Author: sanjith p

We are building an intelligent automation platform that seeks to transform how patients access care

Season 4: Episode #125

Podcast with Pranay Kapadia, CEO and
Co-founder, Notable

"We are building an intelligent automation platform that seeks to transform how patients access care"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Pranay Kapadia, CEO and Co-founder of Notable Health, discusses Notable’s value proposition in the automation space for easier patient access and reducing friction in patient access processes. He also talks about the trends driving digital health investments, what clients are looking for, and the opportunity landscape for automation and digital health startups.

Most health systems think of automation as a cost-cutting endeavor and not as how they can tackle the change in how patients engage with their healthcare provider. According to Pranay, automation is about marrying patient experience that is ADA compliant, in any language, and that works on any device for any human on the planet, with the best workflow integration.

Pranay also talks about how at Notable they are working to navigate the uncertain economic environment and shares his thoughts on the current digital health startup and environment. Take a listen.

Our Podcast Partners:

Show Notes

00:31 Tell us about your background, how did you start Notable Health and what does it do.
02:56Where do you see automation gaining the most traction and where is a health system looking to deploy it the most, today? Can you share your own client examples?
08:45Are you a robotic process automation (RPA) company? How do you categorize yourself when you look at automation technologies at large?
12:33 What does your competitive landscape look like? There’s the startup ecosystem vs. the traditional EHR companies vs. the enterprise class companies that are non-EHR but have a powerful enterprise class workflow platform.
19:06How are you seeing your clients? Do the trade-offs matter when they have to choose between a truly innovative solution from you vs. one that may not be best-in-class yet easier to deploy, integrate, work with and have lower overheads?
23:31 There is an emergence of a mindset around treating digital health as a product management function. How do you create value for the end customer? How do you back into what you need to do to build it out?
26:19 Its an uncertain time for digital health funding now. What does that mean for a digital health startup and what’s your advice to them? How are you preparing your own company to work through the next four months or longer?

About our guest

Pranay Kapadia is Co-founder and CEO at Notable. After years of hearing his family of physicians objecting to the state of technology in healthcare, Pranay founded Notable to enrich every patient-provider interaction and eliminate manual burdens for staff and providers.

Pranay has focused his career on tackling problems at the synapse of data, finance, and user experience — defining and building products that simplify ease-of-use while reducing financial paperwork within highly regulated industries. Prior to Notable, Pranay and his co-founding team worked to revolutionize how millions of people file for mortgages. As Vice President of Product Management at Blend, a technology company reconstructing the mortgage and lending industry Pranay worked with customers like Wells Fargo, US Bank, and Fannie Mae to bring simplicity and transparency to consumer banking. He also held multiple roles at Intuit, leading Mint.com, Quicken and QuickBooks.

Pranay Kapadia is Co-founder and CEO at Notable. After years of hearing his family of physicians objecting to the state of technology in healthcare, Pranay founded Notable to enrich every patient-provider interaction and eliminate manual burdens for staff and providers.

Pranay has focused his career on tackling problems at the synapse of data, finance, and user experience — defining and building products that simplify ease-of-use while reducing financial paperwork within highly regulated industries. Prior to Notable, Pranay and his co-founding team worked to revolutionize how millions of people file for mortgages.

As Vice President of Product Management at Blend, a technology company reconstructing the mortgage and lending industry Pranay worked with customers like Wells Fargo, US Bank, and Fannie Mae to bring simplicity and transparency to consumer banking. He also held multiple roles at Intuit, leading Mint.com, Quicken and QuickBooks.

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 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.  

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.

By and large, public health IT infrastructure is glaringly 20th century.

Season 4: Episode #122

Podcast with Tom Leary, SVP and Head of Government Relations, HIMSS

"By and large, public health IT infrastructure is glaringly 20th century."

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Tom Leary discusses the recently published report by HIMSS titled “Public Health Information and Technology Infrastructure Modernization Funding” which recommends over $36 billion worth of investments over the next ten years in public health technology and infrastructure modernization. Tom unpacks the report to discuss why they have published the report now, what it means, and what the opportunities are from a public-private collaboration and partnership standpoint.

Tom also discusses the challenges of implementing the modernization, including interoperability and the siloed nature of data in our public health infrastructure, workforce training, and more. He shares his thoughts on how this modernization program can present new opportunities for health systems and technology providers. Take a listen.

Our Podcast Partners:

Show Notes

00:49 HIMSS published a report recommending $36.7 billion in public health technology. Why have you published the report now?
06:11When you say public health, what do you include in that - state, local, federal?
07:45Can you help break down the $36.7 billion between the different components? What’s the time frame you’re recommending in the report, and what are your immediate priorities?
09:35 You've highlighted glaring gaps in our current public health infrastructure. How does the United States compare with other OEC countries in this regard?
13:37This is a massive modernization effort going on and there will be the challenges from the implementation standpoint. What’s the big lift when the government decides to find the funding and launch the program?
18:28 You mentioned the workforce challenges and their enablement. How much can a government really staff up on its own, given the scale and scope of what we're trying to accomplish here? Is there a role for a meaningful public-private partnership here?
20:58 What about the information and data security aspects of our current fragmented infrastructure? How does your report's recommendation address that aspect?
24:28 What is the big takeaway from this report for health systems and technology executives?

About our guest

Tom Leary is Senior Vice President and Head of Government Relations for HIMSS (Healthcare Information and Management Systems Society), where he leads the organization’s digital health policy development to achieve One HIMSS voice that transforms healthcare delivery around the globe. He guides HIMSS strategic engagement with government and membership through policy analysis and outreach to establish and support priority engagements and strategies to achieve the HIMSS vision to realize the full health potential of every human, everywhere.

Tom Leary is Senior Vice President and Head of Government Relations for HIMSS (Healthcare Information and Management Systems Society), where he leads the organization’s digital health policy development to achieve One HIMSS voice that transforms healthcare delivery around the globe. He guides HIMSS strategic engagement with government and membership through policy analysis and outreach to establish and support priority engagements and strategies to achieve the HIMSS vision to realize the full health potential of every human, everywhere.

Tom also serves as the executive director of the HIMSS Foundation, the philanthropic arm of HIMSS, which enriches the public discourse on public policy; advances clinical informatics and data science education; presents undergraduate and graduate scholarships; and fosters partnerships to advance equity, access, and inclusion in the healthcare information and data science workforce.

Tom is a proud member of the Leary Bunch from Wanaque, NJ.  He lives in Falls Church, VA with his awesome educator wife, Day, and sons, Jackson Thomas and Marcus Paul, who are his current and future heroes!

Q. My guest today is Tom Leary, Senior Vice President, Government Relations at the Healthcare Information and Management Systems Society (HIMSS). HIMSS recently published a report you co-authored, which recommends $36.7 billion to be invested in public health technology infrastructure modernization. My question is why now?

Tom: We started our journey in 2018 and some of our staff had said that public health was supposed to be phase 2 of high tech back in 2010. But we were heading into 2019 with no real, specific investment in public health infrastructure. We had gotten into a problem where CDC had 159 different systems that all talked to themselves rather than with each other organization-wide. This was a real problem that HIMSS needed to be lead on. We started that journey by launching ‘Data: Elemental to Health’ campaign in 2019 even as the measles outbreaks commenced across Washington State, New York and Kentucky and others. At that time, the CDC director, Dr. Redfield said, “I’ve got a real problem. I can’t respond to this information, because I’ve got 2015 data in early 2019. And only one specific staff member who can help me analyze this.” That’s how the conversation started a full year ahead of the pandemic.

If you look at the data campaign and this report, the specific focus is on some key areas that this report takes to a different level. What we’ve learned through the pandemic and why this report is so important right now, is that as we set up our clinical response in hospitals and clinics country-wide, they were able to respond pretty rapidly by adding telehealth, remote patient monitoring and other capabilities. That’s because we invested in the EHRs and other health IT solutions through the meaningful use program.

However, the public health community couldn’t keep up for it didn’t have access to the data of report-after-report or anecdotal representation of the COVID testing clinics that were set up in parking lots, of staff taking down vital information, case reporting, important data being put in the EHRs for the hospitals and clinics to use. In order to report it to public health, they had to write down the information and then, fax it to the public health department time-after-time. That’s really what the anecdotal evidence pointed to.

Now, some communities were further ahead than others. While public health IT infrastructure was glaringly 20th century or even late 19th century information gathering, the clinical setting was well into 21st century solutions. In terms of response times, or being able to revert to the patients on a positive test, and what public health could or could not do to help them, everything was dramatically slowed down by their inability to have great technology available to them — technology that was absolutely available in the marketplace but not available to the public health setting.

That’s really what prompted us to write the report. We’d made the investment at the clinical side ten years ago but what did the public health community need? It took us longer than we had anticipated but the results of the four-month review in multiple interviews across the United States afforded us the opportunity to gather the information that’s needed, the $36.7 billion that we’re recommending.

Q. When you say public health, are you including the state, local, federal in that definition?

Tom: For this report, we’re primarily focusing on the state, territorial, local, and tribal requirements as part of the data campaign initiative. We’ve been pushing for funding for the CDC to help to modernize their systems, as well as have them work with their partners at the state and local levels.

But this report takes the conversation one step further and answers the question that we’ve heard from appropriators and policymakers across the country. What are we really talking about? When we were asking for $1 billion over ten years as compared to IT systems already implemented – federally, at the DOD or VA and EHR modernization or some of the efforts that are underway in health systems across the country — that was really just scratching the surface. The question became, what do we really need to invest at the state, territorial, local, and tribal levels? That’s where this report came from.

Q. Can you help break down the $36.7 billion between the different components? What’s the time frame you’re recommending in the report? What are your immediate priorities?

Tom: We break down the report into two phases — the first five years address key areas such as, electronic case reporting, electronic lab reporting, immunization registry, immunization information sharing, and modernization of vital records and the second phase is for workforce development for which there’s an investment of over $25 billion at the state, territorial, local, and tribal levels in order to get them up to speed and really be equal partners with the clinical with the traditional clinical side of healthcare delivery here in the U.S. Then, we look at the EUR 6 through 10 establishing a true learning health system within healthcare to include public health as well as other key, long-range Investments that result in the remaining $10 billion investment.

Q. These are big numbers and you’ve highlighted pretty glaring gaps in our current public health infrastructure. How does the United States compare with other OEC countries in this regard?

Tom: Our sense is, it’s because the care delivery models are a little different. From a population and public health perspective, other countries go at it with much more of a coordinated effort. I’d say some of the population health investments that we’re hoping to make in the prevention aspects in the U.S. is just part of the fabric of healthcare delivery in other countries.

On the flip side, as seen in some recent reports, recent work that HIMSS has done in Europe and Asia and a little in Latin America, the United States has made the investment, particularly on the clinical side, through the high-tech acts in 2010 through 2020 timeframe, and that’s given us a great foundation to be able to respond.

What we’re seeing in the EU for instance is, they’ve created a European Recovery and Resilience Fund to help countries begin or improve their digital health transformation, so that they have the foundation to then be able to build on the pandemic response.

In the United States, the investment in the meaningful use program, particularly the hospital, clinic, and provider setting enabled us to layer on top of all that technology, the telehealth and remote patient monitoring services that improved access or kept access high. It also kept people safe from being unnecessarily exposed to the COVID 19. The same cannot be said for all places around the world. They’re therefore suggesting that similar foundational investments need to be made.

Q. Even a country like in India, for instance, has a massive effort underway right now to build this common infrastructure via the National Patient Registry among other initiatives.

Tom: Lav Agarwal was the Secretary, the Global Digital Health Partnership (GDHP), established, about four years ago. He and the Indian government really made some great strides and we’re thankful for all the work that they’re doing in India, being able to compare and contrast what’s happening globally.

Q. This is a massive modernization effort but what will be the challenges to implementation? What’s the big lift when the government decides to find the funding and launch the program?

Tom: It will be twofold, really. I’d say, we’ve got the executive order from the President and that’s required the Office of National Coordinator and the CDC to work basically attached at the hip over the last year and a half. They’ve selected two great leaders — Mickey Tripathy, a longtime HIMSS member and an advocate for interoperability from his days in Massachusetts. Then, there’s Daniel Jernigan, who is no stranger to the technology advancement needs of the broader public health community. He has a lot of the experience having worked in HL7 workgroups etc. That’s the first step of making sure that the two agencies are working very closely together and in partnership with the public health community. I think it’s a dramatic improvement over what we saw in 2020 with respect to the initial response to the pandemic in what seemed to be a very fragmented approach. The second issue that’s going to be really a challenge, particularly at the public health, at the state, territorial, local and tribal levels is workforce development. You can have an influx of technology capabilities, but if you don’t have the data analytics capabilities, whether it’s on staff or a hub and spoke approach between the state and the local public health departments, you really need to make sure that the funding and the workforce are available.

With respect to where it’s headed, there’s been a lot of conversation at the CDC consortium about what the infrastructure looks like and equally importantly that a career in data analytics, in health care is something worth pursuing. It’s also critical to understand that a data analytics career in the public health setting is just as rewarding part of what the administration and Congress have done over the last year and a half. I’d say that the tail end of the Trump administration is looking at those workforce issues and so, the development and release of funding for this new center within CDC on pandemic and natural disaster health forecasting implies emphasizing and ensuring that the data can be shared between CDC and the local and state communities. That is a great new investment that came in with the Biden administration and Congress’s funding.

Secondly, this new omnibus with the ARPA-H, modeled on the Defense Advanced Research Program Agency is a new one for health care which will have tremendous impact not only on the NIH community — we would anticipate this as we saw Francis Collins in the tail end of his career with his tenure at NIH – but also, for the CDC and the public health community.

Q. You mentioned the workforce challenges and their enablement. Without making this a political question, how much can a government really staff-up on its own, given the scale and scope of what we’re trying to accomplish here? Is meaningful public-private partnership possible?

Tom: You’re right and again the answer’s twofold really. It’s got to be a public-private partnership. We learned a lot from the meaningful use program and I go back to it for the historian in me wants to look at the programs and what we learned from them to ensure the next set of programs works great.

What we’ve learned is, it’s got to be a public private partnership. There’s an opportunity, whether it’s cloud providers who have been right in there or the CDC consortium conversations with the ONC. The question is how can we help public health leapfrog into the 21st century using the right technology? It’s the systems integrators who have years of experience working with the states and the CDC. It’s got to be a public-private partnership because the government can’t do it by itself and the overall high-tech program that we should be taking into this new phase is not familiar to the public health departments. They have neither expertise to purchase the right equipment nor to hire the right staff. If they can work in partnership with the experienced private sector, whether it’s similar to the old regional extension center program or a collaboration of sorts, it will decrease the time to decision-making, lower the costs and sidestep the unnecessary challenges.

Q. What about the information and data security aspects of our current fragmented infrastructure? How does your report’s recommendation address that aspect?

Tom: From the security aspects, if it’s not highlighted in the report, then, shame on us. What HIMSS has been saying for the last five or six years is that we’ve learned a lot of lessons by reiterating that information sharing is a key, and provider and patient need access to such data but you need to make sure that its transmitted in a secure way.

HIMSS was a big, first voice in the health care community calling for what is now the 405 C and D report components of the Cyber and Infrastructure Security Act of 2015. We made sure health care was involved. There’s now a great collaboration between large organizations and less funded or less-resourced organizations on information sharing, cyber, and the health sector. The Coordinating Council Cybersecurity Task Force that we helped advance is a great example of what the public health community needs to be thinking about with respect to cybersecurity. Healthcare must be a focus for tech development because state-sponsored and independent bad actors are targeting it and we’d be absolutely remiss if we didn’t make sure that security was front and center in the discussion.

Giving credit to our friends at the council, state, and territorial epidemiologists, the American public health labs, and the CDC, I’d say, they have been banging the drums over the last 12 months making sure that cyber is part of the discussion, in the very beginning of the framework, so, HIMSS and our partners believe and drive that. I’ll say, just before we go off of that, that’s if it’s not there, that’s a great reason for version three of the report to be put out in the next six months. Hopefully, the number will continue to rise.

Q. What is the big takeaway for our listeners from this report?

Tom: The big takeaway is that it’s time for public health to be an equal partner with the clinical setting. It’s going to take a public-private partnership in order for us to make that investment to level the playing field between clinical, traditional and the public health settings.

If we’ve learned anything from the pandemic, the measles outbreak and the e-cigarette challenges of 2019, it’s that siloed approach to public health, a reactionary approach, is not going to get us the kind of success we’re looking for in the US. This report really calls on the investment not only at the federal level, but truly at the state, territorial, local, and tribal levels, so that everyone has the technology, and the people they serve have equal access to the best available care and the best response times. That’s the big takeaway.

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.

Machine learning paired with data interoperability can help uncover ways to enhance patient care, improve outcomes, and ultimately save lives.

Season 4: Episode #121

Podcast with Dr. Taha Kass-Hout, Director of Machine Learning and Chief Medical Officer, Amazon Web Services

"Machine learning paired with data interoperability can help uncover ways to enhance patient care, improve outcomes, and ultimately save lives."

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In this episode, Dr. Taha Kass-Hout discusses Amazon’s investments in AI and ML for the healthcare space. He also talks about their work with healthcare organizations across the globe in empowering healthcare and life science organizations to make sense of their health data with a purpose-built machine learning platform.

Taha talks at length about Amazon’s work with leading healthcare organizations and how the Amazon HealthLake platform enables the aggregation and analysis of large data sets. He also talks about the current state of AI and ML, the opportunity to analyze unstructured data, and the big gap in the acceptance of AI/ML due to issues such as algorithmic bias that must be addressed in applying AI/ML to healthcare. Take a listen.

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Show Notes

01:58Tell us about your role as the Director of Machine Learning and Chief Medical Officer at AWS
05:40What is the current state of AI and ML in healthcare?
11:02Tell us about your machine learning use cases.
15:16 From the Amazon HealthLake perspective, what is the state of the union of data landscape?
20:37Where do you think is a big gap in the acceptance of AL/ML and issues we need to consider as we start applying these tools in the healthcare context?
26:41 How do you support all the different healthcare bets Amazon is making - Amazon Care, Alexa Voice Service, HealthLake – through your machine learning capabilities?

About our guest

Taha Kass-Hout, MD, MS is Director of Machine Learning and Chief Medical Officer at Amazon Web Services, and leads our Health AI strategy and efforts, including Amazon Comprehend Medical and Amazon HealthLake. He works with teams at Amazon responsible for developing the science, technology, and scale for COVID-19 lab testing, including Amazon’s first FDA authorization for testing our associates—now offered to the public for at-home testing.

A physician and bioinformatician, Taha served two terms under President Obama, including the first Chief Health Informatics officer at the FDA. During this time as a public servant, he pioneered the use of emerging technologies and the cloud (the CDC’s electronic disease surveillance) and established widely accessible global data sharing platforms: the openFDA, which enabled researchers and the public to search and analyze adverse event data, and precisionFDA (part of the Presidential Precision Medicine initiative). Taha holds Doctor of Medicine and Master of Science in biostatistics degrees from the University of Texas and completed clinical training at Harvard Medical School’s Beth Israel Deaconess Medical Center.

Q. Taha, you’ve got an interesting background across the government, private sector, and health systems. Tell us about your role and responsibilities.

Taha: My role at Amazon spans bridging tech, science, and medicine to help develop the right technology services and enable customers to solve their problems. In my current role, I really enjoy working with scientists, engineers, and product managers even as I interface very directly with customers across health care, life sciences, and genomics of all sizes, from startups to academia to large Fortune 500 companies. All of them are trying to help solve concrete problems for patients, consumers, and health systems, or introduce better ways about how they can operate more efficiently or design better systems.  

Q. Tell us about your time with the government. 

Taha: Before coming to Amazon, I was at the Food and Drug Administration (FDA) during Obama’s second term. As the first Chief Health Information officer, my role revolved around how to get innovation, big data, the cloud, and machine learning to spur innovation in industry. 

I also looked at how the FDA could ensure product safety and efficacy on the market in a way as to enable advancements in technologies and the cloud to help medical reviewers even as I worked with industry, medical device companies, pharmaceutical companies, and regional health companies. Not only would this help them innovate, but also ensure safe and effective medical products.  

The last couple of years at the FDA, I was part of the core team collaborating with the NIH and on President Obama’s Precision Medicine Initiative. A part of that was all about how we should introduce something called precision to help industry better benchmark next-generation, emergent sequencing, machine learning and AI algorithms coming to market in ways that use a standard based approach. How can you ensure accuracy and reproducibility in a way that also advances regulatory science?  

I have a unique background, being both, a clinician – an Interventional Cardiologist by training — as well as a statistician with a lot of depth in applications, population surveillance, clinical trials, and bringing innovation in big data whether for disease surveillance, post-market analysis, or monitoring.  

I’ve done the whole lifecycle then, from dreaming up something to bringing it to reality, and advancing those therapeutics. It’s really great to be at Amazon because we like to think of big problems and how we can solve them for these customers. I bring that perspective and the level of depth with these customers into working with the engineers and scientists to craft the right strategy and understand how we can go deep into solving those problems.   

Q. Tell us a little about how Amazon is really helping your customers specifically in the healthcare space. Also, what are your thoughts, at a very high level on the current state of AI, ML, and healthcare? Where are we seeing the big wins? 

Taha: Machine Learning is transformative, perhaps one of the most transformative technologies we’ve seen. It’s a technology that can use data to build algorithms that allow computer-based systems to generate models for meaningful interpretation and for health. That’s also a potential clinical use. And the dust has settled on a number of areas in Machine Learning, for example, with Natural Language Processing, the better algorithms are really about high accuracy. So, you can imagine how important this is for predictions, tasks, and pattern recognition.  

If you look at health data, for the major part that’s unstructured, data comes in the form of images, notes, and signals. So, ML is really amazing for sequential and unstructured data encountered in the health space where, today, we see demonstrations across science organizations from the largest healthcare providers to payers and IQ vendors to the smallest system integrators and entities across the globe, who are applying massive machine learning services to improve patient outcomes and accelerate decision making. 

You saw the digitization of medical records over the last decade. Now that we’ve gone from something like 15% maybe five or six years ago, some of your data may still be in paper charts today, but about 98% of all systems are captioned in digital form. With that comes a really amazing business opportunity in value-based care. When the health system is really moving more towards the quality of care and measurable outcomes, you have more data to be able to drive decisions. This is where ML paired with data interoperability can help uncover ways to enhance patient care, improve outcomes, and ultimately, save lives while simultaneously, driving operational efficiencies to lower the overall cost of care by enabling secure access to health data and supporting health care providers with predictive machine learning models.  

Life science companies, pharma, and biotech, enable an understanding of how to seamlessly forecast future events like stroke, cancer, and heart attacks and conduct early interventions with personalized care and superior patient experience. They’re designing better therapeutics, fast-tracking the drug discovery cycle so it’s not something that takes ten years for what could be done in a matter of weeks or months.  

It’s similar with vaccines, Cancer therapeutics, medical devices and what we work on with Amazon Web Services. The cloud was invented by Amazon, and we provide our customers, healthcare, and life science organizations with absolutely the broadest and deepest set of purpose-built AI, ML services on top of the most comprehensive cloud. That includes data storage, security, analytics, compute services and beyond. And as you’ve seen with our health AI services, now there are purpose-built services for the health industry such as, Amazon Comprehend Medical that can help analyze and detect information, extract and structure this from medical notes, Radiology reports, or medications and conditions and then, map it to the right Ontology, to offer with full transparency and high accuracy insights into how we’re doing.  

The Amazon HealthLake is how you can store, index, and analyze this massive amount of information at-scale and in a matter of minutes. We have a number of other services as well which offer consistent data transparency and controls to protect patient privacy. We want these customers to be able to make sense of their vast troves of health data and simultaneously, support their machine learning workflows to make sense of this data. We are committed to developing fair and accurate AI ML services and providing the tools and guidance needed for these customers to build responsible AI and ML applications.  

Q. A lot of health care organizations are moving to the cloud for a variety of reasons, such as Analytics, for one. Can you share one or two examples of how your machine learning capabilities and tools have made a difference? Do tell us about one or two use cases as well. 

Taha: We’re talking about maybe two use cases – one, on operational efficiency, in which we see a lot of traction; ML’s there, and one on the analytics.   

With regard to operational efficiency, for example, the Harvard Beth Israel Deaconess Medical Center uses deep learning models built on Amazon SageMaker. Our end-to-end product is for developers and scientists to build, train, and deploy ML models, and detect bias in the process or be able to monitor those in a way that they were able to optimize the schedule of its 41 operating rooms and align those to improve patient flow and the inpatient settings. But they also use Amazon Comprehend Medical because as you can imagine, for a regional hospital, they receive a lot of patients that are referred to their hospital, for operations and beyond. They come with documentations and to be able to sift through all that and extract key medical terms from co-morbidity, broad prior procedures, to even their blood type and more is where the Amazon company medical purpose-built service HIPAA eligible for understanding the context of the medical text, extract the meanings, and use them to identify history and physical information that’s really needed before the procedure. That’s one example where our health system was able to realize operational efficiency in those settings, translate it into dollars savings, align schedules between surgeons and patients, and benefit the patients via better experiences.   

The service also enabled surgeons to have more meaningful schedules on the healthcare side with analytics. We’re really excited about the use case with Rush University Medical Center. We work with them to create an cloud-based analytics hub using the Amazon HealthLake I just mentioned. This hub allows them to securely analyze patient admissions, discharges, and hospital capacity in real-time to provide care to the most critically-ill patients.  

They use predictive models around social determinants of health across Chicago to help identify gaps in care before they happen. This is really a great example about how they’re able to bring all that information, organize induction via HealthLake and then, start layering all these analytics to be able to identify those at risk. Outside the health system, there are additional data sources and blood pressure monitors which really offer more of a complete picture around care for all the Chicago Metropolitan that population.  

Q. That’s a great example. However, healthcare has a fragmented data landscape. What’s your approach to sorting through the plethora of data sources? 

Taha: While healthcare organizations are capturing huge volumes of patient information in medical records every day, however, this data is really not easy to use or analyze. As a matter of fact, 97% of this information, today, is not being used at the point-of-care as data since it’s unstructured in nature and trapped in lab reports, insurance claims, clinical studies, recorded conversations, X-rays, doctor notes and more. The process to extract this information has been fairly labor-intensive and error-prone not to mention the cost of operational complexity which is challenging for most organizations.   

We’re finding that every health care provider, payer, or life science company, is trying to solve this obstruction to data, because doing so can enhance patient-support decisions, improve clinical trials, ensure operational efficiency, and even identify population health trends and get ahead. The majority of this medical data today is also stored in various forms, formats, and systems that are not exposed through application programing, interfaces, APIs, or microservices. You’re really still trying to deal with that, but the impact is palpable. I mentioned a couple examples, one on a population level and how Rush University Medical Center is trying to really accomplish better insights into their population.   

There’s also Harvard General Hospital which is realizing better operational efficiencies through machine learning but even at the point-of-care, today, the most widely used clinical models like predicting say one’s heart risk, are built from commonly available variables with very simple features that are about 10 to 30 data points. We must get to the level of truly offering what the patients really need, to them. Even the most common conditions like diabetes or depression or for example, of diabetic patients, only 10% of those are similar. Thinking through the therapeutic options and what’s best for the patient, oftentimes takes a while just to understand from a data driven approach, what really might work for them rather than this broad stroke approach. If you look at patients, medical records have at least 200 to 300,000 data points, including your medical notes for sure. None of that is used to manage patients and predict their outcomes. Why you want all this data to come together and organize a way out of the point of care is to build better and more accurate predictions. This is really why we introduced Amazon Health — to start helping these customers address these challenges by storing information in this structure and organizing it in a way that enables better analytics to be built by using more information on that patient. For the last five to six years, there have been standards being developed by the community around healthcare, interoperability, resources, or FHIR. It is amazing for exchanging data in a structured way or it’s a great lexicon and standard for healthcare data.  

However, if the majority of the data are still unstructured, you need to be able to index that information and this is where Amazon Health really comes in. We have a machine learning model trained to support these organizations to automatically normalize an index and structure this data and bring this information in a way that creates a complete view of a patient’s entire medical history. This makes it easier for the providers to understand relationships, the progression and make comparisons with the rest of the population to drive better patient outcomes and increase operational efficiencies. This also helps leverage the power of machine learning capabilities for this kind of a problem and enables the designing of better cohorts, better dashboards to monitor and compare these patients, and start personalizing at the individual level, predicting disease onset and beyond.  

When we bring this massive amount of unstructured information, we use machine learning capabilities integrated within HealthLake to understand the medical context, extract this information, and augment the records. Then, every data point on the timeline is mapped into the FHIR standard which is helpful when you’re trying to store and exchange this information.  

Q. From all indications, now there’s great acceptance of AI algorithms in enabling clinical care. You mentioned Rush and Beth Israel but there may be others too. Where do you think is a big gap in the acceptance? What are some of the issues we need to be thinking about as we start applying ML in a health care context?

Taha: You mentioned data quality. Of course, there’s bias that comes with it. We’re over the hyperbole of what ML is with applications around Natural Language Processing and pattern recognition enabling better predictions. We’re seeing that across life sciences and healthcare, customers are really benefiting from this. The power of machine learning is not just to apply it across the entire end-to-end data strategy from data annotation to understanding any biases in information but also undertaking data wrangling by putting all this information together and leaning on machine learning. For example, in health care this would be undertaken with the large majority of unstructured data. This is why we have Amazon Comprehend Medical national banks. They help us to understand the medical context and extract medical entities and then, map those data and healthcare — not only multimodal but also highly contextual.  

There are codes, for instance, diseases have certain standards like ICDs, drugs, whether that’s generic or branded and all the formulary around them. It’s enormous. How is machine learning training purpose-built? How is it pre-trained to understand this information? How does it know that this is a family history, this is negation, there’s anatomy structure, and that information can be extracted with full transparency and a relationship between this condition and this medication be derived? How does it know medication structures, dosage, and more?   

We’re really removing the obstruction to enable customers to structure this information in the first place with outcomes and that’s what you really need to look at when you talk about machine learning. I look at it as an end-to-end data strategy from the data prep to when you build those models to when you deploy those models. Then, when you monitor those models in the wild, there’s no one model that you can put out there and expect it to work forever. Do these models aggregate this?  

Take one machine learning model, let’s say being worked on by an Assistant Radiologist in one hospital. They train on one data and then take the same model across the street to another hospital acquired by a health system. You’ve acquired one hospital that is using the same old coding system of ICD nine instead of ICD ten and so on. Your sepsis model no longer works so, these are technical biases that come into the data.   

If I’m just to take it from the top three and eight of us are committed to developing fair and accurate machine learning services and providing the tools and guidance needed so that when these applications are done responsibly in the first place, this is really where we’re making a lot of mature investment processes. A part of that journey in democratizing machine learning to the masses at scale is also about ensuring the privacy, and detecting bias. it’s not just, you know, referred to as data-driven for it creates imbalances in data or disparities in the performance of these models across different demographics.  

This is also an area where machine learning really is of tremendous help in mitigating the bias by detecting potential bias during data preparation and then wrangling the data in your deployed model. As you examine specific attributes, you’ll be able to understand bring the black box. These are the features influencing the output and they could be potential of the output, but we haven’t looked at them because not every feature that goes in the model is, is a predictor. There’s contamination as well and these can be where it starts having different kinds of biases in the output.   

Then, of course, the monitoring aspect via a human review becomes so important. It helps understand model behavior once you develop a subset of migration. Today, if you come up with a new drug, you design a clinical trial, but you won’t design it for the entire population in the world. You design a clinical trial for the population you control for every variation and variable. Then, you put it out in the world. That’s when your post-market surveillance is going to monitor for adverse events. Imagine now you have all the tools necessary working for you, and that is really what we package.  

With machine learning you don’t design one or two models, typically, you build hundreds or thousands of these until you get to the best performing one. But you’ll have to continuously monitor your leaderboard because the data is going to drift, the model is going to drift as you apply it to heart failure predictions and one population or the other tracks a particular region, a different kind of construct of the population in order to constantly iterate and develop an agile way to do that.  

Q. What are the different healthcare bets that Amazon is making? You’ve got Amazon Care, Alexa Voice Service, HealthLake, SageMaker, Comprehend Medical — How do you support all of these? Tell us about that. 

Taha: I can only speak about my role within it. We build the technologies and the services to help solve a lot of these problems for health care providers, payers like finance companies and biotech and entities of all sizes and levels of complexity. That’s our goal and the material investment we’re making. ML is such that anyone should be able to pick it up, but then, it’s important to really try to break the black box, remove the complexity, and do the heavy lift for a lot of these customers.  

No matter who is building what for whom, with machine learning, AI and other transformational technologies, we want to be able to give right guidance and build these the right way, the responsible way. That’s our approach to it. That’s on the AWS side. We partner with a lot of health care providers and customers, too, because we see a lot of repeated use cases across the board, which is enough for us to really understand the heavy lifting and why we started making those services in the first place.  

Q. Would it be fair to say that even an Amazon Care is an internal customer for some of your services, just like a Beth Israel or a Rush or any of those health care providers are?

Taha: I can’t talk about Amazon care. We have to think about Amazon Web Services as a cloud provider, first. Whether that’s an internal customer who is going to use a cloud or an external customer is how we will look at it later. Then they’re going to have a lot of common problems and that’s exciting for us because we can really think hard about the heavy lifts that they observe to be able to start pulling up on those. The last few years have been exciting on the other side of building those purpose-built services.  

Pre-trained on the medical context, whether that’s Amazon Comprehend Medical, Amazon Transcribe Medical to understand medical transcriptions, Amazon HealthLake to really provide you that scale with indexing and information on patients and be able to really kind of build these dashboards and cohorts and do these wonderful prediction models, whether that’s for operational efficiencies, improving outcomes, or reducing biases, and closing gaps in care.  

Today, over 4 billion people don’t have access to care. Forget about high quality care. I do believe that AI and technology have to be part of the future that can close such gaps in care, enable access to care, and provide more equitable solutions. Innovations in precision medicine, APIs for data interoperability, and system interoperability, intelligent scribes and others are components that can really be part of that solution to being more accountable in offering care to the world.  

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.comand write to us atinfo@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 want to define what ‘good’ looks like and prioritize our digital health investments accordingly.

Season 4: Episode #120

Podcast with Tim Skeen, SVP & CIO, Sentara Healthcare

"We want to define what ‘good’ looks like and prioritize our digital health investments accordingly.."

paddy Hosted by Paddy Padmanabhan
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In this episode, Tim Skeen, SVP and CIO of Sentara Healthcare, discusses how he determines his technology priorities and initiatives for driving digital transformation. Norfolk, VA-based is an integrated, not-for-profit healthcare system comprising 12 hospitals. As CIO for Sentara and its affiliated health plan (Optima Health), Tim focuses on driving synergies through technology to improve member/patient experiences, manage population health, and drive efficiencies.

Tim explains how data is the foundation to drive better healthcare outcomes and how the right data sets can identify care gaps, lower the cost of care, and improve overall healthcare outcomes. He discusses their strategic partnerships for cloud-enabled data and analytics with Microsoft, including their investments in industry consortium Truveta. He also talks about their cloud transformation journey and the IP they have developed for cloud migration that they intend to monetize through a commercial venture. Take a listen.

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Show Notes

00:54Tell us a little about Sentara Healthcare, the populations you serve, and your role.
04:39Many would refer to Sentara as ‘payvider,’ a payer and a provider. How do these drive technology priorities as a CIO? Can you share some of the unique needs of an entity like Sentara?
08:08What's the best outcome for the patient population and consequently for the organization? From a technology standpoint, is data a common use of platforms?
17:54 Where are you in your cloud transformation and CRM journeys? Where does your core transaction platform for the health system – Epic – fit in?
22:09Several progressive health systems are also patenting their cloud migration process. What's the big driving force behind taking internally developed IP and then spinning it off as a separate entity?
26:51 How are you approaching the digital health solutions landscape as you transform your organization?
34:06 How are you managing the governance for all your digital initiatives?
37:30How do you see the role of the CIO today and what has changed in the last couple of years?

About our guest

Tim-Skeen-profile

Tim Skeen, SVP & CIO for Sentara Healthcare, has overall responsibility for leading the enterprise technology organization supporting all aspects of the Integrated Delivery Network (IDN), Optima Health Plan, and Corporate Services.

He is an accomplished executive with more than 30 years of experience both inside and outside of health care. Tim has always been focused on ensuring technology plays a key role in every aspect of the business to enable associates to serve consumers efficiently today while building a foundation for tomorrow. He empowers teams to bring creativity and forward-thinking to their roles daily and understands the vast opportunities technology, advanced analytics, and digitization are bringing to the health care industry.

Tim-Skeen-profile

Tim Skeen, SVP & CIO for Sentara Healthcare, has overall responsibility for leading the enterprise technology organization supporting all aspects of the Integrated Delivery Network (IDN), Optima Health Plan, and Corporate Services.

He is an accomplished executive with more than 30 years of experience both inside and outside of health care. Tim has always been focused on ensuring technology plays a key role in every aspect of the business to enable associates to serve consumers efficiently today while building a foundation for tomorrow.

He empowers teams to bring creativity and forward-thinking to their roles daily and understands the vast opportunities technology, advanced analytics, and digitization are bringing to the health care industry.

Prior to Tim’s role at Sentara, he served as Anthem’s COO of the Government Business Division and as Anthem’s CIO responsible for enterprise architecture, data and analytics, SOA platforms, cloud operations, infrastructure, information security, network operations, and business and corporate applications. Tim also served as chief information officer at Amerigroup, chief technology officer at Molina Healthcare, and chief information officer at Unisys for the Health Information Management Division.

Q: Tell us a little about Sentara, what populations you serve, and your background. You’re relatively new to the provider space, but not to healthcare. How did you get into this role?

Timothy: Sentara’s been around for over 130 years as a nonprofit mission delivering care to the community. Over 20-25 years ago, it started supporting health plan and insurance products across multiple lines of businesses.

Sentara’s made up of 12 hospitals that cover almost a million health plan lives across Medicaid, Medicare, the individual, large, and small groups. The bulk of that — 60% plus — are in the Medicaid space and from a regional standpoint, across Virginia. It was originally founded in the Hampton Roads area, but now caters to Northeastern and North Carolina, as well. We have a College of Health Sciences, nine Magnet Nursing Hospitals, over 300 sites of care, more than 900 physicians, over 470 advanced practice providers and 1,370 medical providers. So, we are a large organization both, on the care delivery and the health plan insurance sides.

This year, for the first time, we’ll be about 50-50 in terms of overall revenues between the health system and the health plan. That balance, as we continue to grow both aspects, really allows us to do some interesting things — in terms of providing access and proper care — as an integrated delivery network that’s also linked to a large membership health plan, especially for an underserved population like Medicaid. That’s important and particularly, meaningful to me because I started my career on the payer side about 25 years ago when I first jumped from finance into the health care world.

On the health plan side, initially, I worked in the Medicaid fee-for-service domain. That was my first experience with health care and delivering services to a needy population country wide. That imparted a different level to the mission of what you needed to do to provide these services that they so critically relied on. Through that process, I progressed through several different large payers and other lines of business where I involved myself with all types of membership – uncommercial, commercial, and the government-side. Recently, I left Anthem Blue Cross Blue Shield and came over to Sentara, the provider nonprofit side of the world.

It’s been a great journey and I’ve got involved with an even more mission-driven organization that is doing, and not just helping, from a health insurance standpoint. Engagement in direct care has also been really rewarding. It’s interesting to learn that process and be part of this organization.

Q: You bring a unique perspective to your role as the CIO. Can you share some of the unique needs of an entity like Sentara? Many would refer to it as a payvider network, a payer and a provider). And from your perspective, how do these drive your technology priorities as a CIO?

Timothy: I experienced this concept — of trying to create value-based contracting and care and building incentives to drive that collaboration where there’s the same incentive for the insurer and the care deliverer to provide the best outcome and the most affordable, accessible care for the end consumer — on the payer side. It shouldn’t be different — a different incentive or a different goal — just because I’m a payer versus I’m a provider.

What we found was that — when we were just in the payer space and trying to get providers to focus on that value-based care and sign-up to some level of risk, which health insurance companies have been doing all their life – it was a very difficult and new concept to grab hold of, as a physician and a care provider on the other side.

There’s a trust-based partnership that must work towards getting the best outcomes. You’re not trying to win on either side, but provide what is the best, most affordable, accessible services that benefit both sides of that equation. Even though I was part of a large payer, trying to get providers to be engaged or forced into that was difficult because trust levels weren’t too high. I thought, “OK, I’ll come here, and we’ll own our providers and the health plan. It’s natural that they’re doing this value-based and trust and that’s happening.”

But there are a couple of different things, such as, being fair, adhering to compliance and regulatory norms that prevent some of that interaction from achieving the depths, they could otherwise have. A lot of it is, once again, their incentive, in their own kind of tower around certain goals to deliver for the organization, as opposed to bringing this in and looking at the overall goal and how that coordination can work better in our microcosm.

Theoretically, I’m supporting all the technology, data, and analytics needs across sides, so, I should have that visibility and unite that. That’s part of the goal and how we measure success, here. To see that come together better and then, take that beyond to say, “How do our hospitals and providers also interact in that value-based way with payers that we don’t own?” We’re not part of these other broader systems’ drive because in our regions, there are plenty of other payers that have many more members. We serve for our care delivery than our own health plans, so, we want to be able to do that, take those lessons and scale those across our entire ecosystem of external payers, as well.

Q: From a technology standpoint, data is in common use of some of these platforms. Can you touch on one or two opportunity areas in this regard, as you look at it holistically?

Timothy: It’s about building a foundation and continuously adding layers to that to allow easier interaction and connectivity. Data has got to be that foundation, so it must flow ubiquitously under the right security and usage rights so that it can be shared to get the best outcome for the care. It must also enable understanding of where the care gaps and other activities lie. We can be proactive to both benefit and create a lower cost of care, while also providing the right services at the right side of service, irrespective of location — in a hospital or at home – to make that outcome the most affordable and the right best outcome for overall health. So, clean, linked, uniquely identified data is critical to that for it helps us know that the consumer and patient entity is the right one.

Once we have the right data set, we roll it up for insights into how we’re performing from a population health standpoint, a practice and cost of care, and the insurance side right down to the way we’re delivering care to that population. What can we do to improve that and be more proactive on some of the care that helps prevent a higher cost of care down the road?

That is interesting and challenging because from a payer standpoint, you have a membership for one year, when you’re enrolled in the plan. You can leave the next year, but you don’t get the benefits, then. But if you think about the solicitor, you care about the health for the next 50-60 years of that population. You have to look at that more holistically.

On top of that data, then, I think about an engagement or a visualization layer that has to be digitized. How do you ensure digital engagement for members and patients to ensure they’re engaged in the best outcome for their own health and take some responsibility for that engagement? We also have our care deliverers, care managers, disease management managers, caseworkers, home health workers etc. so, how do they have that digital interaction with and visibility into that data to also optimize that care overall?

And then, there are pieces that go beyond just the technology to deal with how you get those operational workflows to work. These did create some great dashboards of data that theoretically could lead the providers to the right areas to do the work. But it was a standalone dashboard that was created, and it wasn’t embedded in the workflow of the EMR. So, whatever be the workflow EMR, it’s important to think of how we can transact and deliver care. We’ve got to move to that next level, above the data, go digital to figure out how to embed that in the workflow to promote engagement.

It’s not them having to get out of their normal workflow and look at other things. Part of that workflow, besides engaging their EMR, is also doing other things that allow them to engage more of their time more effectively, so, we can start getting into Natural Language Processing, natural language understanding, Machine Learning, AI, voice, etc., things that can help with the fatigue and burnout yet get the documentation that’s needed, out. We need good programs across the board to measure this from a payer and provider standpoint.

Q: You came from a large health plan, and in general, they’ve been slightly ahead in their use of technology and data-enabled strategies. Tell us about your initial impressions as you came into this organization and do share your priority areas, as you try to bring these two organizations together to drive synergies.

Timothy: There are a couple of things. I came into this with a viewpoint of “How do we build up the conferencing capability of our technology platform or infrastructure?”

First off, I wondered “How simplified is our environment? Can we simplify further?” We were in a good place from a simplification standpoint. But were equally good from a security standpoint? Did we have a good security posture? These are all like Maslow’s — you’re going up the spectrum of what things you have to have in terms of food and shelter. This is the same thing. Then, I thought of resiliency. “Do we have a level of resiliency for disaster recovery and business continuity?” We didn’t have that, but we were trying to do the most advanced digital care, remote patient monitoring activities. This was going to be difficult and problematic without a robust foundation.

I looked at that and then, at scale because if that’s absent, then, growth, affordability to do this on a broader impact is tough. You have to change what you’re trying to tackle your goal. If you don’t have a platform that can scale and support that growth, that’s another missing foundational piece.

Those are areas attacked early-on in the process. Fortunately, the previous CIO had done a great job for the previous three or four years. They’d undertaken Cloud transformation and as a foundational infrastructure, got 80% of our platform stack — on the health plan and the health system — into a single Cloud structure and a segmented, secure environment for that data and that compute. What this enabled us to do was scale because cloud translates to your agility to be able to scale-out, scale-down and be secure within that compute environment. So, security was another piece of that.

I also undertook additional security adversary simulations to see how good we were both, physically and digitally. I checked our disaster recovery to change our recovery time on our core Tier one systems from what was almost 20 days with tape and off-site recovery to an actual real time instance between Cloud to Cloud that we could replicate and get our DVR system up in four minutes. That was a massive change.

What we’re putting on top of that now, are expanded data layers where we’re engaging more with external and broader types of data, including partnerships with companies that have Deep Learning and products in AI and Machine Learning and use NLP. We’re engaging in a digital transformation that takes us beyond just a portal to really something that can be a framework for all types of digital interactions and provide broader virtual care platforms.

If COVID showed us anything else, it was momentum around what we can do from anywhere in terms of meeting patients where they need to be and providing that care in a more virtual world. So now our platform can scan across the entire way from hospital all the way down to home and spans wearables from an on-the-move standpoint, that enable interaction. That kind of platform means we’re really stepping up.

When you think about all this capability and connectivity, you’ve also got to step-up on how you think about CRM or customer service support. When you think about a contact center in environments, it’s not just about calling a phone and being told “I’ll call you back with an answer.” Interactions now have to happen through all sorts of omni-channel connections, we need folk that are engaging at a higher level of competency and knowledge to really provide true omni-channel interaction experience where people feel like they know them. It’s personalized and encourages engagement because we need that engagement every day across our system.

If you think about it from a provider standpoint, we average more about 2.7 interactions a year with our patients. This isn’t enough to get engagement, trust, or even the full breadth of health and wellness that we have to bring to that population. We want to increase the interactions and it doesn’t have to be every day because I think they don’t want to interact with us more than 2.7 but because they’re interacting with us from a sick care experience. We want to think about health and wellness in their interactions, whether they’re doing really well or they’re doing really poorly. They’re interacting — not necessarily paying anything — because we are now their trusted ecosystem where they want to manage their health and wellbeing and that of their family and extended family.

Q: You referred to Cloud and CRM. Can you tell us where you are in your Cloud transformation, migration and CRM journeys? In that context, where does your core transaction platform for the health system, Epic, fit in?

Timothy: Great question! We’ve focused on getting those Tier-one platforms and EMR such as, Epic, on the provider side, along with the core claims processing, financial billing, payment systems on claims systems to support the health plan side. We’ve migrated both into Microsoft’s Azure Cloud. We have multiple segmented instances where we control who accesses what systems across that.

We also have regional instance as a direct primary to support that and so, the bulk of our compute, as well as all of the data and reporting, is up in that cloud. We spent time on this and have a provisional patent that’s tied to what we did with our cloud transformation. That patented solution will be leveraged with our lessons learned over the past three or four years, which are more than just how to get something in the cloud, such as, how do you change from CAPEX to OPEX? How do you convince the board in ELT about the value of cloud beyond just saving dollars?

It’s about agility, how fast you can move, spin-up and spin-down, how easily you can interact with other cloud-based systems and technologies like Salesforce and CRM. That’s one of the tools we rolled out — Workday on April 1.

These are all Cloud-based systems that can interact better in a Cloud environment. One of the things we pushed hard over the past months, and which will emerge soon, is a spin-off, a for-profit Cloud IT services organization built-up in terms of capability. The aim was to get talent to keep growing and do what they want to do in a for-profit world within a new company, a joint venture, where those folk can grow while we retain and get the best technology folk that will work for an environment like that without thinking of their primary IT job being working for a not-for-profit health system.

That’s a tremendous story in terms of what we did, how we learned how to do that effectively, and how we ate our own dogfood. Now, we have a framework in a construct that is licensable and driven towards a pattern that is real IP. Thus, we can help other health systems or payviders on their foundational journeys to the cloud while helping them realize the benefits of all these other areas and components.

I’ll briefly also answer the CRM component. There are number of CRMs today and the most recent one that we rolled out leveraged Salesforce inside our health plan. But I would like to think of it more as a CRM or a contact ecosystem of all those omni-channels – something that’s more than just your standard, old school CRM. Even if people don’t think Salesforce is old school, the old school deployment of a CRM or a call center is very different than where it needs to be in terms of a true contact center or contact ecosystem.

Q: I see some other progressive health systems doing the same thing – Providence and Intermountain come to mind — Is it just being opportunistic? What is driving it – talent?

Timothy: Great question! It’s really a mind-shift from coming from a for-profit payer world and what we would have been driving towards, which was generally around profit, spending, valuations, and spinning-out overall dollar values.

First, it’s a belief in doing this and being really focused on a couple of different problems. It’s reflecting to our community and the outside world that, “Hey! We are progressive, we’re innovators.” We’re trying to drive for those best solutions — not just clinical solutions — that can really fuel the best outcome for our communities, patients, residents that we cover. So, part of it is about being progressive, innovative and showing our commitment to that as a 130-year-old Sentara.

Second, it’s around our talent and commitment to members of our team, who are the most important aspect of our company. They’re the fuel and everything to what we deliver to our customers as value. Being able to create an environment where I don’t have to outsource to lots of different technology-only vendors, all my expertise and my jobs for my region, enables those folks to develop, grow that technology world and not feel like they have to go to a Google, eBay or Microsoft. That helps them connect closely with the mission of making our environment better.

We care about other health systems — Intermountain or Geisinger etc. – and we want to be a part of that. That’s an important piece of the value. It allows us to take other technology compensation capabilities and have a place for them to land so as to retain, attract, be able to get that talent into that environment.

Since you mentioned Providence and Intermountain, we’ve worked with the former and that was the first system I was introduced to when I first started here a year and a half ago. One of the companies that was spun-out of Providence right through that — an AI, machine learning, digital data company that’s for-profit — as part of that Series A and with another 20 other health systems with the same mission. That’s a great story.

Intermountain was involved in Graphite — a not-for-profit as opposed to a for-profit. But the previous year I spent time with Ryan who’s just announced he’s moving over as the CEO for Graphite Health. It’s really an environment to allow all the talent to help build more competency and capability on our own whereas probably historically, we were held hostage to all the technology and vendors out there that were doing these things to us. Now we’re becoming more mature and our ability to do some of that for ourselves is critical change in the mindset of historically a not-for-profit health system.

Q: Now you have an EHR vendor, Epic, and the opportunity to work with enterprise class technology companies, Microsoft, ServiceNow, Salesforce etc. There’s also this growing ecosystem of digital health startups that are bringing a lot of innovation to the table. How do you parse through this landscape as a CIO, managing the risks yet driving innovation as you transform your organization?

Timothy: Another great question. It’s a tough thing to solve, no matter where you are, how big you are, for-profit, or not-for-profit. Knowing every startup, every technology and where it’s progressing, what’s real and what’s not makes for a very confusing, chaotic environment out there. That’s a difficult thing to attack.

What it leads to is what I inherited when I first came in here, and started looking at our digital transformation program, enterprise wide. I inventoried almost 150 different digital pilots or proof of concepts going on all over the place with IT’s involvement. Now, you want some of this innovation to happen, but you don’t want to happen in chaos. In that way, where you have six solutions for the same problem, there emerge duplications, so, I brought in a digital officer and started making an inventory. Then, we collapsed that back down so as to clean up and evaluate the environment before adding more things to the pile.

I would also recommend having some good, trusted partners to help you in that journey of assessment because they can focus greatly on that marketplace while you focus on your full-time day job. After inventory and collapsing, you need to get control over what’s happening, herd the cats and ensure governance in that model to figure out what you’re trying to solve and the solutions for it. I found that we were bringing in lots of solutions looking for a problem, but we weren’t doing well. It’s important to define what the problem is, what good looks like, what the outcome that we want to achieve is and what the value, if we were to achieve that, is, and then prioritize those things that bring the highest value. Then, go, attack in a structured way.

The best solutions — either things you already have in-house or integrate or new solutions externally that you bring in to help solve that problem — enable a constructive way forward that isn’t about “Here’s a great cool technology, let’s figure out where we can use this.” It’s about understanding our big problems and our big value creation across the system, and focusing on those two things. The beauty of that is, once I have that construct now, I stay focused on what I really need to solve. When I get 20 emails a day from various vendors and both, internally and externally, I can put it against that lens and say, “Hey, that doesn’t fit in my top priority things that I’m worried about. I’m not getting 120 for another 18 months. So, come back and talk to me then.”

Q: As you go through the rationalization process, are you leaning more towards an EHR-first approach towards your digital engagement solutions and opportunities, OR are you looking at each individual opportunity on its merit and evaluating all the best-in-class solutions out there, regardless of whether they come from your EHR or not?

Timothy: It’s a good question. Before I joined the health system, they created the Sentara app focused around Epic, and the approach taken was to leverage Epic’s API. So, we integrated our own solutions with the API framework, to create a very customized environment.

What happens with Epic is, they’re investing a ton into moving certain things forward, especially in MyChart and that environment continues to improve. When you’re always a couple of releases behind the API, they aren’t keeping up with the capabilities. So, Epic’s ability is not to do a generic MyChart, but the MyChart extended framework allows us to operate — I don’t love the term Digital Front Door, but — a digital environment that not only supports but enables seamless interaction with its capabilities and functionality. It also allows me to bring in other types of solutions and connect other product sets within that framework.

So, we are moving more and more to that framework to create a cohesive application or digital environment that includes the help. So, if I’m a patient and an optimum health plan member, I want that digital engagement to be seamless in terms of me seeing my care, what I need from each exploration of benefits, what I need to pay from a building standpoint, my premiums, and everything for all of my family across all those spectrums. It’s not just about “Can I be Epic-first?” only. There’s no way because I have to cover all those other solutions as well.

That being said, though, what I need to go out and figure is if I’m going to use a solution, I need a certain solution — a certain hammer for a certain nail. So, I go to my key partner and core vendor like Apple and say, “Hey, listen, this is what I need. Do you have it or will you have it soon?” Or, “It may not be the best solution in the marketplace but is it the second or third best? Is it 80% or 90% of what I need and good enough?”

If it is, then, I’m going to leverage that framework because I need that discipline around creating a simplified environment. I’m not letting my environment go back to a bunch of cats running everywhere. So, the framework keeps it disciplined and herded. If the answer is not always going to be Apple, it needs to be our first place to validate that across.

Then, a second place would be the rest of our solution portfolio right in our CMDB to see the assets in there. If it’s not, then, we need to tap the right solution and define what we’re looking for and how to score for those solutions in a fact-based way that allows us to make the right decision, not because somebody has a brother-in-law or their next-door neighbor or they know somebody who knows somebody, which tends to happen. At least, that’s what I’ve observed can happen in these environments.

Q: Can you talk to us about how you’re managing the governance for all of your digital initiatives? What’s your org. structure? How do you go about making the investment? Is there a pool of funds that you know that’s signed-off of the border?

Timothy: That’s probably a full hour topic on that front! I spent a lot of time on that early in the process, because governance, especially across our digital properties, was a little all over the map and there wasn’t good correlation between the financial investments and the results and whether those results were achieved without financial investment and how that investment got added, was ad hoc.

So, we came up with a good idea. I spent a lot of time besides inventorying and consolidated rationalizing to figure out what the right governance teams were and finding the right senior leaders that should be part of what we call the G9 — the top nine leaders that are engaged in approving both, funds and prioritization. It’s an interactive model where they’re engaged. They’re the Steering Committees you find historically which are here, but the people on it aren’t showing up to the meeting. They weren’t engaged and they didn’t know that they needed to be actually rolling-up their sleeves and being embedded in this. They actually got to put in that energy and engage in it. If they did not engage, they’d be replaced with another who wanted to engage irrespective of seniority.

It wasn’t enough to engage, they also had to be empowered to make decisions. If we needed to make a decision on something, we didn’t need to go to somebody outside of the G9 to ask, “Mother, may I?” That was a top governance piece.

Below that, my Chief Digital Officer created a Chief Digital Steering or Execution Team that comprised people from IT, the digital team, and every operational area that’s out there. Part of this also was about going to the senior leaders on the G9 and saying, “Hey! Listen, I need a strategic person, an operational person that knows your business in and out. They have to be empowered to be able to engage anywhere and help shape the things that have to be done in that area, whether it’s around their strategies or where they’re heading, or whether it’s operational re-engineering that needs to occur.” So, we created that broader core team that is doing that day-to-day work.

We executed on creating that prioritized portfolio. Now, we have sponsored an Initiative Owner for every initiative in that digital portfolio, which we didn’t have before. There were no sponsors that were engaged or held accountable for being engaged. So now, we have initiative. Now we say, “This is a great idea. If you want the initiative, you must also have a sponsor. Do you have one? Do you have an owner? Here’s the definition of an Initiative Owner. If you don’t have one, we’re not going to approve that.”

So, it’s not just about saying this is the right list; it’s also about checking if we have the right skin in the game to make it successful because you can’t do digital transformation off the side of your desk. It’s a core component that’s all encompassing of people’s time.

Q: How do you see the role of the C.I.O. today and what has changed in the last couple of years?

Timothy: Great question! There needs to be a certain amount of technology background and engineering discipline involved because this is a complex world where technology gets bigger and bigger in the forefront of enabling business and a lever in the business.

Historically, where the technology and technology leaders were thought to perhaps be the necessary evil to keeping the lights on, things running, and my computer working, it must be a strategic lever to our overall enterprise, special business and operations strategy.

In some of my roles, I’ve always been an engineer and a technologist by heart, driving architecture environments both, as C.T.O. and C.I.O. In my last role, I held Chief (Operations) and I.C.O. responsibilities in Governance. So, understanding the business and the full value chain from beginning to end is a critical part to being successful as a technologist and especially, a critical part to be a successful C.I.O.

If Sentara wanted me to join as a C.I.O. to just run technology thinking that I’m a technology guy, I probably wouldn’t have come here. I would only want to come here if they saw me as an equal business partner at the table, figuring out what we want to do with this growth strategy, what lines of business we want to grow, the additional care services we want to expand, the M&A work we want to do etc. If I don’t have an equal play and an equal seat at the table and if I can’t say, “This matters and I have an opinion on things more than just technology,” I wouldn’t have come here and I don’t think you’d get as much out of the C.I.O. role.

The more you can find that, the better. You’re not necessarily going to find it all in one package. The fact that I’ve been in health care for 25 years is a tremendous benefit that you may not be able to find. In some areas, maybe your Chief Digital Officer coming from the retail world without any health care experience helps because they’re not jaded to the environment. For my opinion as the core head technology leader, having that experience, knowing that business and being able to think like an operator as well and then, that put with the balance of funding with value, balancing around operations – giving and taking what matters, becomes important.

I could say, “Give me a hundred million dollars for security. I’ll make you more secure.” So, are you going to be – “Is that really going to pay off? Is making you secure enough to justify 100 million? What is the balance of that pragmatic approach to leveraging tech?” The analogy in a business, and I think, that’s what a C.I.O. needs to be in the environment and stay as effective as they can.

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 industry is moving away from point solutions

Season 4: Episode #119

Podcast with Kristin Myers, Chief Information Officer, Mount Sinai Health System

"The healthcare industry is moving away from point solutions"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Kristin Myers, CIO of Mount Sinai Health System, discusses topics related to the digital transformation journey at Mount Sinai – telehealth and access, digital patient experiences, remote care, home health, and more. Kristin also talks about the multi-year cloud transformation journey at Mount Sinai with Microsoft and the key themes that her team is focused on this year.

Kristin discusses why telehealth and virtual health are critical components of healthcare in the future and provides insights into how she makes technology choices in a rapidly changing landscape. She reflects on the changing role of the CIO in healthcare and why she decided to rename the IT organization. She concludes with advice for startups looking to partner in Mount Sinai’s digital transformation journey. Take a listen.

Our Podcast Partners:

Show Notes

01:51What does your digital strategy at Mount Sinai look like? Can you share your top priorities for enterprise digital transformation?
05:21Please tell us a little bit about your recent announcement about a multi-year cloud transformation journey. What led you to do it and how is that going to enable you to accomplish all the goals that you just talked about?
08:24A large part of your application's estate is going to the cloud. Are you moving your EHR, for instance? Can you talk a little bit about what all that means?
09:46 What does it feels like to be one of the pioneers at the front end of this cloud migration wave from the point of view of health systems and health care providers? Are we in very early stages of cloud migration as a sector, as providers?
12:07Tell us about your experience in the investments you've made in your telehealth program. Where do you see yourself today with regards to your patient population and provider community adopting it?
14:32 What are the challenges you've had to overcome and what are your immediate priorities as it relates to the next stage of evolution of this hybrid model of care?
15:54 Can you talk to us about how you approach the platform choices to create this seamless consumer experience?
23:14Tell us about your high-level approach to data and analytics.
26:35What are your thoughts on automation technologies and where you see them being applied in your context?
30:47What's your advice to the startups if they want to approach Mount Sinai to be a partner in your journey?
32:53Why is the industry moving away from point solutions?

About our guest

Kristin Myers is a visionary leader who is steering IT transformation efforts to align and support the strategic goals of Mount Sinai Health System. As Executive Vice President, Chief Information Officer and Dean for Information Technology, her main objectives are to drive agility in the department to support the health system’s mission of clinical care, research, and education; optimize the department’s operations; and enable the Health System for digital change.

Ms. Myers joined the Health System as a Director of IT in 2004. Her many key accomplishments include leadership of the Epic clinical and revenue cycle implementations and the organization’s transition to ICD10 coding, and establishment of the IT Program Management Office and Change Management as a discipline within IT in 2009.

Ms. Myers is a nationally acclaimed healthcare leader. She was chosen as one of Crain New York’s Notable in Health Care list in 2021, selected to join the 2021 HIMSS Future50 Community, awarded the Modern Healthcare 2021 Top 25 Women in Healthcare honoree, and listed as 102 Women to Watch in Health IT in 2020. Under Ms. Myers’ leadership, Mount Sinai was awarded the prestigious Health Information and Management System Society (HIMSS) 2012 Enterprise Davies Award of Excellence for its electronic record implementation to improve quality of care and patient safety. Most recently, Mount Sinai Morningside and Mount Sinai West received HIMSS Stage 7, the highest level of technology adoption.

Before joining Mount Sinai, Ms. Myers worked at Cap Gemini, Ernst and Young, and the Cerner Corporation in Australia. She holds an Executive Master of Public Health from Columbia University and an Executive Chief Information Security Officer certification from Carnegie Mellon. She has been designated a Fellow of HIMSS; has received certifications in Program Management (PgMP), Project Management (PMP, Prince 2), and AIM Change Management; and is a Certified Professional in Health Information and Management Systems.

Q. Kristin, thank you so much for joining us, today, and welcome to the show! Please tell us a little about Mount Sinai.

Kristin: The Mount Sinai Health System was created in 2013 when the Mount Sinai Medical Center merged with Continuum Health Partners. We have eight hospital campuses in New York, and the Icahn School of Medicine. The Mount Sinai Medical Center has had a very long history. We started out in 1820 with the New York Eye and Ear Infirmary, and over time have accumulated hospitals. Our main hospital was founded in 1852. We have around $9.3 bn in revenues, 43,000 employees, and over 7,000 physicians — a very large academic health system in New York.

Q. What does your digital strategy at Mount Sinai look like? Can you share your top priorities for enterprise digital transformation?

Kristin: Everyone is aware of the pace at which technology and digital is transforming health care. It’s just accelerated exponentially, especially with COVID. Given the number of ways of doing business, today, we have to shift to digital workforce, embrace new digital channels in which we can engage our patients and, adopt innovative ways to provide care. My goal has been to reinvent and transform technology and digital as an organization and drive real change in culture so that its innovative and resilient within the department. For me, then, there are three key themes I’m really focused on: first, is customer service, and being able to serve and support and enable our stakeholders. The second is innovation, that must be done at-scale, at the enterprise-level with focus on differentiation, new ways of working, and new business models after which we must examine new opportunities to drive change and transformation.

The third is around digital, where we think about our patient and employee experiences within an overall digital strategy and roadmap. The focus, then, is around digitally enabling Mt. Sinai as the preferred destination for our community. It’s important to anticipate needs so that we can provide that equitable and seamless experience to everyone we interact with.

Also, when I think about digital, I go back to a framework with three key components: digital business models to reimagine the way we do business with digital and technology capabilities; digital experiences that focus on the experiences that our patient and employees are having; digital core, which is around our operating model that revolves around people, process, and technology.

We’ve really taken a step back to think about how we can devise a more experience-led, integrated approach so that we’ve got a digital roadmap that prioritizes the identified key opportunities, understand what the technology implications and changes are that need to be made to support that, and then, incorporate other considerations like program governance, change management before activating it as a whole enterprise-wide.

Q. Mount Sinai has made a recent announcement regarding a multi-year cloud transformation journey. What is its scope and scale? How is that going to enable you to accomplish all of these goals you’ve mentioned?

Kristin: I’ve looked at each functional area in the technology organization — the data centers, our business continuity, and disaster recovery plans etc. Question is, how do we transform that? When I see our target operating model over the next five years, it means that we have to have a Cloud transformation, need to mature our capabilities around business continuity and disaster recovery and then, provide that modern and scalable platform in which we can grow with the Health System.

We’ve partnered Microsoft, our cloud provider and Accenture, our system integrator to really execute on that Cloud and data center transformation and support innovation efforts to enable new business and growth models that can drive research and A.I. efforts. These measures will support an academic medical center with more modern technology infrastructure and increased security, that will improve our uptime recovery and enhance agility while avoiding significant costs to complete facilities, remediation and hiring of additional data center and facility staff.

Just to give you a sense, we have 13 data center and server rooms across the Health System. That’s significant and being able to reduce that to at least one on-prem, eventually, would be good. It’d be great to have none, but one at least will significantly reduce our costs and improve our ability to recover from outages that would impact revenue, patient care and operations. We get to have that geographic diversity and failover capabilities that are in the Cloud, too. This, then, was a large step forward that was necessary for us to do as an organization.

Q. Are you moving your EHR, for example? Can you talk a little about what that means?

Kristin: We’ve gone through our application portfolio and reviewed which applications would be a light lift to move to the Cloud versus a heavy lift. Now, there are some applications that, today, are not ready to be moved to the Cloud, so, we’ll have to work with those vendors over a period of the next few years.

As it relates to the EHR, our intent is to move Epic to the Cloud. We’ll start with the training and testing environments, and disaster recovery before we even move to some of our larger environments, and ultimately, production. But, we’re working very closely with Epic as well as Microsoft and Accenture to make sure that that transition will be successful over the coming years.

Q. You would be one of the pioneers, you know, and at the front end of this cloud migration wave from the point of view of health systems and health care providers. What does that feel like?

Kristin: We’ve seen the financial services and other sectors that have already made this transition. When I speak with other CIOs it’s clear that everyone’s looking at Cloud and Software as a Service. Many applications that are already in the portfolio are SaaS. So, CIOs are taking a gradual approach.

But it also depends on the investments that have been made historically, in data centers. Some CIOs have built their data centers from the ground-up and invested significant amounts of money in doing that. For us, it was a very different picture when we started looking at our investments and how many data centers we had. Overall, the business case for us to move to the Cloud really made sense. For other organizations it may not make sense at this time. But, taking that gradual approach might.

Q. Going back to some of your digital transformation themes, one of the big one of the big shifts in the last couple of years has been towards telehealth models. Do share your experience with this. Where do you see yourself, today, with regard to your patient population at Optum and your own provider community?

Kristin: We’d developed the infrastructure prior to Covid and had a number of physicians experimenting with telehealth. But it was not necessarily part of the model of care, across the Health System. When COVID hit, we were able to scale very quickly and we saw large volumes with telehealth, too. Today, as we see with the trends of other health systems, it’s dropped, but it’s been very steady — around 15 to 20% of overall ambulatory volume, which is significant. Investments will continue in this.

We’ve made a lot of investments around tele consultations in the in-patient setting, too. And this has resulted in savings in the cost of care leading to alleviation of clinical capacity constraints by diverting patients from higher acuity sites of care. That will also continue to be an area that we invest in. For us, access is really the center of our digital roadmap and a core priority, so, ensuring that we have virtual health as a key pillar that we continue to invest in, will always be important.

Q. We’re now settling towards a hybrid model of care — a mix of in-person visits complemented by virtual visits. Here, the quality of the experience becomes very important. Can you talk about the seamlessness this entails? Also, what are the challenges you’ve had to overcome to get to the next stage of evolution of this hybrid care model?

Kristin: It’s important to make sure that the platforms that we’re utilizing are ones that integrate very well with the EHR. We’ve used a variety of tools that have integrated well with Epic. We’re currently looking at Zoom as part of our overall unified communication strategy. They have been integrated with Epic and may be a good vendor long-term for us to work with. Considering that, we’re looking at them more broadly across the organization.

Q. When you look at your tool and platform choices, there is a plethora of options out there. How you approach these platform choices to create a seamless patient experience? Do you have an Epic-first policy to go with or do you evaluate tools on a case-by-case basis?

Kristin: I always think about the overall Epic roadmap because it is one about foundational platforms similar to maybe ServiceNow, Salesforce and ERP. It’s important for you to understand what the roadmap is and what functionality is coming in the next 2-3 years. There are so many gaps with any of these foundational tools that you always need to be looking at other solutions to complement them.

My approach is looking at the solution in the context of experience, specifically, for our patients and employees. That’s key. How does the platform integrate with some of the foundational products like an Epic is important, too. It’s equally crucial to be really intentional about what the roadmap looks like — Are we implementing a product or a point solution for 2-3 years before it becomes part of the roadmap of Epic? Will we decommission it when Epic releases this function and adopt that? It’s methodical but Epic tools need to be able to have the functionality of these point solutions, and that’s some of the challenges over time.

Q. I think that’s a very valuable and interesting input for, especially for startup founders listening to this podcast Let’s now talk about the remote care and home health part of digital transformation. Can you tell us about your own experience and some of the programs that you’ve got going in remote monitoring and home health spaces?

Kristin: This is a space our teams are working on, specifically with Mount Sinai Health Partners, in population health. Currently, we have approximately 2,000 patients enrolled in remote patient monitoring, specifically around, an area like blood pressure. It’s a priority for us and we need to be able to expand these programs. In the meantime, we’re looking at possible foundational partners overall, for remote patient monitoring. There are a number of vendors since it’s a crowded marketplace! But to have one vendor for many of the capabilities while that’s ideal, I don’t think we’ll get to a 100% of the capabilities with one. However, if we can get a vast majority with one, that would be helpful. I’m interested to hear what your thoughts are about this space.

Q. I see that home health is definitely going to be the default mode of care in the next 5-10 years for a large part of one’s routine and chronic care needs. When one needs to come into the hospital, one comes to the hospital. The big investments will come in from companies like Amazon who will define the space in some way going forward because they’re approaching the market from a different standpoint. The technologies that are emerging can make it a viable reality. So, whether it is remote monitoring, where you can use the sensors and monitors and devices to pull the data and intervene appropriately or whether it is voice recognition technologies, each one will enable the shift towards more of a home health model.

Kristin: What are you seeing with the vendor marketplace? From our perspective, it just seems very crowded. There are also many of the vendors who do not want to integrate with the foundational system.

Q. There is a lot of tension between a foundational system, Epic in particular, I’d say, and the vendor community out there at large, and that’s got to do with the source of the data. How do you get the data to drive the experiences? While the vendor landscape is thriving, it’s also very fragmented so it’s very hard to see who’s going to make it and who is not. There’re a number of things in play there — Integration with Epic HER, EHR and transaction systems, the workflows, how do you really take care of people at home? How do you create a seamless model where they can come into the hospital, go back, do a tele-visit, be taken care of at home etc. There’re al these that need to come together, seamlessly. I think, we’re still some distance away from creating that seamlessness.

Q. Mt Sinai’s got the Hasso Plattner Institute for Digital Health. You have significant research-related data and an analytics program. Tell us about your high-level approach to data and the analytics program.

Kristin: About two years ago, we took a step back and looked at all of our data assets across the Health System. Being a research organization, we have a number of them. But while we have a lot of data assets, we needed to create an enterprise data hub. We’ve been making a lot of investments, looking at data governance and data stewardship, making sure that when we’re providing data to either our researchers, educators or faculty, that it is of high quality. That’s been an area of focus.

We’ve been ensuring that our data is accessible and can be sent to our payers. There are significant incentives that we get owing to this like any health care organization, so, being able to create that real-time data feeds to the payers has also been an area of focus.

Predictive modeling has also been critical for us. We have an amazing clinical data science team that develops predictive models and integrates them with Epic. We’re looking at ways in which, potentially, we could spin-off some of the work that is being done for it has a very large outline and tremendous operational impact in really improving quality and outcomes. So, there’s a lot of exciting stuff going on here, but, predictive modeling is probably one area that stands out to me.

Q. You mention data quality. I often hear about the fragmentation of data sources, devices and absence of a standard data model. Is it fair to say getting data in a standardized format that can be wrangled into a usable dataset is a significant challenge?

Kristin: It is a challenge and something that we’re working through as part of our overall enterprise data hub strategy.

Q. Let’s talk about the acute labor shortage economy-wide that we’re experiencing and the automation technologies that are stepping into the breach in some way. Can you share your thoughts on automation technologies and where you see them being applied in your context?

Kristin: Automating administrative tasks through Robotic Process Automation can reduce human workload and realize cost savings. It can increase employee satisfaction and retention rates because it takes some of the very simple and basic work and automates that so employees can focus on the more complex work. We have an RPA team that works with the business and looks to identify, evaluate, and execute some process automation opportunities.

We’re also investing in some conversational AI to free-up capacity, there.

The IVR is also a tool to automate administrative tasks, improve employee experience and prevent burnout. That’s a real problem that we’re seeing across the board, whether it’s the clinical teams — our physicians and nurses – or frankly, everyone in health care.

Q. You’re the CIO of one of the largest health systems in the country with a long career in technology. How has the role of a CIO changed over the last few years? What are the big leadership qualities expected of CIOs, today? How is this different from what it might have been before?

Kristin: It’s so different. If you asked people what the role of the CIO was pre-COVID, you probably got different responses. So, it goes back to how technology and digital innovation has just accelerated. It’s no longer about managing IT anymore. It’s about leveraging technology and the digital to enable business, drive growth and create value. Being a partner at the executive leadership table means I can influence and help formulate and enable the business strategy of the health system and then, execute on those priorities to really achieve the business outcomes.

So, it’s a huge change in mindset and how people view the IT function, which is why I renamed our function — Digital and Technology Partners. This represents our vision, value, culture, and contributions to the health system.

If we say IT, it doesn’t necessarily appeal to a new digital generation either, right? We want to be able to try and retain and recruit technology talent. This will continue to be an ongoing challenge. Everyone’s aware of the great resignations, so, being able to attract talent is really important. So, it’s a very different role.

Q. There’s a lot of folks listening to this podcast who are from the technology startup ecosystem. What’s your advice to them if they want to approach Mt. Sinai to be a partner in your journey?

Kristin: Be clear on the value proposition and the business model. We’re a large, mission-driven organization and our operating margins are pretty tight. So, we’re always looking for sustainable business models with measurable impact. Some companies will offer a “free pilot before you scale,” but, nothing is free because it means that resources and teams are being redirected and all of this comes at a cost to the organization. Understand that, even if that offer is made, it still requires a comprehensive review.

I’d encourage these startup organizations to think about how the industry’s moving away from point solutions. So, if you’re going to pitch that, you need to ensure that you’re articulating how to address capability and experience gaps and how that could integrate into our foundational products, such as, Epic, the ERP, etc. Health care organizations are going to start focusing more on the patient and employee experiences, so, having so many digital health vendors that don’t integrate with one another, only dissatisfies our patients and employees.

Q. This may be a topic for a much deeper conversation but I’d like your thoughts on is this lack of integration causing the friction that you’re alluding to and is that why the industry is moving away from point solutions?

Kristin: I believe so, because we have frictionless experiences in our everyday life with other industries. With health care, there’s a lot of friction. Some of this is really down to the lack of a focus on that experience. If there are so many vendors that aren’t interoperable and providing that seamless experience to patients, it is dissatisfying, right?

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.comand 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 unlikely to see digital health investments doubling again this year

Season 4: Episode #118

Podcast with Justin Norden, MD, Partner, GSR Ventures

“We are unlikely to see digital health investments doubling again this year”

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Justin Norden, Partner at GSR Ventures, shares his personal story to inform the investment thesis behind GSR Ventures’ health tech-focused venture fund. Justin is both a physician and a computer scientist by training and has a real passion for the Medicaid sector. He discusses the many challenges in healthcare for startups and points to the potential that lies with the Medicaid population and how technology can help turn it into an opportunity. GSR Ventures specializes in funding early-stage digital health companies.

Justin talks about the digital health funding environment and why he thinks that in 2022 we won’t see the same levels of investment as in previous years. He shares his advice for founders looking to launch digital health companies and what it takes to successfully sell to and partner with health systems. He also offers thoughts on how the entry of big tech in healthcare will open new opportunities for startups. Take a listen.

Our Podcast Partners:

Show Notes

05:41Last year, USD 30 billion was pumped as venture capital into digital health startups. What's your outlook for 2022?
09:25There's a lot of risk for health systems betting on a startup that is unproven or surviving from one funding cycle to the next. How do you square this influx of capital here with growth in the number of startups?
11:21The big techs are making big investments. What does it mean for your portfolio companies and the competitive landscape they are operating in now?
13:57 When you talk to your portfolio company founders and teams, what do you see as significant challenges they grapple with on an ongoing basis?
16:59There is a criticism that technology startups tend to look at everything through a technology lens. How would you respond to that on behalf of your founders in your portfolio?
18:52 What is your piece on the Medicaid space? Where do you see an opportunity to serve the population and make money?
22:32 There’s an acute talent crisis in the tech sector. How does that factor into your investment decisions? How are your startups working through this challenge?
24:45If I were a startup founder with a great team of engineers, a great idea to serve the Medicaid population, and listening to this podcast, how would I be able to appeal to you?
25:34What is your advice to founders listening to this podcast, wanting to build a digital health startup and make a difference?

About our guest

Justin Norden is a Partner at GSR Ventures, where he focuses on early-stage investments in digital health. Prior to GSR Ventures, he was the CEO and co-founder of Trustworthy AI which was acquired by Waymo (Google self-driving). He worked on the healthcare team at Apple, co-founded Indicator (an NLP based platform for biopharma decision making) and helped start the Stanford Center for Digital Health.

As an academic he is an award-winning machine learning and bioinformatics researcher with 20+ publications. Finally, Justin is a former professional athlete and 3x world champion in ultimate frisbee.

Justin received his MD from Stanford University School of Medicine, MBA from the Stanford Graduate School of Business, M.Phil in Computational Biology from the University of Cambridge, and BA in Computer Science from Carleton College.

Q. Justin, welcome to the show and tell us a little about the fund and how you got into launching it.

Justin: GSR Ventures is a health-tech focused venture fund based in the U.S. My partners and I share a common vision to transform healthcare through new technologies that really have yet, in our opinion, to disrupt the healthcare ecosystem. So, I can walk you through my own personal journey and we’ll see how that informs our investment thesis with the fund.

I started out as a computer scientist — my undergrad and master’s are in computer science and computational biology, where I focused on machine learning and genomics. The plan was always to be a physician coming from a family of physicians, and this was something that I always felt was such an amazing thing — getting to care for patients.

Through my journey, I ended up coming to Stanford for medical school, where armed with this computer science and tech background, I felt like I kept banging my head against the wall of “why are we not able to do things better with technology? Why don’t we augment what we’re able to do, augment the repetition, automate some of these processes and really spend more time with patients and deliver that better care?” Ultimately, I took some clinical detours, which ended in launching our Stanford Center for Digital Health. We’re doing some of the first telemedicine visits out of Epic, taking care of our ACO population.

From there, I left to join the team at Apple, where we were doing some amazing things at-scale. I want to talk a little bit more about what big tech companies are doing, today. You can’t spend this long in Silicon Valley without getting the startup edge, so I tried my hand a few times, as a founder of one of the companies focused on algorithm safety and trust. “How do we know what client is doing, what it’s meant to do?” Ultimately, I ended up selling that company to Waymo, Google’s self-driving car company, and then came to GSR Ventures where we just shared this common vision to change healthcare through technology.

Some of my partners here have similar backgrounds as physicians, former entrepreneurs or former technologists. And fundamentally, we saw this opportunity to take that technology into health care and make it happen. Now, it’s not easy, we know. Many of us have tried to do this for years but in the recent past, we’ve really seen transformational changes — with COVID, with adoption, with physicians finally buying in that this will be the future. We think that is really only going to accelerate.

So, for us at GSR Ventures today, we’re focused on companies that don’t offer incremental improvements, but focus on 2, 3, 10, if not 100x X improvements through the use of new technologies, such as, asynchronous telemedicine, digital therapeutics, and companies working in Medicaid, which have previously been ignored. These are things that really get us excited.

Q. Let’s now talk about the big picture. Last year, USD 30 billion or so was pumped as venture capital into digital health startups. The corporate sector and many health systems — Providence, UPMC, Kaiser, Unity Point — launched their own funds. So, what’s the outlook for 2022?

Justin: I just spoke with Matthew from Unity Point and Craig from Cigna Ventures at a conference in Chicago and I think, it’s really accelerated — more than doubled for the past few years — so, I don’t think we’re going to see that doubling again this year.

You mentioned a few of the parties who’ve come to the table in the past few years — health systems, payers who’ve jumped in but the other group that’s really jumped in from the investment standpoint is people who traditionally work outside of health care. There’s a lot of former technology investors, very big inventors, hedge funds and venture capital firms who previously had been on the sidelines for health care, but who during COVID said, “Hey, this is a market we should jump into.” It’s really all of these parties who’ve created this rapid acceleration in funding.

Is that going to double this year? No. It’ll be fairly close to where we were in 2020 to probably 2021 from a venture capital dollars standpoint, because there are many great companies and amazing opportunities, as companies have really good fundamentals, are growing and again, have the four trillion dollar health care market to go after.

What’s going to be different, though, is there were some companies that — especially of investors, who maybe weren’t as familiar with how health care works and had little idea how long it takes to sell into some health systems and payers — saw some overhype in certain categories and valuations and which looked more like software companies, when really some of these that were recently funded, were more traditional health care services with software on the fringes.

There’s just really going to be an awakening. It’s been seen on the public market-side of these companies that were valued like true tech companies, when in reality, underneath the hood they’re really more health care services companies that trade at very different multiples. That has already corrected some on the public market-side. Many of the companies that went IPO over the past few years went through SPAC mergers, however, have come down significantly as people realize, “Hey, health care is hard.” And fundamentally, these businesses look a little bit different than we expect. So, we’ll see that traction in valuations in the private market side, but there’s a lot of room for growth here, so we remain incredibly optimistic for our companies going forward.

Q. Companies that have gone IPO have seen a drop in their overall market cap. No one’s making money. Privately held companies that are VC funded are operating perhaps at subscale, individually, and fragmenting the market. There’s a lot of risk for health systems betting on a startup that is unproven or surviving from one funding cycle to the next. For the startup, too, long sales cycles are fatal. How do you square this influx of capital here with growth in the number of startups?

Justin: You offer a fair assessment. A lot of money has gone into startups, ideas and some early traction but what’s really needed for them to successfully sell and partner with health systems is, proven ROI clinical validation of the solution. That’s something I’m hoping to see more of as we progress.

Take mental health, for example, one of the leading areas for investment the past few years. There’re so many solutions on the market, most of which have never published results that their methods are working, or that their patients are really getting better and instead, rely on some very soft ROI metrics. I think this is an area, in particular, that we’re going to see consolidation and companies moving around.

Have you really proven your results? Does your technology solution actually work to make patients better? Are people really seeing ROI from a health system repair result after implementing these solutions? We’re starting to see that. In crowded areas, this is a way that startups will break-out and the health systems will say, “Oh yeah, this startup has clinical evidence to prove this. This other one, doesn’t.” So, we’re going to go with that and I expect to see more of both this year and in the future — just how people pick and sift through the many options for certain conditions.

Q. Consolidation is definitely one path for many of these startups showing some potential and promise. Let’s talk about the big tech companies. They’re making big investments as well. What does it mean for your portfolio companies and the competitive landscape that they’re operating in now that Amazon, for instance, is getting directly into the business of healthcare services?

Justin: It’s exciting to have so much interest in the market. Fundamentally, we all chose health care, not because we were hoping to make a quick buck but because we wanted to make this better. It’s fantastic that we’re getting all of the big tech companies and people interested in doing that.

In terms of what it means for our startups, we need to figure out how to work with them. Take for example, CVS announced a large partnership with one of our companies, Marable, around making clinical trials better, creating an access point for those patients. As start-ups are really able to prove that they’re delivering their solution, these Big Tech companies become a wonderful partner to take that distribution channel and really scale it across the country. So, that’s the first example we’re really excited about as our startups really begin to prove that they’re winners in their field. These tech companies become a fantastic partner to really grow and continue to build that relationship.

In other areas, it’s always a joke. It’s the easiest thing to say, “What if Google or Amazon, you know, does this?” It’s real now, in this space. Know that if you’re trying to deliver medications to someone home, you are now competing directly with Amazon. It’s exciting and interesting to see that growth there.

Fundamentally, some things we think about as early-stage investors are — What is going to beat them up? How are you going to build a network proprietary distribution IP around what you’re doing? As long as you do a good job of those things, you’ll be able to compete against some of the big tech companies as you are growing able to be successful. It’s interesting partnership opportunities for if things go sideways, I’m assuming we’re going to see more acquisitions from some of these big tech companies. But fundamentally, it doesn’t change if you’re taking an interesting idea, figuring out a way we can really find this position in the market and grow from a position of strength, then, startups will just be fine. Health care is so big it’s going to take many, many hands to make this better.

Q. When you talk to your portfolio company founders and teams, what do you see as a one or two big challenges that they grapple with on an ongoing basis? How do you help them think through it?

Justin: So many challenges! It depends on the day of the week for what things are coming up but, one of the most important ones within health care is — How do you build real fundamental partnerships that are win-win?

As an early-stage company, this is one of those big challenges — Do you take strategic capital from a potential big player? Does that hurt your financing options, later? Do they have too much control so you can’t partner with one of their competitors? How do you structure a contract such that there’s real buy-in that they’re not just buying your IP, buying the option value with no kind of real guarantee that they’re going to deliver on their app?

These are fundamental things — How do you contract a partner with some of these bigger players so that, if it goes well, it can be a huge boon to your business but, if it goes badly, it could really hinder you from other potential partners without any kind of real upside. Navigating a few simple things like that whether it’s pharma payers or health systems, quickly, is something that comes up again and again, especially for early-stage founders.

Q. Are you saying that taking on more risk is something that start-ups should be prepared for when contracting?

Justin: Not necessarily; it’s just being really smart about how you’re thinking about a distribution channel. So, it’s about ensuring that there’s real skin in the game and that they’re excited that you’re going to move through a procurement process, quickly, and not going to get stuck in a two-year cycle.

This future version that you’re talking about around value, is every digital health company’s dream of saying, “yes, we’re going to work with a payer and take on value when ensuring the cost savings.” But, in reality, it’ll take you multiple years to get there.

We work and talk with our advisors at many of the big payers and often, find that you’re going to have to start in a fee-for-service world. But, make sure you have those conversations upfront so, in the next 12 months, you’re going to move from fee-for-service to a bundled payment and then, ultimately try to move towards capitation or something else, if you can do that with your patient population.

There’re many versions and ways to do this. One of the things that’s just so important is ensuring we set expectations correctly with our founders. When we connect them with someone on the other side, we’re making sure everyone’s ready and prepped for the conversation and not just talking past each other, which happens just too frequently when Silicon Valley tries to interact with some of the legacy health care players.

Q. Fairly or unfairly, I hear the criticism that technology startups tend to look at everything through a technology lens. You’re both, a technologist and a physician and healthcare is a people business workflow. So, how would you respond to that on behalf of your founders in your portfolio?

Justin: I would say, at large, as a field, I mostly agree with that criticism. And that’s part of our job, especially, when we have founders who don’t come from the healthcare industry. To coach with them and work with them, get them to understand that health care is a people business, that health care is more risk-averse — it is going to take longer to build that trust because that’s how health care works.

I teach at Stanford — for medical school – and work with early students. So, sometimes, we tell them, often physicians are the last players to build trust and move towards a new solution. That’s something we work with our founders on, on a daily basis to make sure they know that and understand what’s happening.

Yes, technology does have this potential to absolutely transform what we’re doing. But I thought myself, both, going through school as a clinician and then, again as a technologist, understanding it is a different world sitting in the hospital, taking care of a patient and, writing lines of code on your computer. We need to bring people closer together if we’re ever going to make it work.

Q. Let’s talk a little bit about Medicaid. There’s a lot to be done there and some real challenges as well — Medicaid members rely on their caregivers and their hospitals to actually offer rideshare because they can’t afford Gas to drive themselves to their appointments, can’t afford the bandwidth or data plans for their mobile devices. Plus, this being a government-run program, there’s a whole reimbursement component to it. What is your piece on the Medicaid space? Where do you see an opportunity to serve the population but also make money?

Justin: Absolutely. Every complaint you just mentioned is a challenge in Medicaid, today. But I would argue almost in each of those categories, that things have got better and the opportunity has got closer for the past few years.

So, why is there an opportunity here? Historically, Medicaid has been mostly ignored by every player in the health care system. For the payers, hospital systems are losing money. It’s just a question of how much. So, they need to think of how few Medicaid members can be served, but making sure they keep their nonprofit status. No digital health company has, for the most part, save a few exceptions, targeted Medicaid early because why would I take a third 20% of the reimbursement I could get elsewhere? It just doesn’t work. That’s where technology has come into play and there’re a few trends I’ll point to. I’ll speak to why it’s so exciting.

So first, from a mobile standpoint, for over the past five years, the amount of Medicaid members and just even the US population as a whole that is connected now to High-Speed Internet and has a smartphone, has gone up considerably to the point where it can be more of an expectation rather than a reality. From a mobile connectivity standpoint, things are fundamentally different than they were five years ago.

Two, from a technology standpoint, this is where technology can make a difference in health care. When if you’re traditionally giving services or even just a pure telemedicine visit, yes, the economics don’t work. If I’m a psychiatrist doing a telemedicine visit, I fundamentally just don’t make the same money per hour seeing a different patient. That’s where technology solutions can come in. All of a sudden, when I can deliver an application, an FDA-approved digital therapeutic for a treatment, it can be done at a fraction of the cost and I can treat these patients at-scale. This is where software has the potential to deploy things across millions or billions of phones; an opportunity to deliver asynchronous telemedicine. That’s a tenth, if not a hundredth, of the cost to reach these patients. Fundamentally, the technology tools are now available to treat these patients for a fraction of the cost.

That last part you mentioned, yes, now, we’re working with government and the states. It’s even worse than Medicare Advantage, where we have to work with one plan. We have to figure out how we’re going to contract with 50 states and the MCOs that work with those states. But more and more dollars have gone from state-funding to MCOs, which really allows for more creative options. So, when I’m responsible for the total cost of care, I can do the rideshare, the food delivery, and other things for those highest cost Medicaid patients.

All these things have really pointed to an area with less than a total of a billion and a half dollars flowing into Medicaid startups. Contrast that with almost $20 billion in Medicare Advantage. I focus on that market, whereas Medicaid’s almost twice the size of an annual spend. This has been an ignored area, but the tools are coming together as is the climate and there’ll be some huge winners that we’re going to see over the next few years.

Q. Let’s talk about your startups and your own business. You’re investing in all these startups where a big factor is talent. There’s an acute talent crisis in the tech sector, so how does that factor into your investment decisions? How are your startups working through this challenge?

Justin: I absolutely agree that is such a challenge to hire the best right now in terms of how it factors into our investment decision. The most important thing from our investment decision at any stage is the team — Is this a founding team? Is the management team one that can succeed in the market? Are they on top of their game?

And such an important part of that is, are they going to be able to recruit those most talented employees at cheaper than they’re going?

Every one of our startups, the top engineers, could make double or triple their salaries by jumping over to Big Tech. So, question is, do they believe in the mission of the company that they’re going to help people? Do they believe in the trajectory of the company that has become a unicorn or decacorn and from a financial side, give them upside as well?

That’s the most important thing. A key component of that is how they, as leaders, managers and recruiters, are able to attract talent. That’s what we think about from an investment decision. That has always been one of the most important criteria, if not the most important criteria, as we think about investments and that really just carries over to the tough hiring landscape, today.

In terms of what we say to our startups and how we work with them, we tell them — talent is important and if they need to make a hire, they need to go above what they have to do to attract and get those people. Talent drives everything and so they have to compete in whatever way to get them.

What we’ve seen with most companies, today, is that people maybe have a historically geographic constraint but that’s loosened across almost all our startups so that, that best engineers with us even if they don’t want to come into office, even if they aren’t in the city where the majority of employees are. That’s something we’ve seen just very tactically across the board.

Q. If I were a startup founder with a great team of engineers, a great idea to serve the Medicaid population and listening to this podcast, how would I be able to appeal to you?

Justin: If they said those things, sent me a cold email, I’d definitely be inclined to respond. In that meeting, when I’d be speaking to them – through a recorded pitch or a 10–20-minute practice pitch — the real key would lie in how they’d respond to questions when you started digging in — Why are you doing it this way? How does this happen?

That’s when the real magic would happen. In terms of, at least for me, I’d pitch in evaluating the founder of the team to kind of see if they’re ready for it.

Q. We’re coming up almost to the end of our time here. What is your advice to founders listening to this podcast, wanting to build a digital health startup and make a difference?

Justin: There’s never been a better time to jump into digital health. For many years personally, I found myself banging my head against the wall. We have to use technology. It’s got to be this way. But I felt mostly ignored by my peers within medicine, who didn’t believe that technology would ever make a change.

Fundamentally, that has shifted across all stages of a company with more people saying, “I want to work on something meaningful. I want to work on something that can really change the world and make a mark.” Digital health is the perfect place. So, in terms of advice, I’d say, if people are thinking about this, this is the perfect time to jump in. There’s so much room for growth. It might be not as frothy or as high a market as it was for the past few months. That doesn’t matter. There’s so much room and capital available to fund good ideas and good teams, so, I’d love to work with you.

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.

Even in a small market, we’re looking to utilize technology to expand access to care while improving outcomes and quality.

Season 4: Episode #117

Podcast with Brian Davis, CHCIO, Chief Information Officer, Magnolia Regional Health Center

"Even in a small market, we’re looking to utilize technology to expand access to care while improving outcomes and quality."

paddy Hosted by Paddy Padmanabhan
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In this episode, Brian Davis discusses the perfect storm of competition for patients, labor, and medical supplies that even a small hospital in remote Mississippi, such as Magnolia Regional Medical Center now faces. Brian describes Magnolia as a large ambulatory facility that happens to own a hospital. He explains how he uses federal grants and state programs for rural broadband access to drive telehealth and improve technology adoption among patients and caregivers.

As a long-time user of Meditech EHR, Brian talks about their deep commitment to Meditech and their efforts to build mobile experiences for patients and caregivers. He also shares his thoughts on the recent Meditech partnership with Google Health. Brian shares his excitement on the emerging technologies such as voice in making care accessible and convenient for consumers. He also muses on how emerging entrants, less limited by geographic boundaries, could be extremely disruptive to their primary care services and, ultimately their referral path into their specialty services. Take a listen.  

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Show Notes

00:27Tell us a little about the Magnolia Regional Health Center and the populations that you serve.
03:42Tell us how you make technology choices and what makes your challenges unique?
06:03What does digital transformation mean in your context?
09:15 When you talk about telehealth, can you give us an example of what you've implemented that benefits your patient population and your providers?
10:57You’re a Meditech shop and they recently signed a partnership with Google. What do you make of that and how will that impact your roadmap with Meditech?
16:03 What are the competitive forces you see emerging for a somewhat insulated regional health system like yours and how do you prepare to meet them?
19:57 You talked about several technologies that you use to transform the patient experience. What about things like automation? Have you deployed those to address the labor shortage in particular?
23:31 What are the challenges that you have to overcome to make sure that the investments are well thought-through, and well deployed while delivering results in the shortest possible time?
24:41What are your big priorities for 2022?

About our guest

Brian Davis is Chief Information Officer of Magnolia Regional Health Center in Corinth, MS, where he oversees all the information systems for the 200-bed medical center and 21 medical offices. He is a CHIME Certified Health CIO with over 15 years of healthcare IT experience. Brian has been instrumental in leveraging technology at Magnolia in innovative ways to consistently deliver business value, whether by creating competitive advantage, optimizing business processes, enabling growth or improving relationships with customers.

Magnolia Regional Health Center earned a 2021 Most Wired designation for both acute and ambulatory services. He holds a Master of Science degree in Information Technology Management focused in Computer/Information Technology Administration and Management from Western Governors University.

Q. Tell us a little about the Magnolia Regional Health Center and the populations that you serve.

Brian: Magnolia Regional Health Center is a 200-bed acute hospital located in the North-east corner of Mississippi and jointly owned by the City of Corinth and Alcorn County. Our mission here is to improve the health of the communities we serve; one patient at a time. We are a fully accredited joint commission facility servicing a seven-county region including four counties in North-east Mississippi and three in South-west Tennessee.

We supply over 20 service lines to the community, including a level-three trauma ED. Also, we operate around 20 ambulatory clinics that are comprised of primary and specialty care and have a residential-based home health and hospice facility.

Our primary service area has a population of around 37,000 while our secondary service area has a population of around 141,000. We do have a higher the national average or higher than national average median age, and about 18% of our families do fall below the poverty level. So, we do have a higher percentage of governmental payers within our payer mix. We also have a higher average of individuals without health insurance that are under the age of 65. And within those populations, we see about 30,000 patients annually through our ED. We have about 90,000 annual outpatient visits, 10,000 inpatient visits and about 33,000 ambulatory visits. So as my CEO likes to say, we’re really an outpatient organization that happens to own a hospital.

Q. You mentioned several interesting facts about your unique health system. You’re in a unique place, geographically and very uniquely defined by your population. Tell us how you make technology choices? What makes your challenges unique?

Brian: Ultimately, I don’t think this is unique to our organization, but we do like to align our technology choices with our organizational strategic plans so that we’re all driving in tandem with the rest of the organization towards the same goals.

At a high level for us, those goals are to engage our teams, provide our patients with high-quality, personalized care, strengthen our financial position, and create a stable future for our staff so that we can continue to deliver our mission to our patients and the community. We are also looking to expand our care by connecting patients with the right care at the right time, delivered by the right caregiver. These are what ultimately drive our technology decisions.

However, being a smaller regional hospital with finite resources, we have to be mindful of the operational impacts of technology and modernization — the costs of both, the short-term, long-term resource commitments to the technology and the associated cyber security implications. We want to provide our staff and consumers with the latest and greatest in technology that helps drive improvements in quality and safety but, we also want to minimize the risks to the organization.

So, we’re constantly asking questions like — Can this technology address multiple challenges intra-organization? Can we leverage existing technology to drive additional product value? Does the technology drive efficiency within our workflow processes? How would the technology complement our existing technology stack? Can we support the solution within the current framework? Do we have the right skill mix in place to support the technology? If not, how much effort will be involved in training the staff to support this? Is there a staff pool available out there for such support? What are the educational requirements for our users? Now, we don’t have a large staff base, but we have to be mindful about it when we’re choosing technology.

Q. What does digital transformation mean in your context?

Brian: I say this year-over-year that, it’s just an exciting time to be in healthcare IT and I may be starting to sound like a broken record to this point, but the level of innovation keeps progressing at a rapid rate, and the insights that are being gleaned from analytics continues to improve and keep pushing the boundaries of what is possible in health care. The pandemic has escalated the adoption of digital technologies.

Despite being in a smaller organization and a smaller market, I’m not sure my answer’s very different from other counterparts or the larger organizations. If you look at our technology roadmap, you’ll see the digital transformation for Magnolia lies in the use of digital technologies to create or transform our processes, culture and experiences from both, our consumers, and staff to enable improved care delivery and potentially, even in a small market, create a competitive advantage.

As far as what we’re investing in right now, if you go back to what drives our technology decisions, we’re looking to utilize technology to expand access to care while improving outcomes and quality. We recently submitted for and received funding as part of the FCC Telehealth Grant to expand access to telehealth services within our region. The state of Mississippi is also investing heavily to make broadband more readily available to residents in rural areas throughout the state. We’re looking to leverage these funds in bringing free methods, provide acute-based telehealth consults for those scarce regional provider resources like infectious disease intensivist and behavioral health sources. We’re also looking to build an urgent care telehealth platform that provides immediate access to provider resources for those non-emergency issues, because, being a smaller hospital, it isn’t easy to get through health care resources within the area as it might be in some or other metropolitan areas.

We’re looking to create a remote patient monitoring platform to help improve outcomes for our patients, post-discharge. We’re also working to develop a richer online mobile experience for consumers with access to self-service tools that deeply integrate with the EHR. Such tools not only provide a better experience for our consumers, but they also provide improve staff efficiencies. However, staffing has become a real challenge within the organization.

Q. When you talk about telehealth, can you give us an example of what you’ve implemented that benefits your patient population, but also your providers?

Brian: We’re using video-based parts with Amwell to provide resources to our clinicians and patients. We had an infectious disease provider on staff but during the pandemic, they moved to a larger area to provide services. That left us with no resources available for our patients. When we investigated if it made sense to continue that to provide those resources locally, we decided instead to utilize telehealth platforms to provide those services. We have expanded on that using the intensivist within our medical intensive care unit and behavioral health. We have an inpatient behavioral health and we’re using telehealth services across parts within the organization to provide those video-based consults for those patients.

Q. You’re a Meditech shop and they recently signed a partnership with Google. What do you make of that? How is that likely to impact/influence your roadmap with Meditech?

Brian: We are a smaller hospital, our EHR is one of the largest financial investments, both from a capital and operational funding standpoint. Here, at Magnolia, we’ve been a Meditech client for over 25 years now, and so, we have a significant investment in the Meditech technology stack.

Within the state of Mississippi, we have eight hospitals that form a CIO collaborative that are Meditech users, and this is kind of a routine topic of discussion for us. If you look at these eight hospitals, it is eerie how similar these organizations are from a technology portfolio standpoint. And I think that’s because there tends to be a smaller vendor pool developing within the Meditech space and Meditech really has a limited number of preferred relationships that they really built deep integration again, into the EHR. So historically, we’ve tried to leverage the EHR or as much as we possibly could, even if it did not provide the exact experiences or outcomes that we were looking to achieve because of that deep integration, keeping our users working within the workflow and the context of the EHR.

Meditech’s been a great partner to us over the years, and it’s really developed some great digital tools and we’re very excited to hear about this next generation of collaboration with Google.

But today we’re taking a little different approach to our selection process. We’re taking a more focused approach to discover what solutions work best for us and our organization, our long-term goals, users, and consumer experiences. There’s been some debate as recent as to whether the EHR should remain at the center of the healthcare digital ecosystem and for Magnolia, the EHR still is our core source for clinical and demographic information. However, we are looking at how we can use APIs, new HL7 capabilities, contextual efforts and launches, and other interoperability standards to create sustainable and scalable solutions around the EHR that continue to deliver on our goals to drive efficiency, quality, and experience.

One example is that we currently are working with Meditech and a vendor of ours to develop a Magnolia-branded app out that will wrap the Meditech-branded portal with necessary integration. If you’re familiar with Meditech, there is a mobile app that has been developed by Meditech that all Meditech hospitals use to provide access to the patient for functionality. Since it’s a single app for all that, the app really provides no site-specific customization outside of branding. So, this branded experience that we are currently developing in unison with Meditech will be the first of its kind for the Meditech site and give our consumers access not only to their medical records and patient portal functionality, but also, all the other digital tools that we’re looking to offer and provide. So, we’re really looking to balance the digital roadmap to help us achieve our goals.

Q. It’s so interesting to hear that. Now, when we talk about the broader context of the competitive landscape, what are these competitive forces you see emerging for a somewhat insulated regional health system like yours? How do you prepare to meet them?

Brian: The competition for patients is going to be greater and greater. Now, we not only have to continue to contend with the larger health systems around us — the largest health care system in the United States is actually just 50 miles south of us – but we have to continue to contend with those encroaching upon our service areas.

You’re also seeing a growing digital health market with emerging entrants that tend to be less limited by geographic borders. Growth within the telehealth space and offerings like the integrated access to Alexa connected devices make accessing care extremely convenient for consumers.

Services like these could be extremely disruptive to our primary care services and ultimately, our referral path into our specialty services. So, we have to continue to innovate and come up with new and creative ways to set ourselves apart, build upon our foundational relationships with our patients to set ourselves apart from those competitors.

Also, another competitive force is the competition for labor resources in our market. That’s increased drastically over the pandemic, which has driven an increasing number of workforce out of health care industry. Remote workforce capabilities are extending the traditional geographic boundaries of labor pools, and we now find ourselves competing with other industries and non-local organizations for labor resources. This is a big challenge and a big change for an organization like ours who is the largest employer within the region. We’ve historically had an abundance of applicants to choose from and filling our labor opportunities. We’re just not seeing that any longer. So we have to continue to design our talent strategies to create the right culture within the organization that creates employee experience advantages, keeps our employees engaged, and attracts the right potential candidates to the organization.

Lastly, kind of a new entrant into the competition is the competition for suppliers – that has become more fiercely intense due to the limited availability and general disruption supply chain. As a small organization, we have struggled to procure everything from electronics to specimen collection cups and crutches — just things you would have never even given a second thought to about availability. Items that we have historically ordered and had onsite within 14 days are now taking months to deliver.

On top of that, our supply cost is increasing in an alarming rate. So, for an organization that doesn’t have large margins to deal with, we’ve really got to think and rethink some of our operational processes as we continue to move forward. Bargaining power for supply purchases will play a pivotal role in hospital operations over the foreseeable futures.

Q. So you’ve got a perfect storm there. Now, you talked about a number of technologies that you use to transform the patient experience. What about things like automation? Are you seriously considering those or have you deployed those to address the labor shortage in particular?

Brian: Labor shortage has been a real challenge for our organization as it has for a lot of health care organizations out there that are being challenged by shrinking labor pool, increasing operational costs associated with staffing due to higher wage rates and overtime associated with store shortages.

You know, this has affected our organization on multiple levels — from our entry-level positions all the way through our skilled labor force. It really doesn’t seem to be slowing down anytime soon, so, we are looking at multiple avenues to counteract these challenges.

One of the avenues is to leverage technology to drive efficiency and effectiveness in workflow automation and repetitive task production and keep our staff members working at the top of their skill set. So, we’re leveraging Microbots and Robotics to perform processing of repetitive tasks.

We’ve also invested in new bedside monitoring platform and nurse cost solutions to integrate with the EHR and eliminate manual tasks and automate workflows within the care environment.

Another area that we’re focused on, is improvements in mobility and communication platforms to complement workflows by providing our clinicians with access to information when, where, and how they really need it.

The goal of these technologies is to remove those friction points and improve satisfaction by keeping our staff doing what they enter the workforce to do in the first place – serve people.

And I touched on it a little bit earlier, but another area that we are leveraging technology in is, within our patient self-service tools. We’ve already begun giving patients access to tools to schedule appointment, complete paperwork online prior to arrival, and for which we’ve received really positive feedback in our satisfaction surveys. But we’re now evaluating giving our patients access to additional tools, unify that experience between prior-to-arrival and point-of-service. This strategy helps streamline that registration process that satisfies patients and aligns the process for our registration staff while eliminating some of that staff burden there as well.

Outside of technology, we’re reevaluating the way we operate by centralizing access to resources and eliminating shallow pools of resources to help drive additional efficiency within our labor force. We are creating some flexible staffing positions and implementing safe scheduling opportunities to give workforce more control over their schedule.

We’re also looking for opportunities to expand our remote workforce capabilities in order to potentially expand our labor pool outside of our normal geographic footprint. But we want to do that in a manner that keeps that workforce healthy and engaged in the organization.

Q. What are the challenges that you have to overcome to make sure that the investments are well thought-through, and well deployed while delivering results in the shortest possible time?

Brian: One of the biggest things is to keep the technology engaged with our organization. We’re working with our leadership, end users, frontline staff members to understand their challenges and making sure that we’re deploying technology that fits their needs and is the best fit for the organization.

Keeping those conversations going is probably the top priority there and probably also one of the biggest challenges because of the reduced staffing across the environment. We’ve got a lot of our leaders pulling frontline shifts just to keep the organization rolling. So, not only is it probably the biggest need is probably also one of the biggest challenges to ensure that we’re deploying technology in the right manner.

Q. What are your big priorities for 2022?

Brian: It’s kind of a loaded question because we have so many priorities right now that when everything’s a priority, nothing’s a priority. So, if I was to break it down into a few areas, I would say that talent recruitment and retention is a big priority for us. You know, we’re seeing people leave the workforce and the industry like never before, and the competition for people and labor has increased dramatically.

So, some of the questions that we’ll continue to evaluate over the near future is how can we increase workforce support and decrease burnout? How do we utilize our digital technologies to improve productivity, automation and collaboration? How can we leverage hybrid remote workforce as a recruitment tool? What can we do to create a more meaningful employee experience that really reinforces the individual’s connection back to the organization and our mission?

Secondly, I would say that we’re doing a lot to upgrade and improve our digital infrastructure in a manner that positions ourselves to be more nimble and better prepared to react to the changes in the marketplace and is really a primary priority for us. This allows us to continue to evaluate moves to digital automated processes and away from those manual processes.

We also continue to evaluate opportunities to leverage cloud infrastructure for scale and within this area, it helps that there’s intense focus on improving our customer experience.

And last, but not the least, I would say cyber security remains a top priority. The attack surfaces for health care continues to expand. So, be proactive with our security measures to protect our systems, and our patient data is probably one of the biggest challenges for our organization and one I’m sure that keeps a lot of CIOs across the country, up at night. So, you know, how can we better leverage our technology to identify risks and better position our users to make good sound decisions? It’s going to continue to be a focus area for us.

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.

Digital health startups must ensure that they have a good business case based on reality

Season 4: Episode #116

Podcast with Paula Turicchi, Chief Strategy Officer, Parkland Community Health Plan

"Digital health startups must ensure that they have a good business case based on reality"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Paula Turicchi, Chief Strategy Officer, Parkland Community Health Plan (PCHP), talks about how the organization went from a completely outsourced service model to taking more control over their operations. PCHP primarily serves a Medicaid population of pregnant women and children in North Texas. Paula discusses how they use digital engagement tools and technologies with their members to improve the quality of care and health outcomes. She outlines how economic factors such as rising gas prices impact their members and their ability to afford access to healthcare.

Paula also discusses their data and analytics programs in partnership with their sister organization PCCI, and how they have repurposed existing applications to serve emerging healthcare needs over the past couple of years (listen to our podcast episode with Steve Miff, CEO of PCCI). 

Paula advises startup founders to have a good business case before they approach them with a solution for their target audience. She discusses at length the various considerations for digital engagement for their member population and the risks/trade-offs that they must address while making investment choices. Take a listen.

Our Podcast Partners:

Show Notes

00:42About Parkland Community Health Plan.
07:06In the last couple of years how have the needs for the Medicaid, low-income population changed and how has that impacted your own strategic direction and priorities?
09:58What kind of digital enablement have you invested for your patients?
16:26 Can you share a few nuggets that you've learned in the work that you've done with PCCI, and the analytics work that you have invested in?
17:54You're investing a lot in technology, data, and analytics. Can you talk to us about the economics of it all?
20:10 What's your advice to the startup founders who want to approach you with an interesting solution and offering that you could apply to the population?
22:23 Are all these cool tools and digital health solutions serving the needs of your low-income population? How do you make it easy for them to adopt this solution?
24:09 Do you end up subsidizing some of the costs as well to your patients?

About our guest

Paula Turicchi is the Chief Strategy Officer of Parkland Community Health Plan (PCHP). In her role, Paula strives to make a difference for patients and their families by strengthening the business of the organization through processes, systems, partnerships, and new ventures.

She has more than 30 years of experience in the healthcare industry and previously served as the vice president of hospital operations and administrator of Women and Infant’s Specialty Health (WISH) at Parkland Health & Hospital System, where she oversaw operations for one of the largest maternity services in the United States.

In addition, Paula was instrumental in the design and construction of the new Parkland Hospital facility and the Moody Center for Breast Health. She is board certified in healthcare administration by the American College of Healthcare Executives and holds a Master of Healthcare Administration from Trinity University and a Bachelor of Business Administration from the University of Arkansas.

Q. Can you tell us about Parkland Community Health Plan and your role as the Chief Strategy Officer?

Paula: We are a very large system. Most people know Parkland because it is the hospital where JFK was brought in way back in 1963 and since that time Parkland has grown tremendously. We have the main hospital, plus many community clinics, school-based clinics, lots of really great specialty programs, one of the largest maternity services in the country, a very large burn center, trauma center. So, it’s just a really sophisticated care institution.

A part of the system includes the Parkland Community Health Plan, which has been in service to our community since the late 1990s. We have a contract with the state of Texas to administer Medicaid benefits through the STAR CHIP and CHIP perinatal programs. And so, unlike Parkland Hospital, which serves Dallas County, we serve a seven-county area in the North Texas community. We partnered with about 35 hospital systems, plus 6000 providers in our network to take care of our 220,000 members in the North Texas area. We provide them benefits, ensure that they get access to care. We partner with many community organizations to make sure that we’re meeting social determinants of health and really serving the community through our health plan, as well as through the system.

As the Chief Strategy Officer, I’ve been helping design our path for the future. We started out as a very small plan when I joined about two-and-a-half-years ago. We were really more of a vendor management type of health plan. We had outsourced all of our activities, primarily, and really only had about 15 employees in our health plan. When our new CEO John Wendling, came on board in 2019, he said, “You know, I really want to be in charge of the service we provide. I really want to be connected to the members. I want to be connected to and provider network. And I really want to be the plan of choice.” The best way for us to do that was to take on responsibility for that service, directly. So, we’ve spent the last year transitioning away from our third-party administrator, bringing many of those services in-house and being responsible for that administration of the benefits ourselves. My role has been trying to create that path forward, taking John’s vision and creating strategic documents, work plans and action plans, along with the leaders throughout the organization to really fulfill on our mission, vision and values and our goals to be the party of choice.

Q. You mentioned running such a large enterprise with just 15 full-time employees while outsourcing other functions. Is it fair to say that you are now trying to reverse that, bring more of it in-house for greater control over resources and directly influence the quality of the services that you provide?

Paula: Yes, especially for the health plan, specifically so Parkland, the system, has about 16,000 employees and a huge service. But the health plan was almost a department of the hospital and really not even considered a separate organization. We’ve tried to mature the health plan as a related but a different organization with a different set of priorities and a different set of stakeholders because certainly, if you’re at the hospital, at the center is the patient. Our focus as a health plan, is the member, the provider and then, also our state agencies. Since our contract is with the state of Texas, we want to make sure that we are following the state’s priorities and their strategic mission for the Medicaid programs, STAR CHIP, CHIP Perinate programs. It’s really kind of aligning our priorities with their priorities and we thought the best way to do that was to really become more responsible and more responsive directly as opposed to indirectly. And so, look at all of the services that we are responsible for in our contract and determine the best way to do that in the most responsible way.

Q. You’re serving largely a Medicaid, low-income population. In the last couple of years how have the needs for this population changed and how has that in turn impacted your own strategic direction and your priorities?

Paula: The changes that have taken place over the last two years during the global pandemic have been very dramatic. We have seen an immediate shift to digital options, whereas we were very reliant on in-person healthcare and our members were very used to going to the doctor. Our physicians were very used to having patients in their offices. So, this dramatic shift to digital options has been rapid and I think, very exciting. I think that everybody’s been surprised at the way folks have embraced it, as well. There was always some trepidation – “I don’t think our members will use it. I don’t think our patients will use them.” But we really have seen this dramatic acceptance of the digital options.

We’ve also seen a lot of social determinants of health — needs for housing, food, different sorts of social services — as the pandemic kind of morphed and changed how people were working, whether they were working or not, whether they had transportation. Now we’re seeing a lot of requests for rides because gas prices are so high. A lot of folks are calling and saying that they can’t afford the gas that it takes to get to the doctor or to get to an appointment that they have to fill out their applications or that type of thing. So, they’re requesting help with transportation a lot more these days. So, we’re seeing these shifts in the different types of social needs that our members have and then, we’re trying to very quickly respond to those to meet their needs and to make it easy for them to access those services.

Q. One thing I must comment on is how remarkable that you say you made some assumptions about your population and that those assumptions need to be reviewed because they may be wrong. You talked about rideshares and enabling these through mobile apps. What kind of digital enablement have you invested in response to this in the last couple of years and the emerging demand from your patient?

Paula: One that has been a great success is an app called – Pyx. It was originally developed to combat loneliness in an older population and when we were approached by Pyx, we said, “Well, is it possible to change the focus of the app for our pregnant women and children’s members?” My history and career have been spent mostly in the women’s and children’s arena and I’ve felt that oftentimes just after delivery, women are somewhat isolated. They may not have the opportunity to interact with friends and family as much as they normally would or during their prenatal period. So, is it possible that this app could be used to combat loneliness in the postpartum period for women? It turned out to be a really great tool.

What we’ve found is that women will engage with the app in the wee hours — between, say, midnight and 2 am — maybe they’re up for a feeding in the middle of the night and they just open their phone, and they engage with the app. It’s designed to really almost be an engagement tool to offer information, resources, tell a few jokes, create a little humor and lightness and so we realized from our members that are using the app that it really was addressing a need. Some of those needs that have come up even include say, for example, women who have experienced a pregnancy loss – and this is often an overlooked group of women who need assistance. So, connecting them with behavioral health services or counseling for their grief has been addressed.

The other thing that we found is that women will engage with the app to find things like food or rides to the doctor. And we have also incorporated our value-added services into that app and often ask — “Did you know that we offer home-delivered meals for women in our health plans? Have you taken advantage of that value-added services? If not, this is how you get it. Did you know that we have rides? Did you know that we could connect you to a resource that can help with your rent?”

It really has been a great tool that folks can use on their own time — it meets them where they are and addresses their needs in a unique way. And it’s been highly successful. We’re really proud of that.

Q. It’s a very targeted need for a very targeted population segment. I’ve had the CEO of the Parkland Center for Clinical Innovation, Dr. Steve Miff, talk about some very interesting work that he and his team do in the context of looking at risk factors for things like preterm births, etc. Can you talk a little about that? I’m assuming part of that work relates to your work as well.

Paula: Indeed, it does. We work quite closely with PCCI, and they have pioneered some programs with the health plan to address kids with asthma as well as preterm birth. And so, some of the things that they are doing with us is to identify those members who are in need of additional help with their disease state or maybe, to take a look at how do we predict, for example, preterm birth? Are there indicators that will help us to prevent, say, a second preterm birth? We have refined preterm birth to over time to ask — What have we learned from this iteration? How can we change the algorithm to identify more women who may be at risk? Is there another factor that we can insert into that algorithm to improve our results even more with the pediatric asthma program?

They’ve really helped us to take a look at what are those factors that can contribute to exacerbation of their asthma. Are there things that we can do either in an interaction with the member or the patient or the family to enhance their knowledge of their medication utilization? Or, are there environmental factors, say, in their neighborhood or in their apartment complex or in the house that they live in? How can we partner the PCCI data with our disease management vendor to identify who we need to actually go out and visit in the home? And is there something that we can do, for example, partner with the Dallas Housing Authority to or the city to say, perhaps there’s a code violation in the location where they live, that needs mold remediation or perhaps they need some type of environmental change, pest control, things like that so that we can remove that environmental trigger or their exacerbated asthma. So, it really is a unique way to use the data to then create an action to improve the outcomes.

Q. And I couldn’t help but notice that most of the data that you refer to is as more in the nature of social determinants than clinical or medical. In the work that you’ve done with PCCI and the analytics work that you have invested in, can you share a few nuggets that you’ve learned that otherwise you might not have?

Paula: I think that one of the things we have learned is that all of these factors go together. You can eliminate or at least minimize one factor, but then, another pops up. So, you really do have this iterative process of addressing one need or one factor, and then, the next will appear. The data helps you identify the next factor that you need to address. So, I think that it is a continuous learning and improvement process. And just by using that data, refining it and looking at the next option to address it is just a continuous learning process in a highly collaborative way — What data do we have, how can we use it, how can we develop conclusions from this data and how can we incorporate it into our day-to-day work?

Q. All this also raises questions around who pays for all this. You’re investing a lot in technology, data and analytics. Can you talk to us about the economics of it all?

Paula: That is one of the things that we struggle with. We’re always on the receiving end of, “Hey, I’ve got a great idea for you, or, have I got a great product for you?” So, one of the things that the strategy department does is helps the rest of the organization really value whether something is a good deal for us or not by asking — Is there an ROI, an actual dollar amount that we can quantify, a clinical benefit to this program?

One of the things that we were presented with recently was an opportunity to look at a maternal intervention, sort of a disease management strategy, and the proposal looked like it could save us millions and millions of dollars, but it’d also cost us millions of dollars! We dug into our own data to see if we had that many women in our health plan with that particular type of issue. Going in and fact-checking that proposal made us decide that probably wasn’t our best expenditure to make.

We’ve tried to refine that process over time to really look at the offerings that we get with a critical eye to see if it really is a good expense because our funds are limited and we really do have to be very thoughtful about where we put our funds and so that we’re not just sort of taking a chance, risk or gamble. But we really do want to assess those opportunities to see if they make good business sense.

Q. So if a startup founder with an interesting solution that could apply to the population, wants to reach out and share their story and their offering, with you, what’s your advice to them before they even approach you?

Paula: I would say — make a good business case and make sure that it is based in reality because some of the things that I’m going to ask, if you tell me you’re going to save me 10 million dollars, is — How did you come up with that amount? Which members are you going to affect? What types of interventions would this take? Who’s going to make those interventions? How is this going to work?

It’s always like, you’re going to have to prove it to me. You’re going to have some solid details behind it, and there must be some homework to it. How is it that you can do this for me that I can’t do myself, because in some cases I often wonder, could I just take that and do that internally because it’s essentially a make-by decision, right?

So, you’re going to have to convince me that I need to buy it versus make it. And is there some special sauce that you have that I don’t have? So, I think those are the kinds of questions that I would ask, and I think that it behooves someone who is trying to really convince someone else to buy their product. You know, “What’s in it for me? How am I going to benefit from this? And how can you show me that that cost is going to pay off?”

Q. Where does your patient figure in all this? You’ve got a low-income population, there’s the emerging digital divide so, are all these cool tools and digital health solutions serving the needs of those that they’re meant for? Or are they just exacerbating the gap? How do you factor that question into your decision-making and how do you make it easy for your population to adopt this solution knowing that they are looking for these?

Paula: One of the things that we have always asked is – “Is this tool or digital intervention going to cost our member money? Will it require more data or bandwidth? Will members have to pay for a service in some way? Certainly, during the pandemic, we heard a lot about digital deserts and whether low-income pockets of communities had access to the internet or to data. So, that was one of the questions that we asked — Can anyone with any model of phone use this? Are there barriers to engaging with this digital option?

What we found, especially with that one, is that there were very few barriers and it was very easy to use. It was open to lots of different types of phones — old or new. So, there were just very few barriers and that led us to really engage with them because removal of those barriers is key.

Q. Do you end up subsidizing some of the costs as well to your patients?

Paula: One of the things that we do offer as one of our value-added services is the Lifeline Program. We try to encourage our members to take advantage of these federal programs that are available to get access to data phones to enable better engagement. We also look, for example, across our provider networks, and some of our pediatric providers already have a digital option. So, working with them to make sure that we connect our members to that information is something we do.

Parkland as a system uses Epic and we have care everywhere. There are digital ways to engage with our providers who offer telehealth services. We want to make sure that we communicate that to our members to ensure they understand what’s available to them.

How do we get them the tools? Certainly, with our health system, one of the things that we have talked with them about is how to bring telehealth services out to the community in a location where the community gathers. So, rec centers, community centers, FQHCs and different locations out in the community, if they have space and equipment, we can assist them with setting up those digital hubs so that is one way that I would say, is not a direct subsidy, but it is a creation of that access point. So, trying to think innovatively and trying to identify those locations where the community gathers so that they have sort of automatic and inherent access to it – that’s how we do 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.

Digital health startups must pick a lane and stay with it

Season 4: Episode #115

Podcast with Matthew Warrens, Managing Director, UnityPoint Health Ventures

"Digital health startups must pick a lane and stay with it"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Matthew Warrens, Managing Director at UnityPoint Health Ventures, shares some of the learnings from their portfolio companies, and how UnityPoint Ventures approaches digital health investments.

UnityPoint Ventures invests in startups at various stages of their growth. Matt discusses their investment themes, what they look for in startups, and how they leverage the UnityPoint Health ecosystem to help their portfolio companies scale and grow – while clarifying that portfolio companies are not guaranteed a commercial contract with the health system.

Matt discusses the ongoing labor shortage and how that is reshaping priorities, the emerging competitive landscape for health systems, and the overall VC funding environment for digital health. Take a listen.

Our Podcast Partners:

Show Notes

00:42About UnityPoint Health and where UnityPoint Ventures sits within the overall organization?
02:12So what led UnityPoint Health to start a venture arm? What's your mandate and focus of the Venture?
05:33When you started out with the Venture, what kind of themes did you decide to focus on?
07:14 Do your portfolio companies automatically become enterprise technology partners to UnityPoint Health?
10:52Can you talk about a couple of the investments?
14:29 What themes excite you today when you look at the digital health startups landscape?
17:14 Do you think automation is what you're referring to when you mention some solutions to overcome the labor shortage issue?
18:55 What are you hearing from the digital health startups about their challenges? When you track their progress, what are the things that you see them struggling with the most?
22:36What’s your advice to new digital health startup founders who approach you?

About our guest

Matthew_Warrens-profile-pic1

Matt Warrens has over twenty years of experience in the health care industry. Currently, he is the Managing Director of Innovation for UnityPoint Health Ventures . An experienced innovation leader, he is driven to transform health care into a science of prevention culture to improve the quality of life. Matt has strong operations experience focusing on identifying, developing, and implementing new products and services for health systems. His ability to identify clinical and operational technologies will accelerate the transition to value-based care.

Prior to joining UnityPoint Health, Matt served OSF HealthCare System for nearly twenty years in various roles including its Vice President of Innovation Partnerships and Executive Director of Jump Trading Simulation and Education Center. He is a graduate of Bradley University’s Executive MBA program and Southern Illinois University’s Healthcare Administration Degree. 

Q. Could share a little bit about UnityPoint Health and where UnityPoint Ventures sits within the overall organization?  

Matt: UnityPoint Health is a health system primarily based in Iowa with regions across the state. We also have small footprints in Illinois and Wisconsin. It’s a 20+ hospital system, and while hospitals aren’t a great measuring stick for systems in the Midwest, typically because there are large quantum tertiary care centers with 700 beds and one can have critical access hospitals like we do with 20-some beds, we have over 1100 primary care providers in our network. We are very much a value-based care organization and have almost 40 percent of our patient population in some type of ACO or value-based model. We’re continuing to trend in that direction of adding even more.  

I joined the organization a little over three and a half years ago. Innovation was a complete white slate here and so it was somewhat attractive and somewhat challenging. Innovation and the venture fund itself report up through the Chief Strategy Officer which I think is similar across organizations. But I would tell you that the entire C-suite is involved with our investment decisions and our innovation program.  

Q. What led UnityPoint Health to start a venture arm? What’s your mandate and focus of the venture?  

Matt: In the organization I worked with previously for over 20 years, I’d been in a lot of operational roles. Later in my career, I was working with the C-suite on special projects and had the opportunity to help build a commercialization arm. Shortly after, there was an idea there, probably in 2015, around starting a venture fund.  

I worked with some individuals managing venture funds outside of healthcare and that was an interesting kind of a learning curve. I recruited a team there and ultimately ended up managing the pipeline for that fund. I spent a lot of time traveling the country, looking for these startup companies and having been an operator in healthcare for so long, I think I somewhat looked at things through the lens of understanding how hospital operations really worked. I was thus able to quickly sift through where the real value opportunity was going to be. When I started learning about the venture aspect, I decided that this was something I wanted to do full-time. I had a lot of other responsibilities in my former role. So, when this opportunity came up, I was really attracted. I talked to the leadership team.  

I get plenty of calls from health system leaders or CEOs who want to start a venture fund. To be quite honest, the first thing I tell them is “You shouldn’t start a fund. Here’s a list of three or four great institutional investors that have a great track record of returning great financial returns.” I tell them that because unless they recruit a team with experience in doing this and really understand how to evaluate opportunities and underwrite specific financial returns versus more like the scatter approach that one sees not just health systems, but across for-profit and not-for-profit organizations who have venture arms doing this sometimes, it’s hard.  

That scatter approach makes it tough to tell how you’re performing. What are you benchmarking against? When you have an actual fund with an actual financial thesis, you can benchmark it in time with other funds during that same time period and show success or failure. That’s why you see kind of a constant reevaluation of systems that may or may not be investing like this. I think that was what attracted me to coming here to UnityPoint. They understood that we needed to take that approach of sticking to a financial thesis, having a dedicated team, and really leveraging the strategic value that having a fund could bring.  

Q. While this is a relatively new initiative for UnityPoint Health, larger health systems have had innovation in venture funds for an extended period of time — UPMC Providence, Kaiser are a few of the names that come to mind — when you talk about those, what kind of themes did you decide to focus on? Was there a difference in your approach?  

Matt: I would say that early on in our approach or if you looked at the companies that were in our portfolio first or early on, they were primarily a lot of point solutions. That was really just bringing my experience from where I had been previously and recognizing that UnityPoint was somewhat behind in what I would call “digital table stakes.” We didn’t have remote monitoring or digital behavioral health. We weren’t doing shared decision-making, asynchronous visits, and there were some intriguing financial opportunities during that time to invest in those spaces, also knowing that strategically, we could then adopt and bring those solutions inside of UnityPoint.  

To your question — then, compared to now, where are we going? – I’d say, if you look at the last three or four investments in the portfolio that are much more enterprise type solutions, we have married our innovation strategy with the organization’s overall strategy, and that’s really allowing us to bring forward what we think are more impactful solutions that will impact the enterprise. You can imagine these are hot topics, especially the current one — recruiting retention. We’ve made some interesting investments in that space just recently.  

Q. How about some of your portfolio companies — do these companies automatically get to become enterprise technology partners to UnityPoint Health? Is that part of the attraction for these companies? Is that part of the intent of even investing in these companies?  

Matt: It’s a delicate balance and that’s the answer there. We’re primarily making our investments financial, first, so we’re looking to underwrite certain financial returns. That’s how we’re making our decision on investing in those companies. We don’t guarantee any commercial contract for any company that we invest in financially. However, we have a dedicated team in parallel to our venture team which starts work once we’ve made those investments. That organization and our leaders inside of UnityPoint do everything possible to see if we can help them get that commercial contract. So that starts with leadership alignment. One of the things that we often tell or ask leaders is, “Hey! What are you not doing today that you want to be doing? What do you think you’re going to be doing/You need to be doing tomorrow or the next day?”  

I often reference this industry agnostic concept, in my opinion of any highly functioning organization, of spinning a flywheel of innovate, operate, grow. So, whatever we’re innovating on today, we put into operations tomorrow to drive strategic growth.  

We’re looking to identify companies that we believe can help UnityPoint do that when we bring these opportunities and platforms forward to our leaders. We know that oftentimes these are early-stage companies and so, may be somewhat of a risk, especially when I describe going from originally point type solutions to now more enterprise type solutions. All we’re asking to do, is just give a fair comparison to anything else they’re looking in the market that might be doing similar things. If there are specific platform advantages, financial advantages, etc., that these long-standing organizations can do, we understand why you wouldn’t use the portfolio company that we brought in. But if you can’t find those differences, we have the support of the C-suite to take the risk on these early-stage companies.  

In addition, once we get to a commercial agreement with those companies, we also have a separate team — our internal accelerator team that doesn’t report to IT or marketing and doesn’t get sucked up into M&A activities or Epic upgrades. They come to work every day implementing those solutions and comprise Nurse Informatics, Product Managers, etc., and they really help accelerate the adoption of these things. There’s also some annual operating cash in those budgets to pay early-on SaaS-based software fees. Every startup has heard this story from a health system that says, “Oh hey! I love your solution. It’s February. We are two months into our fiscal year. We run on a 12 month budget cycle, so let’s talk next Spring.” What having that kind of a bucket of money does, is help us accelerate those things. So, I’m proud to say that of the 13 companies we have in our portfolio today, 12 of them have a commercial contract with UnityPoint.  

Q. You mentioned that you sometimes have to sell within the organization about making bets on these early-stage companies. How early is early? Can you talk about a couple of the investments — at what stage did you get in and how far have they come since?  

Matt: When you have these financial returns first alongside a strategic opportunity, you do have to be somewhat opportunistic. So, if you really buy it at our portfolio, you will see investments everywhere from Seed Stage to Series B and some things in between. You can kind of imagine what the revenue path of those companies are. A couple of great examples of companies in our portfolio are our CEOs that you’ve interviewed in your previous podcasts. 

The very first investment that we ever made was in a company called RxRevu, which is doing real-time benefits check. Our group has a motto of looking for solutions that make healthcare frictionless for consumers and make Providers’ jobs easier. And so RxRevu, when you think of it through the lens of those two things, every time a physician orders a new medication for a patient, he is automatically pinging the PBM and the insurance company and getting back in real-time what the co-pay for that patient is.  

You know, if you ask patients what the number one question they ask their provider, it is when they undertake an office visit, it is — how much is this medication going to cost? And prior to having a solution like RxReve, if a patient asked that, a physician would either say, “I don’t know,” or they would have to get up and leave the room and call an 1800 number, and it would be super painful, right? So, that really meets the standard there. And I would say that was more of a later stage company when we got involved from the investment side.  

An earlier stage company, one of our more recent investments, is TailorMed, which is helping payers. I know you recently interviewed the CEO from there. They’re helping patients with financial navigation. So, any health system of our size has what you call financial navigators who come to work every day and they’re working a list out of Epic of all the patients from that night, the day before that etc., who have been ordered to get these high-cost drugs, quite likely infusion drugs or Oncology drugs and whose insurance is not going to cover this. But the good news is there are Pharmacy Manufacturer Rebate programs out there, obviously federal and state programs and independent foundation programs, but those financial navigators must apply to all those different places where they might be able to find coverage for that drug for those patients. The TailorMed solution automates all that for those financial navigators. We’re back again then, to that mantra of frictionless experience for a consumer. So, I’m finding a way to pay for these medications

But, for us, we’re expecting on the financial navigation side that we’re going to increase our productivity from anywhere from 5-10X. And we’re not going to use that to get rid of FTEs. We’re going to use that to expand these programs to help more patients get this type of coverage.  

Q. USD 30 billion in VC money went into these digital health startups last year. The money’s going into various themes — there’s this whole patient engagement theme and it’s become like a catch-all term in many ways, there’s AI and clinical trials along with a variety of other themes. What themes excite you today when you look at the landscape?  

Matt: I mentioned recruiting and retention earlier, and this is a problem the pandemic has created with not just nursing travelers, but really all of the healthcare professionals that are doing traveling, or locums. It’s creating huge expense to the health systems. And it’s not going to just end when the pandemic ends, because we’ve created now somewhat of a bubble that’s going to go out for years. We’re going to be dealing with this and so, anything that we can bring to bear in that space is of high interest to us.  

You mentioned the AI space, and I’d say that personally I still don’t think we’re there. It’s still just a lot of machine learning. I would also tell you that every health system of our size has a team — ours is fairly small — but of people who are creating machine learning processes inside of the platforms that we already use. So, often, when we show that team and the stakeholders some of the start-up solutions in that space, they’re like “We’re already doing this; we’ve been doing this for a while.” So, we’re not really seeing anything that’s, you know, mind blowing in that space.  

To come back to your question about what else are we interested in? We’re no longer competing with the hospital across the street. I mean, watch the quarterly report of any for-profit health plan today, and the CEOs don’t even refer to themselves as Health Plans. They refer to themselves as Health Providers. These organizations are very well financially backed and we’re trying to bring to bear for the organization the types of tools and platforms that we believe we need to compete with them.  

Q. You alluded to the labor shortage a couple of different times. This is by far the number one issue on the minds of healthcare CEOs today, or for that matter for CEOs. There’s this statistic from Mercer, I think, a report last year which said some six million health care workers at the frontline — people who do the real work in many ways – will retire or leave the workforce, and only about a third of them will be back through organic processes. One of the terms I hear constantly is the role of automation in this. Do you think automation is what you’re referring to when you mention some of the solutions you’re looking at?  

Matt: So, this labor crisis is so big that it’s not going to be one single solution. And if there was, I’d tell you we should find that and put all our money there. So, it’s going to take several different approaches.  

One thing that I feel we must do is when we talk about the amount of people who are leaving the workforce is, we have one opportunity to create ways to bring those into a different environment, a more centralized environment, maybe not as high-paced or high-stress as what they have been working in and which is causing a lot of the reasons that they are leaving. On top of that, what technology can we bring to bear that enables those clinicians to provide value, valuable-based care and be a valuable-based portion of this care team that’s on the front lines? 

Q. You mentioned that some of your portfolio companies have been on the show. We invite a lot of innovative startup founders to talk about how they’re approaching health care and they have innovative, different ways of looking at problems. I always ask them about their single-biggest struggle when trying to make it in healthcare – a notoriously slow and conservative domain. What are you hearing from them about their challenges or when you track their progress? What are the one or two things that you see them struggling with the most? 

Matt: One of the things that we look for in our partners, our portfolio companies, is really strong CEOs and really strong founders. I’d say, even more than the financial or the market-size or the product because this is hard and you’re really, in a way, betting on them — Do you truly believe they can do this? Until our benchmarks review, you’ve got to meet two of probably the best CEOs that we have in the portfolio.  

Then, more specific to your question. Now, we take an active governance role with every company that we invest in, and sometimes it’s in our voting role, sometimes it’s just an advisory role. So, we’re listening to them on a quarterly basis of what those challenges are and then, weighing-in from a health system perspective. How can we be of help to them? So, if it’s a matter of understanding, just take market, for example. If they’ve got an understanding what they think the total market is, we can quickly figure out the market just for our system. And we can help with some math around that.  

When you think about product placement and how to pitch it and talk about it, we get into the board room with our leaders. We understand how they think, what’s motivating them and what will resonate with them. So, we can really do a lot to help and work with our portfolio CEOs on that pitch.  

The world does get really small relatively quickly when you bring together innovation leaders from across health systems and they tell you — we’re talking all the time with eight or nine other executives that are doing what I’m doing — “Hey, how are you doing this? Have you heard of this?” And there is a lot of inside baseball there.  

Lastly, I’d say about our portfolio CEOs that they do a lot for us too. They’re also a small world. You quickly know who the really good CEOs are, and they all talk to each other too. So, they’re saying, “Hey! We’re having great success with this health system here and this is why.” And they’re making intros as well. So, this network effect is really important.  

Q. The answer that I get from the CEOs, and founders I’ve spoken to has been that their biggest challenge is the sales cycle where the healthcare organizations, because eventually, it’s about surviving with the funding that you have on hand and marketplace traction on hand. The differential must be made up within the normal sales cycle because if you don’t make it then and you run out of money, you may not get another round of funding and you may have to either do a distress sale or go out of business or face any number of other undesirable outcomes. So, what’s your advice to new startup founders who approach you and say – Matt, I’ve got this great idea. I’ve got some early traction.  

Matt: I’d say the first thing is, it’s important that you somewhat pick a lane and I mean that in a couple of different aspects. There’re a lot of great startup companies out there that could sell into health systems, into payers and directly, into large employers. So, you must ask yourself — Should you?  

There’s also a lot of great startups out there that can do many different things based-off of the platform they built. But you really need to ask — should you? Maybe to get more specific, yes. If you have a great narrow product, maybe you can and should sell to all three of those markets that I described. But if you have a broader product trying to sell that to all three of those markets, I think, that becomes a big challenge early on. I’m not saying you can’t expand later, but trying to do that early to your point, could really break you because of the timing of things.  

You talked about the health system sales cycle, and that is a huge barrier. One way that we’re trying to break that is by having this annual operating budget to help with it. However, one thing I want to point out is, we don’t bend the security or the contracting processes. The only special treatment that our portfolio gets in those two buckets is, “Hey, will you please put our things on the top of the pile to be reviewed?” But other than that, they must pass and go through that same standard.  

I would tell you that I think I’m not an expert on the work on the payer side, but I think the some of the challenges that the startups see there is, whoever they’re working with initially in that industry, those people don’t stay in roles very long. They may be getting promoted or moving on to other things or typically, plans are growing fast, so, people are moving up. And they end up working with different stakeholders which is a barrier on that side. So, both present interesting challenges.  

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.

As an industry we should be implementing basic security controls a lot more

Season 4: Episode #114

Podcast with Lee Kim, Senior Principal, Cyber Security and Privacy, HIMSS

"As an industry we should be implementing basic security controls a lot more"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Lee Kim, Senior Principal, Cyber Security and Privacy at HIMSS, discusses the findings of their annual survey of cybersecurity. She talks about the emerging landscape of cyberthreats, the current state of security controls, and the heightened risks due to the interconnectedness of healthcare with other sectors. She also shares her thoughts and observations on the new threat that has emerged in the wake of the Ukraine crisis and what she is hearing from HIMSS members.

Lee discusses the onslaught of ransomware and phishing attacks from expanded networks of the nation-state and non-state actors and how a greater dependence on electronic information, forced by the circumstances of the pandemic has created a positive inflection point for improving our preparedness and responses to cyberthreats.

Lee talks about how HIMSS enables information sharing among “trusted circles” that include agencies and other non-provider organizations to help healthcare enterprises achieve greater maturity levels. Take a listen.

You can download the HIMSS healthcare cybersecurity survey report here.

Our Podcast Partners:

Show Notes

00:48The AHA recently issued an advisory for hospitals to be on high alert for possible cybersecurity incidents, including ransomware. What are you hearing from your membership at HHIMSS and what have you what have you learned so far?
03:39Is HIMSS planning to issue or has issued any kind of an advisory within its own membership?
04:56HIMSS recently published an annual report, based on your survey of the state of cyber security in healthcare. Can you walk us through the big highlights of the report?
07:11 Were there any big changes from the previous year's survey?
10:04Investment levels are going up in cybersecurity. Is it because cyber criminals are getting smarter and are becoming more sophisticated, and therefore you need to throw more money at the problem to stay one step ahead of them? Or is it because you are underinvested to begin with?
15:00 What are the cyber criminals fishing for?
19:36 Is there a pecking order in terms of where cyber cybercriminals like to target the attention? Is healthcare a preferred target for them?
22:32 What is the risk healthcare organizations are taking by choosing to partner with an increasing number of innovative startups? Is there something that we should be concerned about from a robustness of security protections and data productions in particular?
27:14 Is there a bigger shortage in cyber security workers relative to other parts of the tech sector? Or is it the same as everywhere else? If so, what's the solution here? What are what are organizations doing to overcome this?

About our guest

Lee Kim is the Senior Principal, Cybersecurity and Privacy at the Healthcare Information and Management Systems Society (HIMSS). Lee’s expertise includes cybersecurity, privacy, information technology, and law. Lee is a published author with numerous articles on data privacy, cybersecurity, and intellectual property. Lee’s publication credits include GCN, the American Bar Association, Digital Health Legal, Nursing Management, and the California Continuing Education of the Bar. Lee presents before a variety of audiences—technical, non-technical and legal for entities across the private and public sectors—and domestic as well as global.

Lee has served as a team leader of the US Department of Homeland Security Analytic Exchange Program and as a member of the National Cybersecurity Training and Education Center National Visiting Committee. Lee has also served with the (ISC)2 Government Advisory Council Executive Writers Bureau, National Cyber Incident Response Plan & NIST Cybersecurity Baldrige Excellence Builder working groups, and as a Vice Chair of the American Bar Association Health Law Section eHealth Privacy and Security Interest Group, eSource, and Emerging Issues in Healthcare Law.

Additionally, Lee is an AV Preeminent peer review rated attorney. Lee’s work experience includes incident response, system, database, and web administration, programming, and legal matters involving intellectual property, information technology, privacy, cybersecurity, healthcare, and EU GDPR.

Q. The AHA has recently issued an advisory for hospitals to be on high alert for possible cybersecurity incidents, including ransomware. What are you hearing from your membership at HIMSS and what have you learned so far in this context?

Lee: Our membership is obviously very concerned about what’s happening with the current geopolitical conflict. It’s safe to say that on any given day, there’s literally an onslaught of ransomware attempts and phishing attacks but what troubles our stakeholders is the great degree of sophistication seen when you’re dealing with the nation state actor or in some context, non-state actors as well. The time horizon in such cases, is much more compressed than regular actors, and there’s much more obfuscation in terms of detecting that intrusion into systems and networks. So, that’s a concern.

Many healthcare organizations and their IT Security departments run fairly lean. Consequently, they’re able to prioritize better and know what to focus on. For example, the Health Sector Cybersecurity Coordination Center (HC3) at the U.S. Department of Health and Human Services, the HSC and others share threat information, which may be of interest, especially regarding destructive malware and otherwise. Those indicators are good to have, however, there are so many threats and vulnerabilities that healthcare organizations have in terms of their IT systems and applications that, frankly, the best and most direct way for all healthcare organizations to be prepared is to prioritize and tackle their biggest weaknesses, first. Then address other things based upon priority. We always say the best kind of intelligence is direct intelligence-sharing with your peers and within your organization regarding cyber threat indicators and phishing.

Q. Is HIMSS planning to issue any kind of an advisory within its own membership?

Lee: Our efforts are not limited to information-sharing within trusted circles of stakeholders, which include providers. So, there are different units of HIMSS that are engaged in getting the word out, including a DHS, CSA and also the HHS and others. The key is to be a convener and be part of that pipeline in terms of information-sharing as it were, within our trusted circles of membership.

Q. HIMSS has just recently published your annual report, based on your survey of the state of cybersecurity in healthcare. Can you walk us through the big highlights of the report?

Lee: Absolutely. Some of the highlights of the survey include things that are already known, such as, the state of cybersecurity across healthcare organizations. We know from the headlines that phishing and ransomware are king in terms of incidents and intrusions that actually happen. But one of the ways in which our report takes it a little bit deeper, is that we test assumptions. We can glean from the report that there are some kinds of systemic weaknesses across healthcare organizations, and that the security controls perhaps, aren’t as robust. However, one of the key questions that emerged when we were developing the survey was — Is that true? If yes, how true? It’s one way to perpetuate assumptions without actual evidence but, in this case, we have actual evidence as to what Providers are doing at a granular level, such as, not including security controls. Working on the technical side for healthcare organizations, I’ve certainly seen many that are slow to patch, but we actually have discrete specific information in terms of how much time it takes to patch given certain perceived levels of vulnerabilities that healthcare organizations may have. So, I’d say that direct intelligence — the more specific and actionable it is, the better the steps healthcare organizations can take to reach higher levels of maturity in terms of their action plan or maturing their programs.

Q. Were there any big surprises from the previous year’s survey that caught your eye?

Lee: Yes, I’d say, the increased funding in terms of cybersecurity, especially during COVID-19, was definitely unexpected given various revenue sources were experiencing a shortfall. Now, COVID-19 isn’t yet over and just last year many healthcare organizations unfortunately had to cancel elective surgeries and turn patients away because of how severe the pandemic was. So yes, it was surprising and to be totally frank, that was very good news. That signaled, at least to me, that cybersecurity programs have become more of a business priority for many organizations.

In fact, if we look at what’s happening, globally, and not just with the U.S., cybersecurity is critical. Whether it’s smaller healthcare organizations in the U.S. or those in countries that perhaps don’t have the electronic health IT. infrastructure like we have, or countries that are less developed in terms of technology, they’ve been forced to adopt electronic health IT to track what’s happening in terms of COVID, healthcare, and treatments. So, it’s safe to say that cybersecurity has raised its profile as a result of a greater dependance on electronic information, which is forced by the circumstances of our pandemic. That’s certainly a positive inflection point for us in the industry.

Q. It’s certainly good news that investment levels are going up in cybersecurity. Is it because cyber criminals are getting smarter and therefore, you need to throw more money at the problem to stay one step ahead of them of is it because you are underinvested to begin with and this is just catch up?

Lee: I’d say both. Let’s look at your second point which is very well-informed and a great observation — the health IT sector. Our first publicized nation-state cyberattack was in 2013, almost 10 years ago, and now, it’s 2022. We’ve certainly had a “catch up” period for that time-period in the past decade. Whereas, if we look at the more mature sectors, as they’re perceived, such as, the chemical industry, critical manufacturing, electrical etc., they’ve had decades to bolster their security practices, turn to more electronic information, follow mature security protocols – In short, they’ve already had a playbook of sorts that’s been tested. They have disaster preparedness against natural and manmade disasters whereas we, have been playing catch-up in the last decade.

But, it’s safe to say that the pandemic among other things, has certainly accelerated our progress. Cyber-criminal activity absolutely cannot be ignored by any organization. We see the rising costs of cybercrime, and other things related to that, such as the cost of dealing with mitigation if you are breached and I’m sure many organizations have concluded that regardless of whether they’ve experienced an attack or feel one’s imminent, we must understand that it is inevitable. No one wants to be in the headlines anew so the focus will be a lot on proactive measures.

However, looking at the questions in-depth, for example, surrounding the degree to which basic security controls are implemented, we really should, as an industry, be implementing the most basic security controls a lot more, whether it’s encryption, identity and access management, or even the firewalls and antivirus. The internet has been booming for over 25 years, so shouldn’t we be on-board in terms of at least antivirus and firewalls if that technology has been around? And if the price point for that in the precedent for encryption solutions has lowered as a result of such innovation, development, and the multiplication of offerings out there, I think, the answer is, yes.

We are really reaching the point where we can’t afford to be unprotected because regardless of whether our sector is specifically targeted or there is a side-channel attack on another sector – water, electrical, manufacturing, telecom –on which we are dependent, we stand incredibly vulnerable in terms of critical infrastructure dependencies. Look at the National Infrastructure Protection Plan, the NIP, that clearly spells out all the sectors upon which we depend. I think, if people aren’t paying attention now, they will unfortunately experience the bite of a cyberattack and will have to unfortunately rethink their strategy.

Q. You make a really good point about the interconnectedness of infrastructure between healthcare and other parts of the economy. But I want to go back to one of the headlines of the report, which is that “phishing is still king.” What they are phishing for? Has anything changed about in terms of what they’re looking for or is it the same kind of data that remains vulnerable?

Lee: What needs to be traced is the motivation for the attack. For example, if I were a healthcare organization with a military base close by or some kind of defense operation in the vicinity, I may be, hypothetically, targeting people that have access to that information. That would be different from, for example, if a diplomat or someone of similar high status were treated at a hospital. Then their information would be targeted based on that. So, it truly depends upon the purpose of the attack. So often it’s assumed that the endgame for an attack is always the same, but we have to look at who’s attacking which entity and for what purpose, before we can make that determination and whether it’s because of the different geopolitical tensions currently happening or it’s because of who is being treated at your healthcare organization currently. It’s safe to say that organizations that are in those special situations are smart and layer their defenses and the strategy to account for that.

On the other hand, as we saw from the survey that money unfortunately tends to be the number one goal of attackers across nation state, non-state actors, cyber criminals, or the “kid next door.” Often, the purse strings that the accounts payable person may have is attacked or a highly compensated employee may be targeted through phishing websites that resemble a payment portal. Unwittingly, if they fall for such phishing attempts, their paycheck may be diverted. We’ve seen those attacks on providers in the past, and the way attackers work. Attackers employ efficient tactics that have worked before, whether for healthcare or another sector. They know time is money. So, the idea is highest efficiency for highest impact. That will achieve whatever their endgame is – money, stealing credentials, sensitive information – patient data, treatments, research on COVID-19, vaccines, or something more nefarious such as, disrupting business operations or even clinical operations etc. That attack is given that kind of purpose so phishing does carry with it many other things. 

Q. Is healthcare a preferred target simply because of the ease of attack and the potentially quick and high returns?

Lee: Well, certainly healthcare itself will be under attack if specific patients’ information is targeted. However, in terms of the sectors and the ease of attack, I think, it’s a bit of a myth that healthcare is easier to compromise than other sectors. Whether one is targeting government entities, other industries or critical infrastructure sectors, there are sectors that are easy to attack, such as, the financial sector. There are entities that do not fully share information within their organization, do not deploy security awareness across all personnel, so naturally, their rates for successful phishing attacks may be quite high.

I’ve heard that phrase before, and to some extent, it’s true, because many healthcare organizations have just hired their CISOs in the past five or 10 years. There are some cybersecurity professionals with really skilled backgrounds within healthcare that have been working at the helm of their organizations for 25 years. So, I can assure you that some of those organizations are very tough to break-in. But if you look at the symmetry of it all, the defense people or defenders on the provider’s side need to be right 100% the time; Someone on the offensive side needs to be right just once.

Q. We’re in an era of digital transformation. But what is the risk now that healthcare organizations are taking by choosing to partner with an increasing number of innovative startups? Is there something that we should be concerned about from the perspective of robustness of security protection and data protection, in particular?

Lee: That’s an interesting perspective. To give some context here, ever since at least January 2014 we’ve seen that the supply-chain style of attacks — whereby a vendor or a business associate has been compromised to essentially compromise the target whether it’s a big hospital or whomever is at the other end that’s receiving those services – are rampant. So, with that in mind, it’s fair to say that as a general rule, the small and medium companies and the startups may be weaker in terms of their security defenses compared with the larger organizations but that’s not always so given. You’re well aware, the asymmetric difference between the attacker’s perspective versus the person on the defense and how the person of the defense needs to always be right. Notwithstanding that, start-ups from what I’ve seen having worked with them over the years, I think, just like many other smaller organizations, they tend to outsource various tasks themselves — whether it’s development or cloud services or others.

If there’s one weakness that I’ve seen — and again, not all start-ups are the same – it’s that, often, smaller companies just assume that by partnering with another entity or individual that it’s the other person’s responsibility. So, they’re less vigilant. What’s more, the degree of vetting from a due diligence perspective isn’t given due weightage. As an attorney I always tell people to be careful about who they deal with from a business and technical perspective, otherwise, how does one know how secure an entity is, whether they’ll be around, or how robust their solution is? Being new, very innovative and perhaps very cutting-edge, doesn’t cut short the need for undertaking due diligence. One needs to see who their partners are, what information they’ll get access to – accounts, machines, systems — who else may be involved because there are various factors, including insider threat, that must be taken seriously.

Q. We’re right now in the midst of a big shortage of workers at all levels, including tech workers. On the one hand companies can spend enough money to get the talent but that talent may not be available. One Wall Street Journal article indicated around 300,000 tech jobs that are open as of January! And healthcare organizations, technology vendors or vendors to a vendor are all facing this same problem. The issue can’t be outsourced and is a bigger concern than cybersecurity. So, is there a bigger shortage in cybersecurity workers relative to other parts of the tech sector? What’s the solution — more automation? What are organizations doing to overcome this?

Lee: In terms of workforce development and having that pipeline, it’s safe to say that many healthcare organizations prefer hiring cybersecurity professionals with previous healthcare experience. Because, you can’t simply ping a medical device, for example, and expect for everything to be okay. If you see malware going into a H-back device or otherwise or some kind of potential trouble, for instance, you can’t necessarily close-off the ports to live devices that directly impact patient care. You need to be careful with that, especially where patient safety and the care of patients is directly connected. So, those are special reasons actually why healthcare cybersecurity pros do have interestingly, a specific body of knowledge that people from other sectors, such as, finance, manufacturing, chemical or even the government may not have. That’s because, if their emphasis is on confidentiality, locking up secrets so to speak, our emphasis above anything is ensuring that information is made available and has integrity so that we could rely upon that data. So that reality is quite different.

But in terms of some proactive measures being undertaken by some healthcare organizations there are things that are quite innovative. For example, some people in informatics may be trained up to assist with IT security duties. So, training from within is definitely a great thing because they’re familiar with the organization and committed to it. So, they find value in terms of what they’re doing.

Even with new individuals that are coming up from colleges and high schools and those that have certified cybersecurity credentials such as, certifications that we all know about or those that may graduate from a 2-4 year college with, you know, accreditation in terms of their cybersecurity degree — we know of some of these programs. I think that those things are prized. And once, a student with that potential, interns at a healthcare organization and is recognized by them to train, they are nurtured so they become familiar with the healthcare environment and continue to grow that way.

We may not be able to afford the salaries offered by more mature sectors in terms of cyber in healthcare but one way to combat that would be in terms of hiring students or people with less experience or training people from within, because, I think, there’s a renewed interest in terms of cyber. People are considering expanding their roles, responsibilities and wanting to delve into tech. Cyber is such a great field to be involved in. You’re always learning. We’re trained to think in ways that people generally don’t. We look at things from the reverse — how can something be attacked or breached? – And that’s like taking the glass half-full approach. We ask, “what’s not fine?” So, you know, it’s an interesting dynamic, but those are a few of the promising trends.

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.

Our mission with digital health is to provide guidance and choice to consumers in an easy, frictionless way.

Season 4: Episode #113

Podcast with Ashis Barad, MD, Clinical Lead, Digital Health, Baylor Scott & White Health

"Our mission with digital health is to provide guidance and choice to consumers in an easy, frictionless way."

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Dr. Ashis Barad, Clinical Lead, Digital Health at Baylor Scott & White Health, discusses their digital patient engagement journey, their highly rated best-in-class homegrown patient mobile app, and how they are creating a seamless digital experience for patients and consumers.

BS&W is the largest not-for-profit health system in Texas and is a pioneer in digital patient engagement. Dr. Barad discusses their focus on consumer expectations and consumer research at length and how that drives their digital investments. He discusses the challenges involved in gaining acceptance from clinicians for launching and implementing digital health, and the need to invest in ongoing research to understand consumer needs.

Dr. Barad talks about their digital investment priorities for 2022, their data and analytics partnership with the Truveta consortium, challenges with harnessing technology innovation, and how the talent shortage is impacting the pace of digital transformation. Take a listen.

Our Podcast Partners:

Show Notes

00:48The American Hospital Association has recently issued an advisory for hospitals to be on high alert for possible cybersecurity incidents, including ransomware. What are you hearing from your membership at HHIMSS and what have you what have you learned so far?
02:01Can you give us a broad overview of the digital health capabilities that you've implemented at Baylor Scott & White over the last couple of years?
06:46Tell us about the genesis of your mobile app and what does it do for your consumers?
10:40 What can you tell us about how consumer preferences have changed? What did the pandemic tell you and what changes have you made since then?
12:17 What are your big investment priorities and focus areas in 2022?
10:29 How long did it take you to figure out that providers are not going to be thrilled about this?
15:26 What are the tech, data, or integration challenges you've had to work through in the last couple of years?
18:45 How do you create a seamless experience for your clients?
22:05 Can you tell us about the data and analytics program being escorted at BS&W. You recently became members of the Truveta consortium. Can you talk about that too?
26:46 How have you gone about identifying digital health startups to work with? What is the message you have for startup founders listening to this podcast?
31:44 How do you keep score of how well you're doing with digital health? What are the one or two metrics that you track?
33:40 Can you share best practices / learnings for your peers?

Dr. Ashis Barad is the Clinical Lead of Digital Health at Baylor Scott & White Health. He is a galvanizing physician leader with 16+ years’ experience in clinical medicine, informatics, digital health, and health equities. He is a proven leader that can communicate effectively with executives, data analysts, and clinicians and bring data insights into clinical workflow.

Dr. Barad leads one of the highest performing physician departments with great energy, attitude, and passion about data and advancing healthcare.

Dr. Barad graduated from the Texas Tech University Health Science Center School of Medicine in 2003.

Q. Ashis, can you tell us about BS&W and your role there? 

Ashis: We’re the largest not-for-profit healthcare system there, servicing 46 counties with 52 hospitals and a completely integrated delivery network — inpatient, outpatient, and all types of physicians. We have roughly 7300 physicians in our system and 49,000 employees. I have been with BS&W for 11 years now. I came in as and still practice as a Pediatric Gastroenterologist. I’ve had this role — Clinical Lead of Digital Health — for the last two years. 

Q. You’ve been with and seen the digital health program evolve over time, so, give us an overview of the digital health capabilities that you’ve implemented at BS&W over the last couple of years? 

Ashis: Baylor Scott & White Health were early in the digital health game for incumbents and so, we’ve had a digital front door – it’s an overused term today – since 2016-17. That’s separate from the one on MyChart and we are an Epic shop. Our digital studio envisions becoming the most desired consumer-centric partner for people’s well-being. So, that’s a critical vision we base our decisions and the products we roll-out, on. We want to think of ourselves as a very consumer-centric organization. The digital health office then, obviously plays a major role in that vision. Its features and capabilities are really focused on five strategies revolving around our digital front door to accord us unprecedented convenience, personalization, and accessibility. 

This also involves a big CRM tech stack that drives consumer engagement with the right message at the right time. 

We also look at innovative products that can get us closer to the consumer. We incumbents probably have something that the disruptors don’t necessarily do and that is brand permission that enables proximity with our consumers as of now. We need to capitalize on that. One line that we like to say internally, in that context is — we want to build Netflix here and don’t want to just make blockbuster lines faster. So, the key lies in not being iterative in what we’re building, but really thinking differently in our products. 

I’ll rattle off a few others here – creating systems of intelligence. We look at data and engagement and Epic, which is our EHR, a system of record. We look at other products and partners that can really envelop the EMR to enable us to get closer to the consumer automation. Lastly, we’ll call it a digital practice, which is building a platform to orchestrate care. We’re certainly providing care but in the new normal, because of all the partners in the ecosystem, the disruptors and, as seen in big tech, we are turning from providing everything to everyone to really orchestrating the journey. We want to put that together as a trusted partner. 

Q. Healthcare is not necessarily known as a consumer-focused industry so it’s refreshing to hear this. Now, you’re at the forefront also because your mobile app is rated very highly. Tell us about the genesis of the app and what it does for your consumers, today? 

Ashis: Thank you for calling that out since it’s really important to who we are. The consumerism aspect of things — and as a physician especially, I will just say — when I speak to physicians and we say “consumer,” there’s a little cringe or some kind of negativity. I just remind them that consumer or the definition I have around it, is actually the “patient,” plus the context of who that individual is outside of their healthcare. Once you really kind of level-set this, it seems to resonate. 

We’re very proud of our mobile app, which is very highly rated. Its genesis can be traced to another terms not usually seen in healthcare – Agile. We came together and made a decision to be more agile so, our app was based on a kind of agile methodology. It’s taken five versions, 40 sub-versions and considerable stakeholder involvement to really get to where it is, today. It was certainly a platform before platforms were cool. 

I’ll give credit to our Chief Digital Officer, Nick Reddy, who had this idea that, our brand is important, and we must unload our digital front door from our EMR. He had a bigger vision of being able to truly have a platform that could be customized to ensure a personal experience for all of our members. This was something we could use for our whole integrated delivery network, which includes a lot of joint ventures, specialists and hospitals that aren’t in our medical posse. So, they don’t have an Epic MyChart. Then, how could we take in full, consumer experiences, have every part of their journey — whether they’re in or out of our medical group — and really create an app while integrating it with the EMR? MyChart was really the only way to do that. So, it’s a fantastic app because it does let you sign-up without having ever walked into any of our clinics and to consume care. 

Q. Based on your experience with the app, what can you tell us about how consumer preferences have changed and how BS&W responded? What did the pandemic tell you and what changes have you made since? 

Ashis: That’s a great question. A couple of words come to mind. One, is guidance. Our users want to know if they need a doctor, when do they need them, where should they go and who should they see. These simple questions lead them to Google and other websites rather than their healthcare system. When we learned that consumers want their doctors and systems they know and trust to answer these, they’re looking for guidance, we saw it as our mission to provide that in a very easy, frictionless way. 

Once we’ve guided them, they’d also want choice, right? With price transparency and a lot more cost-sharing. This is a big reason why healthcare is beginning to look a little more like retail. So, our consumers get a choice same as they’re expecting in retail for where to go to consume care. 

Q. You have created a best-in-class mobile application and set the benchmark within healthcare enterprises. In 2022, what are your big investment priorities and where does your focus lie?

Ashis: I think that when moving into the orchestration of care space, scale matters. So, growth and using our digital and virtual tools to really grow as a system and move to markets that we may not have a physical footprint in, will be big priorities for us. You’re seeing that with a lot of large health care systems, today. 

Q. What would be an example of that — going beyond your current footprint, using your virtual means? Give us an example. 

Ashis: So, we see a lot of people moving into virtual primary care and so our virtual-first primary care product allows us to get into many markets and geographies that are not necessarily where we have a physical footprint. So that’s an example. 

I think other examples are around a lot of talk about home. We’re really leaning this year into home and hospital-at-home care. Home convenience, like vaccines-at-home labs, and some other home convenience products are what we will roll-out. 

The other thing is really creating a retail-like experience for all of our consumers, whether you’re in our physical geography or not, much like an ecosystem connector, right? So, if you’ve done genetics through 23andMe and if you are an avid Peloton rider, you know where you have these other retail-grade experiences that are part of your health or your wellness that we want to know about. People expect their health systems, their doctors to know them for who they are and again, other things that they’re doing regarding wellness. So, we’re working to connect to their whole world if they allow permission for us to do that. 

Q. What kind of challenges have you addressed along the way – tech, data, integration, internal culture-related? Talk to us about a couple of the big ones you’ve worked through in the last couple of years. 

Ashis: I’ve heard you say many times that, it’s 10% tech, 90% people, right? You’re absolutely right when you say that. The tech isn’t terribly hard now. The caveat to that is we’re short-staffed — on the nurses, tech, data people, engineers, designers’ sides – and talent is hard to find to really create this wonderful team. So that is a challenge today that we didn’t have as much, a few years ago. 

That being said, I’m a physician, so, we doctors don’t really move at speed with new technology. Working on the physician side of the house and getting things to really move at scale is why my position exists. I do think it’s important to find a physician champion that really understands both sides of the equation and moves a lot of these digital tools to help health systems become scalable and operationalized. 

Then, the other thing I’ll say is that a major challenge is, legacy healthcare systems have had this culture of a vote by veto. Typically, here, you have one stakeholder that just says “no, we can’t do that” and the whole thing falls through. That’s another challenge. We’re really working hard to change the culture as such to say “yes” versus “no” and then, really letting something fail. 

Q. In an abundant yet fragmented technology landscape you have to take a lot of different technology — Epic, which is your core system — and layer on other stuff including your homegrown mobile app. How do you make all that work together to create a seamless experience for your clients? 

Ashis: It’s what we wrestle with every day. It takes a large team and a lot of resources to really do it, especially since our app and video visits platform are homegrown. We’re quite blessed to have a very talented team — engineers and designers — as dedicated resources for digital health at Baylor Scott & White Health. They’re very passionate about healthcare.

I don’t think that in healthcare we always sell ourselves really well to the outside world as far as our mission is concerned. But if I talk to these teams every day, they have the same passion for healthcare that I do as a doctor taking care of my patients. Once they’re invested and in, we realize that the work they are doing is improving health care and health outcomes. They find a lot of value in being in health care versus other industries, so, the other aspect of that is that we really try to spend a lot of time on that internal culture within the digital health office to really be able to see the outcomes of other products. 

Q. You made such an important point – it isn’t the money but the sense of mission and purpose – that’s something I’ve observed across every health care organization I’ve worked with. You mentioned data and how you’re using it to drive experiences, understand your consumers etc. Talk to us about data and analytics and in that context, about you, as a member of the Truveta Consortium – a group of health systems coming together to pool data assets to drive insights that can collectively improve healthcare outcomes.

Ashis: Thank you for bringing up the Truveta Consortium. They’re adding health systems every month now, which has been wonderful because there’s a lot of data and there’s big data. They’re up to 16 percent of all U.S. healthcare data, which is certainly a large percentage. 

Talking about data, one term that gets thrown around a lot is personalized care. But to get to that end of the spectrum where we can predict people’s outcomes and be prescriptive in their care, we need data. I love to give the example of a particular patient I meet in office to who I say, “It looks like in a year’s time, you have a 40% chance of developing diabetes.” Now, if I left the conversation there, the person walking out of that door wouldn’t be happy. So, if I can then, take it a step further and say, “If you do these three things, then you can reduce that risk by 50%.” How do we get to that place in healthcare? 

I certainly don’t think Truveta alone will solve for everything but having that big data and being able to utilize 16% percent of the U.S. healthcare and leveraging the diversity of data that Truveta brings – that is important. 

We talk a lot about big data but data also needs to be diverse. One stat that appalled me when I saw it was — only less than three percent of research data is comprised of Hispanic and African American patients. We make so many decisions on incomplete data that does not represent the patient that’s sitting in front of us. To get to a point where you can actually personalize care to then say, for example to a Filipino, 50-year-old lady with breast cancer, “A thousand patients just like you underwent this therapy and had the best success and are now in remission.” I think that’s a lot more powerful than what any study that maybe had 95% Caucasian women in it. Truvada really does allow us to get to that level of care because of that diverse data. 

Q. It’s interesting you mention that. Two of my recent guests were the folk from Epic who’re on the Cosmos dataset which is similar to what Truveta is trying to build. But what’s always bothered me is the Balkanization of the data landscape in this country. The data’s sitting with different people, they’re all trying to do the same thing, but they’re not doing it at scale. For me, one vision of utopia, is where all this data gets consolidated with access granted in some way that allows everybody to do the kind of things that you talked about, because quite frankly, it’s not happening and it’s hurting caregivers, healthcare economy, and healthcare consumers. However, these initiatives are underway, involve innovative solutions that have been put together by startups. While the perspective is fresh, there are risks. How have you gone about identifying digital health startups to work with and what is the process you follow? What’s your message for startup founders listening in? 

Ashis: I get pinged a lot by start-ups looking for a door in and so, this is a wonderful call-out. I’ve heard this on your podcast as well that our systems are slow and the cycle at which we do things is slower. So, I’d imagine that’s very frustrating. 

One thing I was speaking about with a start-up CEO, recently, was, “How or what can we do better for you?” What he said was really enlightening for me. He said, “We spend a lot of time guessing what it is you want us to solve for. We spend money, resources and time but want more transparency to solve the pain point identified. Let us know we’re putting our time and resources in the right place.” If anyone’s listening on the incumbent healthcare side of this, I think that was a learning lesson for me. I’ve used that and it’s worked out quite well to make sure that end product we iterate and come together for, really solves the problem that we’ve both agreed upon. 

That being said, it is a tough atmosphere for start-ups because different healthcare systems of different countries have their own culture and things just run very differently. I don’t think anyone startup can go to Intermountain and say, “I’m going to use the same technique and same product to solve the same pain point for BS&W, and it’ll scale just the same as it may have done at say, Intermountain.” 

Taking some time to learn the strategy, the system KPIs of that particular health care system, looking at the ecosystem in which it lives — is it living a value-based care, is it living still in the fee-for-service role, is crucial. And because what we’re solving for is sometimes different as we really learn, so I’d say take the time to just learn and understand what the ecosystem of that system is, and go from there. 

Q. I had a startup founder who recently told me that the biggest challenge for them is surviving the sales cycles in healthcare. If a start-up has limited funding from venture capitalists, and run out of money pretty quickly, its shut down. In which case, where does that leave the health system that signed-up this innovative start-up? 

Ashis: I’m right there with you. And I think that for the startup, I would also suggest one tip — identify a business owner so when going into the healthcare system, you have an individual that you’re really talking to about trying the use case, doing a point solution. To scale, you need a business owner that’s truly passionate about the problem that you are solving for, because there is nothing more powerful in the health system than someone who’s going to take that, run with that torch, and really sell it for you. It’s such a large system that if you try to be that person within the system, often, it just doesn’t get the message across. 

Q. That is really valuable advice. How do you keep score of how well you’re doing with digital? What are the one or two metrics that you track? 

Ashis: Sure. We really believe the future is digital and we know where consumers are going. We certainly know that the digitally native consumers are going to be the largest part of the workforce going forward. And so, one metric, for example, is we’re tracking how many consumers are into interacting with us — more digitally than even in person — through phone calls or coming in, in person. So, virtual video visits, care journeys, and care navigation tools are what we use to track that.

I mentioned before, growth through digital channels is what we call digital-first growth. We ask, “did you actually interact with BS&W through a digital mechanism, first?” And then, on the back end, it’s our job to engage you in a personalized way, navigate you to the right care. We’re not just visually engaging with you once, but actually turning that into a sustained relationship.

Q. That’s good to hear. Are there one or two best practices or learnings that you would like to share with your peers who may be listening to this podcast? 

Ashis: At Baylor & Scott and White, one of the books that we have to read — this is our Chief Digital Officer who asks us to do so — before we sign on, is “Who says elephants can’t dance?” The IBM story, right? And so, yeah, Lou Gerstner. 

Q. Yeah, that’s right. I know Gerstner turned around IBM in the 90s. 

Ashis: Being agile and taking it the right way is important. We know that agile can be masquerading. But we’ve really changed our culture internally at all levels — all stakeholders — to really take on agile. 

My other advice would be to go from being a supply-driven company to demand-driven one. We need to spend time and resources on the voice of the consumer to learn what the demand is, where it lies and what consumers need and want. We think we know the pain points and that’s probably part of the paternalism in health care. So, that is not true. 

We have learned that as we go out, spend time and resources on the voice of the consumers, that often, what they want, need their pain points are very different from what we assume. 

So, my advice would be — really spend those resources, that time to truly learn the voice of the consumer because we’re never going to get to the retail level of care and experiences if we don’t spend that energy and time there. 

Q. That is so refreshing to hear again. Ashish, it’s been fantastic having you on this podcast. Thank you so much for setting aside a time when we look forward to following your progress and all the very best to you. 

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.

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
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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
To receive regular updates 

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.

Digital health must leverage AI, chatbot, and data analytics technologies to understand patient propensities.

Season 4: Episode #108

Podcast with Ryan Younger, VP of Marketing, Virtua Health

"Digital health must leverage AI, chatbot, and data analytics technologies to understand patient propensities."

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this podcast, Ryan Younger, VP of Marketing at Virtua Health, discusses the consumer-driven era of healthcare, emerging digital health technologies, and why active listening to the consumers at every phase is crucial. Virtua is a leading New Jersey-based not-for-profit healthcare system that operates a network of hospitals, surgery centers, and physician practices.

Digital health tools like AI, chatbots, and leveraging data and analytics capabilities assist clinical leaders in understanding patients’ propensity. Ryan identifies insights in business, identifies channels for growth, and indicates why marketing will always be a critical organizational function that binds people and drives digital engagement. Take a listen.

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Show Notes

01:13Tell us about Virtua Health, your role, and the digital transformation journey.
02:26How has your role evolved since the pandemic, and what are your priorities for 2022?
03:57How is Virtua Health addressing the changing expectations in a consumer-driven era of healthcare?
05:57 How do you research these preferences? Can you talk about some of the things you’ve done to look at what your patient populations are specifically looking for?
09:37 Can you share one or two nuggets of insights that you've gained over the last year, which is driving your marketing programs?
13:16 How are you deploying CRM and where does it fit in your digital engagement goals?
14:52 How do you leverage the data? How do you make the connection from an infrastructure and data analytics standpoint to drive this service line strategy?
16:30 What are the two to three things you see across healthcare that they're all focused on? What will be the big themes in 2022?
18:16 There are so many non-traditional players in the health care services space now. What do you think really differentiates a traditional health system like yours in the eyes of your target population?
19:50 How can your peers raise their profile or visibility and highlight its importance in the digital era?
21:19 What are the important technologies that you think will drive the marketing function in the future?

About our guest

Ryan Younger, VP of Marketing at Virtua Health has worked in health care for three well-known organizations. He has been a frequent speaker on driving revenue growth strategies, connecting marketing technology, consumer insights and brand. Currently, he is vice president of marketing at Virtua Health, the leading health system in southern New Jersey.

Q: Ryan, tell us about Virtua Health, your role there and the digital transformation journey.

Ryan: We’re a medium-sized health system in southern New Jersey with about 300 locations including the hospitals, ambulatory surgical centers, and urgent-care physician offices. Our mission is to help people be well, get well, and stay well.

Q: Tell us what your role as VP-Marketing, entails.

Ryan: My role entails a little bit of everything within the team – from managing the brand, creative strategy, analytics, digital to a plethora of areas across the organization where I work with people on experience, recruitment, philanthropy and support both, operations and the clinical aspect. It’s expansive and keeps me going.

Q: Quite the comprehensive role but how has it evolved since the pandemic and what are your priorities for 2022?

Ryan: Some of the changes that are on the horizon or have happened during the pandemic were certainly there, before. People have spoken about how much these got accelerated. Virtua Health’s always played a critical role in intra-organization communications with research and insights, creative strategy, and content development. We continue to grow in influence in terms of how much the organization is counting now on strategy, digital health, change management, peoples’ experiences, and how we can influence it.

This year too, we hope to extend our influence across areas — digital transformation, building that brand and content strategy. Since the past three years that I’ve been at Virtua, one of our three strategic goals has been orienting to the consumer and that’s driven us. That will continue into 2022.

Q: Healthcare has never been really known as a consumer-focused industry up until relatively recently. So, how is Virtua Health addressing these changing expectations in a consumer-driven era of healthcare?

Ryan: It stems from the leadership understanding that to succeed we must be close to the consumer. That is one of our three organizational goals, and it helps us address changing expectations. With regard to expectations, some of that has to do with generations — new generations accessing more healthcare.

If we think about the millennials, the oldest there have hit age 40 now, and they have families, are homeowners as well, so we can’t use that term to imply they’re young people. They want things when they want it, and they certainly have considerable resources at their fingertips, so, they’re empowered, and the expectation is they’ll influence decision-making. They might not go through a primary care physician for all their healthcare. Instead, they may switch to an app or a digital mechanism or urgent care. So that consumer push has been here for a while with people looking for convenience and access and just different expectations around greater value being assigned to time. We’re all busy people, not just the doctors and that influences many areas.

Q: How do you research these preferences? Can you talk about some of the things you’ve done to look at what your patient populations are specifically looking for?

Ryan: I’m glad you mentioned that because it’s definitely all ages that research their options. Our seniors are more tech savvy than they’re given credit for. As for our strategies for research, we just actively listen to our consumers at every phase. We’ve also built a Community Insights Panel, which now comprises over 30,000 people and that’s where we ask them about preferences, how they feel about different services we offer or how they make decisions, and what’s important to them. We tap that group a lot as well.

Q: You have the panel offering feedback, then you action that via some digital health program which is a way to meet the patient where they want to be met. Since these days, it’s all online, how do you pull a program like this together within an organization? How do you bring together the Infrastructure, IT, contact centre, marketing, partners to align and serve patients’ needs?

Ryan: All these areas you’ve mentioned are important. We try to be that voice of the customer and talk about what we’re hearing, seeing, and what our customers are telling us. So, whether that’s patients to clinicians, employees to HR, or customers to the access center, we try to bring that message forward and remove some of our subjectivity. If all of us align along a particular goal, we’ll talk about testing what works – this creative or that or whether this message resonates more than the other. We put that right into the field – an email, a digital ad – and check what gets people to the action that we want and just maximize from there. That’s an effective way of aligning people with one goal — when you put the needs of the customer first, and make it about the data, that’s what gets us there.

Q: Can you share one or two nuggets of insights that you’ve gained over the last year, which is driving your marketing programs, perhaps something that came to you as a surprise?

Ryan: Sure, I’ll mention two. Everyone knows a lot about the pandemic and the long-haulers or people with long-haul symptoms. We were trying to launch a service around the long-haul effects that people were having. We wanted to see if people understood what it would do, how they’d access it, what’d make it valuable to them.

We’ve learned this in some other areas that language makes a difference. People don’t want to be identified by their disease if they’re long-haulers, and that became very clear. So, when we launched the service, we called it Care After COVID, which was just another way of looking at it. It’s descriptive enough so people didn’t wonder what it was. It looked at things a little differently and that’s an example of something where we asked people and figured out what would work best.

Another instance would be just how we learn about behaviour. We all know this intuitively, but one thing that we were able to test in our CRM system was how to get people to move towards action? If we could understand the health services they might need, how do we connect them to those? What we wanted to learn was how many rounds of communication it’d take? So, we always got the best and the largest number of people to act upon the first time we reached out. We talked about the power of the nudge – where if you talk to people that second, third, fourth time, they’d be four times more likely to use the service intended for them. While we weren’t surprised that we needed to do that, we learned a lot about the number and the type of communications to be used.

Q: You mentioned CRM. Many health systems are investing in it now and there’s so much you can do with it. How are you deploying CRM technology and where does it fit in your digital health engagement goals?

Ryan: One of the most important areas that we’re tying it is in our service-line strategy. We’re analyzing patients’ health propensities for different diseases –heart, cancer, orthopedics — and trying to figure out how best to connect them to these services. They may not want to hear about Cancer for instance, but they should know that they need to get connected early on to a mammogram and empower themselves to think about prevention. If something does come around after all, at least they catch it early. It’s the same with heart disease. We use CRM to help us understand those propensities and to predict the types of services people will need. That enables us to talk to them, strategically, in a more personalized way since we know who they are and what may interest them. That service line strategy has been important to us.

Q: How do you leverage the data? You’re obviously looking into EHRs, so, how do you make the connection from an infrastructure and data analytics standpoint to drive this service line strategy?

Ryan: It starts certainly with talking to the clinical leadership since they know their patients best. Then, we understand who we need to reach and why. As we do that, we ensure the clinical leadership knows we have all this patient data that’s anonymous to us. I may be looking at John Smith for example, but to me he’s just person A who has this higher propensity. People have got excited about technology that makes us much more proactive for how to reach and connect with others. It’s AI-technology that’s driving all this. It’s much smarter than we are about how to reach people, identify them and make it relevant.

Then, there are the platforms, that carve out those audiences, create the right automation rules and reach the right people. If the users of these platforms answer one way, then, the platforms follow-up in a certain manner thus putting together their patient journey. It’s just so powerful in enabling us to understand people, enhancing personalization, enabling us to see how they act, what works, what doesn’t, and ensuring adjustments. Patient confidentiality is maintained all this while and while we don’t know who the patient is, we’re trying to make our information much more relevant to them. And that’s where our technology tools have helped.

Q: When you talk to your peers across healthcare, what are the 2-3 things that they’re all focused on? What will be the big themes in 2022?

Ryan: I think people are trying to make sure that they can be very targeted. The resources are scarce, and we’ll be held accountable to do more with less, so our ability to target and measure results is something everybody will be after. It isn’t always easy to do in healthcare, but we’ve got better at it. So that’s a big one.

I would say that brand is another for sure. During COVID, in a lot of ways, people got equalized as did healthcare organizations because COVID was not necessarily seen as expertise of one organization over another. So, you see people needing all these different healthcare domains now and that’s where the brand, and how it connects with them becomes relevant. The focus I think is re-energized in 2022 for a lot of people, so it will be competitive, and people will be making choices based on brand.

Q: The brand is an important concept because we are now in a competitive landscape that’s changing. There are so many non-traditional players in the healthcare services space — the national retailers, digital health start-ups, big technology firms trying to get into the primary care space. What do you think really differentiates a traditional health system like yours in the eyes of your target population?

Ryan: Great question. I think trust always gets up there to the top for me. We want to be that trusted partner because people do have access to a lot of different information. And to your point, the amount of capital flowing into healthcare from these companies, like Amazon and Apple is beyond what we’ve seen. There are so many entities in that primary care market on the retail side, but trust is an important one. We are more of a regional system, and so people tend to live and work in the same area. So, we’re among that community, hence, it’s a great opportunity to continue to build that trust. That’s always big for me.

I also think personalization is important since it ensures that your information is relevant to the right person at the right time. Those are certainly the two that come on top for me on brand.

Q: When your peers ask, “how do I get a seat at the table” today, if they’re not getting one, so to speak, what would be your advice to them? How can they raise the profile or the visibility of the function and highlight its importance in the digital era?

Ryan: I think more and more marketing has been able to get that seat at the table. I work with a lot of our colleagues nationwide and I think, they’re doing a fantastic job making a big impact on their organizations. For groups that are looking to be able to build that more, it’s to some degree a kind of leaning into that ability that marketing has and always does around connecting people, whether that’s within the organization or outside of it, that’s important. We’re influencing vision, strategy, business goals, and mission. So, we can always be a connector through all those seams. What we do well is understand our audience, whoever it is. So, we serve a lot of those needs and be that advocate.

For the consumer that is becoming more empowered, organizations realize that and so they ask more questions around how they can connect with that. So, leaning into that power of what we have and what we do should continue to build that influence that we’re looking for.

Q: From your perspective, what are the important technologies that you think are going to drive the marketing function going forward? You already talked about CRM. Are there others that come to mind?

Ryan: It’s a term that can be used very broadly, but Artificial Intelligence in general is driving so many things including our CRM and media-buying for instance. It drives our chatbot online and how we respond to consumers. So, that’s a big one that we’re trying to work with.

We’re also trying to figure out ways to build more texting capabilities into our pockets. How that integrates with platforms because it has become such a universal communications mechanism is amazing, but you must be careful here since not everyone wants to be texted. So that must be used appropriately. How we integrate that into our platforms is going to be important at a more granular tactical level. So, those are a couple that jump to mind.

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.

RPM can enable better access and enhance the standard of care to those who have the hardest time receiving it

Season 4: Episode #107

Podcast with Lucienne Ide, M.D., PH.D., Founder and CEO, Rimidi

"RPM can enable better access and enhance the standard of care to those who have the hardest time receiving it"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this podcast, Dr. Lucienne Ide, Founder and CEO of Rimidi, acknowledges the rapidly evolving healthcare market and discusses her passion for making healthcare scalable and better for all stakeholders by leveraging the right tools, insights, and analytics needed at the points of care. Rimidi is a clinical management platform designed to optimize clinical workflows.  

Dr. Ide wears many hats – an executive, a physician-scientist, health IT enthusiast, entrepreneur, and problem-solver. She states why sustainable, innovative, and impactful solutions are crucial for chronic disease management and share some unique perspectives on how technology and policy need to align to extend care to those who have the hardest time receiving it. She also acknowledges reimbursement as one of the barriers in enabling digital health models at the point of care. Take a listen.

Our Podcast Partners:  

Show Notes

00:31Tell us about Rimidi and what led you to start it?
02:41What according to you is the current adoption rate for telehealth and RPM modalities? Specifically, for your platform which is in the RPM space?
05:24Who are your customers today and what is your ideal profile?
06:49 Can you give us an example of one of your clients who's used your platform and how do they derive value from it?
09:09 Data is at the core of how you deliver value. What were the challenges you had to overcome and what is the State of the Union on that?
15:29 How does a platform like yours address social equity and health equity disparities in access to care?
19:32 What are the big trends in digital healthcare and virtual care models in 2022? Can you share some of the goals for your company?
21:55 What are your thoughts on this whole explosive landscape of digital health funding that we have seen?

About our guest

Lucienne Marie Ide, M.D., PH.D., is the Founder and Chief Executive Officer of Rimidi, a cloud- based software platform that enables personalized management of health conditions across populations. She brings her diverse experiences in medicine, science, venture capital and technology to bear in leading Rimidi’s strategy and vision. Motivated by the belief that we can do so much better as individuals, in industry and society, Lucie left clinical medicine to join the ranks of healthcare entrepreneurs who are trying to revolutionize an industry.

Q. Tell us a bit about Rimidi. What led you to start it?

Lucie: Rimidi is an Atlanta, Georgia-based health IT company focused on providing tools to the healthcare provider market and helping clinicians make data-driven, personalized, proactive decisions about patient care.
I’m a clinician myself but I started my career in data working for the federal government. Then, I spent a little time in medicine. When I became a clinician, I thought I’d be an academic physician and have a long career, there. But I was really intrigued with the workflow and data challenges that clinicians faced and decided to leave clinical practice for what I could do on the technology and informatics side to make that better for clinicians and their patients.

Q. As a doctorpreneur who’s coming into technology with deep knowledge of clinical needs, combining both has got to be challenging. But, with telehealth, remote patient monitoring etc., becoming mainstream ideas today, what according to you is the current adoption rate for these modalities specifically for your platform which is in the remote patient monitoring space?

Lucie: It’s been an interesting two years due to COVID and its impact on healthcare delivery. Telehealth and remote patient monitoring have been some of the major accelerations. We have worked in this space for a long time — in terms of innovation years, where 6-8 years is a lifetime — and we’ve enabled the sort of continuous models of care as I call it, right from in-clinic to at-home and all the touchpoints in between because that’s what it takes to manage chronic health conditions.

A patient lives with hypertension and/or diabetes or heart failure, every day, not just the four days that they happen to have an appointment each year. So, that’s always made sense to us. But, there were barriers to that like reimbursement that obstructed scalability to a larger segment of the market. So, a lot was capitated at risk for groups engaged in those activities because they felt it was the right way to deliver patient care. Now, while the reimbursements weren’t new, the pandemic helped tear the band-aid off for everyone. Their hesitation around adopting this novel, whether it’s telemedicine or RPM and overcoming the fear of doing something new saw two camps being created — the risk bearing entities for whom this is the most cost-effective and efficient way to deliver good care and achieve their quality measures. And the groups, who still live in a very fee-for-service world that have really embraced the reimbursement which enables them to do this work and deliver high quality patient care. So it’s still kind of a split market in our experience with our customers divided into groups.

Q. Who are your customers today? What is your ideal profile and what kind of entities do you work with?

Lucie: We do work with the accountable care organizations that bear financial risk. While I agree that everything follows the money in healthcare, I often say that CMS created these reimbursement models as an on-ramp to value-based capitated kind of behaviours.

When we first launched into the ACA world, it was a bridge too far for so many organizations to go from their fee-for-service decades of behavior to becoming a risk-bearing capitated entity. We have clients who’re able to take advantage of the reimbursement because they still live in a fee-for-service, do their remote patient monitoring, and start behaving in this more proactive, comprehensive way of delivering healthcare.

Q. Give us an example of one of your clients who’s used your platform. How do they derive value from it? How are they paid for it? How does it work for a patient with a chronic condition like diabetes or hypertension? Walk us through this from your platform’s perspective and how you’re pulling it all together?

Lucie: We’re working with a group called Leon Medical Group there in the Miami market, South Florida, the Medicare Advantage Group. So, they survey the risk on their patient population and have an older polychronic population. They use our platform to help them manage diabetes among their patients. They undertake RPM with the connected Glucometer and the data collated is monitored by the care management team of pharmacists who are engaging with those patients, educating them, adjusting the medication as they monitor the blood glucose levels, while also intervening on the clinical side.

Since it’s RPM it’s not really a thing unto itself. It is a part of understanding what’s happening with this patient, how to manage a condition like diabetes, have they had all their screenings, are they on the right classes of medications to decrease their cardiovascular risk, are their blood glucose levels controlled and are these successfully decreasing their cardiovascular risk of complications?

They target variations for poorly controlled diabetes defined by an A1C over 9, and they’ve been able to get 88% of those patients to goal by engaging them more intensely through RPM, but also more holistically because the whole platform is integrated with their Epic EHRs and so, that paints a much more complete picture of what’s happening with that patient.

Q. Let’s talk about the data because that’s at the core of how you actually deliver value. It’s a challenge putting all the data into the system or wrangling it to make holistic sense of it. What were the challenges that you had to overcome? Is it still a work in progress? What’s the State of the Union on that?

Lucie: We have been very early evangelists of FHIR for the HL7 FHIR data standard because this was always the vision — how do we get all of this into that workflow to the point of care? None of us as physicians are begging for more data. What we want instead, is the insight, the curated information. So, the question is what is this data telling me? What’s the story? What do I need to do?
When I first started the company, FHIR had just turned 10 years old. It was more an academic-level project than one of commercial relevance. We’ve been on that journey of standardizing APIs and interoperability and FHIR has become the dominant standard as the company’s grown. That’s been an important part of our story because now, we can finally achieve that vision of aggregating data into a consolidated experience for the physician.

A big part of what we do is clinical decision support so while I don’t need more information, I need to know. I need to do the right thing without missing something about a patient with that level of workflow.

Q. A number of companies are in the RPM space and approaching it from their unique vantage points. But the central message is the same — It’s the big use cases in chronic disease management, diabetes, hypertension, obesity, etc., where they collate data from the points of care through sensors, devices, monitors and apply intelligence on it to intervene. But where they differ is in the kinds of target markets they’re in. Is there a sweet spot today, or do they organically find the traction which makes the most sense for a company in the European space?

Lucie: It depends on the problem you’re trying to solve and the segment of the market you’re trying to solve that for. My passion has been in the healthcare delivery system because my firm belief is that’s where most of the healthcare is delivered. There’s a segment of the market where consumers, payers, and employers will embrace that sort of employer-driven health care.

Certain payers do a really good job of driving case and disease management by engaging their members. However, most of us receive healthcare from a doctor who’s part of a clinic or a health system and that’s the messy part of the market. There’s this desire to go outside of that and if there’s something more efficient, then, I understand and I applaud that, the other entrepreneurs in the market. My passion though, is, we’ve got to fix the system we have because that’s the majority and that’s the way most of us receive healthcare and it’s what’s driving a majority of the costs.

Q. In terms of numbers, what are the quantifiable metrics you’re looking for? Is there a certain threshold for sharing risk? Do you put some of your own revenue at risk? Walk us through the thought process behind those transactions.

Lucie: Every client we deal with is trying to achieve two, maybe three outcomes — clinical, operational, and financial. You really get to the financial one, but you should see the clinical and operational because the challenge of healthcare delivery is—what’s the outcome I’m trying to achieve? How much does it cost me to get there?

Historically, we’ve drawn people at the problem — more nurses, more doctors, and more case managers to engage and interact with patients and that isn’t scalable or cost-effective. In 2021, we’ve had half a million people leave the healthcare workforce. You can up for people, the problem, but people can’t hire nurses — they’re not there. This emphasizes the point that the technology has to make the delivery more efficient while still achieving that same outcome for the patient, because that’s the business we’re in. And healthcare must deliver better health to the people we care for. So that’s almost assumed and the lesson I’ve learned on this journey. I came in with a clinical background thinking the measure we’re trying to change is the clinical outcome. What I’ve learned over the years is let’s all assume that we’re going to achieve that clinical outcome, but the question is, how do we get there?

Q. Currently, we’re in the midst of this great resignation and healthcare is failing just as much as any other sector, probably more so. The consumers of healthcare are also equally impacted. The pandemic has also highlighted the disparities in access to care. Can you discuss how your platform addresses social equity, health equity, disparities in access to care etc.?

Lucie: We work with many federally-qualified health centers and safety net hospitals, which are caring for those most vulnerable patients in our system who have the most barriers to care for instance – “It’s hard to get off work”; “I don’t have transportation”; “I don’t have child care”; “I may not have the level of health literacy that other patients have” etc. Then we also know that these chronic health conditions tend to over index in that same population. So, it’s a big part of our business to enable better access and enhanced standard of care to those who have the hardest time receiving care. RPM is something new to a lot of those care delivery systems and clinics, but it’s something to really embrace.

There are some challenges to that from a reimbursement point of view currently, under Medicare – federally-qualified health centers cannot get reimbursed for RPM, so, they get grants from the FCC and from other private foundations to do this work that creates a sustainability problem. That must be solved and we’re involved with many others and advocating for that.

To your point, there’s this light being shine on health equity. I’ve been involved with a group this year called the Health Equity Access Leadership Coalition, which is a lot of digital health companies coming together and asking — What are the policy changes? What are the best practices we, as technologists, must follow to ensure that we’re building solutions that don’t propagate the same problems we’ve always had in terms of equity?

Q. You referred to the Federal Grant Program last year which set aside a couple of hundred million dollars so a number of health systems were able to access it and use it constructively. What needs to happen for this to become a sustainable model for the most vulnerable populations to continue to receive the care that they need and not on a one-off basis?

Lucie: Two changes concerning the restriction – Federally-qualified health centers and rural health clinics can get reimbursed for RPM along with providers of care for any other Medicare beneficiary and then, get the alignment of state Medicaid plans. It is a state-by-state kind of a hodgepodge right now, whether Medicaid reimburses because RPM is currently, on-ramp. We’ve got to give these organizations some runway — a couple of years of reimbursing them and giving them a financial model that works to deliver care in this way—is possibly how we can transition them to value-based capitated or tight contracting models. But we’ve got to give them some time to really build the systems and the people in the processes to do that.

Q. What are the big trends in digital and virtual care models for the coming year? Can you share some of the goals for your company?

Lucie: On the trends, you’ve touched on a lot of it. Health equity is on top of everybody’s mind. While it’s going to continue to be so, we must ensure that we’re being inclusive. How should these programs be designed and offered to patients so that they’re accessible? This hybrid model of care is here to stay. And how is that related to value-based care?

The Biden administration’s been looking at value-based care again, so what will be the next iteration of that value-based care 2.0? I think, hybrid models of care will be a big part of that. It’s how we get there because we’re really not there at scale one accountable care or any of that versus where I think a lot of us want it to be.

Our goal is to continue to grow. We certainly are focused on continuing to grow in this segment around community health centers, FQHCs and others and working out the sustainable model with then going forward. On the technology side, at the end of day, we are a technology and a healthcare company. So we’re really pushing forward with some exciting new things such as, FHIR advances, CDS hooks advances — all of that technology and really staying on the front-edge of that.

Q. The last two years have been huge for digital health funding. Are you an institutional funded company yet?

Lucie: We are. That’s probably part of our journey in 2022 as well as the next level of funding.

Q. What do you make of the 5000 or so companies that have been funded so far? Are you seeing any trends in terms of either breakout companies that are really making a big difference or a shakeout at the other end and everything in between? What are your thoughts on this whole explosive landscape of digital health farming seen this year? Will we end it at 20 billion, give or take?

Lucie: I think the factor there is sort of the sustainability issue. You’ve mentioned this huge number of companies that have been funded, yet, the market needs sustainable solutions, not all these point solutions. We’ve seen some consolidation this year, and that’ll continue, going forward. Some of the smaller point solutions will be aggregated into larger platform-based solutions. That’s been part of our journey over the last year and why we’ve moved from originally being focused on one disease state to multi-disease state to now outside of the chronic disease phase — because that’s what the market wants. So I think that’ll be some of the shakeout — what gets rolled-up and what doesn’t survive because it was a great technology that the health system didn’t want an app for.

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.

Healthcare and health outcomes must become more accessible and equitable for everyone, regardless of their backgrounds.

Season 4: Episode #106

Podcast with Cynthia Brandt, President and CEO, Lucile Packard Foundation for Children's Health (LPFCH)

"Healthcare and health outcomes must become more accessible and equitable for everyone, regardless of their backgrounds."

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this podcast, Cynthia Brandt, President and CEO of the Lucile Packard Foundation for Children’s Health shares her passion for giving back and encourages others to do so with their financial support, time, and expertise. The Lucile Packard Foundation for Children’s Health unlocks philanthropy to transform health for all children and families.

With the exceptional team at the Foundation, Cynthia wants to channelize philanthropy to healthcare to improve health for all children and mothers in the Bay Area, California, and eventually across the world. She acknowledges the benefits of telehealth and digital health in the wake of the pandemic and shares their digital priorities for 2022.

Cynthia encourages everyone to see themselves as philanthropists. She suggests why empathy and commitment are necessary when leveraging science to help heal humanity and elevate a community and the population equally. Take a listen.

Please visit here to get involved in Lucile Packard Foundation for Children’s Health. 

Our Podcast Partners:  

Show Notes

00:51Tell us a bit about your background, how you got into the Foundation and its affiliation to Stanford Medicine.
03:32Can you talk about the business of philanthropy and what it looks like for your mission at the Foundation?
09:01Tell us about the Foundation’s work and the different aspects of Children's health that you focus on – in Bay Area and globally.
15:27 What does the Foundation do for kids with special needs?
17:51 How has the pandemic changed the way you focus or approach the Foundation's mission? What are your priorities for 2022?
20:03 Some of your programs are now actually being delivered through a digital modality. Can you talk about that?
24:30 If someone wants to get involved in the Foundation's work, what should they do?

About our guest

cyndiabrandth-profilepic

Cynthia Brandt was thrilled to join the Lucile Packard Foundation for Children’s Health as president and CEO in 2018. Now she is on a mission—with the outstanding team at the Foundation—to unlock philanthropy to improve health for all kids and moms, in Silicon Valley and around the world.

During 20+ years in fundraising and communications, Cynthia has contributed to important missions and great teams as Campaign Director for the Smithsonian Institution, VP for Advancement at Mills College, and Associate Dean for External Relations at Stanford University’s School of Humanities & Sciences. She is grateful and motivated to give back because others’ generosity allowed her to pursue a PhD and MA in sociology at Stanford and a BA in English and fine arts at Vanderbilt.

Cynthia is passionate about the potential for science to heal humanity and the planet. She is emphatic that this work must be grounded in empathy and a commitment to lift up all people equally.

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.

Digital health technology is helping people to engage in a healthier lifestyle

Season 3: Episode #105

Podcast with Richard Ashworth, President and CEO, Tivity Health

"Digital health technology is helping people to engage in a healthier lifestyle"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this podcast, Richard Ashworth, President and CEO of Tivity Health, discusses why senior fitness is an important space and brimming with opportunities waiting to be capitalized. Tivity Health leverages core healthcare capabilities to deliver market-leading fitness, nutrition, and social engagement programs that improve health and lower healthcare costs.

In the episode, Ashworth talks about two significant macro trends in healthcare: the shift to digital health solutions and growth in Medicare Advantage. He further acknowledges how seniors have enthusiastically adopted technology but maintains that the future of healthcare is hybrid, i.e., a combination of digital and in-person care.

Healthcare is mission-driven and offers ample innovation opportunities in digital health, data, mental health, senior living, and home-based care. He advises youngsters to pick a job to make a difference, leverage opportunities, and continue to innovate and learn. Take a listen.

Our Podcast Partners:    

Show Notes

00:38About Tivity health and how you came into the role?
03:42What are the macro trends you see playing out in healthcare as we head into 2022? How will they impact or influence your business?
07:49Who are your consumers and who is paying for the services -- the health plans, the employers, the individual subscribers, all of them?
12:10 After the pandemic, telehealth kind of took off like a rocket. Wasn’t the case pre-Pandemic. Do you also see an analogous trend in your business?
15:47 Peloton and Apple Fitness come to mind first but where does your company fit in that milieu of online fitness?
20:59 Health systems are in a fee-for-service model and health insurance companies are trying to get everybody into more of an accountable care kind of a model. Do you see a tug of war between these two instincts?
29:47 What is your advice to the younger generation that is coming into the workplace today and is looking at healthcare as a career?

About our guest

Richard-Ashworth-profile-pic

Richard Ashworth is the President and CEO of Tivity Health. He has spent his career focused on improving the health and well-being of others, with a passion for making a difference in the lives of customers and members. As a pharmacist, Ashworth has a keen understanding of the factors that influence health, including social determinants, adherence to treatment and a healthy lifestyle.

As President and CEO of Tivity Health since June 2020, Ashworth has brought financial stability and strategic focus to the business, prioritizing growth in the company’s core SilverSneakers offering and creating a digital-first strategy to drive further expansion. Previously, Ashworth facilitated the growth of Walgreens for nearly 30 years, transforming the company into a global leader in pharmacy and health and wellness. He most recently served as President, responsible for the leadership, development and management of all Walgreens operations.

Ashworth is an influential voice in public health policy and the future of healthcare and has shared his views at the White House and on Capitol Hill. He earned a Doctor of Pharmacy degree (PharmD) and a master’s degree in business administration (MBA).

Q. Tell us about Tivity Health and how you came into the role.

Richard: Tivity Health’s number one focus is on empowering people, communities, and partners and supporting them on their lives’ journeys. Our vision is healthier, happier, and more connected lives so we’re trying to help an aging population manage this in a couple of ways. One is through physical and virtual activities. So, we help people by giving them a gym membership and having them engage in physical, healthy behavior. We enable engagement and help people have social connectedness as well as mental enrichment. At Tivity Health, we also have a couple of other businesses like an integrated health service that has Chiropractic Care, Physical Therapy, Occupational Therapy, Acupuncture, Acute Therapeutic Massage etc. Our premier brand, Silver Sneakers, is the nation’s leading fitness program for older adults. Then, there’s also prime fitness, which is a discounted access to thousands of fitness locations. This is undertaken in partnership with commercial plans and employers. There’s also Whole Health Living, which is an integrative kind of health management business.

I started working as a stock boy at Walgreens when I was in high school, and really fell in love with pharmacy. So, I became a pharmacist. I just loved the way pharmacists worked within the community. You could walk up to any drug store and talk to a pharmacist any time, and they’d always be there to help you. So, it wasn’t just about the medicine; it was more about the community, the relationships, the life, and I was drawn to that aspect. I was at Walgreens for 30 years and by the time I left there as President, I’d held a lot of roles — commercial, operational, Strategic, International etc. Then, I came to Tivity and I’ve been here for 18 months.

I’ve spent my whole career on the treatment side of healthcare so, by the time I got to the people, they were taking medicine, were overweight, and struggling with health. I really do have a personal passion for fitness and nutrition and actually for the elderly, so I was keen to reach a spot that helped me do that well. There’s no better place in all of healthcare to do that than here at Tivity Health.

Q. What a fascinating story! So, Richard, what are the macro trends you see playing out in healthcare? How will they impact or influence your business?

Richard: I think there are two significant trends. One is more toward digital health solutions which have obviously been accelerated through the pandemic but were growing before. Then the pandemic hit, and digital health just took off at a stratospheric growth rate. The second is the growth in Medicare Advantage.

On the digital front, the seniors have adopted virtual solutions more readily than what everyone expected. That’s enabled us at Tivity Health to drive our SilverSneakers platform to deliver services differently than before. In fact, a recently published HHS study showed a 63-fold increase in the use of telehealth under Medicare during the pandemic. If you think about seniors using telehealth for their regular healthcare, while it’s hard for them to get around and go into offices, into facilities, then, that is a massive increase in the adoption.

When during the lockdown, many of our fitness locations closed, we quickly pivoted to offer virtual lives with instructor classes. Today, we’ve had more than three and a half million visits to those classes. So, the enthusiasm and the appetite are clear. We also have a pretty robust research engineer and so end up having lots of conversations with our members. These indicate that 85% will continue to use digital offerings in addition to visiting physical locations or fitness centers. Over 60% will use technology for video calls and live streaming with their friends and families. Over half will use it for medical appointments and fitness classes.

This tells me there’s a coalescing of adoption of digital health. Our members can choose from thousands of virtual activities, each week.

We’ve logged more than 3.4 million of that but many of those members are first-time users of SilverSneakers — almost half – that implies that the barrier to entry into maybe working out or engaging in a healthier lifestyle – technology, virtual or digital – whatever the term — is really helping people get into it for the first time.

On the Medicare side, 10,000 people age every day. It’s a fantastic entitlement program to take care of our older population. By 2030, the number of beneficiaries enrolled in the program is supposed to hit 80 million people. So just the sheer numbers require us to think very differently about this population and their expectations will also shift. The Baby Boomers coming in today versus those coming in 10 years from now will need very different technical capabilities and they’ll likely live longer. Those that get older later, will probably want to age in place with their own community, friends, family activities, while maintaining an active lifestyle. All this will influence the kinds of programs and services that get offered to seniors in the health and wellness space.

Q. The pandemic has accelerated the shift towards digital health. So, who are your consumers? You mentioned Medicare beneficiaries for your SilverSneakers program but who’s paying for the services — the health plans, the employers, the individual subscribers, all of them? Do explain.

Richard: The number one way we deliver SilverSneakers is through a partnership with the nation’s leading Medicare Advantage plans. So, the funder of the program makes this available to the beneficiaries. There’s no out-of-pocket cost for the members, themselves, since they sign up for their chosen Medicare Advantage plan. If Silver Sneakers is part of that then, they access this at no cost to them. Membership into our virtual experiences include social engagement, mental enrichment, and virtual fitness programs. In that context, members also avail of a robust gym network of up to 20-23,000 gyms across the United States. So, we share a goal with the health plan and that’s why it works so well. Not only us, but many times, the members themselves and the plan, really care about providing physical fitness options for older adults.

What we also care about is the community that’s built around that. So, the result of engaging with SilverSneakers is better health outcomes, lower healthcare costs. A study with Avalere Health showed savings in total annual average health expenses, including lowered medical and pharmacy costs. So, if you’re a SilverSneakers member, that’s a nod to $4463 in healthcare costs, versus an average of $5303 if you’re not. It is a significant reduction. It’s how a healthier lifestyle positively impacts your overall costs – for instance, somebody who works out is probably healthier than somebody who doesn’t; somebody who eats poorly probably isn’t as healthy as someone who eats well. What we do at SilverSneakers is help people engage in