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Saul Marquez:
Hey, everybody! Saul Marquez with the Outcomes Rocket. I want to welcome you back to another episode of our podcast. I’ve got, no stranger to the podcast, you guys all know Bruce Brandes, he’s joining us today. He’s the president of care.ai. He’s got over 30 years of experience in executive management, and entrepreneurial thought leadership to build growth-stage technology-based businesses in the healthcare industry. Bruce’s experiences range as a strategist, operator, entrepreneur, investor, fundraiser, and marketer to advance the transformational promise of digital health. Whenever I think digital health, I think Bruce Brandes. I’m so excited that he’s here to speak with us today. So Bruce, thanks for being with us.
Bruce Brandes:
Saul, as always, thank you for having me. You’ve been a good friend for a long time, and I’m just so impressed with how well you’ve evolved the transformational promise of the podcasting format. Just such a great job, so thank you for having me.
Saul Marquez:
Of course, Bruce, it’s a pleasure to have you here, and thank you for that. For those that don’t know, Bruce has a really rich history in a lot of different awesome companies like Livongo, Teladoc. He was at AVEA, you know, was a leader at AirStrip and really began his career at IBM, but certainly at the forefront of digital health. So, Bruce, as you think about some of the areas where care.ai is really answering some of the biggest problems, what would you say those are?
Bruce Brandes:
Yeah, I mean, well, certainly, hospitals and health systems don’t have a lack of problems to deal with and issues and opportunities. But I think above all of the noise of things people are facing, I think there are two existential challenges that are drawing everyone’s attention. One is recognizing that increasingly what we ask of our caregivers is becoming humanly impossible. And unfortunately, the technology that we’ve brought to bear to try to help them has actually made their lives harder, not easier, and look no further than the EMR, causing a lot of additional burnout as well as, with the best of intentions, a lot of individual point solutions that by themselves have utility but collectively are further fragmenting an already very fragmented provider experience, and so, therefore, we’re losing our best caregivers. And then secondly, even if you had all the labor and caregivers that you needed, the underlying cost of our current acute and post-acute care models, are just fiscally unsustainable. And so what we’re really focused on is recognizing the fact that to solve those existential challenges, you can’t just tinker around the edges and make a little tweak here or there, you really have to take a step back and reimagine how do we deliver care and where can we bring technology that’s been transformative and proven in other industries to address these existential challenges so that the healthcare of the future looks very different, but by the same token, never compromises quality and safety, and regulatory compliance in an era where we can’t continue to accomplish those things in the same way that we have in the past.
Saul Marquez:
You know, thank you, Bruce. Those two topics of the labor and cost seem to be at the forefront of most conversations today with healthcare leaders. Sometimes when you’re so deep into it, it’s hard to imagine something different. You go back to what you’re used to. We got to look at other industries, and you and I had a good chat, I think it was last week, around this. Talk to us about some of the inspiration and the solutions that care.ai is bringing to market.
Bruce Brandes:
First of all, I should give you a little bit of background on our founder, Chakri Toleti, because it’s an interesting one to get to this path in his career. He’s actually a filmmaker by training, and his first job out of film school was as a Disney Imagineer working on the motion capture team to take human movement and create animated characters, so Mulan and a lot of the beloved characters of Disney films in the 90s reflect his work. And so that, married with the fact that he is on the advisory board of a publicly traded company called Luminar, which builds the advanced sensors and AI that power many of the self-driving cars in the world, and through that lens, being technical and creative and understanding how this ambient intelligence technology has been transformative in the transportation industry, that really inspired him to start care.ai, apart from being deep and well entrenched in understanding the problems of healthcare through two earlier ventures that he had, plus all the personal experiences that we all endure and understanding that healthcare is really broken. And so the idea was, if you can, back to the transportation industry, if you can keep with autonomous driving vehicles, keep the driver and society safe from somebody whizzing around at 80 miles an hour on a winding road in the rain while they’re watching a YouTube video on their phone, certainly, we can take that same technology and put it into a hospital room and reimagine how care gets delivered in a safer way. And so that was a big part of the inspiration because while we’re not there with autonomous driving cars yet, if you think about where we are as an industry, autonomous driving cars have automatic braking and lane change assist, and dynamic rerouting that allow us, when we start extrapolating out this at scale, when you start reimagining not basic features like a backup camera, which is what we’re good at in healthcare. And what I mean by that is a backup camera in a car is ubiquitously available now, and it’s a nice incremental improvement where you don’t get into as many fender benders in the parking lot, so it’s better, but by itself, is not transforming anything. We, in healthcare, and transportation and other industries are facing the opportunity for transformational change. And so, what does transformational change look like in transportation? It’s challenging the status quo of legacy costs and inefficiencies that we’ve just accepted for a very long time, like what we pay for car insurance and traffic and road construction and first responder deployments, and taking a step back and reimagining a world where, you know, autonomous driving cars that are leveraging ambient intelligence, all of a sudden maybe that world, maybe those things are no longer taking such hold over us. And so, how do we apply that same technology to many of the entrenched? You talked about falling back on what we’ve always done, how do we make sure that we’re not just looking at a lens of standing up a whole series of new backup cameras, but taking a step back and reimagining a lot of the inherent challenges that we have with a new lens of what’s possible with this type of technology and challenging some of the inefficiencies and costs that we’ve just incurred for a very long time? So that’s one example of many others, including if you’ve ever been to an Amazon Go store or a FedEx distribution center that are smartly using sensors and AI in new ways to drive new efficiencies and possibilities.
Saul Marquez:
Yeah, Bruce, so inspiring, and thank you. And from the founder of the company to the inspirations that you guys take through different verticals, using ambient technology, it is fascinating to think about what the future can look like inside of a hospital, inside of a sniff, inside of a nursing home, or in our own home. So talk to us a little bit about how you guys are thinking about the solution, maybe the segments of value that you’re offering to care providers. It’s always good to unpack that, to really kind of bring it to life.
Bruce Brandes:
First of all, looking at this from the perspective of bringing ambient intelligence to healthcare to create a smart care facility, and to enable and empower smart care teams which look different than the traditional hospitals and traditional care teams, so how do we think about what that looks like? But by the same token, with this broader vision, how do we start with very specific use cases where the ROI is very compelling in solving some of the most immediate needs that an organization has? And actually, one of the ways that our company grew so quickly was, fortuitously, one of the silver linings that came out of COVID, we were building this smart care facility platform, and then COVID happened, and it became obvious that the first use case was smart entry screening and digitizing the physical front door to keep people safe during COVID. And we had a very unique window of opportunity where in the first 90 days coming out of COVID, we stood up 1500 care locations without ever physically visiting any of them.
Saul Marquez:
1800.
Bruce Brandes:
Right, it had forced us to be innovative …
Saul Marquez:
That’s awesome.
Bruce Brandes:
That you normally wouldn’t, and also gave us opportunity to grow in ways that we ordinarily wouldn’t and earn trust from these clients. And so when COVID started to stabilize, it became a logical conversation to say, hey, where else do we go with this platform? And there are really two pillars that we found people have gravitated to. One is around ambient monitoring and using these sensors that are in the room to be able to address a variety of use cases, most notably falls prevention and, not falls detection, but falls prevention. There’s a significant difference. Pressure injury avoidance, high hand hygiene compliance, rounding compliance, staff duress, the list goes on and on with other capabilities that these same sensors can address by ambiently looking and listening 24/7. And then the second pillar is really around virtual inpatient care, which obviously works hand in glove with the ambient monitoring. So virtual nursing, most notably, is what people are talking about. And interestingly, today, you could ask 100 nursing leaders, what are you doing about virtual nursing, and how do you think of it? And you get 250 different answers, and that just goes to show that a lot of people are talking about it, but not a lot of people have figured out how to do it. And for us, looking at virtual nursing as a good starting point, we recognize that there’s a tremendous amount of utility out of the gate to get it right, if you get it right. But if you’re looking at this as just another point solution or just another backup camera and standing up virtual nursing is cameras in a room, or worse yet, iPads on a stick that you wheel in, if that’s all you’re looking at, you’re missing the transformational opportunity, the transformational change of looking at wrapping it with ambient monitoring and further with AI, where you can really reimagine the underlying models of care and the way in which the business is run of healthcare, all the clinical and operational workflows. And so that’s a common starting point, is virtual nursing, but the key is to look at it more broadly and understand what’s possible with the ambient monitoring capabilities and AI to really turbocharge the transformation that this opportunity represents.
Saul Marquez:
That’s great and super exciting. And a lot of people might be wondering who’s on the other side of the cameras because the solution gets to a certain point, but at the end of the day, it still requires people, right, to help, oftentimes licensed clinicians. So talk to us about that side of the fence.
Bruce Brandes:
First of all, the whole reason for doing this is to help offload the bedside nurse and all the bedside caregivers with a lot of the tasks that are not what they went to nursing school for or not what they went to medical school for, and not allowing them to do the things that they’re passionate about that frankly, only human beings can do, you know, to hold someone’s hand, to show compassion, to physically examine them. And so, what we’re really trying to do is offload that as much as possible with technology, whether it be technology with a human being on the other side, or technology that is leveraging AI to help enable the right resources wherever they may be as when the time is right. And so generally, on the other side, really depends on what the use case is, specifically around virtual nursing, it’s a licensed senior nursing professional. And generally, what we tell people is, this is all about building trust with the bedside nurses and extending the careers of your seniormost nurses who are just burned out or physically unable to continue to practice at the bedside to give them the opportunity to take on certain tasks that you don’t physically have to be at the bedside to do. The most common ones everyone talks about is admit discharge, medication reconciliation, patient education. But that’s who’s on the other side of this is, whether it’s a senior member of the care team who’s already trusted by the bedside care team because they’re known, and we intentionally don’t want to be in the staffing business because our belief is every health system actually has enough caregivers, they just don’t want to continue to work for you because it’s too hard, so how do we make it so that the job becomes more fulfilling for what they really want to be doing? And so that’s a big part of our focus, is helping to just extend the care teams and have virtual and smart care teams that are working together. And it really doesn’t matter who’s physically at the bedside, what’s being done ambiently, and who’s on the other end of the camera, they’re working in concert, in service of providing the best possible care at the right time to those patients that they serve.
Saul Marquez:
Thanks for that, Bruce. It’s good to understand the strategy and the approach. Where do you see healthcare ten years from now?
Bruce Brandes:
I’ll make a couple of comments because ten years is a really long time.
Saul Marquez:
If we go with five?
Bruce Brandes:
Let’s just say impossible future. I certainly, apart from what we do, I hope for a world where incentives are aligned for providers to be compensated for keeping people healthy, not for perpetuating a sickness.
Saul Marquez:
Amen to that.
Bruce Brandes:
So I think that’s a foundational element that we should all strive for. And it’s actually a really important point, though, because I think we need to be making investments today that serve health systems well, and the reality that we are in fee-for-service for the most part, 94, 95% in fee-for-service. So we need to invest in technologies and solutions that serve us well and have a compelling ROI on fee-for-service but will be the catalyst to enable us to have the data and the delivery mechanisms to be able to more effectively and confidently start taking risk and move more aggressively into a value-based care, and the ability to, you touched on it earlier, to take care of someone not only when they’re in the inpatient setting, but in the post-acute setting, whether it’s a sniff or assisted living or in their home is going to be really critical to start to look at one neural network that is capturing data wherever someone is in that care journey, and where I get to know that individual layering an AI where I’m really starting to know that person so I can hyper personalize a consumer experience for patients and for people who are not yet patients and ideally create an environment where we’re caring for them in the lowest cost, most clinically effective venue, and many times that’s not going to be the hospital. But unlike the shopping mall, we can’t afford for our hospitals to go out of business, we need them. And so we feel great urgency in what we’re doing to help to empower our health systems, to understand how to control their own destiny, and to reimagine their care models so that they can play, take advantage of their incumbency, and their incumbent advantage as so many competitive pressures are coming their way so that in the future, the health system is a health services company that provides high acuity services and everything all the way into the home and as people are just living their lives, but to have a technology stack that, and smart care exists throughout that continuum. And I see a world where the technologies that we’re investing in now will serve us very well for where healthcare needs to be in five years.
Saul Marquez:
I want to be part of that world, and I know everybody listening here wants to be part of that world. And so huge kudos goes out to you, Bruce, and your team at care.ai for the work that you’re doing to make that world a reality. As we wrap up today’s episode, what call to action would you leave to everybody listening?
Bruce Brandes:
First of all, the status quo is no longer acceptable. And I would also challenge you, if you’re thinking about more individual point solutions that are backup cameras, that’s not going to create the transformative change that every organization needs. I would challenge folks to get out of their comfort zone and don’t start thinking about how you’re going to solve things with a product or a vendor that you’ve had for ten years that used to do one thing, and now they can do one more thing and still hamstringing you until, older technologies advance so much you’ve got to move fast. I think the most important element that I would challenge everyone to look for in a partner, we’re in the first inning as it relates to where all this is going, you need to be leaning in with partners that are agile and have the ability to understand and adapt quickly as we continue to iterate as an industry to address these challenges, because no one has it figured out yet, but those who can move fastest will prove to be the winners in the future state of what healthcare looks like and move the fastest without compromising quality and safety and everything else that is near and dear. So, break down the fragmentation, we’ve got to look more holistically at how we deliver care in new ways and a simpler way.
Saul Marquez:
Yeah. Hey, I’m glad you went there, Bruce, because, you know, there’s, this is true for not only health providers, but also the incumbent med device and pharma companies, right? Like partnering with more innovative agile companies like care.ai to take their business to the next level could also be the solution to really scale much faster.
Bruce Brandes:
Again, this is not to disparage any incumbents, but just like the challenges that many health systems face because of their legacy business and the strongholds they need to protect, it’s one of the reasons why so many health systems are struggling. So many other established vendors, and suppliers, and partners really aren’t going to be able to adapt as quickly as an organization might want. If you, as a health system, want to be able to move quickly, you really have to reassess all of your partnerships and say, is this a catalyst to get us to the future, or are they an anchor that’s going to slow us down as we need to go where we need to go? And it’s probably a combination of the two, but I think the winners will be those who are most agile, and you’re seeing it now happening exponentially in other industries. And incumbents beware, but of all the incumbents, we can’t afford to have our health systems not succeed.
Saul Marquez:
Love that. Bruce, as always, thank you. Appreciate everything that you and your team does at care.ai. And by the way, folks, the website is care.ai. We’ll leave links to all of the things that we discussed with Bruce and his company care.ai. Bruce, thank you so much, appreciate talking to you.
Bruce Brandes:
A pleasure, as always. Thank you.
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