Category: Season 4

Healthcare is the last industry that hasn’t yet been truly revolutionized and disrupted by technology

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In this episode, Julia Hu, Founder & CEO of Lark Health, a leading AI virtual healthcare counseling platform, is helping nearly 2 million people manage and prevent chronic conditions, stress, and anxiety. Having invested more than $100 million in R&D, Lark combines cutting-edge AI with remote patient monitoring capabilities to provide 24/7, real-time, text message-based health counseling to patients whenever and wherever they need it.

Julia explains how their text message-based counseling platform is clinically equivalent to live nurse care management services. She also talks about how virtual and at-home care delivery has been impacted by the supply and demand curve, the digital health startup ecosystem, and their new partnership with Salesforce to expand into the “payvider” segment of healthcare. Take a listen.

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Show Notes

01:21Julia, can you talk us through how you got to starting the company and some of your personal journeys that have led you to where you are.
03:40 What kind of conditions do you address using your approach and your platform?
04:53How is your remote and AI enabled care different?
06:42Can you explain the term clinical equivalence?
09:15How has the pandemic impacted your demand environment?
12:20 This year, apart from all the macro factors, inflation, and interest rates, the VC funding environment has contracted a little bit. What does that mean for you and for the digital health startup ecosystem?
15:37You've done some interesting partnerships, especially one with Salesforce. Can you talk about that?
18:03What is your advice for startups founders, those who have either recently come into the market with a product and they're finding themselves facing headwinds because of the macro environment or those who are looking to get into digital health right now.
19:39Julia, you mentioned “payviders” and this is a very interesting segment which is quite different from the normal payer-provider dynamic. Talk to us a little bit about that and why you mentioned that segment as a focus area for your company.
21:58You mentioned early on that you're working mostly with health plans and with employers. Could this potentially be your opportunity to expand into the provider?

About our guest

Julia Hu is an entrepreneur and co-founder and CEO of Lark Health. Founded on the personal experience of living with an undiagnosed chronic condition, Julia is passionate about bringing compassionate care to those preventing or managing chronic disease. Named "10 Most Innovative Apps'' alongside Uber and Airbnb, Lark’s trailblazing A.I. platform allows payers to offer an unlimited, one-on-one chronic disease prevention experience to all patients and is a covered medical benefit offered by many health plans.

Hu was named on the Business Insider’s 30 Under 40 Changing Healthcare list and was awarded as a member of the UCSF Health Awards Hall of Fame in 2021, as well as the EY Entrepreneurial Winning Women™ North America Class of 2021.

Julia Hu is an entrepreneur and co-founder and CEO of Lark Health. Founded on the personal experience of living with an undiagnosed chronic condition, Julia is passionate about bringing compassionate care to those preventing or managing chronic disease. Named "10 Most Innovative Apps'' alongside Uber and Airbnb, Lark’s trailblazing A.I. platform allows payers to offer an unlimited, one-on-one chronic disease prevention experience to all patients and is a covered medical benefit offered by many health plans.

Hu was named on the Business Insider’s 30 Under 40 Changing Healthcare list and was awarded as a member of the UCSF Health Awards Hall of Fame in 2021, as well as the EY Entrepreneurial Winning Women™ North America Class of 2021.

Before founding Lark, Julia ran a global startup incubator, the CleanTech Open, that built a sustainable construction startup, and was an Entrepreneur-in-Residence at Stanford’s StartX incubator. She sits on the board of the Council for Diabetes Prevention and is an active Singularity University faculty member. Hu received her Master’s and Bachelor’s degrees at Stanford University and half of an MBA from MIT Sloan before founding Lark.


Q. Julia, you have a very interesting personal story for how you started Lark Health. Do share that and tell us about your personal journey that led you to where you are.

Julia: It’s certainly been a journey and one that started when I was a child. I’m not a doctor. I have no clinical background, but I am a deep consumer of health care. Ever since I was a little kid, I had many different chronic and autoimmune conditions. They were all undiagnosed but left me pretty sick as a child. My dad had to quit his day job to take care of me. After visiting dozens of doctors, he found this Pediatrician for me and it was like my 24*7 care team — my pediatrician, my dad and I. Over 12 years on this journey where my pediatrician would completely change my diet and help me manage pain, exercise, sleep, medication, and stress, I found that it really changed my life. I got rid of 90% of my attacks, even though I didn’t know what I had as a condition or a series of conditions. That’s what really changed the way that I saw medicine. I felt that if you could treat the whole person and provide 24*7 personal, compassionate care, you could really do a lot to change people’s lives.

Fast forward to me as an adult, I saw that there were not enough doctors and nurses and the ones there were so overworked. How then could you really create this unlimited infinitely scalable care, especially focused on people struggling with chronic conditions or health issues that could lead to chronic conditions or mental health struggles?

As a tech entrepreneur, we decided to tackle this very big problem of using AI and remote patient monitoring, behavioral health, and cognitive behavioral therapy — How do you use these tools and technologies to infinitely scale virtual care? That’s how Lark was born.

Q. What kind of conditions do you address using your approach and your platform?

Julia: Think of our platform as 24*7 text message-based counseling, plus all of the remote patient monitoring. The devices that someone might need, whether they have diabetes, hypertension, pre-diabetes, stress and anxiety, or they just want to sleep better or stop smoking – we cover about ten conditions in preventative, chronic and mental health. We treat about two million patients on our platform and our health plans manage 30 million lives right now for one of these ten conditions.

Q. Are your main customers health plans?

Julia: Yes. We also have about a thousand employers that we work with. We’re also actually just starting to work with pharma companies as well.

Q. Remote care, AI enabled care has been around and there’re a lot of companies that are taking a similar approach to remote care. How is yours specifically different? Is it the cognitive behavioral aspect or the tech?

Julia: Most of population health, today, is what I would call either health care services or tech-enabled health care services, which means you have a care manager, or a nurse and they get on a phone call with you or, they do a webinar with you or, you go in-person to a doctor to get a care plan. That obviously has scale and cost constraints.

What we do is we try to say, “Okay, what if you could automate this first line of defense and turn it essentially into an AI chatbot?” We spent about seven years, $100 million in R&D and trained our AI on about a million patients. It started getting clinical equivalents to live nurses. That’s how we started scaling our services. That’s also why we’re able to manage more than 2 million folks through all this tech and automation.

Now, the tech and automation are not just the devices, the hardware and remote patient monitoring. Also think of us as a friend. We’re there at 1 a.m. If you need to text when you’re feeling stressed, we’ll do a five-minute meditation session with you. When you’re a diabetic and you have some increases in glucose, we will help you understand what you ate that triggered that. So, we’re really all about using the best of cognitive behavioral therapy, the best of the care plans, and providing care in an easy to digest way.

Q. You mentioned the term “clinical equivalence.” What does it mean?

Julia: What we’ve done is, shown that just with our AI text message-based counseling, we can have equivalent outcomes to live nurse care management type services. So, everything from — we’re seeing one-point a1c average drop for diabetics, we’re seeing 13 points drop on hypertensive, and we are, for example, CDC fully recognized as a DPP provider. CDC does a longitudinal look at 2400 providers, and we are in the top 25% of those providers.

We’ve been able to show that our outcomes are just as good. But because we are AI and not taking up and using all these nurses and coaches, we’re able to be much more scalable and deliver care at much lower the cost.

Q. Do you in commercial terms offer these kinds of assurances to your clients — health plans — and really take risk and participate in the rewards and the gains based on this experience?

Julia: Yes, we do. That’s why we do performance-based pricing. We only get paid if we hit certain clinical thresholds and if we engage patients. So, we have that — PMPM and performance guarantees. We really try to ensure that we put our money where our mouth is.

Q. In the last couple of years, we had the pandemic and within that, behavioral health and mental health was a big pandemic. The other big forcing function more recently has been the shortage of labor. How has that impacted your demand environment and your own business in terms of these macro level factors?

Julia: I think that the pandemic has really changed everything. However, specifically the silver lining to the pandemic in my mind, is that healthcare has been the last industry that hasn’t yet been truly revolutionized and disrupted by technology.

I do feel that the pandemic has pushed us probably up a whole generation on unlocking some of that innovation for us. With regard to our managed members, we went from one to 30 million for our health plans. We went from a ragtag team of engineers and tech and data AI folks and raised about $160 million during the pandemic and scaled our team close to 500%.

So, we do feel very excited that we’ve been able to participate because virtual care and getting care delivered through your phone, wherever you are or safe in your own home, are things that really started shifting with supply and demand. It’s been a real learning curve.

Now that the pandemic is in a much better place, people want to stay here. They want to get convenient and cheaper access to care when they want it, when they need it. They want consumer care now rather than health care being very non consumer-centric. In those ways, we’ve been a beneficiary of the acceleration toward digital innovation.

But of course, we have also had to struggle with building a completely remote workforce and creating the culture to align teams. We have not been immune to this recession that’s looming, and I’m just very grateful, though, that we’ve been really pushing forward and had a good growth spurt.

Q. The last couple years were good for fundraising, especially for later stage startups that had demonstrated some degree of traction, stability and growth potential. But things have changed a little in the second half of this year. There’re the macro factors — inflation and interest rates, and the VC funding environment has contracted a little bit. What has that meant for you and the digital health startup ecosystem?

Julia: It’s so interesting. You and I were just talking about the health conference that came out and I was so shocked at how many hundreds of vendors and new digital innovations in the exhibit halls, there were.

I do think that the funding has really pushed forward a ton of innovation. And with the recession coming and the big draw-back of capital funds available now, you have a lot of new companies needing to essentially get toward a go to market strategy, a product market fit, get to more profitability and revenue much more quickly. There is going to be some bumpiness. There is definitely going to be consolidation in the market, a lot of point solutions getting deals here or there that are pretty young and so, the partners on the employer side, on the health system side, on the health plan side might also experience some bumpiness as they work with very innovative but very potentially new and young companies that hopefully, get through the Winter.

However, I think it’s our job — not just of the young companies, in fact all of us growth companies, and the newly public companies — to be good stewards of the capital in our coffers, to really focus on the core business, drop and deprioritize some fun experiments and R&D efforts and really just lean into the focus areas.

Q. One of the things that I’ve learned as an entrepreneur is it’s just as important what you choose not to do as it is to decide what you choose to do. Your comments about the funding environment and what it means for startups that have sort of overextended themselves is true and we’ve seen examples in the behavioral health space with companies indulging in a culling of the herd. Is the recession you mention twice above, a given based on everything that you’re saying or are we probably already in one and we just don’t know it?

Julia: I am not an economist. I don’t know enough about the markets. However, I feel like we need to be very honest with ourselves. We are in the beginnings of winter. I don’t think that winter will be over, immediately. I hope for the best, but I also plan for a more serious winter.

Q. You’ve done some interesting partnerships, especially one with Salesforce. Do tell us about that.

Julia: We were just at Dreamforce with the Chief Customer Officer and the Chief Health Officer launching our products partnership that we created a tech stack with Salesforce. It’s very exciting because here we’ve been able to bring together two parts of the tech stack that serve the marketplace.

Salesforce is very good with being a market leader in CRM and essentially with a data infrastructure and tool kit for everything on the marketing side as well as now for the clinical workforce — the pharmacists, the care managers, the telehealth providers providing data to them through a clinical CRM — so that they can perform at the top of their license. Salesforce came to us and said, “Hey, we’ve got this market leading product. Now, what we do need is a way and a technology to really mass acquire members and patients — to engage them, triage them into virtual care plans, and then, to be the front line of defense for care and at the right time, escalate them to nurses, care managers, providers, ensuring that they get the clinical data so that they can perform at the top of their license.”

That was our exciting partnership — this idea of we being the B2C and they, being the B2B platforms and us cross-selling that into health plans, providers, value based care providers and pharma etc.

Q. It looks like 2023 will be a difficult year. What’s your advice for other founders startups who have either recently come into the market with a product and are now facing headwinds because of the macro environment? Or those who are looking to get into digital health right now and have a nice idea. What’s your advice to them?

Julia: I think you gave great advice — Hold on to that cash.

I think that focus would probably be my advice. Just focus on where your strengths are. Be very honest with yourself, on what your strengths are and where you’re weak. Focus on those strengths and leveraging how do you lean into those strengths to leverage them even more.

For us, I keep telling my team our two strengths are we have a cost advantage and we have a scale advantage. Where do we lean in to, to really where that matters? Where we have a cost sensitive client.

You’d say “Oh! All clients are cost sensitive.” But in fact, we found a lot of interest and scaling in value-based care partners in fully insured. We power many fully insured book of business for health plans. We power Medicare and Medicaid. It’s these types of things, really leaning into your strengths and just being very focused.

Q. So Julia, you mentioned payviders and this is a very, very interesting segment. By the way, my firm does a lot of work with payviders as well. There is a very unique dynamic which is quite different from the normal payer provider dynamic. So, talk to us a little bit about that and why you mentioned that segment as a focus area for your company.

Julia: Absolutely, I’m really excited about the payvider aligned incentive model, right. You’ve got the payer and the provider on one side. They’re all financially aligned to provide value-based care. The plan can provide tools that allow the provider side to really perform at the top of their license. And so, you know, the Salesforce deal that I mentioned that really is a provider type tool. The work that we’re doing is really can we be an effective front line of defense and patient member activation channel for our populations that are at risk because, you know, as a as a product that can scale aggressively, you know, we can engage every single member, you know, in their journey as they become patients, as they need certain things from their chronic condition journey. So, think of us as the, you know, the ongoing engagement and care services in between the doctor visits. So, we’re able to become a front line of defense for providers and, you know, a value-based care service that not only does all the remote monitoring to provide that longitudinal record but pushes people at the right time back to their nurses, doctors and care managers. So, I’m really excited about the transformation and the growth of all of these provider systems.

Q. And for the benefit of listeners who may not be familiar with the term provider, these are integrated health systems that have a large health system, whether kind of a fully owned health plan, which is the payer side of the business. So, these are not the most elegant of terms, but it kind of, you know, conveys the message. And of course, I imagine, Julia, that beginning to work with private providers also now gives you an inroad or a visibility into the provider market segment itself, which is a large, you know, segment on its own. And you mentioned early on that you’re currently working mostly with health plans and with employers, but this could potentially be your opportunity to expand into the provider. So, is that part of your thinking as well?

Julia: I absolutely think that the provider is at the center of care. And as a tech company it’s our job to really be the front line of defense for the provider population, for the PCP population that unfortunately right now is very strained, and a lot of doctors are burning out and we’re not putting enough energy into the PC P ecosystem. So, the short answer is yes. The slightly more nuanced answer is that I think we work best in a value-based care construct because we are, you know, really trying to help the care of the whole person.

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.

It’s a myth that delivering care digitally will result in higher costs

Season 4: Episode #138

Podcast with Michael Hasselberg, Chief Digital Health Officer, University of Rochester Medical Center

"It’s a myth that delivering care digitally will result in higher costs"

paddy Hosted by Paddy Padmanabhan
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In this episode, Michael Hasselberg, Chief Digital Health Officer at the University of Rochester Medical Center (URMC), discusses their digital health priorities and technology solutions to engage the patient population they serve. URMC is a unique organization as it is the only health system still attached to its parent university, and Michael talks about how that differentiates them from others.

URMC, a fully integrated academic medical center, was recently named in our inaugural list of digital health leaders and innovators for our Digital Maturity Awards program.

Michael states that the rural population engages more via digital modalities like telehealth and video visits than in-person visits. He talks about why their digital transformation strategy focuses on data and how the future of healthcare depends on structured and organized data sets. He also talks about how they make their technology choices and digital health priorities for 2023. Take a listen.

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Show Notes

01:44Tell us about the University of Rochester Medical Center and what makes your organization unique?
04:06 Can you talk about your digital health initiatives and the kind of populations you serve?
08:16What are you hearing from your populations in terms of what they want and seek from an organization like yours. Also, talk about the technology enabled solutions that you've developed from a digital health standpoint and the benefits you have delivered?
15:29How have the caregivers and the physicians responded to the digital modalities?
21:08How do you go about making technology choices? Specifically, about the tradeoffs you make when you consider something that is native to your EHR platform, something that may be a standalone tool which is best-in-class but also has its own set of tradeoffs.
25:58 What do you see ahead for health systems? From URMC standpoint, what are you planning for from a digital health priorities/ investment standpoint in 2023?
29:19What do you think of the policy environment? Are you looking at data from the point of view of consumer data strategy that helps you improve your engagement and outreach, or more from the standpoint of improving health care outcomes? Or is it both?

About our guest

Michael Hasselberg, PhD, RN, PMHNP-BC is an Associate Professor of Psychiatry, Clinical Nursing, and Data Science at the University of Rochester (UR). Dr. Hasselberg is the first Chief Digital Health Officer at UR Medical Center and is the co-Director of the UR Health Lab, the health system’s digital health incubator. He was recently named to the “Top 50 in Digital Health” list by Rock Health to recognize his work to improve health equity through technology innovation during the COVID-19 pandemic. Board certified as a Psychiatric Mental Health Nurse Practitioner, Dr. Hasselberg completed his PhD degree in Health Practice Research at the UR and a postdoctoral certificate in Healthcare Leadership at the Johnson School of Management at Cornell University.

Michael Hasselberg, PhD, RN, PMHNP-BC is an Associate Professor of Psychiatry, Clinical Nursing, and Data Science at the University of Rochester (UR). Dr. Hasselberg is the first Chief Digital Health Officer at UR Medicine Center and is the co-Director of the UR Health Lab, the health system’s digital health incubator. He was recently named to the “Top 50 in Digital Health” list by Rock Health to recognize his work to improve health equity through technology innovation during the COVID-19 pandemic. Board certified as a Psychiatric Mental Health Nurse Practitioner, Dr. Hasselberg completed his PhD degree in Health Practice Research at the UR and a postdoctoral certificate in Healthcare Leadership at the Johnson School of Management at Cornell University.

His expertise expands health and technology as a Robert Wood Johnson Foundation Clinical Scholar Fellow and advisor on digital health modalities to the New York State Department of Health, the Department of Health & Human Services, and the National Quality Forum. He also serves as an independent consultant to several digital health.

Q. Michael, can you talk about the URMC and what makes it unique?

Michael: We’re actually even more unique than most academic medical centers left in the country these days in the sense that our health system is still truly fully integrated into our university.

What that means is the budget on the health system side rolls up to the budget of the university. Most academic health systems, today, are no longer fully integrated with their parent university in that they have broken off from the parent university. On the health system side, we tend to make money but on the academic side, it’s much harder to do so. The health system then, ends up subsidizing and sending a lot of their margins over to the college to help support those missions.

A lot of academic medical centers said, “Hey! If we broke away from our parent university, it’s going to be easier for us to obtain our 1-2% annual margins per year that we’re trying to achieve.” At the University of Rochester, we have made the conscious decision that we are not breaking away from our parent university and we actually leverage that as a differentiator for us.

When we think about digital health and digital transformation, I have access to some of the most brilliant engineers, computer scientists, data scientists, business faculty in the country. I have access to even the faculty from our music school. I can apply that expertise and capacity to solving some of the most difficult problems in our health system. I can leverage that expertise to build, create, and deploy new technology solutions into our ecosystem. It’s a unique place and I love it.

Q. Does it also influence your priorities regarding the kind of digital health initiatives you should be in, in addition to serving? Also, tell us about the populations you serve.

Michael: We serve a very diverse patient population. To give you some context around the URMC and Health System, we’re the largest health system outside of New York City. In terms of geography, we have a large geography in the state of New York from central New York all the way out to the Ohio border and all the way down to the Pennsylvania border. This entire region has patients that we serve.

In terms of the kind of diversity of these patients, we have everything from the inner city of Rochester, which looks like the inner city of most moderate sized cities across the country. But if you go 20-25 miles outside of the city, you could be in some of the more rural areas in the States or in the country.

A good portion of our patient population is safety nets and Medicaid. We have a lot of underserved and vulnerable patients that seek care out at our academic medical center. For those reasons and in trying to engage and reach those patient populations, we’ve had to think outside the box and other technology solutions to, not only meet the needs of patients in the inner cities but also meet those for who, there may not be a specific specialist for four counties around them. How do we get care out to them?

With regard to our technology priorities and the influence that the college has on that, actually, there’s not a whole lot of influence from the college in the normal sense. We have a very clear digital transformation strategy that’s set out. When we have gaps in our technology stack, we say, “Hey! We need to solve this problem.” If we don’t have a solution in our technology stack, we may lean on the college. That expertise—if we can’t find a solution or an external vendor that we think is best of breed to fill it in—is what we will leverage and say, “Hey! Can you help us develop the solution in-house?”

It’s not that we don’t develop technologies for the purpose of spinning out companies. We don’t have a true investment arm, so, we’re different from another one of your honorees like Providence Health, which has a $300 million venture arm where they actually incubate a lot of companies in-house. They invest in them and spin them out. We don’t do that.

When we build our technologies, they are truly being built to serve our patient population and community. We build to open source our code and give our technologies away to other health systems in the country. We have a lot of examples of doing that and of other health systems and industry coming in, taking our code, and applying it to their systems.

So, the college, I would say, kind of augments the strategy but doesn’t satay or drive it. They help us fill the gaps.

Q. What are you hearing from these populations in terms of what they want from URMC? Can you talk about the solutions you’ve developed that are technology enabled from a digital health standpoint? What kind of benefits have you delivered?

Michael: Access to health care is something that we hear across the board that these populations are seeking. So, it doesn’t matter if you’re in the inner city or if you’re in rural America. Folks want to have access.

I think one of the myths that jumps out often in the digital health space is this digital divide — that some of these populations don’t have access to the technology needed to receive care or there’s not sufficient broadband in these communities — so they cannot engage.

What we have found in Rochester, for our market and the patients we serve is, that it’s a total myth especially, in some of the more rural areas of the state. What our previous Governor of New York state did was, they invested really heavily in getting broadband access across the state so, there isn’t a problem of Internet not being out in some of these more underserved communities.

The other myth is, a lot of our patients don’t have one of these devices – the smartphone. Pretty much everybody has one of these and you can do a lot with engaging patients on that smartphone. However, as we started deploying things like telemedicine very broadly during the pandemic, what we found was especially in some of these more rural areas and with our safety net patient population, while they engaged quite a bit through the telephonic interactions with our care providers, it wasn’t very significant on the video side. We did a deeper dive in that and found that although there’s Internet access out in these rural communities, the only Internet that’s available to them is through their data plans on their phone. When you’re pushing out a video conferencing feed to somebody’s data plan on their phone, it eats up that data plan quite significantly. So, we’ve thought of and engaged them via more text-based and mobile applications and we’re thinking outside the box around how we can identify other partners and where we can meet these patients in their communities to actually deliver video-based care.

A selfish plug here — just last month we had a publication in the New York-New England Journal of Medicine, Catalyst, which actually talked about our experience delivering telemedicine to the safety net Medicaid population in these rural areas. As they engaged in care, we found out that these populations engaged more via digital modalities than actually in person. On comparing them, we found they engaged more in the digital modalities than even some of our commercial payer patients did. Not only did they engage, they required less in-person care after that engagement in their video consult. They weren’t ending up in the EDs more often than our patients coming in-person. They also required less expensive imaging and lab work than those that were coming in-person.

All these myths then, that delivering care digitally is going to result in higher costs because providers are going to lay hands on them, so, they’re going to need to order more tasks, more imaging to get the data to make those confident care decisions, is not something we saw. The idea that, because the provider’s not going to lay hands on these patients, they’re going to require more in-person follow ups because they’re not going to get their care needs met is not what we saw at all. Again, the patient population that did the best to decrease cancelations, no shows and more follow up was the safety net Patient population engaging in telephonic and video digital modalities who received care.

Q. Does this hold true for all types of care — episodic, preventative, or chronic disease management — or is it more pronounced for one type of care?

Michael: Where I think we had the most success was in primary care because our primary care sees whatever comes through the door.

Another area that we continue to have success in is behavioral health. We’re also having a lot of continued engagements and considerable success in the urgent care and emergency department settings with these modalities.

In terms of the types of digital modalities we have success in some of our subspecialty areas actually may not be telemedicine. And part of that is, digital health in some ways really disrupts their current workflows. Those workflows and more procedural based subspecialty disciplines are set up to be successful with that patient showing up in the office and being seen in-person. If you apply too much digital transformation to those subspecialty areas, it disrupts what’s working for them now.

Being in a health system that’s primarily reimbursed or still in fee for service, we have very little value-based reimbursement contracts. We really don’t want to disrupt a whole lot of our high-cost procedural based subspecialists and what they’re doing. So, in some of those areas, digital engagement has perhaps not been as strong as it’s been in primary care, behavioral health, geriatrics, and urgent care and some of our more non procedural based specialty kind of discipline areas.

Q. How have the caregivers and physicians responded to these digital modalities even if it is for primary care or urgent care or something more specific? What have they had to change or adapt to in terms of their own training, reorientation? Can you talk about their expectations and how you met those?

Michael: I suspect a lot of your listeners — the other health systems — are going to have experienced a lot of what I’m going to say. When we started our digital transformation strategy in our health system, the first two years of the strategy were primarily focused on access and on how we could essentially create a digital front door where our physical front door was located. Our physical front door is primary care. That is where we narrowly focused the beginning of our transformation strategy.

When we started in primary care, we had a significant amount of resistance around, “Right now, my caseload is falling. I don’t have room to take on any more patients. What do you mean you want me to use more technology? This electronic health record that you have for me is the bane of my existence. I am documenting all day long and answering messages from my patients and looking at labs all day. You can’t add another technology on top of this. I can’t do it.” That was a lot of what we heard in the resistance.

We listened to and understood that. We needed to help relieve some of their pain points. We realized the need for a true digital patient portal into our health system. We are an Epic shop and MyChart is the patient portal for Epic. So, we started there in our MyChart penetration. Our digital transformation was not high in primary care — in fact, it was below 30% — and we knew that if we were to engage our patients through digital mechanisms, we had to get that MyChart and that patient portal penetration up. However, the resistance from the primary care site meant they were not championing the patient portal in MyChart because they didn’t want more messages coming in. They equated that patient portal to being their in-baskets, which was overwhelming them.

To get early wins and buy in from our providers, we had to help them out and do a deeper dive into what was clogging up their in-baskets. We found some low hanging fruit here and made system level decisions of getting all that out. We were able to really quickly reduce the in-basket burden on our clinicians by 15% and all this by clicking a button in our system. Getting that win had never happened for these primary care providers in the years that I’ve been in the institution, since we’ve gone live with Epic, and so, that was huge for us.

That gave them more confidence so they said, “Hey! Let’s give this a try.” They started engaging in the digital transformation strategy and started championing MyChart. Now, our patient portal penetration in primary care has gone from less than 30% to up about 90% in a two-year period in the primary care setting. There was resistance at the beginning, but we had to get those early wins.

Along that transformation in primary care, we celebrated those early wins with our providers. We showed the benefits of, “Hey! We’re going to save you more time and free you up to do the things that you really want to do. You can see patients and not be documenting or doing the rest of the stuff.” That’s how we were successful.

We find the same kind of experience in our specialty service lines. We’ve expanded our transformation and one of the things I’m very grateful for is having a great partner in crime. Dr. Gregg Nicandri, our Chief Medical Information Officer and I are attached at the hip. He leads the clinical informatics teams.

We help with the translation, enable getting by at the provider level, and really, leaning on the clinical informatics team. Leaning in on Rosemary Ventura, our Chief Nursing Informatics Officer on the nursing side has also been really helpful to move forward this digital transformation with our providers.

Q. With regard to the technology landscape, how do you make technology choices? What are the tradeoffs you make when you consider something that is native to your EHR platform versus something that may be a standalone tool which is best in class but also has its own set of tradeoffs?

Michael: Folk that have heard me speak in other forums know that I’m, in some ways, a little bullish in my response because we’re an Epic shop. We take an Epic-first mentality. What that means is, if Epic has the functionality and it’s good enough — it does not have to be the best or peripheral but if it has patient experience or patient access functionality that’s a little bit outside of Epic’s bread and butter, then, we’ll go with the Epic solution every single time, even if there is a better solution out there. Part of the reason we’ve just made so much of an investment as a health system into Epic is because we have to maximize that investment is as best as we can.

That being said, if Epic doesn’t have the functionality or it’s on their roadmap but there’s no real clear indication of when it’s actually going to go live, which happens a lot, then, that’s when we make a call about whether this is a high-enough priority. We can’t wait until Epic gets there on the roadmap. We need to find a solution.

The way we evaluate external vendors is not the typical way a vendor may think they would get evaluated. I don’t really care if you’re the best-in-class vendor out there. My first priority is less about your success with regard to your UI, UX and results there. It’s truly about the level of your integration into Epic. If you don’t have a nicely integrated package within Epic already, you’re probably not going to make it on our list of even a vendor to consider. That level of integration is priority number one for us. If we then find a solution that integrates well with Epic’s hyperspace and with the patient MyChart portal in a way that it the patients continue to have that omni channel experience, then, we can onboard that into our health care ecosystem to fill that gap.

One of the things that’s really unique about Rochester and what probably excites me the most is we actually have a true digital innovation incubator. It’s not a research shop. It has faculty from all of our schools — the medical, dental and nursing schools under the same roof — and it uses design thinking methodologies to build solutions in-house to fill those gaps. We build them fully integrated into Epic. That’s the thought process at the URMC as we think about our technology stack and how we take on new solutions.

Q. We are going through a very challenging year in 2022. What do you see ahead for health systems? What are you planning from a digital health priorities/investment standpoint going into 2023?

Michael: Our big investment in priority is actually data. We’re collecting a lot of new data from new technologies that we’ve to had before in our databases within the health system. So, getting our data organized and in good shape is top priority.

As a large academic medical center or health system, we also have a lot of data silos and no source truth of data. It’s important then to build our enterprise data warehouse and break down those silos, bring in all of this new data from these technologies that we’ve rolled out over the last couple of years and make sense of it. That’s actually going to set us up uniquely in two different areas.

One, it’s going to help my health system make more strategic decisions around taking on risk from maybe a payer standpoint in the future. It will also get us set up nicely for moving into more value-based arrangements. That’s priority one.

Priority two is our workforce struggles and shortages. Data will allow us to understand where to start making investments in the workforce. When data is all cleaned and aggregated, we can start taking advantage of some of these Machine Learning products that are popping into the markets. A lot of that machine learning and artificial intelligence technologies that are coming out can potentially significantly impact the workforce shortages, help us start automating things, and supplementing where we have gaps in our workforce.

I have a lot of AI vendors that approach me and want to partner with Rochester. However, my response to them is, we’re not ready yet. The reason is, you may have the best algorithm or model built, but my data isn’t there, yet. If I was to roll out your model now, and I put my data in, then, the results emerging will probably not be the results I was hoping for.

We want to put ourselves in a good place to not just take advantage of machine learning and artificial intelligence in the future to help our workforce but also to help us make better strategic decisions around transformation, in general. That may be on the digital side or even on the payment side.

Q. Are you looking more at data from the point of view of a consumer data strategy that helps you improve your engagement and outreach? Or is it more from the standpoint of improving health care outcomes? Or, both?

Michael: It’s absolutely both. One of the things that excites us is on the outcome standpoint and actually merging that data. We’re very proud of the fact that Rochester’s the home of the bio psychosocial model of medicine and it’s all about focusing on care from these holistic and broad domains.

We made a strategic decision about seven years ago to profile our patients using patient-reported outcomes within those broad domains. It didn’t matter if you came to my health system with a toenail injury but we were going to ask you about your emotional distress, physical functioning, pain interference, and social functioning every single time. We collected this data on iPads and integrated it right into Epic. My health system has, as far as we’re aware, the largest patient reported outcome data set in the entire country. All this is systematically collected in these broad domains. Now we’ve got these outcomes based off the patient’s own perceptions and in their own voice about how they’re doing in health care. We can combine that with some of the more quantitative data from the EHR about lab or mortality outcomes and these newer consumer engagement data that we didn’t otherwise collect using technology. That’s going to be the secret sauce.

When I think about disruptors, in general, in other verticals, Amazon comes to mind. They totally disrupted retail, but Amazon didn’t do it because they were setting up an e-commerce website. It was the data behind that. Amazon knows you as a consumer better than you know yourself. That’s where we want to get to in health care. I want to be able to help predict what you’re going to need as a patient before you know you even need it and get you to the right level of care at the right time. We think that combination of patient reported outcomes collected in these broad domains combined with our EHR data combined with this new consumer data that we’re getting from technology combined with claims data and others will help us at Rochester develop our own Amazon recommendation algorithm that they’ve patented. We’re going to do it for health care. That’s where the future is going and that’s why we’re now heavily invested in getting our data to a point where we can start leveraging our Data Science Institute and the college and some of these AI vendors to help us get there.

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 macro trends driving the growth of digital health funding are still in place

Season 4: Episode #137

Podcast with Jacob Effron, Principal, Redpoint Ventures

"The macro trends driving the growth of digital health funding are still in place"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Jacob Effron, Principal at Redpoint Ventures, discusses the venture capital (VC) environment for digital health. Redpoint Ventures is a venture capital firm focused on investments in seed, early, and growth-stage companies and has been investing in the healthcare tech landscape for the last decade.

Jacob believes that the fundamental trends driving the growth of digital health are in place. However, later-stage companies looking to raise additional capital may experience some uncertainty in the short term. He also talks about the demand environment for Redpoint’s portfolio companies and his advice to founders looking to navigate the health system space. Take a listen.

Our Podcast Partners:

Show Notes

00:32Jacob, tell us about Redpoint Ventures and your role.
02:56 Give us your State of the Union on where we are with digital health, especially the younger companies.
05:24Have you changed focus considering what's happening in the macro environment? Are you investing more in one stage versus another?
06:52What are you hearing from the startup entrepreneurs and the founders about the demand environment, their operations, the talent etc.?
10:10What are you hearing from the market about the demand environment for digital health solutions?
11:43 You mentioned value-based care and how startups now must get creative about demonstrating value, taking on risk, and being able to put more money at risk to earn the right to a seat at the table. Tell us how that's playing out.
16:07What do you think of the policy environment? Are there things that you would like to see in the near term that could make a difference to the picture?
18:34What are some of the core attributes you seek before you begin funding one of these startups?
21:43The competitive landscape for the startups today has big tech---Amazon, Microsoft, Google, Apple---coming into the core healthcare services space. What’s your take on what this means for smaller companies?
24:04What's your take on what to expect for 2023 and what are you advising your followers?

About our guest

Jacob Effron is an investor at Redpoint Ventures specializing in digital heath. He's an operator-turned-investor, having worked as a product leader at Flatiron Health before going into VC in 2019. Jacob’s background as an operator grants him firsthand knowledge of the pain points that health techs go through. He also regularly shares his thoughts on the digital health industry and how he’s approaching his investments on his Substack, Vital Signs with >2K subscribers including many CEOs and industry veterans.

Jacob Effron is an investor at Redpoint Ventures specializing in digital heath. He's an operator-turned-investor, having worked as a product leader at Flatiron Health before going into VC in 2019. Jacob’s background as an operator grants him firsthand knowledge of the pain points that health techs go through. He also regularly shares his thoughts on the digital health industry and how he’s approaching his investments on his Substack, Vital Signs with >2K subscribers including many CEOs and industry veterans.

Q. Jacob, tell us a little about your firm and your role there. 

Jacob: I’ll start with Redpoint and then, give a bit of background on myself. Redpoint is fund, and kind of a classic Silicon Valley venture firm. We’ve been around since the late nineties and the heritage of the fund’s really on the side of enterprise software, data infrastructure, and other categories. So, think companies like Stripe, Snowflake, Twilio and HashiCorp and Ramp. But in the last decade, we’ve gone into health care in a big way so, it’s actually about a quarter of our fund, now. 

The way we think about it is really in bringing the best of enterprise software, data tools, consumer experience, fintech etc. that we’ve come to expect in every other part of our lives into health care. As a firm, we’ve invested in companies like Cityblock Health, Galileo Health, Strive Health, AcuityMD, Garner Health, and hims —a whole host of a really exciting companies. That’s where I spend my time. 

In terms of my background, I joined the health care policy side in college. Then, I started my career at McKinsey working with state Medicaid agencies, payors, providers, and pharma companies. Subsequently, I went over to Flatiron Health, which was doing Big Data for Cancer treatment to help start a new business line there. Eventually, I joined the product team and helped build workflow tools for Cancer centers we worked with. After we got acquired (by Roche), I switched over to the venture side and have been at Redpoint for the last two and a half years. 

Q. With regard to the digital health landscape, we’ve moved from celebrating the blow out funding numbers for startups here to a blowing up of some of these companies. Give us your State of the Union on where we are with digital health. 

Jacob: One of the interesting parts of being at a firm that invests in health care tech is, you get perspective on what’s happening across spaces that venture capital firms invest in. 

There are a series of later stage companies that raised rounds last year when the market was roaring and people thought good times were exclusively ahead. Now that the public markets have really corrected in every space—in software, fintech, and health care—a lot of people don’t know what these later stage health care companies are worth. 

What that means is—and I’ll bifurcate what’s happening in digital health investing right now to early stage and later stage—on the later stage side, there’s just a bit of confusion as to what these companies are worth. People are waiting to see that. With the public markets moving around so much, there aren’t that many health care companies that are public, so, there aren’t that many examples to point to that are analogous to a lot of these startups. In that environment of confusion, folks may be a little bit reticent to invest in some of those later stage health care companies. A lot of the later stage companies are then, facing a period of uncertainty. 

One has to make sure you’ve got runway to see it through to greener times. The overarching theme then, is like all the macros that are driving health care and this is really relevant to the early stage. They’re still there. None of that’s changed because of the current environment. That’s not like last year when the health care cost curve was going up a ton. This year, it’s suddenly flattened. Last year, there was a need for technology and providers, payers, pharma, and that’s suddenly changed. So, all the thematic reasons that make digital health really interesting are still there. 

However, I don’t think the market’s changed dramatically for early-stage companies and really, for strong teams, and going after interesting problems. It’s really these later stage companies where there’s just uncertainty about how they should be priced. 

Q. Have you changed focus in light of what’s happening in the macro environment? Are you investing more in one stage versus another, now? How’s your firm looking at this? 

Jacob: We’ve retained focus on the same stage, throughout. Certainly, there are opportunities across the board and the saying, “No one knows how to price some of these growth rounds” is interesting. They’re actually becoming interesting opportunities. 

There are some great later stage health care companies that are in the private markets that maybe were planning to IPO and now, isn’t really a great time to do that. There continue to be more interesting opportunities across the board but it’s just that maybe last year those deals were priced at a certain price and now they’re not pricing at that level. 

Q. What are you hearing from the entrepreneurs and the founders running these companies about the demand environment, their operations, the talent etc.? 

Jacob: There’s a lot there so maybe I’ll start with the talent side. 

There’s an interesting opportunity on the talent side for digital health where in the past, maybe large tech companies have been able to pay salaries that dwarf what any digital health company can pay. So, anytime you’ve got this inflection in the market as a whole, it’s like an interesting dislocation where it forces people to reconsider, “Oh! I thought I had all these options and I thought they were going to be worth so much money that I had golden handcuffs and I was going to stay at this, at Facebook forever.” Now, people are rethinking that. 

One trend I’ve seen across the board is that folks want to do more mission-driven work that’s meaningful to them. I talk to people all the time and they’re like, “I want to go into health care or climate.” So that’s where they want to spend time and for a while it’s actually a really interesting talent market. 

Across the board, in our portfolio companies, we’re seeing incredible engineers, product people that maybe are using this current environment as a inflection point to think about, “Okay, what do I want to do with this next stage of my career?” On the talent side, I hope to see this continued influx of folks into the digital health space, which is really interesting. 

On the customer side, I guess a classic investor thing that has always made people interested in health care is that it is in many ways countercyclical. There’s this fear in software at large right now that like all these startups sell to other startups. And the second the music stops, there aren’t as many startups out there like all these companies.

Actually, in health care, a lot of our customers and companies sell to large employers, hospital systems, or pharma companies and certainly, there’s a tightening of the belt across the board. But again, back to the original point, the problems haven’t changed. If anything, you have some companies that actually make for really interesting inflection points. For instance, we have one portfolio company, Garner Health, that focuses on helping employers lower the cost of care and improve the member experience. That’s actually even more relevant in this current environment. They have a lot of folks that are seeing the premium costs for next year and saying, “In this economic environment especially, that’s something we really want to tackle.” 

Q. With regard to the enterprises—health plans or health systems—what are you hearing from the market about the demand environment for digital health solutions? 

Jacob: It’s interesting that on the health system side, maybe if you were to bucket different kinds of solutions, there’s stuff that feels like, “Hey! This is a point solution that just does, a very specific thing or, seems cool like a cool algorithm or a cool tool.” But it doesn’t really have an ROI or that’s unclear, still TBD (to be decided). 

We’ve always been reticent to invest in some of that and in this environment, you’re really going to see a bifurcation of tools that are broad in scope, that can really be partners for systems at a much larger level, along with tools that have clinical and financial studies behind them and proof points in case studies with other systems that they work. You do find the best but in this current environment, it’s a really hard time for systems right now. 

When you approach a system to talk about specific clinical applications in one department that maybe has some clinical validity, it’s about how much time you get relative to the person that’s like, “Hey! I understand the staffing challenges you have and here’s something that we’re building around that.” Or “Let’s talk about revenue cycle.” Or “Let’s talk about patient engagement and keeping folks within your system.” Or “Let’s talk about some of these new, value-based models you may be moving into.” 

The current environment forces a prioritization. That’s always been there because it’s always hard to sell to these systems and payers if you’re not one of their top two or three priorities. 

Q. You mentioned value-based care and so let’s talk about how startups now have to get creative about demonstrating value, taking on risk, and being able to put more money at risk in order to earn the right to a seat at the table. Tell us how that’s playing out. 

Jacob: There’s an increasing trend of startups moving from a fee for service world to actually taking on risk for the services they provide. In some ways, it’s the ultimate kind of confidence in your own model to say, “We’re not just showing you a pretty slide that says this thing saves money. We’re so confident it does that we’re willing to go at risk for that.” A few trends that happened have really enabled that. 

The first is, a lot of this stuff follows government policy. There’s been a lot of government policies over the past decade and even more in the last two, three years that have created these interesting models that startups can then, opt into. A lot of times the government creates these models—first, it was ACOs, then, these kidney choice models, and now, direct contracting and easier reaching. They just announced the enhanced Oncology model. So, there’s a whole host of these different models the government introduces, but then private payers also latch on to you. All this it creates an interesting opportunity for startups to provide care in a different way. 

If you think about what a lot of these companies want to do anyway, they want to provide a higher touch, better consumer experience type care, and these payment models enable them to do that. So, there’s a lot of promise in these kinds of businesses. There are early proof points as seen through companies like Validate, Know Street that have demonstrated really interesting outcomes both, clinical and cost related. So, a lot of folks will look at those companies and at their valuations, the way that Oak Street, Agilent, and Validate Health are all valued. They’ll say, “That seems, in a way, like we can do things that are in line with how we want to provide care and also stay financially lucrative.” 

Q. Healthcare is very good at following the money and notwithstanding all the excitement about alternate payment models, value-based care, and risk based, the vast majority of health care payments still go through some model. Do these models work better perhaps for employers but maybe not as much for health systems? Is there a nuance there worth thinking about? 

Jacob: A few thoughts on that. One, as you well know, healthcare is just so massive that all these worlds can coexist and still be really big. You’ve got Oak Street, which, depending on the day is a $5-6 billion company or a ChenMed—All these things that people talk about have done a wonderful job and created a lot of enterprise value but they touch less than one percent of Medicare patients. And there are still massive businesses. 

Then, you have the systems that are more in the fee for service world. I totally agree with the point that almost all payments in the system world are on the fee for service side now. It’s obviously been slower to move to value based than maybe some of the independent physicians and groups, but both worlds can coexist and still be pretty large for the time being. 

I do think it’s a really good point that on the system side, there are a lot of people that come in and they say, “Oh! We’re going to sell value-based care and do something that really works in those models.” However, in these challenging times for systems, you can’t go into a room pitching someone and talking about something that’s not one of the top two or three things they’re thinking about. A lot of times when we talk to early-stage companies, we encourage them that they’re going to do something in the value-based world where a lot of the innovation is really happening. 

Q. What do you think of the policy environment? Are there one or two things that you would like to see or do you anticipate in the near term that could make a difference to the picture? 

Jacob: On the value-based care side, the big policy question is whether any of these models are going to be made mandatory at some point. If I think about how they’ve evolved, basically about how these benchmarks get set up, how much should it cost to take care of a population etc., it’s a median or an average. 

As you can imagine, companies are very good at saying, “Well, you’re in the top quartile of practices. So, if you don’t lift a finger or change anything, you will do better in this model than you were doing in the status quo, because it was set at the median.” So, you have a lot of practices that were in that top quartile saying, “Great, the value-based care sounds awesome.” It’s a real way for health care to move to a different payment model. 

What you’ve seen though, is some of those practices that maybe would or most need to transform. There’s no incentive or even a reason for them to opt in to some of these models. Therefore, the big question is it’s politically difficult. I don’t envy the policymakers that have to do this. But, are these models going to have a little bit of teeth in them where you start pushing people to make the transition? As long as you make it optional there will be some subset of folks that think they’ll be better off in this kind of a future world than they are today. 

Q. What are some of the core attributes you seek before you begin funding one of these startups? 

Jacob: Sometimes a fresh perspective can be helpful but obviously, one needs to have a lot of humility with the U.S. healthcare system. So, we really focus on a combination of things. 

First, if someone’s just like a learning machine—because health care is endlessly nuanced and weird, there are those that love that weirdness or find it interesting—and asks, why something is the case or the way it is. It’s really hard to successfully build in the space and we get really excited by folks that have been inventorying surgery centers for three months for example. But they’ve possibly already uncovered something in that research. They’re just more fluent in that space than just about anyone you talk to. 

Then, there’s a sort of humility like, “Hey! There’s a lot that we don’t know,” which entails bringing the right folks around the table. So, if you’re a technologist, bring in someone that’s an M.D., or someone who has a lot of experience in whatever it is you’re doing. Form that team right on. 

But the one thing that gets me super excited about a lot of the companies we invest in is they’re starting to be like this interesting second generation of founders where essentially, they were tech people, then, they moved into a first wave health care startup like Oscar or Flatiron or HIMMS or any of these companies that were really popular from 2013 to 2019. Then, they went on to form their health care startups. 

That’s just incredibly exciting because those people are great technologists. They have all the stuff you’d want in the traditional software world, but they’re not brand new to healthcare. They ran provider networks at Oscar or they did something that was in the weeds in health care but they know the space really well. That kind of archetype of entrepreneur is really exciting. The more you know and the more folks that come into digital health, the higher the chances of that kind of second wave. 

Q. The competitive landscape for the startups today has big tech—Amazon, Microsoft, Google, Apple—coming into the core healthcare services space. What’s your take on what this means for smaller companies?

Jacob: It’s not something that we spend a lot of time thinking about. The hardest part is that the health systems are hurting. How do you get your solution to matter for that health system and simultaneously, have nothing to do with the competitive landscape? Do you have a product that’s compelling enough to go through all the hurdles that are required to get something adopted? 

As I think about the role of big tech, the Lord knows the pie is big enough in health care and there is a lot of technology that needs to be introduced here so, if we just start moving toward there being more solutions, I think, there’s plenty of pie. 

But if I were to reflect on the role of big tech in health care today, there’s definitely a lot of pieces that are interesting or that folks are trying out. However, I wouldn’t say any of the big tech companies have really figured out how to have an at-scale impact on health care. Amazon One is a great example—they tried to build their own business and they ended up acquiring One Medical that had come from the startup world. In some sense, it’s always good to have more smart technologists working on the problem. 

From a startup perspective, these are potential acquirers. That’s great as they want to do more in health care. But it’s not like we don’t have companies that go head-to-head with pitching against Google, for instance. I think a lot of that problem, for both the big tech companies and the startups, is much more about figuring out. How do you figure out a product that really has resonance for the startups? If we get really good at that, we’ll get to a world in which there’s a lot of direct competition between them. 

Q. One very unique aspect about the competitive landscape is the dominance of electronic health record platforms. 

Jacob: We do think a lot about Epic. Epic is probably the most relevant to the world of selling into health systems than Google, Microsoft, or Amazon. 

Q. How about the macro environment? This year has been an interesting one—interest rates continue to rise, inflation continues to be high, and the demand environment is uncertain. What’s your advice to founders for 2023?

Jacob: I’m certainly not an economist so I will not pretend to have the kind of prescient macro take. But I would say, obviously there’s a range of things that might happen next year. The advice that we always give is, there’s many ways things could go. 

I think next year could have many of the same struggles that this year has. So, we tell our entrepreneurs that they must be ready. If the world starts booming again, great. They can always adjust, accelerate hiring, and change things around. But they may want to plan for what is somewhat a likely case, which is that things don’t get a ton better next year. 

Luckily, we worked with a lot of our companies to make sure they’re well capitalized and can navigate that because I don’t think anybody knows whether things will go down or stay flat, and you just want to be prepared for whatever those circumstances are. 

Q. What’s your firm’s outlook? 

Jacob: We’re very actively investing. We just sent two term sheets in the last few weeks. As a firm, I believe, a lot of the best companies get built in downturns. So, we’re back to where we started. None of the macro trends have changed. Yes, this is like a macro economy change for the time being, but like the things that got us excited about health care a year or three ago, if anything, they’re more exacerbated in this type of environment. The opportunities are very much still there, people just need to figure out on a later stage side, what are things actually worth. 

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com and 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.

Digital health is about applying data in a smart way into interactive user experiences

Season 4: Episode #136

Podcast with Russ Thomas, Chief Executive Officer, Availity

"Digital health is about applying data in a smart way into interactive user experiences"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Russ Thomas, Chief Executive Office of Availity, discusses their core business of clinical and claims data to drive better healthcare outcomes and reduce costs. Availity optimizes information exchange between two of the most critical stakeholders in the healthcare ecosystem – health plans and providers – through a single, secure network.

Russ talks about their recent acquisition of Diameter Health to standardize the unstructured data to automate clinical workflow, make it available to the right people at the right time, create a better healthcare system, and ultimately drive better healthcare outcomes. He also offers thoughts on the digital health landscape. Take a Listen.

Our Podcast Partners:

Show Notes

00:13How would you describe the current state of digital health?
03:17 About medical data, is EHR data specifically, also part of the datasets covered?
04:53Is there a HIPAA consideration here? What would be the top considerations when it comes to exchange of data?
11:18You mentioned prior authorization as one of the biggest friction points in healthcare. What is the competitive landscape looks like for you?
12:48Can you share a couple of use cases coming out of the Diameter Health acquisition that enhances the value of your business?
17:02 What about the health outcomes? What is the role of your data set and platform?
20:27Digital transformation of healthcare data and analytics is super important in all of this. Do you work with digital health startups? How do you enable them? What should they know about you?
27:14There’s the emergence of a lot of data consortiums – Truveta, HIEs, etc. What are your thoughts on the market right now?

About our guest

Russ Thomas is the Chief Executive Officer of Availity. His vision helped to diversify Availity’s solutions and grow its customer base, creating the foundation for the expansive Availity network that exists today. Combined, the enterprise now delivers healthcare business solutions to a growing network that connects more than 1,000,000 physicians and allied care providers, 2,700 hospitals, and more than 600 technology partners with health plans nationwide. Under Thomas’s leadership, Availity is leading the charge in provider engagement and empowering health care professionals to improve results.

Russ Thomas is the Chief Executive Officer of Availity. His vision helped to diversify Availity’s solutions and grow its customer base, creating the foundation for the expansive Availity network that exists today. Combined, the enterprise now delivers healthcare business solutions to a growing network that connects more than 1,000,000 physicians and allied care providers, 2,700 hospitals, and more than 600 technology partners with health plans nationwide. Under Thomas’s leadership, Availity is leading the charge in provider engagement and empowering health care professionals to improve results.


Q. Russ, tell us a little about Availity.

Russ: The company’s been around for 21 years now, so, we’re two decades old. We have been in healthcare technology since arguably before it was termed healthcare tech.

At our core, we connect health plans and providers for their business transactions and enable data exchange so they can run their respective businesses more efficiently. What that means in practical terms is that we’ve got two million providers on one side of our two-sided network, and on the other side, we have every health plan. Between them then, we transact roughly 13 billion transactions a year, including claims.

If you look at the aggregate claims and value their network, it’d be claims around USD 2.5 trillion billed through the Availity network on an annual basis. So, there’s a lot of economic and business activity between two of the critical stakeholders in the health care ecosystem. We see a lot of things paying off now.

Q. Availity sits in the middle so neither party really gets to see the other’s data, but eventually has the ability to use the data in ways that create business value for both sides. Is that correct?

Russ: Who owns what is I guess core to that question. So, a provider would say, “When we create a claim, the work that goes into the creation of that claim is our work. So that is our data.”

We send that data through Availity to the health plans. They receive it in the form of a claim. The payer would then say, that at that point the claim becomes theirs and so does the corresponding remittance or response. But then again, when the provider gets that back in their system, now suddenly, that’s their data.

We don’t typically get into the debate around who owns what between health plans, providers. Generally speaking, I think the industry has been fairly practical about these ownership rights when it comes to business workflows. It’s been more focused on getting the workflow automated than haggling over data rights in the context of “Is it claims data? Is it medical data? Who owns it?”

Q. With regard to medical data, is EHR data specifically, also part of the datasets covered?

Russ: Historically, we’ve been moving almost purely administrative data. However, over the last several years, we’ve begun to move more and more medical data which is what we use generically for clinical data in various forms ACT, CCD and variety of formats.

A little over a month ago, we closed on the acquisition of Diameter Health, and we’re very excited about that. If people think that structured X12 data is very standardized — unless you work with it every day wherein you realize that it’s not really as standardized as previously thought – they must see one payer implementation. They’re all different when it comes to clinical data given it’s still very much the Wild West in terms of how data is facilitated, created, transacted, named, or even identified. There’s still a lot of opportunity to provide a structure around clinical data so that it can be used and automated into workflows, which is where we are. We’re very much focused on that.

Q. Is there a HIPAA consideration here? What would be one or two top considerations when it comes to this kind of exchange of data?

Russ: It plays a bit to our strategy. We’ve never sold data and we have a lot of claims data. While remittance data and a lot of very valuable data flows through our networks, we’ve always felt that it’s better to be a trusted data steward than a data broker. So, just like any firm that resembles ours, we take secure information along with security, and privacy, very seriously.

The fact that we have not been in the business of selling data has enabled us to strengthen trust with both sides of the equation — payers and providers — which we think is going to let us create some interesting use cases for data in that business workflow.

But to your specific question, you have just your core underlying concern of “Let’s make sure the data about the right person is going to the right person at the right time.” Our network, like any health care network, is constantly under some form of assault by people trying to breach it or get into it. So, we spend a small fortune on information security and privacy.

Beyond that, it’s about where you’re going. Once you move from those standard business transactions, which everybody opts into to how do you really use that clinical data to create a better health care system, then, you’ve got to be super careful about data rights, both in terms of the payer, provider, and patient who some would say ultimately, owns all the data.

Q. With regard to your recent acquisition, what does Diameter Health bring to the table?

Russ: I’ll use a few analogies to explain this. There’s considerable clinical data being mined out there in the market, many aggregators, and data collection sources as well drilling for oil so to speak, in this case, drilling for data. What we’ve noticed missing is, the ability to take that raw crude and turn it into a usable fuel.

Diameter Health is the data refinery that receives data from a variety of sources. They don’t actually have endpoints into provider systems to gather any data so are wholly dependent upon their customers to create those endpoints. That’s one synergy they have with Availity, which creates endpoints for data all day, every day.

Diameter Health pulls that data in from all these disparate sources and refines it to a particular client’s standard whether that client is a payer, an HIE, works in the government sector, etc. They have a variety of different customers with use cases for clinical data to drive better health outcomes and enable cost reductions, everything we want to see happen.

However, given how fragmented this data is, our ability to automate its flow into a utilization management system or a care management, encounters gaps making it hard to achieve the required scale. Diameter Health applies their tech to raw data and upcycles or standardizes it to create a structure by applying clinical knowledge to the data. Clinicians at Availity — nurse practitioners and Pharm Ds– work on these data structures so that when we flow it back to the end user client, it can be pushed into an automated workflow.

Q. Have you started tapping into individual data?

Russ: We’ve never had a direct-to-consumer strategy because we’re direct-to-provider and the providers ultimately source a lot of the data that the health plans need and vice versa. A direct-to-consumer strategy then, feels like a pretty big lift and one that, frankly, for the use cases that we are bringing to life, includes a lot of patterns. There are many low hanging fruit. To automate workflows like authorization, care management etc., the data required by the plans lies in the provider systems so, that’s where we’re really focused on data capture.

Q. You mention authorization and that’s one of the biggest friction points in healthcare. What is the competitive landscape like for you?

Russ: In that particular one and in others where you have the payer partnering with Epic, we serve as the gateway for the payers that have been identified. We’re big fans of automation, whether it comes in an Epic system or any other application, so we help automate data and workflows.

That said, the biggest pain point between providers and health plans today, is one that frankly has not been solved at scale. I really like what Epic’s doing with the Epic Payer Platform and driving all the automation there. That’s going to be an important source. Frankly, we’ll be a catalyst for a lot of other innovation around over the next few years.

Q. Can you share a couple of use cases coming out of the Diameter acquisition that enhances the value of your business?

Russ: Let’s start with Auth because I really have very personal reasons for wanting to solve the Auth problem. I just think it’s bad not only for business but also, for patient care. Any time a patient’s left standing at a doctor’s front desk waiting for an Auth to be approved, that is not good for patient care. That, to me, is one great example of where even though we’ve got some great tech that’s being applied to the Auth problem itself, you still have to empower data in a consistent, logical way so that it can be transacted into the payer system. One of our helpline partners is Elevance. And to that point, even they’re right. You’ve got to be able to push the data into their systems in a consistent and automated way.

One example of where we will put the Diameter technology to work is upcycling that clinical data that gets used in a Auth UM workflow both, for Auth determination as well as ultimately, the second phase of that process, which is medical necessity determination. If you can get an Auth and still not have medical necessity approved, you have got to have a way to pull that clinical data into the system so that you’re solving both problems at once. So, starting Auth is a great example of that.

I’ll bucket it under the general heading of chart retrieval, for various purposes. Today, the chart retrieval process is still a very manual process with thousands of people sitting in the bowels of health systems looking at paper records all day and scanning them into some OCR system and then, pushing them through. Ultimately, the plan is not to look for that entire medical record. They’re looking for data elements that are in that medical record to approve whatever it may be right for, whether it’s a medical necessity determination, etc. That’s another area where we think there’s just a ton of room with what we’re doing with Diameter Health to bring that data to life.

Everyone knows the data is there but it’s how you bring it to life in an automated way that needs to be seen. One of the comments I was going to make about Elevance is, there’s a lot of really smart people there, but one, in particular, who uses the term “auto adjudication” instead of just “automation.” He talks about auto adjudication in context not just of claims but everything from provider directory data. When a provider updates a piece of demographic data, how do you auto adjudicate that all the way through the planning system to clinical data? It’s a great example as well of getting clinical data and being able to then, auto adjudicate that through whatever multitude of systems the plan may need. That is where we think the real value of Diameter Health is and where you can start to really prove ROI. We know the large costs entailed when a human has to intervene in a chart review. So, that’s a couple of great examples of how we’re going to do it.

Q. What about the other side — health outcomes? What is the role of your data set and platform?

Russ: I love the idea of bringing disparate data sources to life around total care management but the one thing that frustrates me about the U.S. health care system is, it’s by and large, a reactive health care system. We treat symptoms, diseases, and specific diseases. We don’t treat real conditions of human health.

I’m personally very interested and trying to get a lot smarter around things like longevity. What can we do to prolong?

Q. Didn’t that come up with a supplement that does that anyway?

Russ: Yes, but one of the reasons that we aren’t more proactive in managing care and paying for the management of care proactively is, it’s really hard to prove returns on investment. We know all day long that if somebody has high blood pressure, then, treating it with a pharmaceutical product is going to help and if it’s high cholesterol, treat with a statin. But we don’t do anything to get at the underlying conditions which are causing that. So, I’m very excited about the notion of being able to go out and get a lot of differentiated data on people and bring it into this central repository.

We talk at Availity about one patient health record. That is not just what’s happened to you retroactive to becoming sick. For instance, I’m ill and now I’m being treated. But how do we proactively enable providers to know what they need to know about you when you come in instead of just how you may be feeling today? My doctor will be able to look at a chart and say I’ll be ok because he’s been tracking the Hemoglobin A1C, and glucose levels for the last three months so can see where the spikes are. He can then talk about my diet in ways that we can do and test things to reduce those spikes. That to me is the health care system.

The question then, is, where does Availity play? For now, at least, Availity’s play in that is in a retrospective manner, but you ultimately have to have a way to measure what value we’re getting from that and total cost of care. I think that’s the way you look at it over time. So, our ability to look at claims and then, the analytics across claims is critical. I do analytics across claims and know what’s going on with the patient but after the fact is where you get a lot of that.

Q. Let’s talk about digital health. Digital transformation of healthcare data and analytics is super important in all of this. Can you do your work with digital health startups? How do you enable them? What should they know about you?

Russ: While I’m very opinionated on this topic here’s what I think. Digital is another highly overused term, not unlike population health and interoperability and that sort of stuff. To me, digital health is about user experience and it really is that simple.

How do we apply data? How do we make data smarter and apply it into an interactive user experience that drives as a high net promoter score, user satisfaction and gives people the answers to questions they need? That is by proactively anticipating the questions that are going to be asked and answering those questions in a very logical way in workflow.

The example I always use and not a lot people can relate to it is that, I’m a pilot and I’m flying what’s called a glass panel, which means I’m looking at a screen just like I’m looking at two computer screens when I’m in the cockpit. That has evolved over decades from six different devices and instruments to one glass panel that gives you all the information you need, as you need it, even before you need it. It is thinking ahead for you and preparing you for what’s coming next. It’s answering questions intuitively, applying analytics to the data that’s coming in to give you routing information. The truth or the same reason that we did it today in health care is that, I think, we’re still very analog in the way that providers and health plans interact with each other. So, where we’re investing as a company is in two particular areas.

We’re investing in data intelligence and data analytics. We’ve just hired Gigi Yuen-Reed, who was a Principal Data Scientist for IBM Watson, and is now, our VP, Data and Analytics and we’re building a team around her. Their job is going to be to take 13 billion data points and make them smart, more intuitive, more interactive to extract insights and knowledge from all the data flowing through our network.

On the other side, we’re investing in our user experience, not just our screens, but the way that we deliver data to our end users, whether that end user is in an Availity application or in an Epic application. That’s because we sell a ton of provider business through our partnership with Epic or in a nascent digital platform that some brilliant entrepreneur has independently developed.

I’ll give you two examples of where we have a budding partnership with Rhyme, which was brought off and is now run around automating the prior authorization workflow. Leveraging tech that Rhyme has built creates what I call nodal activity – it’s not a very good term. However, the problem with the auth workflow is not a transaction but a conversation between disparate systems and health systems in a payer system. So, Rhyme has really brought intelligence to that conversation so that they can actually speak the same lines. Rhyme is a great example of a partnership where we are bringing value to a young startup digital company to help them get scale.

The other is Vin who’s a very close friend and what Vin is doing with clinical data capture at the point of care is particularly valuable in smaller EMR and EHR systems. We are now leveraging Vin as our own point solution, if you will, which we will bring to scale, to extract and deliver clinical data and insights directly on the provider’s desktop.

Where we are investing is in building an underlying architecture in an API framework so that we can very easily stand up partnerships with some of these brilliant young entrepreneurs who are building applications and sitting there having built something really cool. But question arises, “How do I get scale? Where can I get to a network where I can actually interact with health plans and providers at scale?”

We think Availity should be a logical place for them.

Q. There’s the emergence of a lot of data consortiums – Truveta, HIEs, clearing houses etc. What are your high-level thoughts on the market right now?

Russ: I’ve been involved in HIEs since 2002, so I go back a long way with them and to your point, I think there are HIEs that serve very viable purposes. They’ve figured out a commercial model and are very relevant as data aggregators and local community voices that help create trust around data exchange. We love partnering with them. We’re partnering in Michigan and California. Now with Diameter Health, we’ve got a number of other places where we’re helping bring that data to life.

There’s no lack of data but what do you do with it? We’ll continue to focus on this. We didn’t last for 21 years by not having a good, sustainable business model and I do believe that we knew that some of these disparate, nascent data elements were going to become more and more important to us. Finding ways to consolidate that data into an existing workflow is an area where I think Availity can be very relevant and start creating real value for the end user. What we do today in just transacting claims and eligibility is highly commoditized but if you do it at scale like we do, it creates a phenomenal platform that you can build around.

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 is now about combining the digital pieces with a personal touch

Season 4: Episode #135

Podcast with Zane Burke, Chief Executive Officer, Board Member, Quantum Health

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

paddy Hosted by Paddy Padmanabhan
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In this episode, Zane Burke, CEO of Quantum Health discusses the current state of digital health and how Quantum is working towards creating a different and better healthcare experience with better financial and clinical outcomes.

Zane is a long-time veteran in the healthcare space with successful tenures in Cerner and Livongo. He notes that while there is progress with digital health, data silos and lack of integration are some of the biggest friction points in delivering better healthcare experience and outcomes. He also talks about how healthcare is intensely personal and why the connection of digital pieces and the personal touch pieces will make a huge difference.

Zane discusses a range of other topics, including digital health funding and the M&A environment, the role of big tech in the healthcare ecosystem, and the pace of digital transformation in general. Take a Listen.

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Show Notes

00:48How would you describe the current state of digital health?
02:20 How did you come to Quantum? What does Quantum Health do?
04:16 Who are your main customers today – employers, plans, or providers? Who would you consider your competition?
08:30In the context of health care, the other big competitor is, “Who pays?” Healthcare is all about following the money. Who pays for the solution as a self-insured employer?
10:42In the context of the markets and data silos, you've been a senior executive at one of the big EHR platform companies and in startups. Give us a State of the Union on interoperability. What's the unfinished business here?
15:27Digital health companies are in their own ecosystem and the consumers are somewhere in the middle with very little control over their data. If companies cannot access the data easily from an EHR system, where do you think that leaves digital health companies today?
18:15 What are your thoughts on the M&A environment of the marketplace today in light of how many digital health companies are actually struggling?
21:27What’s your take on the role of big tech in the healthcare ecosystem going forward?
26:35What is your advice to the health systems and digital health startups trying to play in this environment?

About our guest

Zane Burke is the Chief Executive Officer, Board Member at Quantum Health. An internationally recognized health IT leader, Burke has both a clear, forward-looking vision for digital healthcare and a unique understanding of the challenges in global healthcare delivery.

As healthcare gets continuously harder for people to navigate on their own, Burke’s professional passion is creating great healthcare experiences for all and addressing the imbalances in healthcare delivery. At Quantum Health, he leads the organization's goal to transform the consumer experience, with solutions that uncomplicate and innovate healthcare navigation. By continuing to reach into new end markets, the company will serve more consumers and ultimately improve more lives.

Prior to joining Quantum Health, Burke served as chief executive officer of Silicon Valley-based Livongo Health Inc., a leading software as a service (SaaS) consumer digital health company. Burke spent more than two decades at Cerner Corporation where he concluded his service there as the company’s president. He serves on several industry and not-for-profit boards of directors.

Zane Burke is the Chief Executive Officer, Board Member at Quantum Health. An internationally recognized health IT leader, Burke has both a clear, forward-looking vision for digital healthcare and a unique understanding of the challenges in global healthcare delivery.

As healthcare gets continuously harder for people to navigate on their own, Burke’s professional passion is creating great healthcare experiences for all and addressing the imbalances in healthcare delivery. At Quantum Health, he leads the organization's goal to transform the consumer experience, with solutions that uncomplicate and innovate healthcare navigation. By continuing to reach into new end markets, the company will serve more consumers and ultimately improve more lives.

Prior to joining Quantum Health, Burke served as chief executive officer of Silicon Valley-based Livongo Health Inc., a leading software as a service (SaaS) consumer digital health company. Burke spent more than two decades at Cerner Corporation where he concluded his service there as the company’s president. He serves on several industry and not-for-profit boards of directors.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

Advancing Care with Digital Health Tools: Innovations in Healthcare Technology

Season 4: Episode #134

Podcast with David Evendon-Challis, Executive Board Member and Chief Scientific Officer, Bayer Consumer Health

"Advancing Care with Digital Health Tools: Innovations in Healthcare Technology"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, David Evendon-Challis, Executive Board Member and Chief Scientific Officer at Bayer Consumer Health discusses their approach to help consumers adopt digital health tools to manage and improve their healthcare outcomes. David also explores trends driving better self-care among consumers.

Digital health tools are gaining momentum among customers and making better self-care more accessible. However, all these innovative technology solutions must seamlessly integrate into the mainstream healthcare delivery models. David believes that increased interest in health and self-care awareness, affordable healthcare technologies, and people wanting to use more technology to communicate combined will bring the perfect storm for improved health outcomes. He also talks about the current state of digital therapeutics and its relevance in improving consumer health. Take a Listen.

Our Podcast Partners:

Show Notes

00:45About Bayer and the Consumer Health Division.
02:08 Self-care has become a big trend among consumers. What kind of trends are you seeing at Bayer and what is driving all this?
04:07 Can you give us few examples of the digital tools that will gain momentum with consumers, specifically in the U.S.?
07:30How much clinically validated is the self-monitored care? It seems like there's a need to integrate all the technology innovations with mainstream healthcare delivery models. What’s your take on this?
10:20What is the current state of evolution and innovation of digital therapeutics in terms of the consumer-facing devices? How are they fitting into the mainstream healthcare context?
12:46Can you talk about Bayer's approach to the movement around self-care and helping consumers with the tools that they need to manage their care better?
15:43 How is self-care different from people just taking time-off, a vacation, go on a diet, or take some me-time? Is there a connotation that you attach to the term?
19:30Where does old medicine, for instance - Ayurveda, fit in this picture? Do you see that as being a part of the self-care movement?
24:11What’s your advice to our listeners, especially those who are digital health startups looking to get their product out in the market in partnership with a global company such as Bayer?

About our guest

David Evendon-Challis is Head of R&D for Bayer’s Consumer Health Division and is a member of the Consumer Health Executive Committee. He is responsible for worldwide innovation and product development, from scoping and ideation through delivering innovation to the market via internal and external development.

David is a British national, with a first class Master’s degree in Biological Sciences from the University of Oxford, UK. Over the past 17 years he has worked across regulatory, communications & public affairs, sustainability and product development. He joined Bayer in January 2020 from RB where he spent eight years in R&D leadership roles of increasing responsibility - most recently heading innovation across the company’s consumer health business. Prior to this he worked at companies including Kimberly-Clark, Salterbaxter MSL and the Engine Group.

He is passionate about creating and scaling innovations that are purpose-driven, human-centric, scientifically robust, and credible.

David is married with two children. He is based at Consumer Health’s global headquarters in Basel, Switzerland.

David Evendon-Challis is Head of R&D for Bayer’s Consumer Health Division and is a member of the Consumer Health Executive Committee. He is responsible for worldwide innovation and product development, from scoping and ideation through delivering innovation to the market via internal and external development.

David is a British national, with a first class Master’s degree in Biological Sciences from the University of Oxford, UK. Over the past 17 years he has worked across regulatory, communications & public affairs, sustainability and product development. He joined Bayer in January 2020 from RB where he spent eight years in R&D leadership roles of increasing responsibility - most recently heading innovation across the company’s consumer health business. Prior to this he worked at companies including Kimberly-Clark, Salterbaxter MSL and the Engine Group.

He is passionate about creating and scaling innovations that are purpose-driven, human-centric, scientifically robust, and credible.

David is married with two children. He is based at Consumer Health’s global headquarters in Basel, Switzerland.

Q: David, can you talk to us about Bayer and the Consumer Health Division?

David: Bayer has been around for a long time; longer than the Queen and I. I joined the company about three years ago. I work within consumer health, which is one of three divisions—pharmaceuticals, crop science, and consumer health.

We’re a leading player within consumer health with 170 brands of which, 15 are extremely large. We focus our innovation efforts on and work across a lot of different self-care areas—allergy cough, cold, pain, cardio, digestive health, dermatology, and supplements—so we have a broad self-care business.

Self-care has become a big trend among consumers. What are the trends you see as Chief Scientific Officer of the Consumer Health Division of Bayer? What is driving this trend?

David: We’ve been seeing, for some years, an increasing interest in a lot of people to take better care of themselves. You become more aware of the impact of things like smoking, watching your weight, exercise, eating the right fruits and vegetables etc. That has been bubbling along, but there’s not been a huge emphasis on real prevention of disease.

A lot has shifted in the last couple of years, so, we know that people want to take much better care of themselves. That’s totally been accelerated by COVID. I found some of the statistics here, super interesting. In COVID, 44% of people started using new devices to help manage their health proactively. About 90% of them had positive experiences, which I think, is extremely high. Over half of the people want to use more tech to communicate with their health care professionals and manage their health.

This isn’t a new statistic but the one that always gets me and continues to blow my mind is the 200 billion healthcare searches on Google, every year. Combining that increasing interest in health care and our ability to take care of our health and prevent disease with more affordable technologies, particularly, things that are already part of our day-to-day lives may just be the perfect storm for better prevention, better self-care. That’s what we’re seeing across the board.

Q: Can you give us one or two examples of the sort of digital tools that will gain momentum with consumers in the specific context of the United States?

David: There’s all kinds of things. You go from the very simple ones but I would still count digital tools as those that help people make decisions about which products they take.

The online health and wellness questionnaires are very basic but these are on the rise. They help people navigate what is quite a complex shelf to choose what to do, what to buy, when to use it, etc. In the U.S., we have majority stake in companies like Care/of. It’s a personalized VMS company. There has been a big rise in using that from a user’s point of view to actually get better products.

There are increasing sales of specialist devices—the things that people carry with them be it their smartphones, Fitbits, or their Apple watches. These are the things that people are starting to get better insights from, and using to manage their health more and more. I can only see that becoming more important in the future as the devices get more sophisticated and better about giving us actionable insights, if not diagnoses. These are the areas that are going to help make better self-care much, much more accessible for more people.

Take my personal favorite. At the moment, for me, sleep is important but I don’t want to wear a special sleep monitoring device. I’m interested, but not that much, in it. However, I will wear my watch to bed and check it every single morning. I will adjust my behaviors based on that, and it will add that into my daily routine. That’s critical as well, having whatever the solution technology might be, something that can seamlessly integrate into your life, and that will always be as easy to be top of mind and enable us to keep doing it. Those are the things that are going to stay.

We know that complicated, unpleasant experiences—even complying with the medication, for example—may make lots of people drop out. Making things super easy and part of people’s lives is part of this.

Q: While there’s a lot you can now do to monitor yourself and take better care simultaneously, how much of it is clinically validated? It seems like there’s a need to integrate new innovation with mainstream health care delivery models. What’s your take at Bayer?

David: I look at it from two angles one of which is, there’re some really promising technologies for things like digital therapeutics, which we’ll see is in the Rx kind of area. I’m a consumer, but I can see that being absolutely relevant for consumer health, as well. In these areas, we could have a debate, although I’m not an expert about the evidence behind some of these. But there is a lot of evidence being generated on those digital therapeutics. From that angle, there’s a huge relevance for self-care and the digital drug is actually helping people to take care and treat themselves.

When it comes to using digital biomarkers to help identify where your problems are, this isn’t just about being able to run a report and giving that to your doctor. It’s about getting better, actionable insights for you to manage your own health. Those don’t always need to be 100% perfect and accurate in order to get generalized insights that can actually help you shift your behavior in a better direction to become healthier. I think there’s absolutely a role for those kinds of things and the two may ultimately kind of meet in the middle.

In the meantime, there’s a lot of value in the more general health, personal health insights that we can get from these different technologies. They can help individuals determine when they might need to see their healthcare provider and actually dig into an issue in more detail. It’s not always the case for things like, for example, my sleep. This is about me feeling better, waking up lighter, and being able to manage my busy job, two small children etc. The kind of insights that I get from my Apple Watch and the app that I’ve purchased are bang-on for that. So, I think it depends on the need.

Q: Digital therapeutics has become almost a mainstream term, now. What is the current state of their evolution and innovation as it relates to some of these consumer-facing devices? How are they fitting into the mainstream healthcare context?

David: Within self-care, it’s coming from all different angles. There are lots of different roles. If you think about this cycle from within self-care, awareness, education, engagement, assessments, diagnosis, treatments, then, in continuing that cycle, there’s this role for different technologies within that.

I’m really interested in things like the symptoms assessment tool. We’ve been working with Ada Health and piloting with a couple of our brands around the world to see what is the role of powerful symptoms assessment to help guide people when they are in areas that are quite confusing, like irritable bowel syndrome, for example, or identifying the causes of some of your pain. Some of these day-to-day things are real issues to people. There are really important technologies that are helping very much with that part of the self-care continuum we’re seeing.

Whilst there’s absolutely going to be a role for self-selection yet the questionnaire-based approaches, complement some of the digital biomarkers which are getting better, and will continue to do so. At one point, I believe, they will become acceptable to the entire health system. In the meantime, I think they will increasingly provide great information and actionable insights.

I also think that is a role and people are increasingly accepting of drawing blood and providing saliva to actually get more detailed information about themselves. All of these pieces are coming together. Unfortunately, I don’t think we quite have the glue, which is where we, as an industry, need to work together a little bit better, because all of these component pieces are pretty much there but the system isn’t quite working seamlessly yet.

Q: Can you talk about Bayer’s approach to this movement around self-care and helping consumers with the tools that they need to manage their care better?

David: We spend all day doing innovation. When it comes to digital health, versus non digital health and everything that is now in-between, the process is broadly the same. For me, this is within good self-care innovation and it is about taking a broad-scale, medical, unmet need and combining that with a big, consumer, unmet need, adding in the right technology that is going to meet those, layering in your evidence, and giving it a great product experience. That’s my recipe for good innovation. That’s the same for digital health.

So that same process is followed. I do think that technology is making it much quicker for us to get insights to develop the products. Digitalization of labs, prediction of stability, which is one of those pieces within traditional product development, takes quite a long time. We’re using digital almost behind the scenes as well as upfront in the part of the consumer or the user experience to make that whole process better and faster along with how you end up engaging with your consumers. It’s not just about going to CVS and picking up a product and that’s the end of that. We’re now able to unlock better care, better education, better engagement in our communities, all of those so, the same principles apply. But in order to add in the layer of digital, use digital technologies.

One of the things that’s super interesting for me is how all of this is unlocking prevention or the idea of prevention in a much more meaningful way. It’s always been important for people, but many of us included, haven’t acted as much on it. I think it’s human nature we deal with today and we don’t worry too much about tomorrow for a lot of things, particularly, when it comes to our own health. Part of that is because it’s hard to measure.

A lot of these tools that are arriving are actually helping us measure the things that we weren’t able to before—from my sleep score to my biological age and comparing that to my chronological age—all of these things are helping us better our awareness of today and tomorrow, which I think ultimately will help with prevention and unlock a whole new kind of series of innovations that the industry can make.

Q: We’ve used the term self-care quite a bit here. How is it different from people just taking time-off, a vacation, go on a diet, or take some me-time? Is there a connotation that you attach to the term?

David: For me, self-care and consumer health are kind of interchangeable. It’s things like me-time that’s been definitely used as a similar attitude to self-care. Me-time is very important, but for me, it’s not health. Self-care is about evidence-based, credible products and services that are going to improve people’s health. So, there are many different things that play a role.

Alternative medicine can also play a role. However, I believe in evidence-based products and services and that’s really at the core of self-care. It doesn’t mean that these all need to be drugs.

We innovate on herbals and naturals. We have a brand in Europe called Iberogast. It’s had multiple clinicals over many years so, there’s a big body of evidence around treating the symptoms of irritable bowel syndrome, for example. It’s a combination of six herbal extracts so it doesn’t just need to be a drug, but that evidence is really important for me as part of this.

In the last couple of years, I’ve come to the conclusion that there isn’t a great definition of what great self-care looks like. So, along with a couple of colleagues this year, we put down some thoughts on what great actually looks like when it comes to self-care, not in the end product, but how you get there.

That’s really important, particularly when it comes to trust and credibility and ultimately, for us, it’s about combining their real deep medical insights, the science of the human being able to tap into sometimes emerging science and discovering new ways to meet people’s needs with technology, which can be drugs, digital, being able to leverage work within and influence the regulatory environment, which within consumer health is extremely fragmented.

It’s also about things like collaboration and my personal favorite topic, the consumer products experience. This is something which some companies, brands have forgotten a little over the years or maybe never got to. I think sometimes with pharma heritage, there hasn’t been that focus on actually providing a brilliant product experience.

Ultimately, if we want people to take care of their own health, we want them to use something on their own to manage this. It needs to be simple, credible, and work. I need to know and feel that it’s working so that they can continue using that product. I think when you combine all of those different elements, you get really good self-care products. That’s what we’re aiming for.

Q: Where does old medicine for instance, Ayurveda, fit in this picture? Do you see that as being a part of the self-care movement?

David: I think two things—people should do what works for them to manage their health. That’s my general belief. Regardless of what I believe, people need to use their own internal compass, do what’s right for them, feel what works, and go with that.

As much as I might be skeptical about some areas in it, I do think there are lots of areas within alternative medicine and Ayurveda, for instance, has a rich history and lots of evidence. It might not always be packaged in the same way as others but, there are things that are proven to work for many, many people.

That’s incredibly important and needs to play a role within health care, including within self-care. For the areas that have no scientific evidence behind them, it will be much harder for them to enter into that credible health area. There are so many that do.

Q: Health care, at least in the United States, is all about who pays for it. There’s the all-important question of following the money when it comes to health care. How does Bayer approach it when it comes to really driving adoption for some of these health care products that you’re putting out?

David: I think it’s evolving. Over the next couple of years, it will continue to evolve, particularly in the role of those small, premium devices.

In general, there’s a role for expensive, niche diagnostics for those that have the money to use them and are motivated to do so. That can generate evidence that can be relevant for the rest of us who are actually out there self-selecting a product.

So, I think that you can use and it’s not just the halo effect, but it’s the evidence you can generate from an increasingly broad population of people that are buying into the top of your pyramid of world class diagnostics along with say a series of supplements or a different kind of OTC product. You can then use those insights to help everyone else select what would be best for them. I don’t think everyone always needs to buy into all parts of this ecosystem.

There are some real benefits that the more the data we generate about products by the interaction of different products with different behavioral interventions, combining that with different factors—areas where you live, how old you are, etc.—will all give much more targeted advice to the people that don’t want or can’t access that.

But we can give them the great insights to say, actually, for someone like you, this is much more likely to work. That’s a real role. I don’t think there’s the elite versus everyone else but that there’s a huge role in taking the evidence generation that guides everyone. There’s always going to be a role for simple products and good education, with robust evidence behind them that people can opt in at an affordable price to help them manage their pain, their anxiety, whatever that might be.

Q: You mentioned partnerships. What’s your advice to our listeners and especially those who are digital health startups looking to get their product out in the market in partnership with a global company such as Bayer?

David: My advice is, it’s a great time to be working in health care and looking for partnerships because I think everyone has recognized that we need each other. In the many years I’ve been working in health partnerships, I’ve seen lots of great failures as well as some good successes. It’s all about the fit. Finding the like-minded organizations with great people who you can trust is as important as a potential deal or a potential commercial opportunity. It’s something that people like to run into first.

But what I’ve learned is when you take the time to understand where a founder is coming from, where an organization or large corporate priorities are, and you can start to find that common ground, that’s a fantastic place to start.

Then, you start to build a relationship rather than a transaction. This might be a little bit fluffy, but in my experience, that spot works and you get to the deal. You can then be more flexible when you’ve built up the trust.

I think it’s about researching, understanding, connecting, networking, and finding those like-minded companies because there can be a lot of wasted time. We will spend a lot of time researching different technologies, talking to lots of different people, and lots of these things are going to be dead-ends. That’s okay. That’s part of the process. Taking the time to get that fit is right.

And what do you really want? If you’re a small company, are you looking for geographic expansion? Are you looking for fantastic regulatory expertise to scale your proposition? Do you need help with evidence generation that’s going to allow you to skyrocket your growth? Are you looking for brilliant, supply chain expertise to trim out the costs to bring your product to the masses? What are you looking for? What are the skills that your partner or many partners have? That’s the most important thing to me.

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.

Consumers are looking for instant gratification with their digital health experiences

Season 4: Episode #133

Podcast with Reid Stephan, VP and Chief Information Officer, St. Luke’s Health System

"Consumers are looking for instant gratification with their digital health experiences"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Reid Stephan, VP and CIO of St. Luke’s Health System, discusses how consumer research drives digital priorities, mobile applications, and other digital features. He also talks about creating a robust technology infrastructure to deliver the superior experiences consumers demand and expect today.

St. Luke’s Health System is a large health system looking to deliver outstanding digital experiences to its patients. Reid discusses three things that significantly impact a frictionless patient experience and talks about how they approach care management, home health, remote monitoring, and more. Take a Listen.

Our Podcast Partners:

Show Notes

01:29About St. Luke’s Health System and the populations that you serve.
03:18 What are your thoughts on the digital health program at St Luke's? Tell us about your current priorities as the CIO in supporting digital initiatives for the organization.
07:33 What are your consumers telling you about what they’d like to see and therefore what might go on your roadmap?
11:41What are some of the common metrics that you track when trying to understand whether your investments in the digital programs are meeting expectations?
13:30Are there any macroeconomic factors that are driving some of your priorities today, either at the national or at the regional level?
15:52 How has the payer mix changed for you and how does that drive your investment priorities?
17:12 How are you using data and analytics to drive access-related initiatives?
19:23How are you setting up your whole IT infrastructure and your foundational platforms to successfully drive digital engagement?
22:27Can you talk about the application solutions? You are Epic first, but how do you choose when enabling the digital features and functionalities that your consumers demand?
24:07How are you addressing providers and caregivers’ expectations?
26:10What’s your approach in care management, home health, and remote monitoring?
28:27What are the one or two pieces of advice that you would like to share, either with your peers or with the technology provider community that wants to be a part of your journey?

About our guest

Reid Stephan is the VP, Chief Information Officer at St. Luke’s Health System. St. Luke’s is the only Idaho-based, not-for-profit health system, with 9 hospitals and 200+ clinics serving the needs of communities across Southwest Idaho. He has over 20 years of experience in the technology space, including serving as St. Luke’s Chief Information Security Officer prior to his current role, and 9 years leading HP’s global corporate IT security incident response program.

He has a Bachelor of Management Information Systems from the University of Idaho and an MBA, Technology Management from the University of Phoenix. He is a HealthCare Information Security and Privacy Practitioner (HCISPP) and a College of Healthcare Information Management Executives (CHiME) Certified Healthcare CIO.

Reid Stephan is the VP, Chief Information Officer at St. Luke’s Health System. St. Luke’s is the only Idaho-based, not-for-profit health system, with 9 hospitals and 200+ clinics serving the needs of communities across Southwest Idaho. He has over 20 years of experience in the technology space, including serving as St. Luke’s Chief Information Security Officer prior to his current role, and 9 years leading HP’s global corporate IT security incident response program.

He has a Bachelor of Management Information Systems from the University of Idaho and an MBA, Technology Management from the University of Phoenix. He is a HealthCare Information Security and Privacy Practitioner (HCISPP) and a College of Healthcare Information Management Executives (CHiME) Certified Healthcare CIO.

Q: Reid, tell us a little about St. Luke’s Health System and the populations that you serve.

Reid: St. Luke’s Health System is based out of Boise, Idaho. Our geographic footprint covers southwest Idaho and a little bit of eastern Oregon and serves the populations there.

Our system comprises eight medical centers and a couple of hundred clinics and centers. We see about three million visits a year between those settings and the population is dynamic. It covers a broad cross-section. We’ve had an interesting change in the last couple of years with a huge influx of folks moving into the valley in the Boise area, in particular, which has shifted our population a bit. Given how it covers a city area like Boise, smaller towns, rural hospitals, and rural areas, it then provides challenges in terms of access and equity of access. So, it’s really a unique market where we have a little flavor of everything, which makes it challenging, but also exciting and rewarding.

Q: Do you have a large rural population that’s widely dispersed in some way as well?

Reid: Large in terms of geography, but I wouldn’t say large in terms of population compared to some of the city urban areas. Certainly, large in terms of just the consideration for digital, in particular. You can assume that they’re going to have broadband access or even a device to engage in some of those opportunities.

Q: What are your thoughts on the digital health program at St. Luke’s? Tell us about your current priorities as CIO of the organization in supporting digital initiatives for the organization.

Reid: I have a love-hate relationship with the word “digital.” I understand it, and it’s the context that’s important, but it’s one of those words that get used so ubiquitously that it can start to lose meaning. Then, you have this Tower of Babel experience where people all hear the language differently.

For me, one of the success measures will be when we just start to talk about health generally, and that just naturally encompasses digital. In my mind, I don’t differentiate between my Amazon experience when I’m on my device ordering something versus when someone physically comes to the door to deliver it. It’s just all Amazon experience.

It’s with that backdrop that we set up a Consumer Access and Experience Program (CAE) a year ago. One of my colleagues and great partners is the VP who leads that. That group’s been tasked with not disrupting for the sake of disruption, but really challenging how we think about things and helping us really start with the question because we think that’s the most powerful tool in the toolbox. Don’t go out and ask users what they might want or expect them to design what that digital health experience might be like, but really, bring questions to bear to draw out from what might be best for them.

There are a few things on which that program is focused on that we’ve helped as an IT shop. We launched an app earlier this year and while it’s still nascent in its development, it’s an engagement, an access gateway, and an experience gateway for the future. It gives us a nice cornerstone then, to build on basic things in place there, now. You can access our patient portal, our website to find physicians and locations, and pay your bill too. We’ve put together a few digital assets into one unified experience, and now we need to really gain insights to understand where to add value and components to that. Where can we reduce friction from that experience?

Another thing that the CAE group has championed that we’ve supported is, an on-demand virtual clinic. Like everyone else, we saw a rapid increase in virtual visits with COVID, so, tapering-off of that last year. But it clearly demonstrated to us that there is an appetite in the market for consumers that want to consume their health care through digital for certain business types and needs. Creating a clinic that’s focused just on that and using it to understand preferences and behaviors, has made us look at ways that we can take advantage of existing capacity. Rather than move right to probably bringing it in and looking at how we’re going to augment and outsource the physician or provider need, we’re looking internally at our capacity in other areas where we can have doctors and other providers who can come in to bear on that need and chip in. I’m excited about just some of the early conversations there.

The last thing I’ll touch on is one of the roles of CAE is to just take a hypothesis, experiment quickly, and learn from it. We’re about to launch a medication locker at a local grocery store that doesn’t have a pharmacy. This is just a small test of change to learn and understand consumer appetite, preference, and desire using that omnichannel approach, where we can give consumers a variety of options and then, understand where preferences lie. Subsequently, we hope to guide them to the option that might best be suited for them. I’m really excited about that kind of focus on consumerism.

Q: You’ve mentioned the mobile app and the urgent care initiatives. What are your consumers telling you about what they’d like to see and therefore what might go on your roadmap?

Reid: If I just used one word to describe it, it would be “instant.” They want the same experience they have in just about every other vertical of their life where it’s always on, always available, and there’s that instant gratification or results from what they’re pursuing. Granted, there’s certainly that in health care but, there are situations where that’s just not a logistical possibility. But there are a lot of areas where we can improve that experience, give that access, and that instantaneous result to the consumer.

Some of the things we’ve done to help glean insight from the consumer include focus groups, which are interesting and simple things like going out and visiting with consumers and asking questions. Our CAE group did something fun this year when a group of students from Harvard wanted to do a case study. They came to Boise and we gave them a problem to look at. They spent a couple of days analyzing and undertaking the academic approach and then, generate a report for us.

Interestingly, one of their insights or hypothesis was that one of the challenges you have with something like your patient portal is many of your consumers use it so infrequently. Like I said, it’s based on when they have the need. Compare that to your banking app, the Amazon app, and the social media app that you’re in kind of daily. You develop this dexterity and familiarity with how to navigate there so then, it seems easy. But when you’re just logging on to MyChart once or twice a year to schedule an annual wellness exam or an episodic kind of need, it’s going to feel foreign because you just don’t use it enough.

That’s been a really interesting observation that we’re kind of just churning over and thinking through about how do we ensure we don’t overinvest in building up every single detail of a completely frictionless patient portal experience when the bang might not be worth the buck? Let’s focus in on maybe the one or two things that really, really matter.

Another insight we’ve gleaned is three things that have the biggest impact that we’ve observed on Net Promoter Score. First and foremost is receiving services, which makes sense. Next, our Schedule and Appointments and Finding a provider. And then, way down on the list is Wayfinding. That was interesting because we’ve kicked around Wayfinding for a long time and the thought was how cool this would be. Given we face financial constraints, we had to be really disciplined and ensure that the investments we were making were going to yield the biggest benefit. They were narrowing our focus then, on how to improve that experience for scheduling an appointment to make it as frictionless and as easy as possible? How do we make that experience easy for someone to find a provider? Or even to find out the details they might want to know about that provider?

That consumer insight is really a key for us because that helps us then, to not only meet the consumer need, but be wise stewards of our resources and ensure the work we’re doing is going to have the biggest benefit for that.

Q: Can you share a little bit about what are some of the common metrics that you track when trying to understand whether your investments in those programs are meeting expectations?

Reid: It’s really the pedestrian ones that you would expect. We look at active MyChart users, meaning they’ve logged on some time in the previous 30 days. We do that ratio against our total MyChart user population.

We look at the percentage of patients that use MyChart to schedule an appointment versus those that call our connection, the percentage of folks that use MyChart to refill a prescription request, and that would use MyChart to look at their images or review their after-visit summary in the provider notes. We just really focus on consumption.

One of the things that has been stuck in my mind is, if you accept the fact that the typical consumer then, is just occasionally using your digital health tool and particularly, your patient portal, then, that begs the question that there must be value you’re giving them other than that episodic, specific need they have.

That opens up a whole pantry of opportunities that are really interesting to examine about what we can offer then that would make that app more of a frequent digital stop for that consumer, where they don’t view it as just the transactional experience of St Luke’s, but as holistic within how they’re thinking about their care, whether it’s diet or exercise or preventative kind of regimens. It’s such a great time to be in health care because we own so much of the solution if we can be really thoughtful about leveraging the data we have, gleaning the right insights from it, and then, acting on it.

Q: Are there macroeconomic factors that are driving some of your priorities today, either at the national level or at the regional level?

Reid: Absolutely. I talked to the CIOs on what difference a year makes and that’s the mantra certainly for this last year. Financially, there were two things that really put some headwinds in place for us. We still have a large volume of travelers that are onsite just to fill our critical nursing needs. We have high volumes—the highest that we’ve ever had—but then, we’ve just had this shift in our labor market and there’s this need for nursing but we can’t hire nurses fast enough. To some degree, there is a trickle-down of that.

On the I.T. side, certainly with the labor market and remote work, it’s up-rising but there are challenges that ensure that we’re being competitive, flexible, and agile in order to have a great workforce and keep the culture we want.

There’s also the payer mix which has been an interesting shift for us since we’ve seen that move in a way that’s not favorable. That pressure makes it more imperative for us to realize that in an era of constrained resources—this isn’t something that’s going to go away in a month or a year or two—it’s the new reality we’re going to have to get really adept at living in.

In a way, it’s a gift that’s going to force us to narrow our focus and understand that while there are some things that we are good at and can be better with, we only have capacity to do the very best thing. So, we have to get it right. We don’t have the luxury of an Amazon to put ten pokers in the fire and hope one of them works out. It’s a challenge, but it’s also helping us mature in a way that we otherwise might not be able to do.

Q: How has the payer mix changed for you? How does that drive your investment priorities?

Reid: At a high level, we’ve seen a shift in government payer versus commercial payer, and being a not-for-profit health system, thinking of even a small shift can have an impact. But the conversations we’re having are not about, “How do we shift that back?” Because that’s not the right answer. The answer is, “How do we care for this population?” If this shift is causing this kind of financial strain for us, then, we need to innovate and figure out ways to do it where that government payer isn’t such a drain.

There are opportunities to figure out how reduce waste, focus more on the health care side, and avoid readmissions or avoid a hospitalization, in the first place. That’s again an opportunity to do some cost cutting and wait till things get better. In fact, it’s a chance to reimagine how we’re doing things.

Q: With regard to data analytics, can you share one or two examples of how you’re using data and analytics to drive access-related initiatives?

Reid: We are a developing nation in this state. We are fast followers and love to learn and glean from others. It’s not unique to us but we are data-rich and in many areas, information-poor.

So, with our data and analytics team, one area of focus is trying to be very explicit and disciplined with operational partners and really defining when they come to us and understand the job we’re trying to do. Like – why are you trying to hire this data? Trying to understand the outcomes they’re actually after, trying to offer datasets they’re not aware they have access to where they can do some of this exploratory and inquisitive exercise on their own. And trying to get out of the arena we’re in today where some of the capacity is being consumed by requests for dashboards or like – we have a dashboard, but I don’t want to treat to look like this. We’re trying to get out of that kind of service requests.

We take a first-come-first-served approach by an analytical team to really put together a comprehensive data platform that can then be used to answer a variety of questions, whether it’s on the clinical side or the business operations side or a CRM side from the marketing standpoint. It’s early days in that because right now, often, it’s based on the immediacy of the need in terms of how deeply we dive into a request that comes in. But we’re really trying to create something that’s comprehensive, scalable, and positions us for the future.

Q: How are you setting up your whole IT infrastructure and your foundational platforms to drive digital? You’re an Epic shop, so that’s key but what else drives a successful digital engagement?

Reid: A couple of things come to mind. We have a cloud forward strategy. It’s not cloud-first. It’s not cloud-only. It’s just that we certainly look to the cloud, but we are so focused on wanting to move things to the cloud that we then miss the chance to critically think through opportunities as they arise. For example, we’re an Epic shop. It’s hosted on-premise and we don’t have any plans in the near future to move that to the cloud, although going forward, I would expect that may be an ultimate outcome. But there are areas where it does make sense.

Between our colo data center and our data center at one of our hospitals that’s a couple hours away, we have a completely redundant infrastructure to run Epic for the entire health system—it’s expensive, doesn’t scale well and we have to maintain 100% capacity, 200% total in the event that we may need it. Now, if you think about it from a risk standpoint, those data centers are about two-and-a-half-hours apart, so potentially there could be a geographic event that impacts both data centers. Therefore, we’re moving our Epic VR capability to the cloud over the next year so we have the ability to just have a small presence there that can be scaled up when needed.

It’s the same thing with regard to the other solutions—we have a mix of SaaS, public-private cloud, and on-prem things, so, we’re always looking at what’s the best solution for the current state operational need and what can provide the cleanest path for that future roadmap.

One thing that we’ve learned early on is, it was years ago that we used to lead with the cloud and consider the ROI in terms of spend or savings. It’s just not the case now. It’s your dollars kind of spend elsewhere. However, there’s been a couple of transitions, especially with our finance team, to help them understand that you may not get such cost savings that you’ve heard about at the CFO conference so here’s what you do get what’s beyond the savings. You’re going to get all that the company has to bring to bear in terms of expertise, infrastructure, and cybersecurity, built in and baked in. These are things that we may not be able to ever fully do on our own or fund on our own. That’s our mindset.

Q: Can you talk about the application solutions? You are Epic first but how do you choose when enabling these digital features and functionalities that your consumers demand?

Reid: We have a Strategic Technology Investor Committee and our three pillars of our backbone assets. We have Epic for our EHR. There’s Microsoft, which runs our desktop server infrastructure. Then, there’s Infor, our ERP.

Our guiding principle is, we’ll look to these vendors first—not always, not only. Previously, it used to be, “Hey, I went to a conference, found this great tool, and I want to use it.” Before we knew it, someone acquired it so we’d be trying to figure out how to integrate it into interfaces and then, it’d have duplicative capability we already owned.

We’ve been able to redirect that now to facilitate good conversations. People have varying opinions of Epic based on where they are, what they’ve been listening to, or reading, lately. What we’ve learned through this is, it’s helpful to enable people understand the significance of the investment we’ve made. This is a choice that we made as a system for our EHR, and it is no small investment. If we ever do something outside of Epic, we have to then, do it intentionally. We have to make that decision that we’re going to add incremental costs for whatever reason—either Epic doesn’t have it or it doesn’t meet our needs the way we need it to. But we try and use an 80-20 rule in those conversations. If we can do this at Epic, Microsoft, or Infor and it meets 80% of the need and is not introducing any kind of unacceptable risk or safety issue, then, that’s what we’re going to start.

That’s been very effective and ensured we certainly have avenues for complementary solutions in areas where we really don’t.

Q: What about providers and caregivers? What about their expectations? How are you addressing those?

Reid: Well, they’re fatigued and they’re tired. What I hear most from providers is, “I just want to treat patients. I just want to talk to my patients.” I go see my provider. He knows my role in the organization and he always has a list for me, which is great because he’ll take care of me and then, I try and take care of him. But his number one thing is, “I don’t like that even for a second I have to take my eyes off my patients and be typing on the keyboard, update something.” It doesn’t have to be that way.

We are looking at some ambient listening-type experiences that can augment that. In-basket, the providers view that as a burden. So, we have a project and a way to figure out how we can automate or bring in other resources to offload some of this burden because it’s for our providers and nurses. It’s a risk to their well-being, to the capacity to care for patients, and for their commitment to the profession—for some of them, long-term. That keeps me up at night, just trying to think through all the opportunities in that target-rich environment. How do we really define that? What are the one or two things that we should be all in on that are going to make the biggest impact for this population?

Q: What about digital in the context of care management? What’s your approach in care management, home health, remote monitoring?

Reid: We have what we call a virtual care center as a 24*7*365 digital telehealth hub and a dedicated team of expert physicians, nurses, allied health professionals, and I.T. folks. What it does is offer three key services.

There’re Virtual Care Centers for Clinic Consultations. If a patient at the clinic sees their doctor and then, has some need for a specialty or some kind of advance discussion, we can virtually bring in someone from the virtual care center. That can all happen in that single-visit location with the patient, rather their referral. They then, have to actually sit down after the fact.

We do a Hospital Consultation which is the same kind of concept where the hospitalist then can, through a telehealth video visit, bring in that expert that might be needed.

We also have Telehealth ICU monitoring that really expands the capacity that we have, to monitor patients in an ICU.

With regard to Home Monitoring, we certainly have programs that support patients at their homes. We provide them the devices that collect relevant information, send that back to the virtual care center, where cross-functional teams receive, assess, and intervene as needed before updating appropriately that patient chart.

I’m really proud of that work and excited for this foundation that sets us up for the future. That emerging space is so important and this Hospital and Home is one of our key initiatives to try and really make some headway there. Because our evidence shows that patients are more comfortable in a home, it’s no surprise that a lot of cases heal, recover, when their care is better delivered at home.

Q: What are the one or two pieces of advice or best practices that you would like to share, either with your peers or with the technology provider community that wants to be a part of your journey?

Reid: We could do a whole show just on that but I would say this, and this is not a technical answer at all, that it is really an important grounding principle for me. Don’t ever be embarrassed by where you’re at your journey and don’t be afraid to start because of where you’re at.

There’s so much great content out in the community. There are folks who bring on their thinking, expertise, and where they’re at, that it’s like light years ahead of where we are. It’s easy maybe to start to think, “Oh, I guess we’re just not smart enough” or “Man, we’re never going to be as good as that person or that system.” I think that’s the wrong mindset.

We’re all where we are for a variety of reasons, but we all have the same opportunity, even if it’s just incremental, to improve that experience whether it’s for the patient, a provider, a colleague, or just within the operational work of the hospital or system where you’re at.

I would just say, as you’re empathetic, curious, and as you engage in rapid experimentation, you’ll be surprised at the progress you make. No matter how unsophisticated you might think you are, the work you do, matters. That makes a difference. Don’t ever let that comparison or your own ego get in the way of that.

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.

Technology integration is one of the greatest opportunities that we have in healthcare

Season 4: Episode #132

Podcast with Jared Antczak, Chief Digital Officer, Sanford Health

"Technology integration is one of the greatest opportunities that we have in healthcare"

paddy Hosted by Paddy Padmanabhan
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In this episode, Jared Antzack, Chief Digital Officer at Sanford Health, discusses the special considerations that go into serving their widely dispersed population and how they design digital solutions for that population. Sanford is a large health system that primarily serves the rural population across the upper Midwest, stretching over 250,000 square miles.

Jared’s role at Sanford ranges from being clinician-facing and consumer-facing to bridging their needs across technology, business needs, and consumer experiences. He states that digital is both about the front-end aspect of technology that users interact with as part of a broader experience and the back end that includes the infrastructure, architecture, databases, interfaces, and networks. Jared points to how the digital divide has become a social determinant of health and how they are removing the friction points to enhance digital patient experience and engagement. Take a listen.

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Show Notes

06:01Can you talk to us about your priorities and how that is impacted?
08:17 When you talk about the types of care that are important to the populations you serve are we talking about primary care, managing chronic conditions, or acute care procedures? What is the most important gap or need now that someone in your role would be focused on?
10:14 Can you give us an example of a digital enablement that you've launched and implemented that addresses your needs?
15:05How do you go about making your technology choices when it comes to implementing the solutions you referred to?
19:28What is the need you're trying to address? What is your advice for someone who is listening to this podcast, wants to approach you, and offer you a solution?
21:46 Should innovators be considering some very specific attributes of your population as they develop their solution for your population? What is your advice here?

About our guest

Jared Antczak serves as Sanford Health’s chief digital officer, overseeing digital strategy and transformation initiatives to enhance consumer and caregiver engagement, support care delivery, improve business processes and expand health care access through virtual care.

Antczak joined Sanford Health in 2022 after serving in leadership positions at Highmark Health, Intermountain Healthcare and Atrium Health. He holds a bachelor’s degree in biology from Brigham Young University-Idaho and an MBA from Wake Forest University, in addition to a product executive certification (PEC) and an information technology infrastructure library (ITIL) certification. He is also a certified professional in healthcare information and management systems (CPHIMS).

Originally from around Salt Lake City, Utah, Antczak lives in Sioux Falls with his wife, Charlene, and their six children.

Jared Antczak serves as Sanford Health’s chief digital officer, overseeing digital strategy and transformation initiatives to enhance consumer and caregiver engagement, support care delivery, improve business processes and expand health care access through virtual care.

Antczak joined Sanford Health in 2022 after serving in leadership positions at Highmark Health, Intermountain Healthcare and Atrium Health. He holds a bachelor’s degree in biology from Brigham Young University-Idaho and an MBA from Wake Forest University, in addition to a product executive certification (PEC) and an information technology infrastructure library (ITIL) certification. He is also a certified professional in healthcare information and management systems (CPHIMS).

Originally from around Salt Lake City, Utah, Antczak lives in Sioux Falls with his wife, Charlene, and their six children.


Q: Jared, tell us a little about Sanford Health, the populations you serve, the size of the organization, and your role.

Jared: Sanford Health is headquartered in Sioux Falls, South Dakota. We cover a geographic footprint that’s approximately 250,000 square miles—across the upper Midwest— so, you can visualize a geographic footprint approximately the size of Texas.

That’s really the population that we serve in South Dakota, Minnesota, North Dakota, and a little into Iowa, as well. Two-thirds of our population are actually classified as rural population areas and so, it presents a very unique opportunity and set of challenges, especially when you’re presented with a digital strategy in terms of how do you engage that population.

I had the privilege of joining the organization earlier this year as the inaugural Chief Digital Officer. For some of the organization’s history, we’ve had this role but prior to this, I spent about a decade in the health care industry in a variety of different technology and digital strategy-oriented roles with a few different organizations. I worked on the provider side and the payer side. I’ve been in roles that have focused both on the clinician and the consumer experiences and fundamentally, always found myself in a functioning and what I would describe as a bridging role where technology, business needs, and consumer experience really converged.

Early on in my career, I worked with the health system that was implementing an electronic medical record with computerized physician order entry and electronic prescribing for the first time. I observed these providers that were spending all of their time staring at a computer screen rather than making eye contact with their patients. I supported them at 10 p.m. at night when they were trying to finish their documentation for the day because they didn’t have enough time to squeeze it in during their clinic time.

I saw firsthand then, how technology often inhibited that patient provider relationship rather than help facilitate it. That sacred moment between patient and provider was often disrupted by the technology of the day, and consequent to that realization and recognition, I actually turned down an opportunity to go to medical school so that I could focus on that problem. That’s really been the driving force behind my career ever since.

Q: What led Sanford to create this role of a Chief Digital Officer?

Jared: I think Sanford recognized that there was an untapped potential and value in digital to really drive value for the organization and the patients we serve. We’ve done a lot of really great work in the past with IT and now, I actually work closely with our Chief Information Officer, Brad Reimer, in the organization.

But really to unlock value and enable some of our goals around patient and clinician experiences, quality improvement, and cost reduction—that elusive quadruple aim that we talk about in health care–every organization is structured a little bit differently. However, the C.I.O. and I are very much joined at the head and it’s been a very incredibly productive and beneficial dynamic for the organization.

Our roles deeply complement each other, as well. We have very distinct areas of focus, but we also have fundamental areas of opportunity where we converge a lot. It really comes back to how we define digital, though.

As an organization, we’ve defined digital as the frontend aspect of technology that users or human beings interact with as part of a broader experience. That’s the focus area for myself and my team. However, there’s also a backend aspect of technology that includes the infrastructure, the architecture, the databases, the interfaces, and the networks. That’s what the C.I.O. focuses on. All these ultimately come together as part of the technology ecosystem but the focus areas are different to ensure that we’re giving the right attention and resources where it matters.

Q: Let’s talk about your populations. Those fundamental attributes drive your digital priorities in many ways. Can you talk to us about your priorities and how that is impacted?

Jared: As I think about the population that we serve across the upper Midwest, the vast majority of the counties that Sanford Health serves in this area are federally designated provider storage areas as well. So, the opportunity for digital and technology to extend reach to some of these patients who live geographically really far from a venue of care is really one of the compelling things that piqued my interest about this opportunity.

It’s not uncommon for some of our patients to travel 3 to 4 hours, sometimes just to get to the nearest doctor’s office. Unfortunately for many people, that means taking time off of work. Sometimes, for some of our farming communities, it means setting aside really valuable harvest time in order to seek the care that they need, find child care, or even transportation to make that journey.

All of those factors ultimately can become a barrier for many people to get the care that they need in order to make a difference. We know that postponing preventive care can really result in other unintended health complications or poor outcomes. We need to make it easy for our patients to be able to do the right thing and for us to do the right thing for our patients. The ability to leverage virtual care tools and digital experiences to bring care closer to home or even in the home can really become life-changing or life-saving for people who live in these communities.

Q: When you talk about the types of care that are really important to the populations you serve are we talking about primary care, managing chronic conditions, or acute care procedures? What is the most important gap or need now that someone in your role would be focused on?

Jared: To some extent, it’s all of the above. Starting with primary care, the basic preventative care needs and then, moving up the chain from episodic conditions and urgent emerging conditions to potentially elective procedures, it’s really about making sure that we’re delivering the right care in the right place at the right time and doing so in a manner that aligns with our patients and consumers’ needs in terms of when, where, and how they want to receive that care.

Some of the additional considerations we look at especially in the rural communities, is, what does digital equity look like? Digital equity in and of itself is considered a social determinant of health similar to food shortages, housing, transportation, or other determinants of health. It also looks at whether they have Internet access, reliable broadband, device availability—Do they have smartphones or tablets or computers with a camera at their disposal? Are they digitally literate? Are they comfortable downloading, registering, navigating a digital experience? Or is that potentially a barrier to entry for some of these people to be able to engage in a virtual care experience?

We’re looking across the board at all those different elements and really understanding what it is like in our community for these patients and how do we mitigate some of those barriers and points of friction so that we ultimately can deliver the right care at the right time for them.

Q: Can you give us an example of a digital enablement that you’ve launched and implemented that addresses one or more of the needs that you just described?

Jared: We’re very much in the process of evaluating some of our priorities. But as an example, we recently launched a virtual care initiative to really transform how people receive care across the upper Midwest. It was part of a $350 million initiative. Next week, we have a groundbreaking for our virtual care facility that will be our flagship building upon which this initiative will be foundational.

With that initiative, we’re looking at remote patient monitoring for example, and checking how we can ultimately get the right devices in order to be able to care for people in some of these remote communities upstream in a way that’s more proactive and where their care team can be engaged with them from a distance so they don’t have to come in to the doctor’s office in order to have their A1C checked or their blood pressure monitored.

We’re looking at different devices that potentially can connect just based off of a cellular signal without the need for broadband access. We’re looking at how to make the experience as plug-and-play as possible.

One example that we’re exploring is for patients who are in our hospitals who might be eligible for an early discharge with remote patient monitoring as an option for that post-acute care. We’re bringing the devices to the patient while they’re still in our facilities, showing them how to connect and use it. The attempt is to demystify the experience for them so that they feel comfortable and confident about being able to use it at home. Then, when we send them home with the device, we follow-up to make sure that they’re still able to use it. That mitigates the amount of time that they have to spend in our facilities and allows them to return home in the comfort of their own atmosphere and environment to heal.

Q: Can you talk to us about your payer mix? How you develop solutions that address the greatest common denominator across multiple populations with various needs?

Jared: We have a pretty balanced payer mix in terms of commercial, Medicaid, and Medicare across that spectrum. However, Sanford is very much on the journey that a lot of organizations are on in terms of the shift to more of a value-based care model.

With that shift, the value and ability for digital to potentially create value for both our patients and the organization becomes that much more important because we start to get upstream more from the traditional visit and encounter RVU model in terms of caring for patients. We think about patients a little bit more holistically and want to keep them out of the hospitals and away from expensive, costly venues of care. Ultimately, that’s where different digital technologies, potentially remote patient monitoring among other aspects really come into play creating considerable value for the organization and patients.

We’re very much on that journey where we have one foot in and one foot out in a traditional health care landscape. Like a lot of organizations, we’re trying to figure out the best way to accommodate our patients needs and meet the organization’s needs at the same time.

Q: How do you go about making your technology choices when it comes to implementing these solutions that you’re referring to?

Jared: Sanford is actually on a single instance of Epic, and that’s quite an accomplishment for an organization our size. That instance of the EMR was actually implemented in some of our locations over 12 years ago.

If you think about the population that we serve, a considerable part is fairly static. There aren’t many moving in or moving out from some of these areas. We have a really long history of clinical data and longitudinal data sets in terms of some of these patients, which is really, really valuable for us and them in order to help generate the right kinds of insights and help keep them all while managing their conditions.

But, like every organization, I think in order to determine what digital technology is the right fit for us, I always go back to making sure that we have articulated the right problem to solve. In health care, it’s easy to fall into the trap of starting with the solution, and being dazzled by the bells and whistles that you see in a demo and then, moving forward with a particular solution, and then, working backwards to try to figure out, what problem it can solve. That’s a trap I’ve seen a lot of organizations fall into.

One of the things that we’re very deliberate and intentional about is making sure that we understand what problems we’re trying to solve, how those problems align with our strategy and how they meet our patients’ underserved needs or jobs to be done. Ultimately, are they desirable for our patients? Are they viable for the business? Are they feasible from a technology and an operational standpoint? That allows us to ensure that we’re taking the right solution to solve the right problems and that we’re getting the greatest value out of it.

Q: The populations that you serve are fairly stable and don’t move a lot. You’ve gathered longitudinal data to understand this segment. How are you leveraging all of that?

Jared: We do have analytics, machine learning, and artificial intelligence function within our organization. It really is intended to take advantage of that really robust data set that we’ve been able to curate over the years and derive some machine learning in order to generate insights about our population. Ultimately, it’s intended to get the right nudges and next best actions either into the clinician workflow or directly to the patients so they can be proactive. The right actions will help people to stay well, look at different risk factors that ultimately may potentially help predict different conditions, and ensure going upstream from there so we can provide the right treatment proactively to keep people well. It’s a really exciting area and one that we’re in the process of looking to grow and expand at the same time.

Q: What is the need you’re trying to address? What is your advice for someone who is listening to this podcast, wants to approach you, and offer you a solution?

Jared: This is something that we deal with on a daily basis. One of the things that we’re really trying to do as an organization is be very intentional and deliberate about making sure that we’re aligning the right sorts of opportunities with the right challenges, or opportunities that we’re trying to solve for.

We have this concept of the 80-20 rule where 80% of the time we want to define the problem, then, go out and compare different solutions that might be in the marketplace. Then, narrow down the right vendors depending on which ones meet our needs the best and ultimately, go forward in that way. But then, 20% of the time, we want to be able to have that sort of outside-in inspiration. There may be something that a particular vendor has identified in terms of an opportunity or an underserved need that maybe just hasn’t hit our radar for whatever reason. We don’t want to close ourselves off to those opportunities either but we want to make sure that we are also bringing those in through a consistent process.

We have a dedicated team that is on point for managing some of that intake as well as the outreach in terms of our vendor evaluations and selections.

Q: Should innovators be considering some very specific attributes of your population as they develop their solution for your population? What is your advice here?

Jared: I think the challenge is that our population is still relatively diverse though we do have a lot of people in urban settings. We have the farmer that’s out on the field that may or may not have broadband access or may or may not be as digitally savvy. We also have the financial advisor sitting in downtown Sioux Falls that we’re serving as part of our population.

Recognizing not only the population but how a particular solution can meet some of their needs is key. From a technology integration standpoint, it’s really important that we’re removing friction regardless of the type of user or persona that we might be trying to serve.

Integration is one of the greatest opportunities that we have in health care. Everybody wants that sort of Amazon-like experience. When Amazon comes out with a new set of features or functionality or capabilities, they don’t create a new app for that. There’s that old saying back in the early 2000s, “There’s an app for that.” Nowadays, it’s just part of the experience.

What we want to create is the Sanford experience. We don’t want a proliferation of point solutions where we’re asking our patients to go out and download a new app for this and that. We want it to become integrated and seamless. We want that digital front door experience where it’s cohesive, intuitive, and matches the user’s mental model. We have the ability to integrate through APIs or software development kits, the right capabilities from our partners and vendors, as well as any capabilities that we build in-house into that cohesive and seamless experience to remove friction so that our patients can engage in a meaningful way.

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.

One of our goals with digital programs is to eliminate systemic racism in healthcare

Season 4: Episode #131

Podcast with Adam Landman, MD, Chief Information Officer, and Senior VP, Digital, Mass General Brigham

"One of our goals with digital programs is to eliminate systemic racism in healthcare"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Adam Landman, MD, Chief Information Officer of Mass General Brigham (MGB), formerly Partners Healthcare, talks about the four distinct user groups that Mass General’s digital engagement programs have identified and prioritized for improved experiences. In addition to fast and convenient patient experiences, Mass General’s digital programs focus on the needs of diverse population segments to improve access to care and eliminate systemic racism, which they consider a public health issue.

Dr. Landman also talks about their data and analytics capabilities, the need for robust technology infrastructure, and their experience and learnings from evaluating and engaging with young, innovative start-ups. Dr. Landman is also co-author of a paper in Nature Digital Medicine on deploying digital health tools within large, complex health systems. Take a listen.

Our Podcast Partners:

Show Notes

03:18 What are some of the top priorities and digital aspects that you’re currently working on as the CIO?
08:06Can you share the top priorities for improving the patient experience?
09:25 What are you hearing from your patients when it comes to the kind of digital experiences that they're looking for?
13:00 How do you design solutions for a population that is as diverse as yours especially with regard to technology-enabled solutions? How do you ensure maximum coverage?
15:48What kind of technology foundation or enablement do you need to have in place to be able to deliver on all these digital front doors solutions? How have you gone about setting up the foundational infrastructure for such enabling platforms?
18:13You stated that you start with the EHR first; however, do you have a strategy that involves other best in class tools, standalone point solutions, enterprise class platforms, or you build some things yourself? How do you approach these technology choices?
22:05What are the rubrics that you use when you start evaluating the digital health startup companies and how do you make sure all these solutions work well together?
28:45 What kind of data and analytics infrastructure are you building within MGB and what are those competencies focused on?
32:02 What’s your advice for your peers in the industry, and for innovative and young technology solution providers who want to be a part of your journey?

About our guest

Adam Landman, MD, MS, MIS, MHS is Chief Information Officer and Senior Vice President, Digital at Mass General Brigham. He is also Associate Professor of Emergency Medicine at Harvard Medical School, and an attending emergency physician at Brigham and Women’s Hospital. He is an expert in health information technology and digital health design, development, and implementation. In his current role, he is responsible for technology solution delivery and support across all Mass General Brigham hospitals and practices. He works collaboratively to design and implement the future digital strategy such that front-line needs for new digital capabilities are met and emerging technologies are considered while support is delivered highly effectively and efficiently.

Landman received his medical degree from Rutgers-Robert Wood Johnson Medical School and trained in Emergency Medicine at UCLA Medical Center. He was a Robert Wood Johnson Foundation Clinical Scholar at Yale University, where he also received his Master of Health Sciences. He completed graduate degrees in Information Systems and Health Care Policy and Management at Carnegie Mellon University.

Adam Landman, MD, MS, MIS, MHS is Chief Information Officer and Senior Vice President, Digital at Mass General Brigham. He is also Associate Professor of Emergency Medicine at Harvard Medical School, and an attending emergency physician at Brigham and Women’s Hospital. He is an expert in health information technology and digital health design, development, and implementation. In his current role, he is responsible for technology solution delivery and support across all Mass General Brigham hospitals and practices. He works collaboratively to design and implement the future digital strategy such that front-line needs for new digital capabilities are met and emerging technologies are considered while support is delivered highly effectively and efficiently.

Landman received his medical degree from Rutgers-Robert Wood Johnson Medical School and trained in Emergency Medicine at UCLA Medical Center. He was a Robert Wood Johnson Foundation Clinical Scholar at Yale University, where he also received his Master of Health Sciences. He completed graduate degrees in Information Systems and Health Care Policy and Management at Carnegie Mellon University.

Q. Adam, tell us a little about the populations you serve at Mass General Brigham.

Adam: First, I want to address our name. You may know us as Partners Health care but now, we are Mass General Brigham. This new name more closely reflects the world-renowned hospitals that make up our system—Mass General Hospital and Brigham and Women’s Hospital—which are really the foundation and heart of our healthcare system. At a high level, the Mass General Brigham vision is to build the integrated academic health care system of the future in which we have patients at the center transforming care, improving outcomes, and expanding our impact locally, nationally, and globally.

Currently, we see about 1.8 million patients per year. We have 80,000 employees. Our inpatient capacity is >3200 inpatient beds. What is also unique about our system is our research enterprise. We really focus on performing breakthrough innovations and translating those innovations to the world. We have about $2 billion in sponsored research, which includes over 2700 clinical trials across our five academic medical centers—MGB Rigor, McLean Psychiatric Hospital, Mass Pioneer and Spaulding Rehabilitation. All of them encompass our academic mission and focus.

Q. What are some of the top priorities and digital aspects that you’re currently working on as CIO?

Adam: I speak today on behalf of an incredible team of colleagues that really enables us to do what we’re doing not just in digital, but also in health care delivery, overall. I want to acknowledge that we’re led by a new Chief Information and Digital Officer, Jane Moran, my new boss who’s really helped us with our strategic planning and prioritization, some of which I’ll share with you now.

Our priorities now center around experiences of our user groups. While this is something we have not thought about this way, traditionally, and it is a little new for us, I really think it’s the right strategy going forward. The four groups that we’re prioritizing are patients, providers, researchers, and employees. We’re putting together a strategy for each of these groups that focuses on meeting their needs regarding digital technology. I’ll just share two examples of that.

First, for our researchers, like other academic medical centers, we are focused on increasingly enhancing their access to the wealth of clinical data that we have and using modern cloud technologies and platforms so that they can use that data for approved research projects.

For our providers or our care teams, we have a lot of work going on to improve their experiences. One of our key projects is working on the in-basket experiences for our providers and patients. One of the best things about COVID was that we, like other health care organizations, saw a tremendous increase in the use of our patient portal. In fact, during the last two years, we’ve seen a doubling of the number of patients signed up for our portal and more of them actually engage with it. We absolutely want to encourage that, but we recognize that the system, the actual technology, and our workflows were not necessarily designed for the increase in message volume that we’re seeing.

I am working with colleagues across the organization on approaches to improve the in-basket experiences. What’s nice about our chosen approach is that we recognize that we really need a multidisciplinary team—technology experts, members from our digital teams, and colleagues that can focus on policy as well as workflow and care redesign. We’ve brought these worker groups from across these areas to collaborate on how we can change levers and improve the in-basket experience.

At a high level, some of the things we’ve done is worked on removing non-value adds in basket messages. So, we’re turning off all duplicate notifications or acceptance notifications that aren’t needed. We’ve also worked on the policy side to set expectations for how our portal should be used with specific emphasis on results, review, and response by the clinical care teams. Gradually we’re working on making changes which we hope will improve the care team experience.

Q. Can you share one or two top priorities regarding improving the patient experience?

Adam: I want to emphasize that while I gave the example of providers, we are focused on enhancing the experience for the entire care team. Even on the in-basket side, while there is a focus on providers, we’re also thinking about how to improve the front desk workflows and make that as efficient as possible.

With regard to the patient experience, I think of one example which will be similar to many organizations that are working on this—the digital front door. How do we make it easier for patients to interact with us and get access to our services electronically? That’s one of our major priorities and one of my colleagues is leading our efforts in that space.

Q. What are you hearing from your patients when it comes to the kind of digital experiences that they’re looking for?

Adam: Many of our patients have a lot of expectations from us. I can share a couple of the key things they want. First, a fast and convenient experience. They don’t want to have to call us, wait on hold for long periods of time, and then, be transferred to multiple different people to accomplish what they want. They want to be able to interact with us quickly and easily. So, that includes being able to schedule appointments quickly, check their test results, correspond with their care teams, and do virtual visits. Those are all components of functions that we are trying to make as easy as possible as part of our digital front door work.

Second, our patients are appropriately concerned about security and privacy. So, I think it’s essential that for everything we do with our patients, particularly from a technology perspective, we must ensure that it is as secure as possible and that everything possible be done to protect their privacy.

Third, equity. This is something that our system has made a very significant commitment to. We’ve launched a United Against Racism campaign, which really acknowledges and calls out that our system believes that racism is a public health issue. It impacts our patients, our workforce, and the communities we serve. We are acting as a system to dismantle systemic racism, and this has important implications in our digital work.

Just to give you a couple of examples, when we’re talking about digital technologies, particularly for patients, we want to make sure that all patients have access to these services, especially these new digital tools. We’re increasing access to interpreter services through the virtual interpreter services. If patients doing virtual visits don’t speak English, we bring interpreters into that encounter to help with patient communication.

Another example concerns our team of digital access coordinators. These are additional resources to help our patients enroll in our patient portal. They speak multiple languages, take time out to answer patients’ questions and help them not just with enrollment but also how to use the portal’s services. That’s how we’re addressing equity in our patient experience.

Q. How do you design solutions for a population that is as diverse as yours especially with regard to technology-enabled solutions? How do you ensure maximum coverage?

Adam: I’d say that I personally learned a lot about this during COVID because we recognized then that we needed technology to help us solve problems and design solutions around how we could make testing available to all our patients? How could we extend vaccination to them?

We also recognized if we used very sophisticated technologies, that could prevent some of our patients from accessing those services. As we think about our approaches, we bring in our experts from different backgrounds, so our team represents diversity, equity, and inclusion. Those team members are part of our solution and ensure that we consider all our patients’ needs. As we design solutions, the attempt is to enable as many patients as possible to take advantage of those services. For instance, we used quite a bit of text messaging. We found many of our patients, even our most vulnerable patients, had access to and in fact, liked interacting with us over text messaging. So, we use a lot of text messaging and web based tools. We have found them to be very, very successful.

We also found that we had a rather sizable population that didn’t have cell phones and that we only had landline phones for them. So, we used IVR tools with some additional AI capability to enable those patients to interact with an agent and even schedule appointments for vaccination directly over a landline phone.

We’ve baked into our solution process the need to ensure that our base technology solutions reach as many patients as possible. Where there are gaps, we address those with other solutions—sometimes, technology-based, and other times, just additional outreach and greater focus in those areas.

Q. What kind of technology, foundation or enablement do you need to have in place to be able to deliver on all these digital front doors solutions? How have you gone about setting up the foundational infrastructure for such enabling platforms?

Adam: We absolutely think in terms of platforms, and this is something that Jane Moran has helped shape. In an ideal world, we want to leverage our existing platforms as much as possible to meet needs. But we also recognize there are limitations to those platforms which is why we need to consider other solutions.

As we think about patient experience, of course, our electronic health record forms the core there. We absolutely leverage our electronic health record. However, there are limitations to what that platform can do. So, we are also investing in a customer relationship management platform to help supplement our electronic health record.

We’ve also invested in additional tools—chat bots that sit on top of our electronic health record and have added some of these capabilities to help improve interactions with patients. We are in the early stages of using some of these technologies, particularly the chat bots, and so we’re really learning how well they work, for which use cases, and for which patients. We will continue to iterate and improve on those as we go.

Q. You started with the EHR and that’s what other health systems do as well, but they can’t do everything. Do you have a strategy that involves other best in class players, standalone point solutions, enterprise class platforms, or will you build some things yourself? How do you approach these choices?

Adam: Here’s how we are starting to think about this. We’re formalizing a process which we’re calling an Enterprise Architecture Review that we’ll go through when there is a new technology need to really consider and determine which solution, we’ll use to solve that need. First, we’re going to look at our existing enterprise platforms which may include our electronic health record. We’re building out a CRM system as well so that would be considered, too. Our HR and Finance systems are also platforms we’re looking to first, to solve requests that are coming in.

Then, if those major platforms don’t solve the issue, we might look to an existing product that might be in use across our enterprise because if we’re already using it, maybe we can extend that. If it’s already being used for this specific use case in another part of our organization so, we could look to sort of leverage that tool further.

If there really is not a tool that we have or an existing platform that would work, that’s when we’d look to another solution in the market. Ideally, there’s a solution out there that we could just purchase and use.

In some cases, we don’t find a solution that we can purchase and use. That’s where we’d love to find partners who want to co-develop and work with us to shape their tool to meet our needs. If it meets our needs, it probably meets needs from other healthcare systems out there.

Finally, if we cannot find a partner and if there’s nothing out there on the market, that’s when we would consider actually building the software ourselves. We do that from time to time, but we really want to have a rational approach to when we’re using those specialized resources.

I will put a plug in here. We did just write a paper on this, and I can share it with you. But for our listeners, we recently published a paper with a colleague, Jayson Marwaha, who was our first author on this paper. This was published in Nature Digital Medicine, and it really describes how we look at bringing new digital innovations into our organization. It summarizes what I was just talking about, more articulately—our process to look at innovations, where, which platform we’re going to use, and which technology leads.

Q. Adam, there is a lot of digital health innovation out there and billions in venture capital money. It can be quite confusing and can be quite risky to place your bets on one or more of these solutions. How do you go about at a very high level? How do you make sure all of these solutions work well together?

Adam: I feel fortunate that I have the opportunity to do some of this digital innovation. For many years, I oversaw the Brigham Digital Innovation Hub. Now, I oversee a small team across the enterprise. Our Digital Health Innovation team has been making some investments in collaborating with early-stage startups to improve health care delivery.

Perhaps the most important first step is identifying the problems that you want to solve and ensuring that there’s not already a robust solution to it. If there is a robust solution, that will meet the needs, you want to try to make sure you’ve looked at that solution first. Working with an early-stage startup can be really rewarding but has a lot of risks to it as well. So, before you’re looking at the new startups, check for established solutions that may exist.

There are so many new, exciting challenges in healthcare for which we don’t have solutions. There are exciting newer technologies that maybe doing things faster, better, and cheaper that we absolutely want to pay attention to in this space. But to your point, we want to have a rubric and a new way of approaching it.

So, while this may sound like an antithesis for people who like to innovate, we are actually going to add, as some of our strategic work in this space, more process to how we look at our investments in early-stage innovation. That’s because we want to be really systematic about it and increase our chances of success especially as we work with emerging technologies. We are going to try to proactively identify where the problems that we want to try to solve, are.

Second, the next step is to not be as opportunistic but have a process we go through to really look at the landscape of startups, critically, and evaluate them. In essence, what many of us are used to —doing RFPs or RFI—this really goes through that process with rigor. So, we’re looking at the startups, trying to select the best partner, and then, collaborating closely with them.

We want to understand what their experience is like, both on the technology side and in health care. What’s their leadership experience? How well do we work together? When you work in this area, what we’re really trying to do is work together to learn from each other and pivot, to try to find the right solution. So, both organizations need to be aligned on what are the problems that we’re trying to solve and how we are going to adjust over time to do that.

You need to get the right team that’s willing to make those changes, in place. Those are some of the things that I look for as we evaluate early-stage companies to work with and I continue to think that this is a really important area for us.

I will just add that we also have a $30 million AI Digital Innovation Fund, and we are specifically designed to be strategic investor, so this is reserved for early-stage companies that we are working with in some capacity. We will make moderate-sized investments at the series A and B levels in these partners.

Q. What specific capabilities or competencies do you think an organization like MGB needs to keep in-house and build out as you work with this ecosystem of technology partners? How do you bring it all together?

Adam: That’s a question that we’re trying to figure out, and I suspect many across the country are trying to identify as well. One context I’ll share is that the unique components of health care are that we work in a mission-critical organization. That’s 24*7*365. So, the technologies that we’re deploying have to work. We understand there will be some failures—some plans, some players—and when they happen, we have to be able to respond very, very quickly. Our traditional approach has been to in-source all of our expertise—our infrastructure expertise, our service desk, and our platforms really have been in-source.

We are like many organizations right now under significant cost pressures. So, we are starting to think about where we outsource. The questions that we’re trying to address, and I don’t have the answers yet, but I’ll welcome them from there, from you or from others that maybe listening is we can’t compromise on the quality and the service delivery aspect that we’re providing. But we’d love to be able to find ways of being more efficient in how we deliver those services. We’re still trying to identify if there are opportunities to outsource, where they are, or where they might be.

Q. What about the data and analytics infrastructure within Mass General? What kind of infrastructure are you building? What are those competencies focused on?

Adam: Like other organizations, we are also investing in our data infrastructure and more importantly, in moving our data infrastructure to the cloud. We have, for many years, had a very successful data lake and we’re now looking at what would it take to put that data lake into the cloud, to make sure all of our data is available, and ideally increase the amount of real-time data that are available. That’ll make it easier for internal users to access all of that data and use it to improve health care delivery. There’s infrastructure work going on to do that.

What I will share with you is, maybe a successful program that we’re leveraging the data from these environments via our Active Asset Management Program. This started at Brigham and Women’s Hospital a number of years ago. The concept around the program is how do we make efficient? For example, enabling efficient use of very high-cost fixed assets like operating rooms (OR). This program is really driven by operational leaders, but that requires data and data analytics to power it. So, our analytics team at the Brigham, led by Rob Horsford, pulled data from our electronic health record to start to show the utilization and you can imagine they broke that data down by day, time, service, and worked with the managerial leaders, including the provider leaders, to iteratively understand what data they needed to make management decisions. They got feedback on that and eventually created formal dashboards using Tableau and other tools to be able to display this data to the managers and hospital leaders, convene the right leadership stakeholders on a regular basis to review the data and more importantly, make management decisions based on this data so they could change staffing, reassign or blocks etc. timely.

Using the combination of the available data and management intervention, we were able to create more access for patients, which was great because they were waiting to have their procedures done.

There was also a revenue opportunity for the hospital. We’re now replicating this data and management system across Mass General Brigham and looking to use our new cloud-based data infrastructure as we scale this.

Q. What’s your advice or a best practice for your peers in the industry, especially smaller health systems that may not have the scale and the resources to do the kind of things that you’re doing? Likewise, what’s your advice for innovative and young technology solution providers that want to be a part of your journey?

Adam: I think the piece of advice that I will share for health systems and tech vendors is that we need to be agile. I really appreciated this during COVID, and I know there are a lot of definitions of agile out there, including that very specific technology initiative. But I think most health care organizations, including mine, when we approach technology, we want the technology solution to be perfect. So, we’d often spend months, if not years, planning projects, getting ready for the big implementation and then, implementing. Of course, because we’re talking about patient lives and patient safety, we absolutely still need to pay really close attention to the details and need to plan these initiatives carefully.

What I have found and what we proved during COVID is that we can work in a different way where we break projects down into smaller components. We roll these out more quickly, even on the order of days or weeks and follow that very closely. We check how that technology implementation is going and continue to tweak it over time, sometimes making changes every day in order to stabilize the system or correct issues that may have come up.

What I found during COVID is, we built phenomenal relationships with our operational partners. We were talking multiple times a day, working very closely with them, and delivering technology at an extraordinary pace. There were some unique aspects of COVID as well so, we focused all of our digital and operational resources on it and used a very different decision-making governance framework where we had incident command.

What I’m now seeing is that we’re going back to our old ways of working. I hope that I’m trying very hard to find somewhere in the middle, where we can be a little bit more agile and nimble and have these close relationships with our operational and technology colleagues and vendors so that we can move faster.

I think what we’re starting to see is that our health systems have a number of challenges. They are only coming faster. And technology is increasingly part of the solution for these, so we need to find ways of being responsive to all the demands coming toward us and continue to innovate. I think that this is kind of a huge opportunity for us as we think about how we work going forward.

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.

When you develop solutions for the most vulnerable, you make it work for everyone.

Season 4: Episode #130

Podcast with Anika Gardenhire, Chief Digital Officer, Centene Corporation

"When you develop solutions for the most vulnerable, you make it work for everyone."

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

Anika Gardenhire is the Chief Digital Officer of Centene Corporation – the country’s largest managed Medicaid services organization. In this episode, she talks about why it is important that their most vulnerable populations “show up” in their digital transformation programs. She highlights the importance of innovation for underserved and vulnerable populations and urges the technology vendor community to focus on building solutions for the most vulnerable populations.

Anika discusses Centene’s digital priorities and how they cater to their population’s specific needs by addressing digital literacy, closing the gap of digital divide, and supporting them with digital tools and technologies. Take a listen.

Our Podcast Partners:

Show Notes

02:13 How do you drive your digital priorities being a predominantly Medicaid-focused organization?
05:30Give us a couple of examples of programs that you’ve launched for your population.
08:50 You're partnering with healthcare providers to deliver the care that these vulnerable populations need. Can you share some examples of what that collaboration looks like?
11:21 Your populations may be living in areas that are bandwidth deserts or transportation deserts, or food deserts. How do you successfully wrap all of that?
14:18 Can you elaborate on the innovation targeted specifically at your population that you’d like to see from the technology vendor community?
16:30What about data and analytics? How are you deploying these capabilities to serve your populations?
19:11 Do you agree that working under constraints makes you more innovative? What challenges do you face in your role as the CDO when meeting your objectives?
22:18 What’s your one piece of advice for your peers in the industry who are on similar journeys or operating in a resource-constrained environment?

About our guest

Anika Gardenhire, RN, BSN, MMCI serves as Chief Digital Officer for Centene Corporation, a diversified healthcare enterprise providing a portfolio of government-sponsored healthcare programs focusing on under-insured and uninsured individuals to more than 26 million Americans.

In this role, Ms. Gardenhire is responsible for leading the Digital Solutions and Products Organization, where she oversees business capabilities that are enabled by technology. At the same time, she focuses on servicing customers, while driving the highest possible value from the company’s comprehensive portfolio of digital solutions and products. Most recently, Ms. Gardenhire served as Regional Vice President, Digital and Clinical Systems for Centene. She held responsibility for leading teams that partner with clinical and business leaders to streamline how Centene allocates resources, achieves goals, and operates more efficiently.

Ms. Gardenhire initially joined Centene from Intermountain Healthcare, where she served as Assistant Vice President (AVP) of Digital Transformation. She led and served on several governance councils, including intelligent automation and data governance. Ms. Gardenhire also led several impactful initiatives such as unified communication and application rationalization.

A strategic thinker and avid learner, Ms. Gardenhire listens, understands, and communicates the impact of clinical and business workflow on proper use and optimization of technologies to enhance the delivery of patient and member care. Previously, she worked as a Principal with Leidos and Senior Manager with Deloitte, serving as an advisor to executives across many prestigious institutions, including The Mayo Clinic and members of the Ministry of Health in British Columbia, Canada. Ms. Gardenhire’s career has led her to hold various positions as an operations leader and implementer of clinical and IT programs. In addition, she holds significant experience working as a change agent regarding how clinicians, information technology professionals, and interdisciplinary care teams integrate and utilize information systems to augment patient care.

Ms. Gardenhire graduated from the University of South Carolina with a Bachelor of Arts degree in nursing and from Duke University with her Master’s degree in Management and Clinical Informatics. She, her husband, Aaron, and their 100-pound bull mastiff, Titan, reside in Weddington, NC right outside of Charlotte.

Anika Gardenhire, RN, BSN, MMCI serves as Chief Digital Officer for Centene Corporation, a diversified healthcare enterprise providing a portfolio of government-sponsored healthcare programs focusing on under-insured and uninsured individuals to more than 26 million Americans.

In this role, Ms. Gardenhire is responsible for leading the Digital Solutions and Products Organization, where she oversees business capabilities that are enabled by technology. At the same time, she focuses on servicing customers, while driving the highest possible value from the company’s comprehensive portfolio of digital solutions and products.

Most recently, Ms. Gardenhire served as Regional Vice President, Digital and Clinical Systems for Centene. She held responsibility for leading teams that partner with clinical and business leaders to streamline how Centene allocates resources, achieves goals, and operates more efficiently.

Ms. Gardenhire initially joined Centene from Intermountain Healthcare, where she served as Assistant Vice President (AVP) of Digital Transformation. She led and served on several governance councils, including intelligent automation and data governance. Ms. Gardenhire also led several impactful initiatives such as unified communication and application rationalization.

A strategic thinker and avid learner, Ms. Gardenhire listens, understands, and communicates the impact of clinical and business workflow on proper use and optimization of technologies to enhance the delivery of patient and member care. Previously, she worked as a Principal with Leidos and Senior Manager with Deloitte, serving as an advisor to executives across many prestigious institutions, including The Mayo Clinic and members of the Ministry of Health in British Columbia, Canada. Ms. Gardenhire’s career has led her to hold various positions as an operations leader and implementer of clinical and IT programs. In addition, she holds significant experience working as a change agent regarding how clinicians, information technology professionals, and interdisciplinary care teams integrate and utilize information systems to augment patient care.

Ms. Gardenhire graduated from the University of South Carolina with a Bachelor of Arts degree in nursing and from Duke University with her Master’s degree in Management and Clinical Informatics. She, her husband, Aaron, and their 100-pound bull mastiff, Titan, reside in Weddington, NC right outside of Charlotte.

Q. Anika, tell us a bit about your background. What does your role at Centene entail?

Anika: I’m a clinician by training—a registered nurse. I transitioned into Clinical Informatics several years ago and then moved into roles that are progressively more at the intersection of business and technology. I work in that function of being an intermediator, translator, and facilitator, and bring it together. I’ve been really fortunate to join Centene as the Chief Digital Officer responsible for our digital solutions and products, and really driving us toward an even more data-driven organization.

I’ve enjoyed working with the senior leadership team and helped them align around objectives and key results, and how to support the organization holistically by putting our collective efforts toward making the business more efficient and providing ongoing consistent value to our customers. It’s a fun job. It’s different every day and absolutely fulfilling and humbling to serve the membership that we serve.

Q. Centene is the largest managed Medicaid provider in the country. How does being a predominantly Medicaid-focused organization drive digital priorities?

Anika: There are a couple of things. One is really thinking about how we identify our customer segments as a large managed Medicaid organization. Also, we’re thinking about the fact that while we’re so positioned, we better product—a Medicare product—so, how are we supporting our customers?

Holistically, we serve the most vulnerable populations and typically, they have very specific needs from a digital perspective. We think about how to look at digital literacy given the endpoint devices that our applications might be on which might look different. How do we support and close the digital divide? What are the specific ways to support our membership and how can we provide digital tools and technologies from a rural health perspective?

A couple of things for us as we develop our personas to build digital tools which those of you in this space will know, concerns how much time you spend doing that. We think specifically about our Medicaid population and try to ensure that there are situations where they’re represented. Our representation really shows up in the personas that we’re building.

We also think differently about how we undertake customer research. We know that our membership, specifically, isn’t always those that you find responding to surveys. So, how do you build out competency around ethnography among other ways to really understand that membership becomes really important in the work that we’re doing?

One of the things that is really our team’s responsibility, and the responsibility specifically for Centene, is to ensure that our membership including, our very vulnerable populations, show up in digitally transformed health care. Often, we’re developing tools to be very transparent for middle America. It’s not that we shouldn’t necessarily do that, but this ensures that for all of us who really need those tools, we are thinking very specifically about how to also provide access to them in ways that meet people where they are.

Q. Can you give us a couple of examples of programs that you’ve launched based on all the research and the background of your populations?

Anika: A couple of things would be the work that we’ve done to support, for example, digital care management. When we think about digital care management and how we really support our population specifically, question arises of how do we think about what’s the minimum necessary to qualify for digital care management? How do you onboard that membership specifically? How do you, assess the level of digital literacy to ensure that you’re able to provide those services in a way that’s specific and unique to that population? How do you support vendors who might not have really thought about this membership first, and help adapt their products and solutions to provide the best, highest possible value to this membership, uniquely? That’s one of the things that we think about.

Then, you start thinking about – What are some of the things actually regulatory wise that we are doing, in order to really support our membership, that might look different? How does an organization like ours respond to the “no surprises, exit and transparency rules?” When we think about trying to specifically explain benefits or other types of tools and services to a membership that’s not been catered to historically, what does that need to look like?

When I talk about endpoint devices, it comes down to—How do I need to think about how heavy that application is to ensure that it will be valuable across all the endpoint devices that it might show up on for our membership?

These are two of the programs that I think we are laser focused on and that are really helping us ensure that we are accounting for the work we’re doing specifically for our membership. I also want to be honest that it’s part of the reason that I love what I get to do at Centene. Very specifically, the reality is that when you develop for the most vulnerable, you make it work for everyone. You really have the opportunity to devise simplicity and create consistency in the experience that will work for the whole because you’ve actually thought about those who have the most needs. It really creates opportunities for us to make an impact in a truly exponential way because we’ve designed solutions for those who have really specific needs or for the ways that they’re going to use them.

Q. When it comes to care management, you’re partnering with healthcare providers to deliver the care that these vulnerable populations need. What does that collaboration look like? Can you share some examples?

Anika: One of the things that if you’ve heard Sarah London our CEO talk, is that she’s been very specific about how we will partner with provider groups—FQHCs. How do you wrap services and support around the places that our members very specifically are going to receive care? There are a couple of things.

One, we think about those who are providing community services and how we can support them from a data and data integration perspective. How do we support our federal federally qualified health centers from a data perspective? How do we think about the future of risk? How do we support those value-based care models for our most vulnerable provider groups separately from FQs? How do we also support those who are really thinking about how to be comfortable taking risks? How do we support them in understanding contract arrangements?

We know that, when it comes to social determinants and the risks that we see in differences in care around race and ethnicity, if we can keep those providers providing care and support them in the communities that they serve to offer better outcomes for those populations, then, we must think in very specific ways about how to provide such a partnership.

It’s not only about how to provide digital solutions and products to them, but also how to support them in thinking about managing panels and taking on risk. Are we supporting them to supply the right data and digital tools at the point of care to help them continue to really impact outcomes for that membership?

The organization is doing a really good job of that. We are laser focused on continuing to build our capabilities that will explicitly support the very close relationship between the provider and the member/patient/consumer, however you want to title them moving forward.

Q. These populations have a bundle of needs, but they may be living in areas which are bandwidth deserts or transportation deserts or food deserts. How do you successfully wrap all of that?

Anika: We have an incredible number of value-added benefits around transportation and food services. I would call out, for example, programs in our North Carolina Health Plan where we have forums where we encourage members to offer input into what some of the most important things are and how we provide differentiated services to the community.

It’s also crucial that when we think about those types of services, we understand the member’s perspective about what’s really most important to them. This is so that they can really get it and leverage the opportunity to provide that type of input. So, there are a couple of things.

One, it’s really about understanding what’s available from a community services perspective. Is it something that we need to provide directly? Is there an opportunity to support a community-based service that’s already in existence but may actually just need some lift?

When it comes to how we provide some of those additional benefits around transportation, food, and/or partnerships with companies like Lyft, then, that’s a part of our entire benefit model. It may span, for instance, supporting transportation partnerships with being able to provide healthy food services or, being able to send out a food truck to a community event to provide for more gatherings and/or quite frankly, just combat loneliness. That’s really the value that we bring as a managed care organization where the care component is really the most important.

The work that we do and the relationships that we build with our members revolves around really understanding how we engage them and involve them in their care. That is the crux of what we’re trying to do. Our medical director team, our population health and clinical operations teams, and the role that we play from a digital perspective not only support our members and providers but all those that are involved in providing that care.

Our members are really important and that’s why when we think about our customer/consumer/provider, we also think of ensuring that we understand the care manager, the utilization management nurse, the pharmacist, and others that are supporting them. We work at how we are supporting those customers who surround them as well.

Q. The third leg of the stool concerns the technology vendor community that’s coming up with the innovation and the solutions. Can you elaborate on the innovation targeted specifically at your population that you’d like to see from the technology vendor community?

Anika: When we look at how we think about consumer research, innovating, and how we’re developing our tools and services, we try to ensure that we have a representative population. We also try to ensure that you are testing those solutions across the spectrum of healthcare and thinking about it from a wellness and care delivery perspective. It’s equally important that you test it in a rural setting, with an ethnically representative population for understanding youth and language changes among others. That’s incredibly important.

One of the greatest opportunities we have from a digital perspective, is to start to self-govern, for lack of a better term, and really think about the impact that we have on people. This is especially for those of us who are blessed to work in the health care space. When I think about the impact that we have on people, that’s as significant as perhaps big pharma and so, I think about the amount of rigor that it really takes to ensure that we are doing no harm.

We have a very specific responsibility to ensure that we are thinking about digital ethics, research, rigor, and the representative populations in the solutions that we’re developing. This ensures we’re able to provide access to care for digital health and to everyone who needs and should have it.

Q. What about data and analytics? Apixio is one of your portfolio companies now, so, how are you deploying all those capabilities to serve your populations?

Anika: When we think about data, Big Data, contextual data, Artificial Intelligence, and Machine Learning, it’s such an important part of the work that we do, today. It’s an incredible part of what we’ll continue to do. It will help us ensure that we’re doing our best to supply things like a next best action to a care manager and undertake interventions that are most highly aligned with the most important benefits to provide to a particular population. Now, that maybe by geography or perhaps a group which has another type of similarity. That’s where data helps our understanding.

I think there is a “know me” component around data that is so important. But when we think about consistency and how we supply the entirety of the team that is going to surround the individual at the center, we must make sure that they know the things that they need to know at the time that they need to know it. When I think about the data story, it’s really the ability of being able to provide the right data at the right time for the right appropriate action for the individual. The action component for the individual is most important whether we’re asking the consumer or a member to do it themselves or asking a member of their “care team” to provide. It’s understanding that action and the outcome that that action had for the member and then, being able to supply the right next suggestion, that’s really the most critical component of what we have to do.

Q. Do you agree that working under constraints makes you more innovative? What are the challenges you face in your role as CDO when meeting your objectives?

Anika: I am a genuine believer that innovation is born out of friction. So, necessity without question breeds innovation. There is absolute necessity to innovate in the face of scarcity for when you have scarce resources, you are always thinking about how to do more with less. How do you do your best with what you have? That is a constant focus. It creates what is a great responsibility not just around fiscal responsibilities but also in ensuring that we are helping get the right resources to those most in need. That is absolutely one of the wonderful opportunities that we have. To your point, one of the pretty significant challenges is really an opportunity to rise to the occasion. It’s an opportunity again to serve the entirety of our patient populations using those innovative solutions.

When I think about sort of what constraints it might put on me specifically, or the team that I have the great privilege of serving, it’s really about prioritization and focus. When you think about trying to innovate, there is often so much that you want to do and so many things that you could do.

I often say most Chief Digital Officers want to build flying cars. I want to build flying cars too. It’s a natural thing for many of us, but, even more importantly, I want to ensure that we have a tarmac to take-off from. We have solid footing, rules, and an understanding so that when we get to the air, everybody is safe and comfortable. It does the thing that that flying car is supposed to do—get us there faster, safer, and better.

Making sure that those foundational things are in place is important. It gives me an opportunity to really think about what those foundational things are and how important they are to have solidified in concrete. Then, we can think about the additional things we really want to provide and the impact and value they’re going to have on the health care continuum for that membership. Finally, we can create laser focus on executing in the best possible way for those very specific things and deliver that value.

Q. If there’s one thing that you’d like to leave behind for your peers in the industry who are on similar journeys or operating in a resource constrained environment, what’s your advice going to be?

Anika: I think my advice will be—make sure that your digital transformation strategy, your digital strategy, and your technology strategy are centered around people, especially for those of you in healthcare. This is a very, very human industry so, I think of digital transformation very specifically. We are doing something tomorrow that’s different than what we did today because we created a thing. It’s having real, fundamental, important impact and delivering real significant value to people. We are driving through the change that we need humans to make to take best advantage of it. So, again, staying laser focused on ensuring that you are bringing people along your journey is the piece of advice that I will give.

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com and write to us at  info@thebigunlock.com

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

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

We’re expanding our concept of access beyond just a face-to-face encounter to all the digital encounters that allow us to stay more connected with patients

Season 4: Episode #129

Podcast with Denise Basow, MD, SVP and Chief Digital Officer, Ochsner Health

"We’re expanding our concept of access beyond just a face-to-face encounter to all the digital encounters that allow us to stay more connected with patients"

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Dr. Denise Basow, a primary care physician by training, is the Chief Digital Officer of Ochsner Health – a health system that predominantly serves Medicaid populations in a risk-based payment model. She talks about how they’re using digital programs to drive improved healthcare outcomes and reduce care costs.

In this episode, Dr. Basow discusses their telemedicine capabilities, which include digital medicine technologies, remote patient management, digital tools to drive innovation and transformation, and digital coaching programs to drive patient engagement and outcomes. Take a listen.

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Show Notes

02:50 What kind of population do you serve, and how does that inform your digital priorities?
06:01What building blocks do you work with as you approach your population's digital needs?
08:14 What kind of programs have made an impact for Ochsner?
12:30 Are there any learnings you'd like to share with listeners working with similar populations? How do you get your patients to embrace the technology?
15:36 How do you make your technology selection choices – build versus buy? Do you start with the EHR first or best-in-class?
21:38 Can you share anything about access-related solutions where you're driving engagement through digital tools and technologies?
24:43 What does Ochsner’s governance model and strategy look like?
28:12 Can you share some of the best practices or learnings with your peers in the industry, especially those who are addressing similar populations and maybe in earlier stages of their digital journeys?

About our guest

Dr. Denise Basow joined the Ochsner Health Executive Team in January 2022 as the first Chief Digital Officer, with a mission to scale digital innovations that improve quality, engage patients, and enhance the healthcare provider experience. She is responsible for innovation Ochsner, a leader in digital healthcare solution development, virtual health and telemedicine, and the digital health business unit, which deploys remote patient management solutions focused on chronic diseases. These solutions are deployed within the Ochsner Health System and commercialized nationally.

Prior to joining Ochsner’s team, Dr. Basow had a 25-year career with global information, software and professional services leader Wolters Kluwer and healthcare start-up UpToDate, where she leveraged innovation and technology to improve the quality of healthcare. She joined UpToDate as a start-up in 1996 and served as CEO for 14 years, including the formation of a larger solutions business, Clinical Effectiveness, that expanded the mission beyond clinical decision support to include patient engagement solutions. At the time of her departure, Clinical Effectiveness served more than 2 million physicians globally and tens of millions of patients.

Dr. Basow received her undergraduate degree in Chemistry from Duke University and her medical degree from Baylor College of Medicine. She completed her residency at Johns Hopkins University and practiced internal medicine for several years before joining UpToDate.

Denise-Basow,-MD-profile-dektop

Dr. Denise Basow joined the Ochsner Health Executive Team in January 2022 as the first Chief Digital Officer, with a mission to scale digital innovations that improve quality, engage patients, and enhance the healthcare provider experience. She is responsible for innovation Ochsner, a leader in digital healthcare solution development, virtual health and telemedicine, and the digital health business unit, which deploys remote patient management solutions focused on chronic diseases. These solutions are deployed within the Ochsner Health System and commercialized nationally.

Prior to joining Ochsner’s team, Dr. Basow had a 25-year career with global information, software and professional services leader Wolters Kluwer and healthcare start-up UpToDate, where she leveraged innovation and technology to improve the quality of healthcare. She joined UpToDate as a start-up in 1996 and served as CEO for 14 years, including the formation of a larger solutions business, Clinical Effectiveness, that expanded the mission beyond clinical decision support to include patient engagement solutions. At the time of her departure, Clinical Effectiveness served more than 2 million physicians globally and tens of millions of patients.

Dr. Basow received her undergraduate degree in Chemistry from Duke University and her medical degree from Baylor College of Medicine. She completed her residency at Johns Hopkins University and practiced internal medicine for several years before joining UpToDate.


Q. Denise, tell us a little about your background. How did you get into this?

Denise: I am a primary care physician by training, but I got involved in a start-up called UpToDate, early in my career. For those who are not aware, think of it as kind of an evidence-based Google for doctors. Then, that startup grew, and we were acquired by a large corporation. I became CEO of that business and continued to build some others around clinical decision support as a general theme within that space. I ran that business for about 13 years and then, just decided to make the move to Ochsner in January this year as the Chief Digital Officer. 

It’s been a journey and I think, it’s a really interesting time to be in healthcare. Healthcare organizations and health systems have a big role to play in what the future of health care looks like, and I wanted to be a part of that. 

Q. What does the role of the Chief Digital Officer entail? 

Denise: We’re still figuring that out. Broadly, I have responsibility for all of our telemedicine, for what we call our digital medicine solutions, which is largely our digital tools around RPM program, remote patient management largely around chronic diseases, and other areas, as well. 

There’s also our innovation team, which we call Innovation Ochsner. So those are the three broad areas. More specifically, I wear a couple of hats, both using digital technologies to improve patient care within Ochsner. It’s all in the family, but entails taking a lot of the tools that we’ve built and looking for opportunities to commercialize them, externally. 

Q. Can you touch on the population you serve and your care mix? How does that inform your larger priorities? 

Denise: It’s huge. Ochsner is in a unique market with just a lot of opportunity. We generally fight it out with Mississippi for being ranked 49th or 50th in most health outcomes, which isn’t a great place to be, and we certainly want to improve that. Some of that is driven by just the prevalence of chronic disease in the state and some of it is driven by the payer mix. We have a lot of patients on Medicaid. I think it’s something like 20% of adults in Louisiana and 50% of children. A pretty high number are on Medicaid. 

We have a lot of patients who are on risk-based contracts so, we do a lot of value-based care. Probably more than 50% of our patients are on risk-based contract, which in many ways allows us to be more innovative. For us to not only survive but thrive as a health system, we have to do a lot of things really well. That’s driven a lot of the innovation that we have a history and are known for. It’s also driven a lot of the tools we’ve built, to be able to take care of that type of patient population and drive both, engagement and outcomes. 

So, that was honestly one of the things that really attracted me to Ochsner because that mix again allows us to potentially be a good or fertile ground for driving change and transformation, because we have to. There’s nothing that drives more innovation than the need to do that. Our location is really key in terms of driving our journey. 

Q. What are the building blocks you work with as you approach your population’s digital needs or preferences?

Denise: You hit the nail on the head, here. We talk all the time about how there’s technology for sure, but it’s the process and people that that really drive the technology to be successful. You really need a combination of all of those things. The technology is almost the easy part. 

Everybody talks about this one example—AI and healthcare and building AI models—but the key to making those successful is how you implement them and what happens to all that data. Where does it go? We can’t push everything back on the physicians like we’ve tended to do over time. So how do you deal with that? 

Even if I think about the remote patient management solutions that we’ve built and I intentionally use the name “management” and not “monitoring”, it’s easy to monitor people remotely. That’s truthfully the easiest part because while you have to do some things right to drive engagement and make sure patients can actually do what they need to do, truthfully, that’s the easy part. 

The hard part is, now that you’ve monitored them, what do you do? That’s where our programs focus. We’re very good technically and we take advantage of that but what do you need to build around that technology to drive outcomes? That is obviously what we all want to do. 

Q. Tell us a little about what kind of programs have made an impact for Ochsner. Can you share some numbers or metrics to help our listeners understand? 

Denise: We are at the highest level so we’ll talk about diabetes and hypertension because those are the programs that have been available the longest and for which we have the most data. With these programs, it’s pretty simple. 

We provide patients with devices to monitor blood pressure, blood glucose, weight, those sorts of things. We have a mechanism for getting all of those readings into MyChart and for that, we use Epic. Then, we surround that with a separate care team. So, it’s a really different model. This doesn’t go back to their primary care physicians, and we communicate with primary care, but we’ve built a separate care team that’s comprised of pharmacists or other APPs, as well as health coaches who absorb all of that data. In addition to health coaching, we also do medication management and that’s the RPM program. 

We have a way of not just monitoring patients at home, but also taking that information and doing something about it at the at the very highest level. And we found a few things. 

First, we’ve done some propensity match studies. For patients who are in our digital medicine programs compared with patients who are not in them for any variety of reasons, but matched them in a lot of ways so that we’re getting good data comparison we found that routinely those patients (in our digital medicine programs) get under control faster, stay under control longer, have reduced utilization of our emergency department, reduced utilization of hospital admissions, and overall save the health system somewhere between $100-200 per month each because of reduced utilization. 

That’s all in, including their medications. That’s why, for a value-based world, that’s really important. I think the interesting things are, one, patients really love it. So, our Net Promoter Scores are in the high 80s. 

Second, it’s worked in every population. We tested it. It works in our fee for service populations, managed care populations and maybe most surprising as it may be, it works in our Medicaid population. We’ve now got around 4000-4400 Medicaid patients in a pilot that we just started 18 months ago that was only supposed to be 1000 patients. And again, all of those outcomes that I just cited are actually greater in our Medicaid population than elsewhere, including Net Promoter Score. So, we’ve been able to digitally engage these patients and drive these sorts of outcomes. 

Q. Are there any learnings there that you’d like to share for the benefit of others who are working with similar populations? How do you get your patients to really embrace the technology? 

Denise: There are a couple of things. 

One, we work hard to make sure that patients can use the technology. So, we have a few different means to onboard patients, make sure they’re comfortable with the devices, and that everything is working well. That’s the technology piece of it. We’ve been doing it long enough that we have that down. Some of it can be done remotely, the rest in person. But there, again, we’ve kind of figured out how to how to do that part of it. 

The other thing, because people have asked me, is the degree of reduction in inpatient admission, as an example, which far exceeds what you would expect from, if we just looked at say, hypertension, and what kinds of inpatient admissions are related to hypertension or what kind of emergency department visits are related to hypertension. You think of coronary heart disease, stroke, those types of things and the reduction that we’re seeing in those high-cost areas of the health system are much greater than you would expect to be driven by, what you think of as complications of hypertension, diabetes. 

We don’t know this for certain, but my hypothesis and this is where it relates to your question, is that when you surround the technology with a care team that’s completely focused on that, and not distracted with trying to do 100 other things, is what really drives the engagement. So, they’re sending these readings in and that’s engagement. They are getting feedback on that. 

We’re experimenting with ways of doing digital coaching and those sorts of things. So, it doesn’t always have to be a person. Sometimes it’s a digital engagement, but they’re getting that feedback routinely. That’s causing a level of engagement that we’ve just not seen before in these populations. So again, it comes back to that—it’s not just the technology, it’s the process and people that surround it. 

Q. How do you go about making your technology selection choices better versus buy? If you have to buy, do you start with the EHR first, for best-in-class? Tell us a little about that process.

Denise: I wish I had a definitive answer for all of that because most of it depends on—as there’s a lot of health systems—do we tend to rely on ourselves, first? Epic is our backbone so; we always want to see what Epic can do. 

But then, we tend to build a lot of things ourselves. We’re starting to recognize that it’s not that we haven’t done partnerships before, but increasingly recognizing that we need to take advantage of more technology that already exists out there. The important thing is that while I don’t have a definitive answer, yet, in making those decisions, you have to have a clear sense of what you want to do and what outcomes you’re trying to drive. 

We get so much outreach from technology vendors these days and the signal to noise ratio is very low, which makes it really difficult. To the point where a lot of times we don’t engage because it just takes so many conversations to have anything that works. So, it’s far better to say, “Here’s a problem we’re trying to solve. Let’s go see if anybody else has solved it.” But again, have very specific outcomes that we have in mind because people have built all sorts of things that solve all sorts of problems but do they solve the problem we want to solve? 

It’s a simple calculus of what does it cost to do that versus building things ourselves in the time that’s required? So, I think increasingly we’re going to find that it’s more effective to partner than we have in the past. But what doesn’t work is to just take in a bunch of cool technology and then figure out what to do with it. 

Q. I imagine that in today’s context, the signals are getting even weaker because of the current funding environment and some of the uncertainties that many of these innovative startups have to live through. Is that a concern to you? 

Denise: That’s always a concern. We all know that the funding that ramped up in 2021 seems like it’s rationalizing a bit this year, which is good, not deep and well decreasing relative to last year, but more on par with the trajectory that happened before the crazy 2021. 

But given everything that’s happened in the last couple of years, there’s the concern of how we find those gems. Once we found them, you almost have to take the approach that if you’re going to start with early-stage companies, we’re going to invest with them to help them be successful. Else, you do run the risk of a bunch of these going under. Or you have to take the perspective that you’re going to work with them but be prepared by whatever means that they may not be successful. Then, what’s plan B? How do you work together to ensure success? And then, always have a plan B. Developing that ecosystem where you can be an innovative partner is going to be really important for health systems moving forward. 

Q. How do you measure the success of their programs? How do you keep score? Do you have a specific set of metrics you’re targeting? Can you talk to us about that? 

Denise: A lot of our internal metrics are around enrollment in the program. So, that’s obviously a big one for us. Then, there are the outcomes that we’re driving. One of the metrics that we use quite a bit for our chronic disease programs are test metrics. Are we continuing to drive those upwards and doing better than our usual care? Some quality metrics, some enrollment types of metrics are being used to the degree that we’re beginning to commercialize these externally. We obviously have financial goals around what all of that looks like. So, it’s a combination of all of those. 

Q. With regard to the investments that you’re making, not a lot of what you just talked about relate to care, especially remote care or chronic care management. These are the high impact, high value use cases and great stories. Can you share anything with regard to access related solutions where you’re driving engagement through digital tools and technologies?

Denise: Access is really critical. Probably one of the top two or three priorities that we have. Ochsner has a whole group that focuses on consumer engagement and then, we collaborate to think about what are our new ways that we can continue to make access easier and easier. 

Some of it is as basic as making sure that our providers have the capability to enable patients to do online scheduling. That sounds so easy, but it turns out that that’s not actually so easy to drive. But we’ve been pretty successful there. We have goals for our providers around access within a certain period of time. 

We are beginning to think about access a little differently. Access doesn’t have to be a face-to-face meeting. It can be a digital encounter. That can be the first access. Then, as we expand how we’re thinking about remote patient management, it doesn’t have to exclusively be around chronic diseases. It can be as simple as monitoring symptoms and a patient with chronic migraines. And then, doing that again digitally, not just in person. 

We’re beginning to expand our concept of access beyond just a face-to-face encounter to what are all the digital encounters that we can have with these patients that allow us to not only stay more connected, but also provide, good access when they need it. We’re also talking about things like e consults and e visits and just all of the asynchronous tools that we have to deliver virtual care. All these are components of the access equation. 

Q. What does Oschner’s governance model and strategy look like? Who’s involved in driving the program besides yourself? 

Denise: Like every health system, there are a lot of top priorities so, that’s always challenging. 

One, we went through a corporate strategy refresh last year, and one of the things that we really drove home is that even with all of our varied strategic priorities, digital transformation isn’t a separate priority. It may be separate but it really becomes a part of every strategic priority within the health system. That may sound like a very simple statement, but it’s an impactful one because it means that it becomes a priority when we’re thinking about solving virtually anything across the health system. I’m fortunate that it’s been set up for success from that perspective because it’s been recognized that it’s an important part of every piece of our strategy. 

This is an executive team level position and since we talk as an executive team about what we need to do, it becomes a part of every conversation. 

We probably spend more just on innovation than a lot of health systems do because it’s just been a commitment there. It doesn’t mean we obviously have endless funding for that but there isn’t a set amount where it’s got to be X percent of our operating income every year. However, that number grows every year. 

From an IS perspective, it’s very embedded in most of our strategic priorities so, it ends up not being quite as challenging as it may sound. What’s potentially more challenging is, for what we call outside the family or for separate businesses that we might want to drive, that’s where the level of investment involves some debates around how to fund all of that compared with how a lot of digital startups are being funded. That becomes a trickier proposition. But it’s been set up from an executive team perspective to drive what we need to drive. 

Q. If you had one best practice or learning from the last six or eight months that you’ve been in this role for your peers in the industry, especially those who are addressing similar populations and maybe in earlier stages of their digital journeys, what would it be?

Denise: It probably goes back to what we already talked about—that it’s not just about the technology. I think that’s my biggest learning. I do think that if you have an organization that either takes a lot of risk or is driving towards that, you can’t move fast enough. So, it has to become a system priority and it has to, again, go beyond what the technology is. Those are probably my key learnings to be able to drive success. 

We hope you enjoyed this podcast. Subscribe to our podcast series at   www.thebigunlock.com  and write to us at  info@thebigunlock.com

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

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

We want to build a data set that connects life science and healthcare organizations into one learning community

Season 4: Episode #128

Podcast with Terry Myerson, Chief Executive Officer, Truveta

"We want to build a data set that connects life science and healthcare organizations into one learning community"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

Terry Myerson leads a very interesting organization – Truveta – that’s trying to aggregate healthcare data from health systems across the country in a de-identified form. They then combine this data with other sources to generate insights that drive clinical research and outcomes and develop new therapies and molecules.

In this episode, Terry discusses Truveta’s value proposition for health systems and life sciences organizations, their data sets to generate insights and the technological challenges in bringing the data sets together. We also touch on a variety of other topics, including the digital health startup landscape. Take a listen.

Our Podcast Partners:

Show Notes

00:29 What’s the market need that Truveta is trying to address?
05:48How many health systems are members of Truveta’s consortium? What do they get out of it?
07:10 What kind of data do you gather from the results? Is there any other data that you bring into the Truveta platform as part of your insights and analysis?
08:55 Can you talk about the types of insights you have given back to your members? Tell us about some of the use cases you've been able to generate using this data set.
11:53 How do you protect the privacy of the data? Are there any special precautions that you take to ensure this?
13:14 You're not selling the data, but you are selling insights generated from the analysis of the data --- is that correct?
15:10 What’s been challenging from a technology standpoint in bringing all these datasets together from across the world's healthcare organizations?
20:20 What do you see as the current moment in digital health funding landscape?
21:44 What's your advice to a startup founder who wants to get into digital health today?

About our guest

Terry Myerson is the Chief Executive Officer of Truveta. A leader for teams responsible for some of the world’s most popular technology platforms, Terry Myerson enjoyed a 21-year career at Microsoft. As Executive Vice President, Terry led the development of Windows, Surface, Xbox, and the early days of Office 365. Serving on the Senior Leadership Team, Terry played a pivotal role in developing the strategy for Microsoft alongside CEO Satya Nadella. Terry excelled at managing large teams at scale, tackling complex software challenges, and driving growth in partnership with the technology ecosystem.

After leaving Microsoft in 2018, Terry joined the Madrona Venture Group and the Carlyle Group as an advisor to their investment teams and portfolio companies. He enjoys learning about new technology, particularly at the intersection of data and life sciences, and helping new companies succeed. He continues with both firms today as an advisor.

An entrepreneur at heart, prior to Microsoft Terry cofounded Intersé, one of the earliest internet companies, which Microsoft acquired in 1997.

Terry is a graduate of Duke University and a current member of the Duke Engineering Board of Visitors. He also serves as a member of the Board of Trustees for the Seattle Foundation.

Terry Myerson is the Chief Executive Officer of Truveta. A leader for teams responsible for some of the world’s most popular technology platforms, Terry Myerson enjoyed a 21-year career at Microsoft. As Executive Vice President, Terry led the development of Windows, Surface, Xbox, and the early days of Office 365. Serving on the Senior Leadership Team, Terry played a pivotal role in developing the strategy for Microsoft alongside CEO Satya Nadella. Terry excelled at managing large teams at scale, tackling complex software challenges, and driving growth in partnership with the technology ecosystem.

After leaving Microsoft in 2018, Terry joined the Madrona Venture Group and the Carlyle Group as an advisor to their investment teams and portfolio companies. He enjoys learning about new technology, particularly at the intersection of data and life sciences, and helping new companies succeed. He continues with both firms today as an advisor.

An entrepreneur at heart, prior to Microsoft Terry cofounded Intersé, one of the earliest internet companies, which Microsoft acquired in 1997.

Terry is a graduate of Duke University and a current member of the Duke Engineering Board of Visitors. He also serves as a member of the Board of Trustees for the Seattle Foundation.

Q. Terry, how did Truveta come about? What’s the market need that you are trying to address?

Terry: Truveta is a company with a vision that we can save lives with data. Using data, we can help researchers find cures faster, empower every clinician to be an expert, and help families make the most informed decisions about their care. That’s our vision and mission.

What do we offer? At the end of the day, we’re raising for any medical product, the most complete, timely, and highest quality data to understand the benefits and the risks of how that product should be or how the procedure or device should be used in a health care environment. There’s always an origin story here about how the company came to be and this one, I think, is just so interesting and eventful.

B.J. Moore, who’s been on the podcast, and I were colleagues at Microsoft two years ago. Since then, he’s moved to Providence. I’d left to join a venture capital firm. I had also become fascinated with the intersection of data sciences and life sciences. B.J. and I stayed in touch and when the pandemic started, he introduced me to this project where, there’s this effort inside the health system to try and understand what’s going on with this pandemic. The health system didn’t have the tools in the early stages of the pandemic to ask and answer questions about whether they should treat symptomatic patients with Dexamethasone or Remdesivir. We’re hearing both work well, but which one should be used? Who should be intubated for how long? There were just no tools to ask or answer those questions.

Building on that, Providence, Northwell and Trinity Health Care, three organizations that didn’t know each other so well at that time, tried to collaborate, ask, and answer questions like that. But they had no regulatory or technical framework or legal frameworks to work together, share data, ask, and even answer questions. We could build, learn from each other, and compare results but there was no ability to do that. Then, we had a life science company, a pharmaceutical company, which was selling these drugs and trying to learn they had no ability to learn off of the same data.

So, this idea that we could build this unprecedented data set that would connect life science and health care organizations into one learning community, that would really drive learning, and help us find those cures faster, figure out the safety, and effectiveness of these various medical products or procedures happened to be one of those that felt like just this incredible opportunity for the health care systems to come together and build something new for the world.

Q. Can you tell us a bit about your background? You did spend a long time at Microsoft and B.J. was your friend. So, how did you get here?

Terry: I spent almost 22 years at Microsoft. For the last decade, I was leading Windows Surface and Xbox. B.J. and I left Microsoft in 2018 and it was the pandemic, in 2020, that reconnected us.

When I got connected to this project in Providence later, I realized that Truveta was an idea that actually started in 2018. It revolved around how health care systems could put their data together to create a data set which they could learn from. It was white papers and PowerPoints. It was a great idea but it took a pandemic for us to really galvanize that and turn it into a company. Without the pandemic, it was just my awareness of the issue or the lack of this.

When you first get exposed to Truveta as an idea, you go, “How could this not exist already? How could it be that we don’t have a data set representative the full diversity of our country? How’s it that we can study any drug disease or device? How could this not exist?”

I didn’t know it didn’t exist. When I got exposure to the fact that it didn’t exist and there was a coalition of willing health systems that wanted it to exist, it just felt like the most meaningful thing. I could spend the rest of my career working on it.

Q. With regard to the Truveta System, how many health systems are members of the consortium? What do they get out of it?

Terry: Truveta started with four health systems in September, 2020. We announced 14 in February, 2021, and now, there are more than 20 large, leading health systems across the United States. More will be announced soon.

I think it’s just amazing how they’ve come together. They’re motivated by participating in this learning community for health, so, they can ask and answer questions, get data representative of the United States, and share those studies with each other while building on each other’s work. That access they get is going to help them take better care of patients.

We’re taking their data as normalized, structured, and de-identified data. They get access to all this for use in their health care operations and we pay them. So, they make money when their data is used by others in their research and they are compensated.

Q. What kind of data do you gather from results? Is there any other data that you bring into the Truveta platform as part of your insights and analysis?

Terry: The healthcare organizations send us medical records which are fully de-identified and validated by a third-party. Those de-identified medical records are being made available for research. Today, we have a partnership with LexisNexis, which is giving us three other important data sets to bring into the corpus.

Before that, there was a token which allowed us to link medical records in the de-identified space across health systems. It’s all coming together into one longitudinal medical record.

They’re also giving us the fact of death. Only one-third of people die inside a health system and so, LexisNexis has its Death Registry up-to-date, daily. Through it, we’re actually seeing if people die on the date they die. Being able to assess death as an outcome for research is very important when without the state and health systems, one doesn’t know if you died.

The third thing is, they’re giving us the largest claims data set in the country. We think about it as we get these deep medical records from all of our 20 + health systems and then, we also get to link it with the medical bills or the claims records.

Last but not the least, we get from LexisNexis the socioeconomic data. This is incredibly vast and includes the social determinants of health. All of that’s coming together as are insights about it. You got the 20 + health systems, fact of that token socioeconomic and mortality data. I maybe forgetting something, but it’s also together in the group of longitudinal records they identified for research. It’s a lot of data.

Q. Can you talk about one or two types of insights that you’re getting back to your members? Tell us a bit about some of the use cases you’ve been able to generate using this data set.

Terry: We talked about COVID and in fact, one of the collaborations we’ve announced since then which we’re quite excited about is Pfizer using the Truveta data set to assess their vaccines and therapeutics in the United States. This company has led the innovation response to COVID globally, and no company responded like Pfizer, one might argue. The fact that they would be using our data, is exciting. It’s terrific and I’m honored.

The other research that has been published is on Colonoscopy screenings in response to Chadwick Boseman’s death. Being African-American and he died of Colon cancer so there was some research done on Colon cancer screenings in the African-American community.

Also, there was some work done in response to the baby formula shortage actually going on in the country trying to understand if there were infant hospitalizations or other infant health issues as a result of the baby formula shortage. This idea that we have this dataset representative of our country and the ability to ask and answer questions quickly is new.

We’re having interesting use cases popping up everywhere but at the end of the day, this is our customers’ research. There’s a research project going on in Savannah, but I’m not talking about what they’re using. But Providence is using our data, Pfizer is using our data or even unnamed customers– they’re using our platform for their investigations and we do expect them to publish quite a bit here in the next year. But it’s their research, not our research to talk about.

Q. How do you protect the privacy of the data? Are there any special precautions that you take to ensure this?

Terry: Security and privacy are just critical. They’re foundational to the company. For full details, we actually have white papers—-a white paper on Security and a white paper on Privacy—on our website, which I would encourage anyone who really wants a double click on these to go get them.

We have the HIPAA too, which is our healthcare privacy law in the United States which sets in place two standards for de-identification—one called Safe Harbor, where you lose geography and timestamp information and expert de-identification.

Truveta follows the expert de-identification model so, we have expert determiners that assess all of our systems. The white papers have some great information so, I would encourage anyone who wants to read more to go there.

Q. The monetization model for Truveta is derived from the use of the data, not necessarily the data itself. You’re not selling the data, but you are selling insights generated from the analysis of the data — is that correct?

Terry: I’m not sure. The health systems themselves have access to study the data for their own research. But life science firms that are engaged with it right now are subscribing to study a disease or set of diseases and so on. We tell them to come and analyze the data, look for safety effectiveness or health equity issues in COVID or Multiple Sclerosis or heart disease. You’re subscribing to a disease so, you can ask and answer as many questions as you want during the time of your subscription.

Q. Don’t they get to take a copy of the de-identified data stack into their environment and use it for other purposes such as marketing campaigns etc.? I assume there are permissible uses in there.

Terry: I think there’s two different questions that you might ask there. There’s the data which is to be used for health care research, and not for advertising. Using the data for advertising is explicitly not a permissible use.

But there are circumstances in which they will need to take data out if you’re making a regulatory filing. If you are, there are just some scenarios where we do allow them to extract patient cohorts. Therefore, the concept of the subscription.

Q. Let’s talk about the tech stack for Truveta. It is built on Microsoft Azure as a cloud platform. What are the other big components of the tech stack? What’s been challenging from a technology standpoint in bringing all these datasets together from across the world’s healthcare organizations?

Terry: We’ve talked about two of the biggest challenges—Security and Privacy.

The third biggest challenge is Normalization and it’s not even the fact that it comes from diverse health care systems. Different conditions record outcomes, side effects, recommendations in a different language, often in their vernacular — that’s probably influenced by where they were trained.

So, you have these vast amounts of clinical notes that have so much insight on patient care and that normalization of unstructured data into an ontology of structured terms that can be used for analysis that the AI which drives that process, which actually is another white paper on our website, is a data quality white paper, which goes through that whole process of how we take all that unstructured data and turn it into a high quality data stream for analytics.

So, security, privacy, and normalization are the challenges and then there’s scale. High volumes of data is one thing, and Providence is an incredible system but B.J.’s also got a number of scale challenges.

When you add Providence, Trinity, Northwell, Tenet and Baptiste you know it’s a large lot and that’s the Truveta data challenge— far larger than any one health system anywhere in the world.

Q. To get a sense of the scale and the magnitude of how large the data set is, are we talking about what percentage of the U.S. population it covers among these top 20?

Terry: When you include the LexisNexis claims data, which fills in the gaps and when you’re looking at 100% of adult Americans, then, you know, for Non adults I wouldn’t know the number.

Q. There’s a lot of similar efforts underway now – the Sequoia Project for one to tackle the interoperability issue, and then, you’ve got Graphite, which is kind of a spinoff. There’s also Intermountain and Providence. Are these complementary to each other? Or do you see them as competitive?

Terry: Everyone’s solving a similar but different problem. With Truveta, we’re not solving the exchange of identifiable medical records, we’re not solving being an API layer for applications inside the healthcare system like some of the organizations you just described. But at the core, we’re all looking at security, privacy, and normalization of healthcare data.

As this industry matures, the shape of the boundaries will evolve over time, partners will become competitors and competitors will become partners. But there’s this many different takes on this problem in terms of connecting health care and life sciences to create one shared truth which we can use to really study health.

Thanks for that though. It’s a very unique point of view and I love being part of it.

Q. Truveta’s a unique organization but it’s also a startup and you’ve raised venture capital money. What is going on in the digital health funding landscape? What does the slowing down in funding mean for digital health startups and their customers who make bets on companies that may now be at some kind of financial risk?

Terry: Truveta actually has not taken any venture capital money. Our approach is that the health systems are the biggest stakeholders in Truveta’s success, they contribute their data and so, they should be the owners. I think it’s a very unique approach so no, there’s no venture capital in the company.

I did spend two years in venture capital and it was interesting that the two years I was there, it was easy to invest in everything when the valuations were going up. Somehow high prices made it easier to invest. Now, we have all this uncertainty—war, inflation, layoffs — and somehow the low prices are making it harder for people to invest.

There’s tremendous irony in that. However, for the next decade, I think the companies that make it through the next couple of years will be some of the best investments in the world because it’s an opportunity. We just talked about, the big data on health and I think, those companies are being founded right now.

Q. What’s your advice to a startup founder who wants to get into digital health today?

Terry: My advice would be — Have a great idea. Have a great team. I think that if you have a great team and you’ve got a great idea, you’ll be able to attract capital. You have a bad idea and a bad team, then, that will be harder.

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 most important technology you can apply for digital health is human

Season 4: Episode #127

Podcast with Emily Kagan-Trenchard, SVP and Chief of Consumer Digital Solutions, Northwell Health

"The most important technology you can apply for digital health is human"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

In this episode, Emily Kagan-Trenchard, SVP and Chief of Consumer Digital Solutions at Northwell Health in New York, discusses a range of topics related to the new focus on consumers, patient data, technology, and analytics infrastructure required to drive consumer and patient engagement in this coming era of digital health.

Patient access is not just about capacity management and appointment scheduling but also about getting questions answered between different encounters with physicians, identity management for patients, and patient engagement. Emily suggests digital health startups take the time to do user experience research and strategic planning to understand the problem at the human level. Take a listen.  

Our Podcast Partners:

Show Notes

00:30 Tell us about Northwell and your key priorities this year.
05:51Tell us about some of the successes you've had and what you consider as unfinished business or work in progress.
14:42In the context of healthcare, how is Northwell approaching this from a tech standpoint? How does the governance work to bring the tech and the program together?
20:06 How are the consumers responding to your recent cloud partnership? Where have you seen the impact of all your investments within your patient population?
23:14 You mentioned access as one of your priority areas. How do you tackle that and the enhanced digital abilities for consumers to take advantage of?
27:55 What do you think of the present moment for digital health technology companies in the context of all the pullback and risk funding?
31:20 What’s your advice for your peers in the industry who’re not as big as Northwell but equally interested in making the kind of progress that you've made?

About our guest

Emily Kagan Trenchard is a much-needed voice from within the American medical system: A spoken-word-poet-turned-healthcare-executive, she is on a mission to remix the human in healthcare, challenging entrenched assumptions about what it means to give and receive care in the digital age. As SVP, Chief of Consumer Digital Solutions for New York state’s largest health system, Northwell Health, Emily leads the digital patient experience teams that push the limits of how we use technology to make healthcare seamless and steeped in humanity, while keeping the company competitive at a time of radical change. The team's transformation efforts have given patients a single key to the digital front door - enabling online booking, bill pay, digital forms and consents, telehealth, test results and more, all from within an award-winning native app. Emily also launched Northwell’s first User Experience (UX) department to ensure that patient and staff perspectives drive the design of digital tools and systems.

Prior to joining Northwell Emily led web systems for New York City’s Lenox Hill Hospital where she led the development of many early consumer health tools, including the first-ever implementation of the ZocDoc scheduling platform for a hospital. Outlets ranging from The Wall Street Journal to TechRebublic and CMS Wire turn to her for a fresh perspective on emerging technologies and the future of healthcare. She is also a nationally recognized poet, essayist, and speaker; recent speaking engagements include the Cleveland Clinic’s Empathy and Innovation conference and WebSumit in Lisbon. Emily holds a master’s degree in science writing from MIT and a bachelor’s degree from the University of California at Berkeley.

Emily Kagan Trenchard is a much-needed voice from within the American medical system: A spoken-word-poet-turned-healthcare-executive, she is on a mission to remix the human in healthcare, challenging entrenched assumptions about what it means to give and receive care in the digital age. As SVP, Chief of Consumer Digital Solutions for New York state’s largest health system, Northwell Health, Emily leads the digital patient experience teams that push the limits of how we use technology to make healthcare seamless and steeped in humanity, while keeping the company competitive at a time of radical change.

The team’s transformation efforts have given patients a single key to the digital front door – enabling online booking, bill pay, digital forms and consents, telehealth, test results and more, all from within an award-winning native app. Emily also launched Northwell’s first User Experience (UX) department to ensure that patient and staff perspectives drive the design of digital tools and systems. 

Prior to joining Northwell Emily led web systems for New York City’s Lenox Hill Hospital where she led the development of many early consumer health tools, including the first-ever implementation of the ZocDoc scheduling platform for a hospital. Outlets ranging from The Wall Street Journal to TechRebublic and CMS Wire turn to her for a fresh perspective on emerging technologies and the future of healthcare. She is also a nationally recognized poet, essayist, and speaker; recent speaking engagements include the Cleveland Clinic’s Empathy and Innovation conference and WebSumit in Lisbon. Emily holds a master’s degree in science writing from MIT and a bachelor’s degree from the University of California at Berkeley.

Q. Emily, tell us a little about your role at Northwell and what are your key priorities this year?

Emily: I’ve been at Northwell for about 15 years. I started in the consumer-facing digital marketing division focused on websites, digital signage, and social media. About four years ago, the organization recognized that we needed to look at the consumer digital space with a little more focus and spun out a program that I ran. This was the Digital Patient Experience (DPX).

As it really gained legs, DPX and many other digital initiatives around the health system in other areas, not necessarily just consumer-facing, witnessed a growing recognition. What was happening in pockets previously for digital transformation needed to come together into something that was more consolidated so we could move to that next level of maturity. This past year, they created a division—Enterprise Digital Services—for which there are five functional leads: Clinical Digital Solutions, IT Operations, Business Analytics, Innovation, and then, Consumer.

My role at Northwell recently expanded and at Consumer Digital Solutions, we’re putting arms not only around the things I was doing for Digital Front Door as well as the consumer-facing websites and other digital touchpoints, but starting to say, “Where do we have initiatives where it’s critical that we start to think more holistically about how we’re connecting with patients and enabling care for them in a digital world?”

A good example of this is there are plenty of utilities out there for folk who want to gather information from our patients and some sort of patient-reported outcomes. We have a ton of different tools in the market that can do various versions of these questions. But how can we stop bombarding people with surveys and start being smarter about the utilities in which we gather this information so that we can truly exhibit a kind of institutional memory when someone tells us things?

When you start to think about those kinds of initiatives, they really broaden the perspective of the consumer’s role at the table. The real intention behind making a Consumer Digital Solutions title on par with a Clinical Digital Solutions title was so they could be equal partners in this conversation. Where do we have issues that we need to tackle together? The biggest challenge that we’re focusing on this year is, access. At its most base, it’s something around capacity management and making sure that people can get into the appointments when they need them with the providers that are best to see them in the right level of care for whatever’s going on. But access is about much more than that. It’s about getting questions answered, the back and forth in between encounters, getting prescriptions refilled, but asking a question about changing dosage. There are all the interim things that occur in the course of the space between an existing doctor’s visit which we can do so much better with different types of communication channels. Clearly, it’s a concerted effort on the operations and the consumers’ sides. That would be one example of something that has a number of projects that we’re now able to pull together into a more comprehensive program that we can run in this more agile and matrixed way.

This year, I have a really big focus on identity and identity management in order to form a real, truly master consumer index. When I say that, I do mean more than just patients. I mean caregivers, as well. We really need to have a centralized way of codifying information we know about people so that it can traverse more than just what’s in an EMR, across all sorts of engagement touchpoints. That’s a very big one for us.

The final piece that we’re spending a lot of time focusing on right now is where do we need to mature some of our channels. We’ve started with a lot of channels that are the standards— websites, apps, email, text messaging, etc.—but the chat functionality is huge. There’s so much you can do there with IVR and voice automation. It’s a lot of opportunity to not just have those types of channels in pockets for small bits of experimentation, but truly make them a part of core platform infrastructure—for the providers, staff, communications back to patients, and care givers. That’s a big rounding-out of our omnichannel portfolio, which we’re also focusing on this year.

Q. You’ve covered all the key elements that must come together seamlessly. Where are you in that journey? Tell us about your successes and what is work in progress.

Emily: There’s the notion of orchestration writ large. Then, there’s the notion of in-specific omnichannel orchestration. Let’s take the larger concept, first. When we’re talking about this type of orchestration, sometimes we do truly mean it in the “Do you send the text message before the email?” sense. If they open the email, do you even bother with the text message in that sort of a comms level orchestration? If a foundation wants to send something out asking about a donation, don’t send it to this person who just had a patient complaint. There’s that level of orchestration, which maybe is a level one of just understanding who’s trying to talk to the patient at any given time. Is it appropriate? Whose “go” is it?

The other type of orchestration we’re starting to see is the importance of trying to orchestrate—in-patient or in-person engagements with online engagements. Where do you have someone starting a task but not finishing it that you pick up now in an office? Where do you start a task in an office that now you complete online? Where do you have a customer service call that came in and then, follow-up with a billing question? When it hands off to billing and their rate, can the office know about that the next time they show up there? That’s an orchestration around engagement that really needs to traverse the online and offline worlds. I’d say that is the place where we know the work to be done. It’s truly about putting in the tools to enable that to occur and you can start in some places.

What we’ve really done then, is to say, “How can we do this at the customer service and call center levels, first?” I think that’s one of the easier places to start to go back and forth at. In health care, especially for those of us who have ambulatory networks, you can consider the front desk as a part of that, too. That truly becomes a customer service desk as well as a call center touchpoint. How do you at least get those folk to understand where someone last left off?

This gets into broader CRM strategy, now. This is obviously not just what happens in marketing. This is a larger CRM philosophy. That’s a really important concept and if we bounce off of that one, one click further out from what you would traditionally consider, you can start to do that with providers as well.

When you start to think about your referral management strategy and your network growth, how do you take this concept of consumer relationship management and think about your consumer as your providers? As people who you want to grow relationships with to find patterns of referral, improve capacity, and improve collaboration, can you take those utilities, use them on behalf of a provider network and take the connective threads you build there to unlock capacity, across network support for complex patient care?

I’d say the next generation of where our heads are at in terms of taking an incredible CRM strategy which we’ve really matured via our marketing department and expanding that concept out for that online offline transition as well as over into the provider space is really the bigger orchestration question. You can cascade that into a whole lot of other places.

Q. What are the basic enablers that you absolutely need to have in place before you can really make any of this a reality?

Emily: I would say patient identity is one of them. For instance, do not click $200 first steps, etc. Then, there’s nuance within that. When we start with patient identity, we ask—Do you even know who is your patient? Do you have an email address for them? Do you have a cell phone on file? Do you know if it’s working? Do you have the right consents and permissions to communicate? That’s even before you talk about preference. I prefer a text message over an email, so, that’s just on the individual patient level, but truly, where my focus and interest lie is actually not just for the patient but for the caregiver, too.

That’s where you start to get interesting because you will now want to have an identity that is not just for the people who have an MRM. You want to have an identity for anyone who comes and is responsible for someone’s care in your organization in order to communicate. Start with your identity and mature your concept so you can build a larger framework. Let’s say you’ve got the identity piece locked or you say, “You know what? I got it for patients.” Let me just start there.

Second, folk really need to be sure that they have some sort of communications backbone that’s going to allow you to do omnichannel. Let’s just start with email and text message. There’s a lot more channels you can talk about but let’s start there. When you’re talking about any CRM worth its salt, it’s going to have email and text messaging capabilities. The power is not whether or not you can send any one of those kinds of cards. The power is in deciding which one to send and when.

When you send an email, do you need to send a text? The name of the game here is really trying to find economies, scale, and cost efficiencies in that communication. If I send someone an email, ask them to confirm that appointment, and I don’t have to send that follow-up text message, I might have saved myself $0.04 a message. That’s not a big deal on an individual level, and way cheaper than getting a cancelation certainly to send that out. But I’d rather not spend anything if my email costs are already baked into my CRM contract. If I’m not responding with that automated text message, perhaps, I’m going to an IVR or sending them to a chase list where I have a human pick up the phone to call. If I can handle all that before a human pick it up, even better.

What you’re really looking for then, is something that’s going to have that sort of dynamic intelligence. Someone responded. Not only did I fire off a message, but here’s what happened to that message when it went out into the world. Here’s how I’m going to change my messaging behavior based on that input. That can be on a case-by-case basis for an individual or that can be an aggregate as you learn about what helps campaigns perform better. That can be on a cohort basis when you start to identify different groups of people who should have different messaging cadences.

But that is really where you can start to do level one multichannel communication customization and not just recognize the benefit of having any digital comms, but having those that can be intelligent, learn, and be dynamic with one another to truly optimize your spend in that area.

Q. In the context of healthcare, how is Northwell approaching this from a tech standpoint? How does the governance work to bring the tech and the program together?

Emily: Let’s talk about what tech pieces are there and then, we can ask, what this may mean for one of the heads to come in and be involved. When we talk about having that sort of backbone, who are we talking to? Where are the data elements coming from? Obviously, my partner who leads the Business Intel and Analytics Division is critical because we’re looking at all these different data sources.

From a marketing standpoint, at a healthcare institution, not only are you going to have sources such as, your EMR and reg systems, etc., but also, third-party data. When we look at our marketing utilities, that’s an important thing. We need a little bit of Church and State from first-party and third-party data. So, what marketing does is reach out to the addressable market which is different from those who might already have an MRM, be engaged or are caregivers. We need to find ways to have the right levels of not just governance but segmentation in the data domains.

Also, we need to make sure that when we’re thinking about what traverses where we understand the intended use of the data so that we’re using things in ways that are appropriate, aligned with people’s consent especially, with all of the new laws around like GDPR and Right to be forgotten, etc. There are certain types of information that can be forgotten and others that can’t because of regulations. Level one then, is all about—Do you know your sources? Do you know how to segregate your sources? Do you know how to clean them? Do you know how to map, match, and do them?

When you’ve got these data elements, you want to talk about doing fun things with that. How do you mix and match? How do you add additional data from different domains? How do you do the analyses that put segmentations on top? Or do predictive modeling on top of these things? That’s where you can take data to the next level. For that, what you want to do is keep things tight and clean in the beginning. Then, when you want to do the fun stuff, you want to be able to bring in as many different variants and flavors as possible.

Our philosophy and strategy are heading towards—and again, let me say that we have CRMs today, which do a really fantastic job and are pretty mature as things are considered—a Consumer Data Platform (CDP). This is really an omnivorous kind of platform where you don’t have to have structured data, necessarily. You don’t need to know what you’re going to put into it to put things in and then, crosswalk, and make it referenceable and available to a number of different end consumers. That’s where our roadmap is taking us. Getting to a CDP is a 2023-24 initiative for us.

When you talk about a CDP, you talk about infrastructure. Here, I would involve my partners from IT because we really do need this to be a backbone that different end consumers—our lab system, call center, marketing for example—can reference, put information back into, gain insights for the data science teams, and apply back out. That’s where we really need to ensure that they’ve got a hand in making this a truly functional utility inside the organization and it does become an engine for us.

Now you’ve got the clinical and innovation pieces, so, of course you want to do data science and interesting data products. You can stand it on the backbone, take the same types of layers of intelligence and say, “Okay, talk to me about someone, the social determinants of health. Overlay that with these risk factors coming out of the EMR and put together an engagement model that’s customized specifically for this person in this neighborhood.” For that true one-to-one, you’ll need to be able to overlay the data sets which can then talk and learn from one another, even though their governance as source data points might be in different areas. That’s why we talk about domains. It starts to get into some of these concepts around data mesh that a lot of us are starting to think about.

That would really be the evolution of where we’re thinking towards. How we really need all these different areas within an enterprise digital view to be sure that we’ve got the parts and pieces required to not just do the basics, but to make this one of the most transformative engines that we can have inside a health system.

Q. Data infrastructure is critical and Northwell just announced a cloud partnership to power some of this. How are the consumers responding to it? Where have you seen the impact of all of your investments within your patient population?

Emily: We’ve had a number of different areas where we’ve taken digital tools and made self-service capabilities that are the bread and butter of any first engagement. I’ll talk a little about where you see things that really end up feeling a little bit more game-changing.

The first is probably around online payments. We think about paying every other thing in our lives, online. Not only do we think about the ability to pay it because you don’t have to sit there, find the checkbook, and write something out but who even has a checkbook anymore? Write in the credit or get on the phone.

But the minute that you enable somebody to pay a bill online, you also have the ability to pull other bills in so that you can roll up charges. You have the ability for people to do it while they’re in a meeting at work or while they’re bored because it’s right there. And you have the ability to put in front of people different payment options. So, if they’re concerned or perhaps embarrassed about struggling to pay something and if you can enable right then in there an option to sign up for a payment plan, you’re using a degree of discretion with something that is deeply emotional, personal, and quite frankly, a huge pain points inside of healthcare, to help people meet their financial responsibilities.

We’ve already seen about 30% of all bill payment volumes offloaded from phones and mail on to digital. With that, we’ve seen a commiserate increase in the speed to pay. By about three weeks, there’s greater speed to pay through digital channels. We have seen a huge uptick in the number of people who are self-servicing on payment plans, which they used to have to call a Call Agent to get set up. We have about 85-87% patient satisfaction with the entire experience. If you think nobody’s happy to pay a bill rate for health care, especially when you have 87% patient satisfaction in something that used to be the primary complaint for the organization, it’s a huge success.

Q. You mentioned access as one of your priority areas. How do you tackle that with all the infrastructure created and the enhanced digital abilities for consumers to take advantage of?

Emily: When you talk about online scheduling, the very first thing to consider is, “Can you have those provider templates made available for online scheduling?” We’re in an effort right now where we are looking at a lot of providers and trying to make sure that just because they have it available doesn’t mean that there’s a spot for the next three weeks. What do we do in order to get that availability to be much sooner so that when you’re scheduling, you’re not clicking the forward button four, five, or six times before you find the next available date and time to see the provider you want to see, online? Of course, this presumes you can book online. But where do you go from there?

When we talk about freeing up capacity for providers, part of what we want to talk about is, what really needs to be an in-person visit versus what can be telehealth. This is the world after the pandemic where telehealth is a foundational part of how people are going to get care and we’re learning how best to use it. Where are the opportunities to actually say, “The provider doesn’t have an in-person visit, but you can do this one via telehealth?” We’re looking at opportunities where we can actually take telehealth volumes, roll it with in-person volumes, and see what kinds of questions you can ask ahead of time in that scheduling flow to identify patients who are good candidates for a telehealth visit instead. Again, we’re unlocking some of that capacity. We’re also taking advantage of telehealth by asking, “Where do you have patients who are coming in for certain things for which a telehealth consult is maybe most appropriate and it doesn’t need to be with their specific doctor?

We have two programs running right now. The first is called ED on Demand, essentially an after- hours program for our Emergency Departments. There’s a rotating call schedule of ED physicians who can take urgent matters in off-hours so you don’t actually have to go into an urgent care or into an ED, but you can talk with an emergency medicine professional via telehealth and really get that assessment before you go anywhere else. That is a great way to take what otherwise may be urgent calls into primary care, stops at the urgent care or into the emergency departments themselves, and take a first round pass of that, virtually. Patients love it, providers love it. It really is a win.

The variation on that is what we’re doing right now. We call it, Same Day Sick. If you’re sick and need to see a provider, today, is it because you actually need to see your provider and they’re only the ones who really deeply understand your case? Or is it a UTI and you just need to get a script? Is it a sinus infection? Is it just a cut? Do you need to know if you can put the antibiotics on? It’s the same concept of a virtual pool of providers who can take calls for Same Day Sick. This is rolling out in our primary care division and it’s fantastic because it’s taking this volume which otherwise would have gone into the pool for the patients who need to actually get in for maybe a true in-person same day visit or an annual well and whatever else is taking up our capacity for our primary care network. It’s offloading some of that volume into a care setting that is still appropriate for the need, but takes advantage of telemedicine in ways that are that next turn of the crank. We’ve got these tools all built and up and running since the pandemic.

Q. Great examples. Obviously, a lot of these solutions are enabled by technology providers that cover the whole spectrum—EHR vendors, enterprise class platforms, CRMs etc. How do you tap into innovation in the marketplace? What do you think of the present moment for digital health technology companies in the context of all the pull back and risk funding?

Emily: First, we have a new person starting on August 4 to lead our Innovations pillar. Rebecca Call will be joining us from M.D. Anderson, formerly at UPMC. We’re super excited to have an incredible innovator who, I think, will take our innovations approach to the next level. What does that mean? Where do we want to go? We definitely have a huge appetite for investing in new technologies. We have spun companies out of our own employee solutions. We do a lot of customer development here inside of Northwell, too, but I think that the name of the game right now is getting specific about what problem you’re trying to solve because everybody and their brother has gone through these consolidations. Everybody in the bubble is going to promise they do everything under the sun. Where do you see vendors that are going to add, quite frankly, as you said, niche, specific, enhanced capabilities that you can plug into existing platforms? The number of people who are going to be running health systems without some base platform infrastructure is shrinking by the day, so, if you’re there looking at these solutions and your answer is, “We’ll just rip and replace yours and put in mine, (whatever the product’s going to be),” it’s a non-starter.

If you’re talking instead about coming with products that have very mature SDK and APIs, logic engines which can be consumed by other delivery endpoints, and nestle well into other existing platform infrastructures, you’re going to see a whole lot of excitement to take those and really extend these platforms that we’ve all invested in way past the speed at which those vendors can actually move. We can move internally, especially in places where there are types of capabilities that are truly commodity in other industries. We can take best-of-breed and bring it back over into health care. That, to me, is a really exciting space. I think it’s really about a retooling of where these companies were headed in the past, which is, everybody wanted to be everyone’s everything. Everybody wanted to be your full engagement suite and solve every problem under the sun for you. But what’s your core workup? What is your core capability? Where is truly the thing that differentiates you? How do you make that as light, fast, and flexible so that you can go and play with these organizations in recognizing full well that they have platforms that you’re going to seek to accelerate?

Q. What’s your advice for your peers in the industry who’re not as big as Northwell but equally interested in making the kind of progress that you’ve made?

Emily: I think the most important technology you can apply is human. When you take the time to actually undertake user experience research and strategic planning to understand the problem at the human level, take that proverbial step back without getting excited just by what the technology is going to offer and not just get excited about what all of your peers are doing, but slow down and genuinely say, “What am I hearing from my staff? What am I hearing from my patients? Where can I make the biggest improvement?” then, nine times out of ten, you’re already going to have the tech in hand.

It’s just going to be about optimizing workflows, lighting something up that you hadn’t turned on before, and solving problems that might not be sexy. But they are the ones that are going to make the biggest impact. If you start there, you are going to gain the traction you need to then, go back and ask for the investments for the bigger, sexier things.

It all starts with human centered design. If you don’t have a human centered design practice, or one that involves that research and analysis into your strategic planning, and particularly the product planning for these sorts of MVP’s—your first crack at these things—do yourself a favor and get that baked in. Then, what you really start to do is evidence-based transformation. That’s what your senior leadership is going to want to hear and see when you’re proving the value of these efforts.

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.

Incrementalism is not a bad thing in digital health

Season 4: Episode #126

Podcast with Tarun Kapoor, MD, SVP and Chief Digital Transformation Officer, Virtua Health

"Incrementalism is not a bad thing in digital health"

paddy Hosted by Paddy Padmanabhan
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In this episode, Tarun Kapoor, MD, SVP and Chief Digital Transformation Officer at Virtua Health talks about the diverse population segments they serve in Southern New Jersey and how they drive digital health priorities and investments. He also discusses how to drive digital health programs in an incremental fashion and gain stakeholder buy-in within the organization for digital health.

Tarun discusses the current state of the digital health startup environment, the longer-term technology solutions landscape, and how to make smart decisions with limited resources. Take a listen.

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Show Notes

00:36 Tell us about your background, how you got into this role, and the populations you serve at Virtua Health.
04:22What are your key priorities for the organization? How does the digital transformation function fit into those?
07:15As the Chief Digital Transformation Officer, how are you directing your investments? Also, how are you factoring in your populations’ expectations from a digital technology enablement standpoint?
16:29What challenges did you have to deal with when you implemented the tech, the data, or the infrastructure?
18:59 There are thousands of solutions to pick from once you’ve designed the experience. Right from the native EHR system, nimble young startups to enterprise-class tech firms and everything in between. How do you make that technology choice?
23:12 What's your advice to startups who are listening to this episode?
25:53 Is there a rubric that you use when it comes to building a case for a new solution where there isn't adequate data for you to say whether it's going to work or not, especially in a margin constrained landscape like health care providers?
28:05 Is there something you’d like to share with your peers?

About our guest

Tarun Kapoor, MD, MBA, is senior vice president and chief digital transformation officer at Virtua Health. In this role, he oversees Virtua’s Digital Transformation Office and orchestrates Virtua’s enterprise-wide master plan in support of an intuitive care journey for all consumers.

Previously, Dr. Kapoor was the president of VirtuaPhysicianPartners™ and the senior vice president and chief medical officer for Virtua Medical Group (VMG), a clinician multi-specialty medical practice. Dr. Kapoor joined VMG as a hospitalist in 2008, where he was the associate director of the Virtua Hospitalist Group, helping grow the practice from 12 physicians to its current size of more than 110 clinicians.

In addition, he joined Virtua’s Medical Informatics team in 2010, helping to develop and implement its inpatient electronic medical record, including full deployment of CPOE and electronic Medication Reconciliation. Prior to joining Virtua, Dr. Kapoor was regional director for EmCare’s Mid-Atlantic Hospitalist Division. During his tenure with EmCare, Dr. Kapoor developed 16 inpatient care programs for Clinical Staffing Solutions, which was subsequently acquired by EmCare. Dr. Kapoor trained in internal medicine at The George Washington University Hospital, where he stayed on an extra year to serve as chief resident and clinical instructor. He obtained his medical degree from Rutgers Robert Wood Johnson, his undergraduate degree in government and chemistry from Cornell University, and his executive Master of Business Administration from the Fox School of Business of Temple University.

Tarun Kapoor, MD, MBA, is senior vice president and chief digital transformation officer at Virtua Health. In this role, he oversees Virtua’s Digital Transformation Office and orchestrates Virtua’s enterprise-wide master plan in support of an intuitive care journey for all consumers.

Previously, Dr. Kapoor was the president of VirtuaPhysicianPartners™ and the senior vice president and chief medical officer for Virtua Medical Group (VMG), a clinician multi-specialty medical practice. Dr. Kapoor joined VMG as a hospitalist in 2008, where he was the associate director of the Virtua Hospitalist Group, helping grow the practice from 12 physicians to its current size of more than 110 clinicians.

In addition, he joined Virtua’s Medical Informatics team in 2010, helping to develop and implement its inpatient electronic medical record, including full deployment of CPOE and electronic Medication Reconciliation. Prior to joining Virtua, Dr. Kapoor was regional director for EmCare’s Mid-Atlantic Hospitalist Division. During his tenure with EmCare, Dr. Kapoor developed 16 inpatient care programs for Clinical Staffing Solutions, which was subsequently acquired by EmCare. Dr. Kapoor trained in internal medicine at The George Washington University Hospital, where he stayed on an extra year to serve as chief resident and clinical instructor. He obtained his medical degree from Rutgers Robert Wood Johnson, his undergraduate degree in government and chemistry from Cornell University, and his executive Master of Business Administration from the Fox School of Business of Temple University.


Q. Tarun, tell us about your background, how you got into this role, and the populations you serve at Virtua Health. 

Tarun: “Wherever you go, there you are,” I think, sums up my journey which wasn’t ever truly planned. I’m a physician by training — Internal Medicine Hospitalist — and I was actually going to be a Gastroenterologist. I had a Fellowship lined up and then, I came to profound realization that I just didn’t really like abdominal pain. So, I gave up the Fellowship before I started and was gainfully unemployed. I ended up joining a startup at a time when hospital medicine was just emerging. So, I was a Hospitalist. We grew a hospitalist company, a business, and then, I exited successfully. Transition points are recurring themes in my journey but from here, I got the opportunity to get connected with Virtua. 

I’ve been very fortunate at Virtua. I’ve had a number of different roles ranging from informatics, being part of the medical group, and population health. In 2019, I was asked to take on an assignment for digital. Since we had done only five ambulatory video visits in 2019, I set the goal for 500. Then, March 2020 came along. As the saying goes, better lucky than good , we were a little short of 200,000 but we did exceed our goal that year. 

That’s the role we created to hardwire into our organization some of those accelerations from digital transformation being produced by the pandemic. How did we do that so as to not revert to the original way of doing things? We created a digital transformation office. I’m so fortunate to be able to head that team.

Virtua created the integrated delivery network in the southern part of New Jersey, right along that Philadelphia latitude. In terms of a market, New Jersey is pretty dense. From the population density perspective, one of the things that’s really interesting is, there is a tremendous diversity in socioeconomics. 

We have some of the more affluent neighborhoods. One of them actually has two Apple stores within 10 minutes driving distance of each other. Seven miles away is Camden, one of New Jersey’s most disadvantaged communities. It’s just a startling fact that the life expectancy among those seven miles is 16 years. That’s important for us to think about and include in our digital transformation. We’ve got to make sure that what has continued to probably create inequities does not continue to accelerate forward. 

Q. What are your key priorities for the organization? How does the digital transformation function fit into those?

Tarun:  Some of the key priorities I’ll list are probably not that different from many of the other integrated delivery networks. There have been these remarkable swings since 2020, a tough year that saw many business operations shutting down resulting in essentially suppressed demand. 

2021, for us and a number of health systems, saw a dramatic rebound of that demand. It’s likely that that suppressed demand from 2020 was coming into 2021. Then came the Omicron surge which actually hit us—from a volume perspective—harder than the first surges did. What a tough first quarter for that from the perspective of economics and running the business! Now again, it’s rebounding. 

One of the things that is really an important for us here, is understanding market volatility. That is not classically something you would think about in healthcare. That was always the story about healthcare. People are always going to be sick and so, will always need healthcare. It’s a recession-proof business. It’s anything but, and is being impacted more than ever before. 

Going one step further, it’s critical to understand that the demand for healthcare is actually way more elastic than anything we realized or expected. We didn’t understand why it was so during COVID. We literally did not see strokes, for example, at nearly the same volume before. I mean, you have a stroke. You’d think people would come forward with these symptoms. It’s alarming. 

That prompted some deeper questions about what was truly happening with our consumers, our patients. That consumer focus and trying to understand their needs is what’s really and hopefully driving for us what we’re trying to take apart. 

Q. Given those priorities, how are you, as Chief Digital Transformation Officer, directing your investments? How are you factoring in these significant differences in your populations and their expectations from a digital technology enablement standpoint? 

Tarun: One hundred percent. Within the priorities in our Digital Transformation Office, I will quote a formula that we stole from someone who we know stole from somebody else. I’m not exactly sure where the true origins lie but that formula is: NT+OO=COO. Memorize that formula because it continues to keep our standards. 

What does that mean? New Technology + Old Organization = Costly Old Organization. 

We have a budget for digital transformation. If it was as easy as buying a technology, we would have all transformed at this point. But if you simply just buy technology and you wire it in to the existing organization, basically you’ll just be an expensive version of what you were, previously. 

And if we were previously good at what we were doing, then why are we doing the digital transformation? Yeah, we try to spend a lot of our time from our priorities on understanding the operations and where lies that mismatch between what the consumer is truly asking on one end and how we provide it today. Then, we see what are the ways we can transform. 

With regard to my title, Digital Transformation Officer, I would say the T in that title is the capital letter. What is the transformation that has to occur? Where does digital come into it? Where’s the operational change as a company? Sometimes it’s going to be a real problem and at others, the digital is ready while the operations is not, for the transformation. Sometimes the operations may be ready while the digital isn’t. That match is crucial. We spent a lot of time asking, “Is it ready?”, and that’s where we’ve been successful, so far. 

Q. Can you cite examples of how you’ve implemented this thinking in practice at Virtua? Where do you start – with a journey map or company research or something else — before you eventually land the technology? 

Tarun: I don’t think I have one very good answer. In fact, rarely is there a right answer. However, there are usually a few wrong ones to start with. If you must, try to avoid the ones that are pretty clearly wrong. That helps you call the field and then, you just have to pick something and go. 

In some cases, yes, you do your consumer research, get focus groups, and get data back. But don’t get paralyzed by saying, “Okay, I need more data.” Get it, make an educated guess, and get a prototype out there. Then, get feedback and do the five iterations into it. That’s when you actually start to realize that’s what the person’s after.

This concept of agile design in software has been around for 20 years. Agile design doesn’t happen in an integrated delivery network. If we, in health care, can specifically start thinking along these more rapid iterations, it’s very uncomfortable for us because as physicians by training, one part of the Hippocratic Oath in our statement agreement on the theory, says, do no harm. You’d never hear that in a software development company. They’re completely fine with it being, “No, that was a bad idea.” We, however, have to find a balancing act. To me, it was a bad idea. But it was safe. However, that just didn’t make the mark. One example would be online scheduling. 

We’ve had online scheduling technology but what we realized as we started digging deeper is that there was a complete mismatch between what the consumer was seeing and what the doctors and our medical groups had in their schedules. The analogy I’ll give you is if you called the office saying “Let’s use an airline,” and if you called say, American Airlines, the ticket agent would see all the seats on the plane if you were physically at the ticket counter. But if you went to the website, you’d only see rows three and four. 

How is that online scheduling? This could be described as one of those moments when “it was on, but the operational piece had not evolved.” So, what we went from is doing around 13,40,000 online scheduling appointments per year to doing 13,14,000 per month. That’s within about 12 months. Thousands of phone calls and people making their own appointments had a downstream impact both from a revenue and a cost perspective and it’s been enormous. 

Q. Online scheduling is a fantastic use case. What were the challenges you had to overcome? 

Tarun: An analogy I’d like to use is, the fear factor. Do people necessarily resist change because they don’t see the promise? No. Most people will say, “Yeah, I can see the promise.” But the question is, I can also tend to see and specifically, having worked with physicians it comes down to our residency training, it’s gladiatorial training. You do X, Y, Z, QW5. Patient survives. 

Now we’re saying, “Hey! Listen, skip a couple of things. Don’t go through this convoluted path. Just go from here to here. It’ll be fine.” I know if I do this every single time, I’ll get a good outcome. The question then, comes down to trust. 

For us, with our clinicians, we say, “Okay, help us understand what makes you worried about putting your schedule online?” The biggest fear over and over was, “I am worried that the wrong appointment is going to get booked.” What that means is, it’s a brand new patient who’s put into an established slot. With new patients, clinicians need half hour, 45 minutes longer. With established patients, perhaps it’s a 50 tweet I’m behind already. That happens first in morning. I’m catching up all day. 

That was something we could work towards. If you get in with it, you always want to have your early adopter folks. You just let them go. Your late adopters are going to be really hard, but you can get the momentum in between. That’s where it is and that’s just working. We say, “Let’s do a couple. Turn it on for a day. It’s not a big bang approach. Just turn it on for a day.” We ask “How’d it go?” and then, just turn it on for two more days. 

It sounds painful and iterative, but the reality is that’s how change happens. I just sit back now. It’s like an Atul Gawande article — slow ideas — everyone wants everything to go viral, and when they do, it’s wonderful. 

But some things don’t go viral and you’ve just got to work with people and meet them where they are. 

Q. Let’s touch upon the technology enablement aspects. What challenges did you have to deal with when you implemented the tech, the data, or the infrastructure? 

Tarun: I had put this in my LinkedIn profile. I don’t know if I came up with this de novo or sublimely, I stole it from somebody else. But I’d heard the statement “Culture eats strategy for breakfast.” If that’s the case, then, workload eats technology for lunch, dinner, and dessert right here. You ask someone to swivel between screens, and I already know the impact of what I want to get if I swivel to another screen, to another log in, even if it’s single, sign on. I already know the voltage drop is going to be enormous. 

The other question we try to ask is “So what?” Maybe there’s a nicer way to ask it, such as “If I do this technology, what am I going to get for it? What’s the proposed return?” 

One of the things our team uses — whether you use a balanced scorecard or you have smart goals — are OKRs (Objectives and Key Results). We ask, “What are my leading key results? What are my lagging key results?” 

If I put this in, one of these numbers has to move. The other thing we do from a technology perspective if it’s not moving, is, check “Are you prepared to rip it up?”

Yet another thing we also do is for every one thing we bring in is, we rip out at least one or two others because it just cannot be this. I think about this poster from the 1980s — He who has the most toys wins . That’s not a viable solution for us in this space. 

Q. There are literally thousands of solutions to pick from once you’ve designed the experience. Right from the native EHR system and nimble young startups to enterprise class tech firms and everything in between. How do you make that choice?

Tarun: Especially given that the frothiness of the investment market has normalized for now, I can certainly give you a framework. We look at different things that are important for us — not everything can be transformational — and incrementalism is not necessarily a bad thing. 

So, we go, “Hey! Listen, we just need to get a little bit better at this.” We need to constantly iterate and I would think of something like order sets. You have to make orders better. I’ve got to make some of my other functionality within my EMR better. That’s incremental and important. You can’t stop that. That’s not where our sharp focus is. We try to focus on five or six major transformational things and we have to stay so. 

One of the problems we had and one of the mistakes we made early on is we didn’t say “No” enough. I am trying to say “No” a lot. If you really want to do this as an operational owner, you have to prove to me what you’re prepared to do, to do this. I can’t make the change for you btu I will make the change with you. It’s how we think about it. 

When we look at technology, I think we look at it as “Is this a problem that one of our existing solutions can either solve today or in the next 18 months? Somewhere in that window?” It’s a little bit different depending on the problem. 

If it can be solved today with an existing solution, then, to go outside of that world, you really need to have a really good explanation for why someone would want to go with a tool outside of that. 

If it can be solved but not today; and if one of our existing tools has a good road map to get there in the next 18 months, then, it’s a decision around the severity of market need. What’s the market demand on that one? 

Then if you say no, we feel pretty confident it’s not on the roadmap or two years out. Then, we’re open to go looking with a startup or a partner. We’re trying to answer this question that states very transparently that we don’t sign ten-year contracts. 

You have to constantly keep proving yourself because the reality is, one of those native systems that we had on our native platforms eventually is going to catch up. It’s probably been on offer for a fraction of the cost of what the startup is. For example, video visits. We were paying hundreds of thousands of dollars for video visit solutions. Now we’re paying $0.28 for one video visit. Purely click as you go.

So as the commoditization happens, the startups have to continue to say, “What is the problem I am trying to solve?” You may have a good contract right now but you have to work out the assumption in three years. That’s a problem someone else may have solved for cheaper. It’s been commoditized. However, take the learnings you’ve had by partnering with the health system to say, “Okay, what are the problems? I’m going to help you solve that.” That’s an approach that I think of when we look to partner with folks. 

Q. What’s your advice to startups who are listening to this? 

Tarun: What is the reality of the world? I don’t think there’s anything I’m saying on the health care space that’s any different than any other space. Everything in health care is side-aligned — you got the big five in their respective areas. 

When talking to startups, I ask, “What’s your exit strategy? Between being lean and being acquired by Optum.” That is literally when half of the store doctors go, “Yeah, that’s our only choice.” 

With some of the startups that I’ve seen and worked with, once you get acquired by Optum, you get pitched and pulled into that space. It changes the dynamic of the original relationship because in some cases we want to work with people who are independent and outside of the ecosystem. 

In some places, it just makes sense for it to be part of the ecosystem. It’s important to be mindful of and check, “Am I sitting in a space that benefits me being somewhat separate from the big ones or complementary or eventually tied in?” That’s because I think there’s a big misnomer in health care I.T. that the health systems are flush with cash. 

If you think that’s the case, you can look at our P&L record. They’re all wrong and almost all not-for-profit. We’re talking low single digit operating margins. So, it was a bloodbath – though that may be a strong word. It was very difficult and tight. 

Each day you have 10,000 people leading the commercial insurance world where that pays better compared to the Medicare world. So, it comes back to that value proposition of what you’re truly bringing. 

Q. So that obviously begs the ROI question Are you making a lot of digital health investments? Is there a rubric that you use when it comes to building a case for a new solution where there isn’t adequate data for you to say whether it’s going to work or not, especially in a margin constrained landscape like health care providers?

Tarun: I wish I could say, we put data into an Excel spreadsheet and a formula comes out and scores 99. We go with it and it comes out with a six. We don’t. I will tell you though that, there are some gut calls you’ll get at times. We won’t leverage the house on a gut call. But I think one of the things we’ve stated, though, is our investment in digital and our thesis is very clear. Any incremental investment has to help us gain consumers who want to be part of our health system, retain consumers who, if we don’t offer this, are going to find another solution that meets their value proposition. And then, it has to be real, tangible savings. 

You can’t be this soft. Sometimes I look at some of the valuations and the ROI calculations people come up with. It’s like, “We’ll save you half a day in the hospital, which will then, lead to $10,000 of savings.” I think “Yeah, maybe you’re off by like two decimals there.” It has to be hard. Tangible.

Q. You’ve been in this role now for two or three years. If there’s something you’d like to share with your peers listening in, what would those be? 

Tarun: I’ll give two. I think they’re probably the same thing, but maybe slightly different way of saying it. 

I mentioned I was in a startup, and when I first came out of training, one of my mentors gave a statement that one of his mentors gave him, and that is, “no one ever went out of business because they focused too much.” Now, you may not be the biggest business. You may not be getting on the speaking stages, and you may not be on the cover of X, Y, Z magazine, but you’ll still be in business. 

A corollary to that is a term we use in our organization. Specifically, my team is called Coldblooded Execution — There’s a lot of cool, a lot of talk, but at the end, those who execute will win and there will be winners and losers in this space. We’ve seen it over the last couple of years and it will only continue to accelerate. That is relatively new for integrated delivery networks. There are integrated delivery networks who are essentially either are going to get acquired or in some cases shut down because they did not thrive in this business. But cold, hard execution ideas are wonderful. Execution wins. 

We hope you enjoyed this podcast. Subscribe to our podcast series at www.thebigunlock.com and write to us at info@thebigunlock.com

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

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

We are 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
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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.

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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.

Q: Pranay, tell us a bit about your background. How did you start Notable Health? What does it do?

Pranay: At Notable Health, we’re building the intelligent automation platform for healthcare; one that fundamentally seeks to transform how patients access care and how health systems get paid for providing that care. Very early on, when we studied healthcare, what we actually found was from the time that a patient, a mere mortal like myself, actually seeks care to the time that that care is built, it takes anywhere between 22 to 35 sets of hands that are touching data in some way. It’s old, archaic, and manual.

It turns out EHRs digitize the health records but not the workflow around those at all. At Notable, we believe that healthcare workflow automation is going to be just as important over the next 5 to 10 years as ours have been over the last 30 years. That’s what Notable does.

A big part of the thesis was actually bringing our experience from our scars, skills, and priors from fintech. We spent 15 years transforming what it looks like to actually do your taxes, to use Mint — and quicken on the personal finance side — the check scanning capabilities that you may have used way back when, all the way to powering a large portion of this country’s mortgages and transforming that to a seven-minutes’ experience in the palm of your hand.

We’re bringing a lot of that experience in healthcare. It’s just been an incredible five-and-a-half years of growth for us.

Q: Automation is a hot topic. Can you share your take on where you see automation gaining the most traction? Where’s a health system looking to deploy it the most, today? Can you share your own client examples, to illustrate the point?

Pranay: The insight that we’ve had in working with health systems across the industry is kind of like with AI. Automation is another one of those buzzwords that people want to embrace but have no idea of how to start or from where. We’ve seen health systems that have created Centers of Excellence and people that are trying to figure out what use cases to actually support! But what we found is, it falls into one of three camps.

There’s a camp where it is about – “I want to build it all internally and hope that I can learn from others.” What they tend to actually avoid or ignore is the total cost of ownership. How do you actually maintain that?

There’s a second that is around – “How do I automate the mundane to reduce costs?” It usually turns out to be garbage-in-garbage-out. I’m starting on the backend and it’s low value. Perhaps it’s easy to automate but it probably shouldn’t be needed in the future with where the puck is going.

There’s a third which looks at what the market trends are, strategically, and how automation may be used for growth. Truth be told, most systems aren’t actually thinking about it that way. They’re thinking about it more as a cost-cutting endeavor and less as how to actually tackle a change in how patients are engaging with our health system. Nobody wants to call anymore. We fundamentally believe we want to eliminate the call center from the US healthcare system. That has to happen. It’s inevitable and maybe, it’ll be 1-3% of phone calls, but you don’t need the vast majority that exists today.

The second part of the growth story is, how do you actually start on the patient access side? So much of healthcare data and workflow starts with — Who is the patient? Why are they coming in? Who’s going to pay for this? With that in mind, we’ve started thinking through that strategy with our partners across different EHRs – Epic, Cerner, Athena etc. But really, we’re looking at what the patient flow looks like. So, how do you engage with the right patient at the right time? How do you collect their insurance information in a delightful way just like we’ve been used to doing in other industries?

What we’ve seen with starting on the frontend and with the access side is, if you do that right, you can engage 80-85-90% of your patients in a digital manner. That is what upstarts around are trying to do. There’s no new health tech startup that provides care that starts with a call center and yet, that’s how healthcare does it.

For us, the places where we can educate our health system partners so as to partner with them truly lies in answering, how do you start on the frontend? We tend to actually partner with operations, red cycle population, and health leaders on — how do you digitize your patient experience to delight them and your staff?

The examples that I share with our partners — be it a large health system in Utah, one in Austin, or here in California — is we’re actually seeing upwards of 80% of patients engaging with health systems digitally. We get feedback from health system staff where their workload is actually reduced by 50% on a Monday, on things that they didn’t have to do — either outbound phone calls to collect registration data, or clinical information from patients, or even have themselves scheduled or rescheduled.

Most importantly, we actually see just elimination of backend workloads — What if you had no follow-up queue? What if you didn’t have a slew of calls that needed to be made to reschedule a patient? All of that starts getting eliminated when you start out on the frontend. We see our role today, in healthcare, as actually helping educate.

One of the things that we’ve done therefore, is codify all of this into something new that we’ve actually rolled out with our partners. We call it the Notable Health Check. I’m really excited about this because what it allows us to do is understand and assess where our partners are on their digitization journey. We understand what their tools and landscape look like and make recommendations of where they would actually get value if they thought about automation and digitizing the patient experience the right way and not just for randomness, like Robotic Process Automation (RPA).

Q: RPA specifically connotes automation of tasks and workflows in ways that essentially replace a human worker with a digital worker. It’s a subcategory within the automation landscape. Are you an RPA company? How do you categorize yourself when you look at automation technologies at large?

Pranay: We actually think RPA is fairly brittle. We don’t consider ourselves an RPA company. We use a lot of different capabilities to integrate. It turns out in certain cases, using APIs are great.

I want to access clinical data using APIs with Fire, App Orchard, or what Cerner has with their code program etc. We want to utilize all of those and we do. We augment that with machine vision capabilities to actually integrate where there aren’t APIs.

We also use a variety of other mechanisms to actually integrate because what we found very early on is, what’s critical in healthcare — the road to purgatory in health tech — is driven by integration. It takes too long to deploy something and then know if it is of value or not. From the time that you actually can get that feedback loop closed, there’s a reorg that’s happened. There’s a change in priority. More importantly, the market has moved on.

What we found is, it’s important to marry — when we talk about automation — a beautiful patient experience that is ADA-compliant in any language that works on any device, for any human on the planet. We spend a significant amount of time on design and how to think about that. To anyone that says the elderly cannot use technology, I like to say they haven’t seen the 60-70-80% conversion rates that we actually see in the 65 + cohort at Notable.

That’s because you sweat the details on who’s engaging, when they engage, and how to engage with them. You marry that with the best workflow integration. It’s not just swivel chair RPA. It’s actually rethinking the workflow in how you collect better data from patients to power clinical and administrative workflows. That’s the industry that we are in. We’re not in just the RPA. If anything, that needs to be commoditized and useless.

Q: 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.

Pranay: I’d say healthcare is a really noisy landscape of every industry that I’ve been at. There’s a point solution for absolutely everything. The reality is, it turns out nobody wants a solution. They’ve already got so many in their ecosystem that they’re trying to get to work together. The patients and staff see that at the seams they don’t interoperate and they aren’t as seamless as we would want them to be.

For us, there are two parts that I like to think about.

One, how do we set the bar with our partners in digitizing every experience? The way that we actually go about it, on the access side, entails running our health check process to understand how many patients are digital, today. What does your website look like? How are patients calling? What does the call center volume look like? How many payments are being collected? How many denials are occurring on the backend?

By collecting that information, we’re able to share a very strategic solution. That isn’t about how do I bolt on here? How do I bolt on there? It’s really one that’s focused on outcomes for our partners and often, that leads to sunsetting a lot of the points solution. You don’t need an appointment reminder vendor if you also use Notable. You don’t need a denials dashboard because we actually provide that capability. We start with the outcome and then, align strategically with our partners to actually set that up.

Now, there are certain systems of record. It could be the EHR vendor, CRM, or others that you actually want a deep integration with the power workflow or to collect data from because those are the single sources of truth. Those are the ones that we actually embed ourselves in deeply with. So, working with the EHR or the CRM vendors in many different ways resonates because if you approach a health system with this as the only way to deploy, it’s not going to work. Often, they don’t even know how to deploy something to get to success.

I’ll give you one example. We actually studied a part of our health check assessment – scheduling — and looked at this with a partner of ours in Kansas. What we found was, about 12% of their website traffic was coming from Google and then, just bouncing because they couldn’t find how to schedule. Fifty-five percent of their phone call volumes was actually tied to scheduling, of which 35 was inbound and then, 20 or so, was outbound because they had about 10 to 12% of their orders at any given point in time that were unfulfilled. They were trying to follow-up with patients to try to get them back in.

Now, once you have that data, you have strategies on how to deploy software and a platform that can actually tackle those. We gave them personalized links that they could embed onto the website for self-scheduling so that it integrates deeply with Google. We set up ways to actually engage with patients automatically based on their prior visits or when they were actually leaving the clinic. We were monitoring the orders that were placed in, checking to see when and if the patient had scheduled something in the future, texting them, and having them scheduled within a certain window as required.

It’s what the call center agent would do. But all of that is actually built on our no-code platform where you don’t need to write code for any of this. This is all point-and-click to set up that end-vision journey. What we saw, was tens of thousands of phone calls actually being avoided. You don’t actually create a faster call center, if you can read this. You completely avoid the call. We actually saw a patient satisfaction score of 98 and up to 40% of all of these health systems’ appointments actually being scheduled in a digital-first way. That was up from 5%. I share that because they could actually angle in 16 different point solutions.

In trying to pull that all together into EHR and CRM, to us, these are all the tools that bring these solutions to life. But you really have to think about how can you do this end-to-end and then, iterate really quickly. The time to actually deploying that value is key. We deploy that in six weeks. That allows us to learn and iterate. If you don’t have that kind of speed, it’s an 18-months’ journey to get your first piece of data and then, it’s not worth it.

Q: There are a number of new initiatives being launched by the big technology vendors, for instance, Epic’s Cheers CRM platform. You’re a big technology firm, too. How 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?

Pranay: I would challenge that belief. But one fascinating point about healthcare in every sense is, every vertical has its system of record. I think healthcare is the only vertical where the system of record is actually, in certain cases, dictating what you can and can’t do.

That’s flawed in how people actually think about running their health system. I’d challenge the assumption that it might be easier or cheaper to actually deploy because what we’ve seen is, the only path to success is iteration. When we partner a part of that health check process that we go through, we actually assess how well an organization adopts Agile. We ask — Do you know what a product owner is? Are we going to get stuck in committees before we can actually make decisions? If that’s the case, you might have all the willpower in the world but you don’t have the ability yet. We need to actually help you understand what iteration look looks like. What does a two week deploy look like?

There was a CIO recently that asked me, “What does your release cadence look like?” It was 11 a.m. in the morning and I just went on Slack. We have a channel called the Dev Deploys and I was counting quietly. The response was, “Well, it’s 11 a.m. We’ve done 56. It deploys this morning, and that’s just how we work.” And he asked, “Oh, you do? No downtime deploys.” I guess that’s how you build a true technology iterative cycle such that you can actually learn through this.

The reason that I share those stories is, when we sit down with CIOs and technology leaders, we try to decipher, are you a technology leader that wants to play it safe and do the least amount of change possible because that’s actually how you see yourself succeeding? If yes, that’s okay. I would rather know that up-front and not waste each other’s time. Or, are you the technology leader that aligns with the business to drive change? We tend to work best with the latter, not the former.

With the latter, we tend to actually set the bar on — How can you actually reduce the total cost of ownership? How can you actually set up? We always think about it as the EHR should exist; it’s the system of record, so, it will always be there. The system of automation that actually sits on top of that and transforms patient to payer or booking the bill, that’s who we are. That’s the role that we play.

Then, there’s a number of different workflows — everything from outbound scheduling to prior off, checking your prior status and texting the patient on their status or having them reschedule – all of those are intertwined flows. They should not be point solutions across the board. When you start to think about it that way, you get a lower total cost of ownership and higher value much faster than when the legacy systems might actually try to try to mimic what it is that we’re doing.

Fun fact — there may or may not be a legacy system that is a monthly meeting on trying to copy Notable’s features. We love that because we’re actually helping move the industry forward, and that’s the role that we have to play.

Q: 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?

Pranay: Can I just add to that with an anecdotal example? We’ve actually seen partners start out wanting to build themselves and then, very quickly realize that they’re not an R&D shop and they won’t have the resources. There’s only one master that you can have. Still, we have to share and educate. Sometimes we tend to think that everything is a form and it’s just a text message and a dropdown. Patients can do X, Y, Z, and I have the tools to do that.

But where we actually lack is in that product function of thinking through deeply. How do you productize intelligence at scale? With the world that we’re in, the example that I share is, we started early on with just scanning insurance cards. What we found was, we could actually do it at 95, 97% accuracy versus a human that would transpose zeros and ones.

But the bigger challenge actually came in matching it to a payer plan. It’s that that denial on the backend doesn’t happen. Two years ago, when we first started to look at this, health systems would come to us and say, “Hey, here’s the rule.” We’d look for this PO box number and contort our bodies, do the rain dance, and hopefully, take the right payer plan up.

To productize that in scale, we determined that it was not something that we should just ask every customer. We actually needed to think about how to instrument the platform to learn from what their staff was doing and automatically create a feedback loop that could actually scale such that we could reduce and eliminate their eligibility-based denials on the backend. Those are some of the places where productizing AI and automation is hard. It isn’t just like the swivel chair RPA or, you know, that my portal can do this.

Q: You’re in the middle of the entire startup ecosystem and have raised a lot of funding for your company. But, it’s uncertain times for digital health funding at large. 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?

Pranay: We talk about this as a team. Our focus is on building a company that outlives us. There’s so much to be done in an industry that has been severely underserved and in really building something that we are proud of.

On the external side, the cost of capital is changing and that just pushes for sustainable growth in a reliable fashion. Internally, our focus is always the same. We’re fortunate enough where people ask me about runway and things of that sort. We are not cash strapped in any way in terms of the revenue that we’re making and the growth that we see in the tailwinds that we have with the industry needing what we provide is great.

However, our focus is just maniacally on what that patient feedback looks like. Every patient that actually uses the Notable interface has their feedback streaming into Slack for the entire company to see. That’s what drives us. When you see somebody that gives you positive feedback and says, “I’m a blind man that did this using voiceover”, that’s compelling. That’s reason to exist.

On the flip side, when you actually see our class report with 100% of our customers recommending us, that’s not to say every deploy is swimmingly smooth, but you can go in with your scars and what you’ve learned. Talk to any one of these customers and they would still recommend working with us. At the end of the day, that’s where value is created. For us, that is our focus.

For anyone listening to this and building a business in healthcare, I’ll say, you got to focus on your customers. At the end of the day, I think that drives you. That is our maniacal focus across the board.

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com  and write to us at  info@thebigunlock.com

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

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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

Season 4: Episode #124

Podcast with Sara Vaezy, Chief Digital Officer, Providence

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

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

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

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

Our Podcast Partners:

Show Notes

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

About our guest

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

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

Sara_Vaezy_profile-pic-tablet

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We hope you enjoyed this podcast. Subscribe to our podcast series at  www.thebigunlock.com  and write to us at  info@thebigunlock.com

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

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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

Season 4: Episode #123

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

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

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

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

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

Our Podcast Partners:

Show Notes

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

About our guest

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We’ve now had enough experience that we’re not treating digital as just a poor replacement for an in-person encounter. There will always be a need for face-to-face encounters in health care, but there are so many times when the convenience and the access that digital health 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.

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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."

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

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.

Our Podcast Partners:

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
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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.

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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 point solutions 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”

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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.

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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 companies. 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. None of the digital health companies 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
To receive regular updates 

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 care for patients 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
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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
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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.

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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?

About our guest

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
To receive regular updates 

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

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

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

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Show Notes

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

About our guest

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.

Our Podcast Partners:

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?

About our guest

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.

Our Podcast Partners:

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?

About our guest

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.


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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?

About our guest

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
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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.

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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.


Q. Tell us a bit about your background, how you got into the Lucile Packard Children’s Health Foundation and its affiliation to Stanford Medicine.

Cynthia: I work with the Palo Alto-based Lucile Packard Foundation for Children’s Health. We exist solely for the purpose of unlocking philanthropy, to transform health for kids and moms, starting in the Bay Area community, and then, reaching out to kids, moms, and families around the world.

We do that by supporting Stanford Children’s Health’s (Stanford University School of Medicine) endeavours related to maternal and child health and the Lucile Packard Children’s Hospital, which is part of the Stanford Medicine enterprise. We’re here today, to support their work and bring so many resources to be on that great mission.

Q. How did you get involved with the Foundation?

Cynthia: I feel really lucky. This is my first time as a CEO, and it was a chance to bring together this huge passion I have for philanthropy with health care and then, use the ability to have Science help Humanity. So, how do we use the power, for example, of Stanford Science to improve care and eventually get to the cures for kids and moms? This is, I feel, like my life’s work and I’m lucky to be doing this with our team at Stanford Children’s Health.

Q. Many of us don’t think of philanthropy as a business, but it is, and it’s undergoing changes, too. Having been part of that world, can you talk about the business of philanthropy and what it looks like for your mission at the Foundation?

Cynthia: Let me say that philanthropy is really a big picture. We talk about people giving — making philanthropic gifts to things they really care about and the impact they want to have in the world. A lot of people also give their time and expertise as well as their financial resources. All of that is what we mean when we talk about philanthropy.

Now the business of philanthropy, like so many professions, has become more specialized over time. At this point, within my organization there are maybe six or seven different revenue teams all running a different kind of business model. So, for example, we have a program that works with corporations who want to make gifts and whose employees are donating time and expertise to our mission. We have another program where people make gifts through their estates, so they’re thinking really long-term about the impact they want to have during their lifetimes and even after they pass. Then, we have incredible programs where people in the community come together and maybe have a lemonade stand for their child’s birthday. So, there’s just so many different ways to participate.

And it’s our business to figure out how to do that better and more efficiently, and to help make the connection between people who want to make a difference and where, in our mission, we need that. So I would say, one of the things I’m specifically very passionate about, is the partnership that those of us who are doing this work have with folks in the organization in health care.

So, our faculty, physicians, the administrative leadership try to figure out how we can do this better and how philanthropy can be an even more powerful lever for what we want to accomplish. And then, we create really strong business plans. When I go to a donor who’s thinking about making a really significant gift, I can tell them about where this money will go, how it will be used and what impact it will have. I assure them about how we will partner with them over time and bring them closer to what their gift is accomplishing. It’s a really interesting time for our work and a time of huge potential.

Q. You were the recipient of a fairly large gift earlier in the year. Could you talk a little bit about that?

Cynthia: We received a gift from Elizabeth and Bruce Dunlevie. Elizabeth is Board Chair at the Foundation and has also been on the Board at the Children’s Hospital for a long time. Bruce is a long-term volunteer and leader at Stanford University, and they’re incredibly passionate about this work. They’ve developed a great relationship with one of our physician leaders, Dr. Yasser EI-Sayed, who leads our Maternal-Fetal Medicine Program — high-risk Ob – so they know what the hospital is trying to accomplish. One of the things is, changing our facilities to keep up with the level of care we can provide while serving as a platform for research and innovation. That will not only help our patients and their families, but also, many others. Elizabeth and Bruce gave us a chance to present an integrated opportunity that supported the transformation of our physical building, specifically, labor and delivery and the antepartum part of maternity Rooms.

There’s also a research program led by Dr. EI-Sayed, which will totally change what kind of healthcare we’re able to deliver, not just here but everywhere, for high-risk moms with high-risk pregnancies. This excited Elizabeth and Bruce so I think they accelerated their gift. They had planned to do things over a longer period of time and that’s how the gift of $80 million for this facility and the research program came about. It’s totally transformative for what we can do for moms and so very inspiring.

Q. Tell us about the Foundation’s work and the different aspects of children’s health that you focus on – in Bay Area and globally.

Cynthia: It does start here in our community, and though people think of Silicon Valley as comprising people with a lot of wealth and doing really well in technology – it’s true – but simultaneously, it’s also true that this community is very diverse – ethnically and socioeconomically in terms of background where people came from, to be here.

Our patient population at Packard Children’s Hospital is equally diverse and a good microcosm for what we’re trying to accomplish on a bigger scale. The things that we try out, for instance, a pilot here, then, can possibly help people beyond the Bay Area and beyond Silicon Valley. The example I really want to talk about is not so much global, but it’s California, and it’s something I hope will scale-up across the nation and around the world. It has that potential. But right now, there’s a care collaborative, in fact, two care collaboratives of hospitals across California – one, that’s about maternal health and the other, about perinatal health. These are called, the CMU-UCC and the CP-UCC and they’re led by people at Stanford Health. It’s all about real-time data coming in from 200 hospitals and 100 different NICUs across California and using that data on outcomes — Who had a premature birth? What happened? What were some of the causes? What happened for the baby and the mother? Using the kind of data at scale to then develop tools for, for example, workwith moms who have hypertension when they come into late-term pregnancy and/or developing and testing some of those tools here and then producing kits and training back for the 200 hospitals and the 100 different NICUs to be able to implement them.

Maternal mortality in the U.S. is on the rise as are premature births and that’s really shocking – globally, 15 million babies are born too early, and a million, die every year. In California, we’ve been able to reduce maternal mortality 65% over the last 15 years through this collaborative model across many health care institutions. That’s where I see the potential. It’s California now but I’m hoping that with some philanthropy and other resources, we will be able to scale this up and other parts in the U.S. and the world can replicate these kinds of data-driven interventions to improve maternal and pre-natal care and premature births.

Q. It’s interesting that you’re in Silicon Valley, the land of great wealth but it seems there’s another side to it too, a population there that does need help. Did I pick up an underlying theme of you trying to bring in some degree of equity through the Foundation and the Children’s Hospital?

Cynthia: We’re very passionate about and quite committed to making excellent health care and health outcomes accessible and more equitable for kids and moms. We’ve seen through the pandemic terrible disparities in health outcomes so, we’re committed to not allowing that to continue. I think, it’s a shared commitment from us at the Foundation and everyone in our health care system and then, far beyond into our community.

One of the things at our Hospital, and typical of children’s hospitals, is that we accept all patients, regardless of their insurance status or their ability to pay. We have, for instance, about 40% of our patients who are uninsured or on public insurance – something that doesn’t fully cover the cost of their care. That’s not unusual for children’s hospitals. So, it’s this very mission-driven approach of seeing that this great health care that we provide here at Packard Children’s Hospitals and other children’s hospitals is available to every mom and every child, regardless of their backgrounds is a powerful message and mission. I hope people get really inspired about children’s health and what a great place it is for the mission of health care in terms of equity.

Q. What does the Foundation do for special needs kids? I’m curious to understand this for a personal reason — my daughter works in that field.

Cynthia: You must be so proud! This is such a special commitment. At the Foundation, we have a small endowment and grant-making program. Over the past decade plus, we have chosen to commit all of those resources to helping kids who have special health care needs and specifically, to making system-level change for kids with special health care needs. I would really frame that in terms of access and equity.

Different kids have different needs and we’re trying to lift-up those who have special needs. One of the organizations we work with is Family Voices, one of our Grantees. With them, we’re really taking on this question of how do families become more engaged in care for their kids who have special health care needs? How do we change the systems and standards of care for insurers, for state agencies, for our health care systems? We’re really looking across the system to say, how do we make this more equitable for kids who do have different needs than other kids? But it’s a huge population of around 1% of all kids who have that kind of medical complexity.

Q. Now that we’re now coming up on the two-year anniversary of the pandemic, how this has changed the way you focus or approach the Foundation’s mission? What are your priorities for 2022?

Cynthia: The new year is a great time to think about what kind of difference we’re making in the world. In that context, our priorities for 2022 are very related to how the pandemic has changed what we do. Some of the needs that have emerged through the pandemic — child and adolescent mental health, for example—are huge issues and they’re something we’d like to direct attention to.

I’ve learned a lot about this from listening to some of your episodes on the delivery of different care, whether it’s mental health or other areas of concern. For us, it’s all about “how do we marry these?” How do we keep them going beyond this pandemic and retain the benefits that we’ve all seen from doing things more, through telehealth and digital health? The example I want to cite here, is that of the Stanford Parenting Center. It’s got some great faculty who’ve asked, “how do we scale-up interventions for mental health and how do we have a longer, more durable impact?” Let’s coach and train parents who spend much more time with their kids than the kids spend with a therapist, for example, or a social worker, and see if we can figure out how to deliver this kind of curriculum in a pandemic situation. You could call this a program for parents through digital means.

Q. The digital means and modalities for delivering care and health care related services is very mainstream, today. But some of your programs though, are not actually being delivered through a digital modality. That’s interesting. Tell us a little bit more.

Cynthia: That has been such a transformation for all of health care. This could have taken 10 years, instead, it took a couple of months for us to be up and running. Programs like the Stanford Parenting Center’s pilot program about Type 1 Diabetes, require so much ongoing monitoring that they make us think of how to enable parents and families to do that remotely and maintain a much higher level of contact with the care providers from Endocrinology that they see. We’re trying to find things like this to pilot from a philanthropic point of view, too, while answering questions such as, “how do we think about what should be scaled-up” now, and even as we enter, the post-pandemic/late pandemic/chronic pandemic period of time.

Some kind of new normal. So, we can’t let go of what we’ve learned and what’s made it more equitable, more accessible to reach out to other families and kids with some of these health care interventions.

Cynthia, you’ve had a remarkable career. And there are some personal aspects of your life that have had a big role to play in your success. You’re a member of the LGBTQ community. How has that impacted career progress from a personal and a leadership development standpoint?

Cynthia: Thank you for the opportunity to talk about that. And I encourage all of us in this field, in health care, to just really embrace those parts of our backgrounds that make us better at this work, and more able to transform health care and health, especially, for kids and families.

For me, identifying as LGBTQ has meant that I have been an outsider. I’ve experienced that many people have from different parts of their identities, and it gives you so much empathy, which is an important part of leadership. That and being able to see, experience, and listen for other people and try to understand their experiences and then, to be an advocate, an ally, to step up and be powerful for that; that’s a huge part of my background and a big part of my leadership. I’m really proud of that.

Q. I personally want to thank you for sharing your thoughts and experience, today. This is an important moment, and we must recognize and embrace all the diversity in our community and population. In these times, when human social interaction is more virtual than face-to-face, there’s a lot that will change. We can only be optimistic and hopeful about the future. If our listeners want to get involved in the Foundation’s work, what should they do?

Cynthia: That’s the best question ever, and I would encourage everyone to see themselves as philanthropists. You are doing great work trying to make health better, more accessible for many more people, so I hope you will take the next step and think about that in terms of what you can give back financially, or of your time and expertise. Our Foundation is a great place to do that. Our website is just the acronym for Lucile Packard Foundation for Children’s Health — LPFCH. And there’s a Giving Page where we’d love for you to come and give.

I also want to make the case for you to reach out to the Children’s Health Hospital in your community. There are so many amazing children’s health organizations and hospitals around the country doing great work. We share so many things in terms of how we want to transform health. And I encourage you all to step up and find the place where you can make a difference. Thank 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.

The Healthcare Digital Transformation Leader

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

The Healthcare Digital Transformation Leader

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

The Healthcare Digital Transformation Leader

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