Category: Season 4

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

Season 4: Episode #139

Podcast with Julia Hu, CEO and Cofounder, Lark Health

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

paddy Hosted by Paddy Padmanabhan
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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.

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
To receive regular updates 

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.

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
To receive regular updates 

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.

Our Podcast Partners:

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.

Technology innovation is about combining unmet medical needs with unmet consumer needs

Season 4: Episode #134

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

"Technology innovation is about combining unmet medical needs with unmet consumer needs"

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.

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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
To receive regular updates 

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.

Our Podcast Partners:

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.

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
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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.

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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"

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

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.

Our Podcast Partners:

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.

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 systems 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 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 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.

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

Season 4: Episode #125

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

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

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

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

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

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

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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 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
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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.

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Show Notes

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

About our guest

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

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

Sara_Vaezy_profile-pic-tablet

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About the host

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

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

Season 4: Episode #123

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

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

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

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

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

Our Podcast Partners:

Show Notes

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

About our guest

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About the host

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

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

Season 4: Episode #122

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

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

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

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

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

Our Podcast Partners:

Show Notes

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

About our guest

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About the host

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

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

Season 4: Episode #121

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

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

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

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

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Show Notes

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

About our guest

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

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

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

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

Q. Tell us about your time with the government. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

About the host

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