Category: Season 4

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

Season 4: Episode #121

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

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

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

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

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Show Notes

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

About our guest

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

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

About the host

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

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

Season 4: Episode #120

Podcast with Tim Skeen, SVP & CIO, Sentara Healthcare

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

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

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

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Show Notes

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

About our guest

Tim-Skeen-profile

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

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

Tim-Skeen-profile

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

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

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

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

About the host

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

The healthcare industry is moving away from point solutions

Season 4: Episode #119

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

"The healthcare industry is moving away from point solutions"

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

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

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Show Notes

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

About our guest

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

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

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

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

About the host

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

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

Season 4: Episode #118

Podcast with Justin Norden, MD, Partner, GSR Ventures

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

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

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

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Show Notes

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

About our guest

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

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

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

About the host

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

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

Season 4: Episode #117

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

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

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

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

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Show Notes

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

About our guest

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

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

About the host

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

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

Season 4: Episode #116

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

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

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

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

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

Our Podcast Partners:

Show Notes

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

About our guest

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About the host

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

Digital health startups must pick a lane and stay with it

Season 4: Episode #115

Podcast with Matthew Warrens, Managing Director, UnityPoint Health Ventures

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

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

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

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

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

Our Podcast Partners:

Show Notes

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

About our guest

Matthew_Warrens-profile-pic1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About the host

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

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

Season 4: Episode #114

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

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

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

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

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

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

You can download the HIMSS healthcare cybersecurity survey report here.

Our Podcast Partners:

Show Notes

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

About our guest

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About the host

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

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

Season 4: Episode #113

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

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

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

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

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

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Show Notes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About the host

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

Our goal is to have clinicians be able to use tools that help get individualized medicine to the point of care

Season 4: Episode #112

Podcast with Jackie Gerhart, MD, VP of Clinical Informatics and Phil Lindemann, VP of Data and Analytics, Epic

"Our goal is to have clinicians be able to use tools that help get individualized medicine to the point of care"

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In this episode, Jackie and Phil discuss Epic’s Cosmos research database that covers over 130 million patients across 800 health systems in 50 states – the largest single healthcare dataset of its kind. They discuss the role of database in driving the Epic Research initiative, specifically in public health, and explain how they ensure privacy protections and safeguards for the data.

Jackie and Phil also discuss Epic’s recent expansion into newer market segments such as retail healthcare and health insurance, and Epic’s new CRM product, titled Cheers.

Epic is one of the largest healthcare IT companies today and has a significant influence in healthcare operations across the country. Jackie and Phil discuss how the Cosmos dataset could power new innovations and research, and also highlight advocacy efforts with regulatory agencies to reduce coding and documentation burdens on clinicians, at a time when the healthcare industry is facing a shortage of workers.

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Show Notes

01:38Can you walk us through a high-level overview of the Cosmos platform?
04:37Tell us a little bit about what you know from the COVID surveillance standpoint? What was the platform able to accomplish for you and how you've used this massive dataset?
08:17How do you make sure the privacy and security aspect of it?
12:23 There are other health systems doing their own rollout. They've got their own data, they're going to use it, and mine the data for insights they can get and they're going to serve their own patient populations. How is Cosmos data different from others?
17:29 Who gets access to the data sets? What about the private sector? Do developers get access to private or academic researchers?
19:34 So, for digital health startups, the pathway to get access to the data is to either build a product or a final product with one of your customers, which would be a health system or an innovation group. Is that the way it is that?
20:43 Tell us about your new CRM platform – Cheers. How does Cosmos fit into that story?
23:42 Epic, which traditionally has been seen as a health system focused software company, is now branching out. You talked about the work with retailers like CVS, you've announced a partnership with Anthem. How does Cosmos fits in all of this?
28:37 What is your view on how your platform can help alleviate the acute shortage of workers, which has been identified as the number one issue for healthcare CEOs in a recent report by the American College of Healthcare Executives?

Jackie Gerhart, MD is the VP of Clinical Informatics at Epic where she works with healthcare executives to advance clinical care and improve clinician well-being. Her current work focuses on the value patients can get from their data and how that information can advance evidence-based medicine and improve outcomes. She leads the clinical team that works on Epic Research studies. She also works on healthcare policy at the local, state, and national levels. Jackie also has an appointment as an Associate Professor of Family Medicine at UW School of Medicine and Public Health and still practices medicine at UWHealth. Jackie earned her MD at Mayo Clinic School of Medicine.


Phil Lindemann is the VP of Data and Analytics at Epic, where over the last 18 years he has worked with various products to define their development roadmap and strategy. He leads the team that works on Cosmos. He has worked on health tech solutions spanning machine learning, data visualization, data quality standards, and real-world evidence generation during his time at Epic.

About the host

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

Besides the act of healing, everything else should be automated away in healthcare.

Season 4: Episode #111

Podcast with Andrew Le, MD, Chief Executive Officer, Buoy Health

"Besides the act of healing, everything else should be automated away in healthcare."

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Andrew Le started Buoy Health after he realized healthcare consumers were relying on Google search and other sources to make decisions about their care. After seeing bad outcomes from consumers relying on inaccurate information or failing to seek timely care, he decided to build an AI-powered service that helps consumers manage their health in a more informed way.

Andrew believes that everything, besides the act of healing, can be automated away. He takes pains to clarify they are not trying to replace a doctor but replacing what today is a very rudimentary system with a search engine that narrows things down for a whole host of different things.

In the conversation, Andrew and Paddy discuss a range of topics from the long sales cycles for digital health startups, their expansion plans for their core product, the trust deficit with big tech firms and consumer data, interoperability challenges, and much more. Take a listen.

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Show Notes

00:22Tell us about yourself and how you started Buoy Health.
03:44You're in the AI-enabled digital healthcare space. What’s your definition of AI and how did you apply that to starting and running your business?
05:54Is your AI application directly used by consumers?
07:48 As a consumer, I’d need to download the app and pay to use it. Are these sources of revenue for the company?
08:41 You didn't mention providers. Any particular reason why providers are not a target market for you?
10:29 How long did it take you to figure out that providers are not going to be thrilled about this?
15:42 Do you think that the acute shortage of labor in healthcare is the next forcing function for your business or any AI-enabled business that reduces the workload on caregivers, clinicians and, consumers and expedites in getting to the right decisions and treatments?
20:11 What are the biggest challenges that you have encountered as an entrepreneur in building this business from data aggregation, management, quality, and analysis standpoint?
23:19 While data, AI and advanced analytics can make a difference in care. How does your company, who is into the data aggregation and analysis business, address it?
27:51 Can you share some learnings from your entrepreneurial journey for all your friends and colleagues in the digital health world, especially those who are looking to start a company now?

Andrew Le, MD is the Chief Executive Officer of Buoy Health. Since founding Buoy out of Harvard Innovation Labs in 2014, Andrew has led the company through two successful funding rounds, raising over $67 million, with prominent healthcare investors including Optum, Cigna, Humana, WR Hambrecht + Co., and F-Prime. In 2020, Andrew was named by Business Insider as one of 30 healthcare leaders under 40 to watch, a Digital Innovator by Employee BenefitsNews, one of Boston Business Journal's Top 40 Under 40 leaders and recognized as a TEDMED Hive Innovator. Andrew holds a Doctorate of Medicine from Harvard Medical School and graduated magna cum laude from Harvard College.

About the host

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

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

Season 4: Episode #110

Podcast with Anish Sebastian, Co-Founder and CEO, Babyscripts

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

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In this podcast, Anish Sebastian, Co-Founder and CEO of Babyscripts, shares how they are reinventing the standard of prenatal and postpartum care by enabling improved virtual and remote maternity care. Babyscripts focuses on the delivery of pregnancy care through the power of technology and remote patient monitoring and addresses the critical shortage of obstetrical providers in the U.S. 

Anish calls the pandemic ‘a watershed moment’ for telemedicine and digital health adoption. He highlights how technology presents an interesting dynamic for pregnancy, and how connected devices can improve access to care at a central level, thereby impacting maternity care in the country.  

The digital health landscape is a chaotic marketplace today. Anish concludes with advice for digital health start-ups who want to make a mark in the industry. Take a listen.

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Show Notes

00:36Tell us about yourself and how you came to start Babyscripts?
02:59What you consider as some of the milestones you've had as a company? Also, tell us how the pandemic impacted your business?
06:24You and your co-founder are both men in a women's health business. Does anyone ever ask you about that?
08:42 What kind of demographic do you mainly serve? Who’s paying for your customers – plans, providers, or employers?
11:54What are the big elements of your platform that go towards providing this comprehensive care?
14:12 What are some of the big challenges you encounter when you're aggregating the data from a large population and trying to make sense of it?
16:06 Is your product or solution embedded in a clinical workflow or is it a separate standalone app?
17:23 Interoperability is an unfinished business. Is it getting better?
19:46 What is the hardest part for you as a start-up with an innovative solution, but also one that is not a part of the core technology and applications infrastructure for health systems today?
22:59 What has been your experience in the last several years and what would you advise to someone who's looking at starting a digital health company today?
26:47 For your peers and other digital health founders, can you share few things that you've learned?
anishsebastian-profile

Anish Sebastian co-founded Babyscripts in 2013 with the vision that internet enabled medical devices and big data would transform the delivery of pregnancy care. Since the company’s inception, they have raised over $37M.

As the CEO of BabyScripts, Anish has focused his efforts on product and software development, as well as research validation of their product.

About the host

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

Behavior change is where value is derived in digital health

Season 4: Episode #109

Podcast with Kyle Kiser, Chief Executive Officer, RxRevu

“Behavior change is where value is derived in digital health”

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In this podcast, Kyle Kiser, CEO of RxRevu, discusses how they have built a data network to provide real-time patient-specific prescription pricing information to providers at the point of care.

Pharmacy Benefits Management is a concentrated space with a handful of players. The PBM model is changing into something more holistic and more focused on managing patients, not just around pharmacy benefits specifically, but managing the total cost of care, using pharmacy benefits as a tool to achieve the goals. RxRevu has focused on building trust in their tool to drive prescription behavior change among providers. Kyle also emphasizes the need to have the tools in the hands of the right users to drive impact.

Kyle advises digital health startups to spend time on understanding where the value accrues in terms of finding customers. While it may look chaotic from the outside, the incentives in the healthcare value chain drive rational decisions for each entity. He urges startups to understand incentives and builds business models within them. Take a listen.

Our Podcast Partners:

Show Notes

00:35Tell us how you came about starting RxRevu and what’s your journey been like over the last few years?
02:07What is the main value proposition here? Who are your main customers -- health plans providers, employers?
04:38What's the differentiator from your perspective for your company? 
06:56 If PBMs and health plans are your customers, do they feel a threat of disintermediation in any way? Do help us understand.
09:16 Give us an example of how you make an impact. What is the kind of savings we’re talking about using the tool delivering real-time information?
13:56 What's the biggest challenge you encounter while trying to do this real-time dynamic integration of the data?
17:02 What’d be your advice to the digital health start-ups like yours?
20:30 How important are the clinical workflows for you? Is yours a standalone solution that can be launched from inside of the EHRs?
22:46 What would be your advice for digital health start-ups or their VC firms who are coming up with an innovative solution and want to enter the market today? What are the one or two big themes that you think are important for 2022?
Kyle_Kiser_Profile

Kyle Kiser is Chief Executive Officer at RxRevu, the industry leader in Real-Time Prescription Benefit services. In this role, he focuses on creating more seamless, cost-effective prescribing experiences for patients and providers. Since 2013, Kyle has helped develop innovative Prescription Decision Support solutions, which allow providers to select appropriate medication options for their patients. By partnering with physicians, health plans, IT vendors, and health systems, RxRevu is driving data transparency and better patient care nationwide.

Kyle has helped grow RxRevu from a vision to a reality and has been at the forefront of some of the most transformational initiatives in the healthcare industry. In particular, he has focused on projects that lower the cost of care, improve health outcomes, and enable informed decision making at the point of care. His focus on interoperability has allowed partners to improve prescription workflows and millions of patients’ lives. Kyle has helped develop incentive strategies for the country’s most innovative employers and led product launches with the nation’s largest payers. Prior to joining RxRevu, he was a senior leader at Welltok, Catapult Health, and Principal Wellness Company.

Q: Let’s start with a short background – tell us how you came about starting RxRevu. What’s your journey been like over the last few years? 

Kyle: I come from an employee benefits background and my family was into brokerage consultancy. As a kid, when I got into trouble, I’d come home from school and must stuff enrolment packets. It was that sort of a beginning. I was always in the payor-oriented side of the business and over time, when I looked at that world, I didn’t really necessarily see the opportunities to impact the system in the ways that I wanted to. You think about the options available to brokers and consultants to solve some problems for employers but ultimately, it’s just passing the cost along with the patient. You can try and distribute the out-of-control spending as best you can. So, I wanted to impact the cost curve by finding a different way to work within the existing system. 

Q: RxRevu focuses specifically on the pharmacy-benefits side of employee-benefits, as you mentioned. So, what is the main value proposition here? Who are your main customers — health plans, providers, employers? 

Kyle: We’ve built a data network that connects to the point of decisions. So, when providers order care, it could be in the form of prescriptions or something else. We connect to the systems they use to make those orders and bring into their consideration real-time, patient-specific, pricing information. We also connect to a network of payers, provider organizations, and PBMs for the data, and to the EHR systems to form that decision with that new cost value. 

Q: Let’s start with a short background – tell us how you came about starting RxRevu. What’s your journey been like over the last few years? 

Kyle: I come from an employee benefits background and my family was into brokerage consultancy. As a kid, when I got into trouble, I’d come home from school and must stuff enrolment packets. It was that sort of a beginning. I was always in the payor-oriented side of the business and over time, when I looked at that world, I didn’t really necessarily see the opportunities to impact the system in the ways that I wanted to. You think about the options available to brokers and consultants to solve some problems for employers but ultimately, it’s just passing the cost along with the patient. You can try and distribute the out-of-control spending as best you can. So, I wanted to impact the cost curve by finding a different way to work within the existing system. 

Q: RxRevu focuses specifically on the pharmacy-benefits side of employee-benefits, as you mentioned. So, what is the main value proposition here? Who are your main customers — health plans, providers, employers? 

Kyle: We’ve built a data network that connects to the point of decisions. So, when providers order care, it could be in the form of prescriptions or something else. We connect to the systems they use to make those orders and bring into their consideration real-time, patient-specific, pricing information. We also connect to a network of payers, provider organizations, and PBMs for the data, and to the EHR systems to form that decision with that new cost value. 

Q: You’re in a technology-heavy, data-intensive business, making these real-time connections between different data sources and potentially surfacing opportunities for reduced costs and perhaps, alternates to medications etc. Am I right? 

Kyle: Yes, that’s right. What we bring to the workflow is price information and any formulary restrictions that may exist — prior authorization, the quantity limit, a step therapy, alternative choices or lower cost options etc. These come in two forms – a different drug or a different pharmacy. The goal there is to help a prescriber. For instance, when they make a prescribing decision, we enable them to consider some other options that might have lower out-of-pocket costs for the patient either by switching drugs to something that’s more in relationship with the rules on the patient’s formulary or to a different pharmacy that would have a lower price-point compared to the patient’s preferred pharmacy. 

Q: Let’s talk about the concentrated PBM space. There’s a handful of players now and the number is shrinking. However, we’re noticing the emergence of a new category of start-ups like yours for instance, who are trying to approach this differently. What’s changed? What’s the differentiator from your perspective for your company? 

Kyle: PBMs are our customers, so, regardless of who’s managing the pharmacy benefit, we want to make sure we’re working on behalf of the risk-bearing entity and connecting them with whoever’s making their decisions. That’s the focus and the difference about what we’re trying to accomplish broadly around PBM consolidation and the model itself though there are changes ahead. The fact that many of them are being absorbed into the bigger healthcare conglomerates suggests that the PBM model is becoming more holistic and focused on managing patients; not just around pharmacy benefit specifically but managing the total cost of care with pharmacy benefits as a tool to do that. Bending the cost curve in general is going to require a lot of tools around care management, benefit management and really drive different behaviors on the front- and back-end of that. Pharmacy benefits are a component of that, but not necessarily the whole story and in that context, the consolidation of the markets evidenced is true.

Q: If PBMs and health plans are your customers, do they feel a threat of disintermediation in any way? Do help us understand.

Kyle: That’s true. We work with PBMs and health plans and in many cases, those are the same entity. It’s true that we’ve built a network that has different functionalities based on what problem we’re trying to solve. In some cases, it’s about simply specifying the cost and offering some lower cost choices. In some cases, it’s based on what we know about the patient. So, we put forth some sites or pharmacies that might be better options for them. One example for this is we work with health systems to ensure that we maximize the opportunities for them to fill those medications because we know that more integrated care is going to drive a better outcome especially, if we can send a patient downstairs to fill the prescription. We can make them more adherent and consequently, empower the provider encounter in a different way. That’s valuable. 

We’re in the position to do so since we’re focused intensely on provider-ordering as the point of intervention and a lot of those conflicts resolve there. The health plans and PBMs are rarely in conflict with regard to preferences, because, PBMs work on behalf of the health plans to manage risk, and both are incentivized to enforce the formulary, find the lowest-cost pharmacy, maintain interest in adherence and manage a better patient experience. We look for such opportunities where stakeholders align well enough for us to try and drive a different outcome because ultimately, finding that path of least resistance is how we make a bigger impact on the system. 

Q: Give us an example of how you make an impact – either by picking a therapeutic category, a client of some kind or what is the kind of savings we’re talking about using the tool delivering real-time information? 

Kyle: Let’s talk about behavior change, specifically since that’s ultimately where value is derived. We’re approaching five million transactions a month now through the tool that represents about $3 billion in annual prescription spent on the pharmacy-side of the world. Those are exciting numbers but what it really comes down to is how do you convert that into a different behavior at the point of prescribing those results at a lower cost option for the patient? 

We did a side-by-side comparison for the business in Florida and when competing with this other company we realized that we were delivering six times the behavior changes as the sort of standard solution. That really comes down to a few things – one, where we’re returning transactions at a rate of about 95%; that means out of all the opportunities we have had to price medications, we’re pricing successfully in returning value that’s relevant. So, 95% of that is 15% higher than the rest of the industry. In that, 15% are the complex things. 

It’s not that hard to price the medications of the capsules. However, what’s challenging is pricing the sort of non-standard forms – creams, inhalers, self-injectables, and things that don’t fit neatly into the other types of drug forms. What I can attribute the behavior change to is we’re working really hard to make sure that the most valuable encounters are successful pricing to service the lower cost alternatives because those are relevant opportunities to impact the patient’s outcome. They’re relevant to the provider, positive experiences and valuable to the users, our paying customers, the payers PBMs. 

Our goal is to create a relevant value for every provider that uses the tool. Technology providers love the data and incorporating it into their decision-making process. Initially, it wasn’t working very consistently because there were only so many payers of the PBMs that were capable of doing this but that’s changed over time. We’ve added the intelligence layers to ensure that it works at an even higher rate and ultimately, it’s the trust in the tool that’s driving more behavior change. So, that’s how we think about success — how do we ultimately convert these things into different behaviors at the point of care and a different outcome? 

Q: This entire platform is built on the premise of real-time data aggregation and intelligence on top of it to deliver recommendations at the point of care. Is that right? 

Kyle: Yes. The only change is less aggregation and more connectivity. Health insurance and health care pricing is quite dynamic, and variable based on location and the insurance coverage phase. So, all the aggregation opportunities become less valuable than the real-time connectivity opportunities. What’s important is our ability to transact in real-time based on what’s happening this second — the price at a pharmacy or at a health system or at this clinic today, based on what one knows, where one is, and one’s insurance plan. That’s the type of insight we must deliver and why this tool will be valuable. 

Q: What’s the biggest challenge you encounter while you’re trying to do this real-time dynamic integration of the data — Is it the technology? Is that resistance from those who have the data? 

Kyle: One of the biggest challenges is convincing providers that it’s real. The providers have, for so long, been at the receiving end of some unmet expectations with these types of tools for two reasons– one, because the data exchange was not happening in real-time so, it was inaccurate, outdated, and providers just stopped paying attention, looking at it or trusting it. Second, to capture the market before the technology arrived a lot of things were misrepresented as real-time, patient-specific, moment in time-specific pricing to indicate price transparency via tools that weren’t so. 

Both cases eroded provider trust in tools so they began to ignore them and one of our biggest hurdles to climb early on was just around convincing the providers that our tool was different, reliable and they could have a different expectation around this. We’ve overcome those hurdles today, because we partnered really closely with provider organizations like the U.S. Health Presbyterian in Mexico, Providence in the Northwest etc., to listen to providers and understand their side of the story. It helped us evolve our pipeline and communicate the value of the tools that we had better. 

Q: Let’s talk about the overall digital health landscape. You’re one of the emerging digital companies, recently raised a Series B round and demonstrated some success. But there’re digital health companies developing innovative solutions and making a difference, but the flip side is, they’re confused about how to really evaluate partnerships. What’d be your advice to these start-ups? 

Kyle: I feel that the answer will be variable based on the type of company. As a sort of general, broad swath, scale matters. We experienced that early on and overcame that issue because in a lot of cases, the functionality only mattered if the right end user was engaging with it and only that could drive impact. 

Now, that’s hard to do in healthcare, especially when you’re talking about provider tools, point of care tools, coaching tools etc., because it’s a challenging B2B sales cycle to overcome if it doesn’t have scale which is, engaging with the users that matter most. Without scale, there may not be a great outcome. So, I’ll talk about how we’re reaching 300,000 providers and five million transactions a month because that’s an opportunity for us to drive value at a much larger scale compared to the early days. That’s the first point. 

I don’t think that necessarily correlates with venture capital, though. We’ve tried to be judicious about how much, when, and from who we pursue those investments and have ultimately decided that finding strategic partners that could help us drive value through who they are, what they do or what they know what was most important. That led us to on a health system path. We focused on provider systems, healthcare systems as strategic investors with a couple of notable exceptions and found a lot of value from those we brought to the table. Ultimately, for us, being very provider-centric and understanding the challenges they faced, how we could help them overcome those challenges was important. Having a web app where we could sort of test and iterate on those things was critical, too. So, the venture capital dollars are the lifeblood for many in this industry. Our perspective was just to ensure we were providing the right types of investors that could add specific and tactical value to our approach. 

Q: What about the EHR vendors? Our healthcare clients like to see single interfaces for all the technology tools. So, how important are the clinical workflows for you? Is yours a standalone solution that can be launched from inside of the EHRs? 

Kyle: Yes, we’re an embedded component of the EMRs where the data network that powers the price transparency features in Epic. We see a lot of value in such partnerships since they’ve helped us drive scale in a significant way. Frankly, these partnerships have considerable important inputs on the right ways to design such solutions because they’ve been serving those users for a long time. Like it or not, they’re some of the best chances we have in platform companies and health care. So, we want to be in those workflows ultimately, because that’s how you drive provider adoption and engagement. However, the minute you ask providers to do anything but their standard, it’s less likely that you are to actually be able to deliver something of value. 

Q: Scale is very important and though it’s still early days for digital healthcare, and there are mergers and acquisitions, many companies will undergo some kind of an evolution. Do you think there’s also the prospect of a shakeout when some of these companies don’t reach scale? 

Kyle: Absolutely. I agree with that entirely. That’s part of the thrill and risk associated with entrepreneurship, right? Not everyone’s going to succeed and that’s the reality of any market you enter. 

Q: Can you share some advice for digital health start-ups or their VC firms who are coming up with an innovative solution and want to enter the market today? Specifically for those already in the game, what are the one or two big themes that you think are important for 2022? 

Kyle: If we were starting today, I would do a lot of the same things we’ve done, which is be entirely obsessive about the incentives that exist and understand where value accrues. Once you understand where value accrues, you know where your customer is. In our case, that was initially prescribing behavior. But because of the value we accrued for the payers, the PBMs, since they were looking to reduce their cost of goods by driving lower cost choices, we became naturally inclined to selling directly to providers. We wanted to engage those providers, users and monetize that effort. In our case, it was a multi-sided network opportunity because the incentives were not aligned necessarily, or the providers’ risk wasn’t to a significant enough scale or didn’t include pharmacy benefits. So, I think it’d be — be obsessed with the incentives in the healthcare value chain because while they look chaotic from the outside, at times, these are very rational decisions being made based on the incentives that are in front of one entity or another. And if you can understand those well enough, you can build a business model within it. 

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

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

About the host

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

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

Season 4: Episode #108

Podcast with Ryan Younger, VP of Marketing, Virtua Health

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

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

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

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

Our Podcast Partners:  

Show Notes

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

About our guest

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

About the host

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

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

Season 4: Episode #107

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

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

paddy Hosted by Paddy Padmanabhan
To receive regular updates 

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

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

Our Podcast Partners:  

Show Notes

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

About our guest

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

About the host

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

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

Season 4: Episode #106

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

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

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

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

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

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

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Show Notes

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

About our guest

cyndiabrandth-profilepic

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

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

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

About the host

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

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.

The Healthcare Digital Transformation Leader

Stay informed on the latest in digital health innovation and digital transformation.