressure cuffs are the same, no two glucometers are the same – and aggregating that to make sense of it?

Anish: One of the benefits we have here is we look at the positive of pregnancy, which allows us to limit data points and devices we use. So, since blood pressure is a critical data point, we did a clinical validation study around how such devices could be valid and okay. We do that kind of data gathering and validate it thereby, narrowing the scope of what we can work with because helps the process. That’s one aspect.

 Q. The second aspect is understanding which insights are valuable and which, actionable. That’s a whole other game. Just because someone within the app clicked on a resource relating to prenatal genetic testing might not necessarily correlate to some higher risk, so that gets a little trickier. There’s a lot more work involved there and it’s a slower sort of a haul. It’s way easier to just follow clinically established guidelines around triggers as opposed to de novo. While that’s not new, it’s giving us things to think about as we develop our product.

 And the final mile, if you will, is actually inserting it back into the clinical workflow, which means EHR systems or whatever app, device or interface a clinician is using. How do you accomplish that? Is your product or solution embedded in a clinical workflow? Or is it a separate standalone app?

Anish: This is super important for at the end of the day, we’ve just come to the conclusion that our ability to scale is almost entirely reliant on our ability to embed ourselves into clinical workflows — technical and non-technical – so, that leads us to think about integration first, as we develop the product.

We do a lot of integrations with all the big EMRs, third-party vendors, and other systems, through APIs or other modalities. We shall continue to invest pretty heavily on integrations as a core sort of our foundational product pillar. The general sort of digital health ecosystem seems to be maturing when it comes to this because we now see all kinds of toolkits, toolboxes, third-party marketplaces, etc., so it’s a kitchen-sink strategy at the end of day and minimally workflow-intrusive for us to scale. That’s a significant portion of what we do.

 Q. And interoperability is unfinished business. Is it getting better, though, is my question?

 Anish: I think so. It’s getting better for a couple of reasons. Number one, standards are forming and that’s a good thing. Fire and Smart About, are good examples.

Second, I think CIOs and hospital systems are recognizing that they need to find the enterprise architecture that’s been optimized for patient quality, safety experience, cost outcomes, and all the tasks, so they’re investing in such middleware.

Third, the post-COVID new normal is forcing health systems to make an appropriate decision – it’s slow but getting better.

  Q. I agree. We have a four-stage maturity model we use in our company when we look at digital maturity of health systems. We see how our health systems are getting out of the EHR mindset and taking an approach that evaluates best-in-class tools and solutions, embedding them into digital strategies, undertaking out-of-the-box integration etc. What is the hardest part for you as a start-up — with an innovative solution — yet one that is not a part of the core technology and applications infrastructure of our health systems, today?

Anish: We decided early on to take the road less travelled. We got a lot of questions and criticism, particularly from venture capitalists and investors to the tune of “You’re selling to Providers? I’m out.”  So, we had to stay focused and convince them that we’d have to be patient since we were in for the long haul. The reason for this, again, is we started with the premise of number one better pregnancies, and very much related to that is the provider-patient relationship. If we broke that to go independent, we could lose our ability to make the impact we wanted. That was a very helpful distinction.

The second is, in the early days we had to go and find the innovative CIO, CTO and leaders that were thinking about where the puck was going to be and not where the puck was. That meant being shrewd about who we wanted to work with. That was also helpful for us to understand what we needed to do to move to the next goal post or milestone. We talked about immigration, clinical, and CFO buy-ins, so we wanted to work that into the contract very early on. So yes, it was all about the methods, protocols, processes that would allow us to scale.

 Q. Let’s talk about the competitive landscape for digital health, today. There are EHR vendors and big tech firms, like Amazon, moving into the digital health space. What’s your take and experience here? What advice would you give a start-up digital health company, today?

Anish: Sure, it’s definitely very confusing and an extremely chaotic marketplace. You can get lost in the crowd up there. Every other day I see a new digital health vendor or a product or platform, so I’ll say you have to know what your message is. For us, it’s to be the world’s best when it comes to virtual and maternity care. That is the towering confidence that we put all of our eggs in. Our hope is to convince decision-makers out there that we’ll play a valuable role in bringing about the digital transformation of their organizations. We do one thing and do it well with demonstratable results. So we look for megaphones to amplify our message.

Second, from a contracting and risk management standpoint, trying to do one-off enterprise contracts with the health system, can get a little bit off. There’s no real solution out there yet. But what I’m seeing is a natural evolution of digital channels. What are channels that are going to come up? As they mature, we would definitely want to kind of plug-and-play into those. One of these will be the marketplaces. That’s a channel we’re looking at pretty seriously.

  Q. We’re not yet in a place where we have the GPOs or the equivalent for digital health, but there are companies out there that are trying to aggregate digital health solutions and create digital formularies. The market is quite fragmented but can be a two-sided coin for start-ups – One, it can be very challenging to stand out in a crowd here and get the attention of your buyer. Two, it can be an opportunity to leverage infinite channels and approaches to be different. What have your learnings been as an entrepreneur over the last six or seven years?

Anish: It’s a good question and I certainly don’t have all the answers here, but a couple of things that I will point to are –

Focus, because it’s super important. It’s easy to go after the big hairy – the trillion dollar and think, that you’ll do everything for everyone. But look at Google, Microsoft, Amazon — all companies that are literally trillion dollars in market caps or close to it who’ve tried to do it yet haven’t been able to figure out their chances to get it right. What are the chances then for a small group of people? So, have a focus.

Have empathy because health care is like a messy, complicated, slow-moving human. When I talk to our clients or customers, nurses, doctors, professionals in health care, we accept that it’s tough and change management in health care can be tricky. So, you need to lock arms with your clients and not just sell them something and walk out of it. This is equally important.

Third, with investors and funding, you must know how to pick and choose them. There are certain profiles and investors that look for a kind of pattern and it’s unlikely to see these patterns in health care such as, unbelievable sort of unicorn-like growth with the margins where you want it to be. So, be cautious as to who you put on your Board and the investors you pick. Fortunately, we have an incredible group of supportive investors driving us down the road less travelled and we’re in it for the long haul. That’s our calling card.

 Q. Well said. Before we close, what do you do in your spare time?

Anish: I’m a new dad, so that takes up a lot of my time. But in what little spare time I have, I read. My New Year’s resolution is to read on average, a book a week – so, I have to get to 50. I’m on track for February, so we’ll see how it lands. Reading is like listening at 2x the speed. I love reading — it gives me a lot of joy.

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