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Manav Sevak:
Welcome to the Memora Health Care Delivery podcast. Through conversations with industry leaders and innovators, we uncover ways to simplify how patients and care teams navigate complex care delivery.
Matt Troup:
Hi, everyone! This is Matt from Memora Health, one of the medical directors and co-hosts of the Care Delivery podcast. I’m excited today to be joined by Aman Shah. Aman, thank you so much for coming on the podcast today. Can you take a moment to introduce yourself?
Aman Shah:
Matt, thanks for having me. It’s a pleasure to be here. And hello, everyone, my name is Aman Shah, and I’m the Vice President of New Ventures and Strategic Partnerships at VNS Health. For those that aren’t aware of VNS Health, it’s one of the nation’s largest home and community-based nonprofits in the country. We recently turned 130 years old, and we touch about 50,000 lives each day. We are also a health plan that really focuses on taking care of complex populations.
Matt Troup:
Awesome! Thanks for that background. I would love to know, you know, you’ve mentioned to me that you’ve spent your entire career in healthcare. What inspires the work that you do? Why do you continue to work in healthcare? What keeps you going day by day?
Aman Shah:
Matt, that’s a great question. And healthcare is really, really hard, as we all know. I got into healthcare when I was 16 years old. When I was 16, I had my mom drive me to a local volunteer ambulance squad, and my goal was to become a volunteer EMT. And I still remember, when my mom took me, and she dropped me off, and she was really nervous because you never know what you’re going to get when you call 911, and I’m still a certified EMT in the state of New Jersey, and I’ve responded to over seven-hundred 911 calls to date, and I actively rode on the back of my ambulance for over seven years. And when I did that, and when I actually was on the ambulance, I saw what I always say, the best of our healthcare ecosystem, and I saw some of the worst of our healthcare ecosystem. There was a call that I had where a patient got hit by a car, and instead of getting care from a volunteer EMT, the patient started running away because he didn’t have health insurance. And I stood there, and I was at this point 18 years old, and I remember it was raining outside, and I said, there has to be a better way. And over all of the calls I’ve been on, I have responded to more drug overdoses than I can count, I respond to more car accidents than I can count. I’ve done CPR on more patients than I can count. And constantly, there was a theme that went in my head, that there has to be a better way. And I’ll tell you this, when I was 18, I honestly thought I was going to change the whole healthcare ecosystem in that moment, and now that I’ve grown in my career, my goal isn’t to change the whole system, but to actually move the needle, because I truly believe there has to be a better way for people like us coming together and people actually coming together across the healthcare ecosystem, that together we’re going to drive change. We’re not going to do it alone.
Matt Troup:
Yeah, I completely agree. And looking at how healthcare is different or the same, in the years since you were first certified as an EMT, where would you say that there’s been, maybe the needle moved a bit, and where are we still in the same place as we’ve always been?
Aman Shah:
That is another great question. In full transparency, I don’t know if I’ve seen the needle move as much as I would have liked to, but what I can tell you and what I’m excited about is that we’re starting to have conversations. We’re starting to have conversations about value-based care. We’re starting to have conversations about putting the patient in the center of everything that we do. What I love to do is I love peeling back healthcare. So if we look at healthcare, we look at the finance of healthcare, we as a country spend about $4.3 trillion in healthcare every single year, and that number always goes up. It doesn’t go down, it always goes up. So if we peel back the layer of finance of healthcare, that 4.3 trillion, 5% of our population control, 50% of that spend. Within that, 50% of healthcare spend is covered by the US government. And if you want to drive change, you’re going to have to start there, right, so understanding where is the spend happening and how can we actually come together to decrease the spend. And I think the way we do it is putting the patient at the center of everything that we do. And what I’m saying isn’t new, we’ve been saying it for years. Matt, we can probably talk about, when you and I were both in diapers, they were talking about it. But I think now, with COVID-19, with a lot of the things that we’ve seen, we’re starting to talk about it. And what I’m hoping in the next few years is that we start taking action about it. It’s not going to happen overnight, and there’s still a lot of work to do.
Matt Troup:
Yeah, and we’ve talked a bit, you and I, about incentives, and let’s touch on that a bit. As you think about healthcare spend and incentives and putting the patient first, where could there be a paradigm shift here in thinking about how we incentivize the healthcare system and the providers within that system?
Aman Shah:
I think the incentive is to always go back to the patient. So when we look at value-based care, I love where that’s going because, for the first time, right, everyone will win when the patient does better. The problem that I always see is how do you always get a baseline when it comes to value-based care, and what we often do across the healthcare ecosystem is we start caring about someone when they become sick. I talked about, we have 5% of the population controlling 50% of our spend. What happens is when we start spending more, and the health plan sees someone spending more, we pick up the phone or our manager calls them and say, hey, is everything okay?
Matt Troup:
Yeah, right.
Aman Shah:
What’s going on? How do you shift that left? And that’s a problem I have. That’s a problem that I always think about, it’s how do you take that cure earlier, and how do you really care about the patient? That problem is a problem that we’re not talking about at a level that I would like us to talk about yet, but we have to start somewhere. Like, I’m not going to hit that home run like I thought I was going to when I was 18 and really change the whole system, and I think now we’re really focused on making sure that 5% doesn’t become 2% controlling 50% of the spend, doesn’t become 1% controlling 50% of the spend. So at least we’re focused on that piece of the puzzle, and that’s important for now. And as we’re able to shift, we’re going to have to what I call on product development shift left to really focus on the entire healthcare ecosystem from cradle to grave. What we need to do across our nation is not just focus on people when they become sick, but focus on actually taking care of people and doing preventative care so we actually care about them early on in their life, not when they are costing the healthcare ecosystem so much money.
Matt Troup:
Yeah, moving upstream for me is often a passion, as like, how do we more incentivize and prioritize preventative care rather than just waiting for something to happen and being so reactive, anticipating the needs before they actually become issues? So much of the work that I’m trying to do now is in that realm, and that’s what leads me to feel like I need to innovate. We’ve talked a little bit about innovation, you and I. How do you define innovation, and how do you really think that innovation, specifically maybe in the digital health sector, can really maybe start to make some changes here?
Aman Shah:
So I love the word innovation because it’s a word that we throw a lot around, just not in healthcare, but just in the world. We’re going to innovate, we’re going to do this. So I think the first thing is, or if you’re a payer or you’re a health system that’s looking to innovate, to find what innovation means to you. And to me, innovation is very simple. And I always say that innovation does not have to be sexy to work. You don’t have to build the next ChatGPT. But innovation is meeting the unmet need for a consumer. It’s that … And how do you meet that unmet need is what drives innovation. And within healthcare specifically, there’s a lot of unmet needs, there’s a lot of cost, there’s a lot of … We can talk hours about and peel back the layer on all of those things, but when you want to be innovative, the first thing you need to do is identify what problem are you looking to solve and then ideate on solving that problem. So if you’re a large company looking to innovate, first, really identify, how does your organization find innovation? The second thing is you want to create a framework for how are you going to innovate, and it should always start with the problem you’re looking to solve and not with a solution you’re looking to launch. Because an average product takes seven times to find product-market fit, so I can almost guarantee you that your idea is wrong.
Matt Troup:
Doesn’t mean it’s a bad idea.
Aman Shah:
Just figure out what the problem you’re looking to solve and create a framework to do that. The third is you need to actually create empowered cross-functional teams. If you’re a bigger system, your team is probably siloed. You know, marketing is one section, sales is in one section, product development in another section, and they don’t often talk to each other. So how do you actually create cross-functional teams to talk to one another, to be able to innovate? And then you need to align incentives like you and I have talked about. Just because you tell your team to innovate doesn’t mean they’re going to innovate. How are you going to align incentives at a leadership level to enable them to be innovative, to actually make them want to be innovative? That is so, so important. And after you figure that out, which is super, super hard, the next thing you’ve got to figure out is, what are your focus areas, and what are the problems you’re looking to solve? And I’ll say that over and over again. People call me all the time, and they have all these great ideas, and I always ask a simple question. Which one? What problem are you looking to solve? Question two: What outcome are you looking to achieve? And most people can’t answer those two basic questions, because although they’re basic, it is very, very hard to find.
Matt Troup:
Yeah, agreed. So let’s say we’ve defined innovation. We’ve picked the pain points that we want to solve for, the many pain points you could solve for in healthcare. In your role, as you’re evaluating new companies, new innovative ideas, you mentioned the question that you ask, but what are you really looking for, and where do you think there actually is opportunity here? Especially as value-based care starts to take off, are you seeing, you know, early-stage companies that are really starting to like have these light bulb moments for how maybe to move that needle?
Aman Shah:
No, that’s a great question, and I’m going to break it down from like, what do I evaluate, and then, kind of what am I seeing in the market? So things that I evaluate when I’m looking at like a new company, team is everything, right? So the first thing I evaluate is people, which is why even at a big company, I always focus on empowered teams. Are these the people that are going to actually drive this idea or this concept to success, knowing that it’s going to pivot seven times? The second thing I focus on is, problem. Is this a problem that is big enough to solve across the healthcare ecosystem? Is this a problem that has high spend right now? Is this a problem that has a lot of market need? Then, focus on progress. I don’t know if you ever heard of like the experimentation mindset, the test and learn mindset. So I love creating experimentation teams. And when you’re going to build a new idea or build a new business or a product, the most important thing to do is de-risk your idea. Then de-risking your idea is asking yourself a simple question. When you identify a problem you want to solve, and you identify how are you going to solve that problem? What’s the next thing you need to do to go learn from your consumers to actually validate your idea? We often spend a lot of time on calls, or in boardrooms like, this is going to work, this is going to be great, and we forget to talk to the customer. We forget to talk to the patient. So I focus a lot of my time, when I’m looking at and evaluating these new companies, how much progress has been made? Have they truly de-risked their ideas? Have they truly used a test-and-learn mindset? Are they creating new assumptions to test in the market and learning from those ideas? And then the last piece is always shoot economics, right? Like understanding how is the business model going to work? Matt, you know, when we talk about diabetes care, we can talk about it all day, but what does that truly mean, and how are we going to actually impact that? So that’s how you evaluate, right? So it’s a simple process, but it’s how I evaluate. What am I seeing in the market, what I love about healthcare, and how you can actually track healthcare innovation is you can also focus on healthcare policy. So healthcare is probably one of the few industries that innovation actually follows healthcare policy because the government is changing incentives, the government is changing how we actually get paid, and as they’re doing that, you can actually follow how innovation is going. So I’m seeing a lot of dollars and a lot of investment go into the mental health space. The difference within mental health now versus in 2020-2021 is we’re spending a lot of time on the clinical models, more evaluating companies mental health, and we’re also trying to really focus on how does mental health actually focus on your whole health. And in the past, I believe, I’m not a mental health expert, but in the past, when we were looking at mental health, they were only taking care of mental health, and we were only focused on the behavioral health spend, better actually compare that to your total health spend. Because if you don’t take care of your mental health, why would you want to go to the gym? Why would you want to take your medication or do any of those things? So that’s a big focus area, member engagement and retention, and I’m talking Memora Health, is a huge focus area. But I think what we need to do for member and user retention is truly understand the problem we’re looking to solve around member engagement and how are we going to then approach and solve that problem, so that’s a big focus area. Complex tier management continues to be a huge focus area that I look at, which is how you take care of longitudinal care patients, really focusing on that 5% charging 50% of the spend. So those are a few areas that I’m also seeing a lot of innovation in.
Matt Troup:
Yeah, that’s awesome, and I really love thinking through those different areas. Let’s touch on member engagement for a minute, something that’s near and dear to the work that we do, both trying to just keep members and largely individuals connected in their care. But how are you thinking about member engagement and how members are having improved access or trying to remove the barriers to access and just have, be more informed consumers themselves?
Aman Shah:
So there’s this visual look at healthcare and housing that we need to make healthcare simple, to understand, easy to access, and meaningful in outcomes. And if you’re looking at it from a member engagement perspective, the problem to solve is everything that you just said. And what I haven’t figured out is how to solve that problem, but what I can say is when we look at other industries, they have figured it out. Like if you simply go on Amazon.com, they know how to target you, they know what you need, they know exactly what you’re looking for. But what is so difficult today, and things that actually pain me as a consumer within healthcare, is like finding a physician. How do I find a physician? How do I find the best doctor? I don’t know. And I work in healthcare probably 60 plus hours a week. And if I want to find a physician, I actually call people at work or call my friends and say, who’s your PCP? And it’s not as simple as going to Google and typing in, who’s the best doctor in New York City? And the things of like buying a product that are so simple and easy, for healthcare, it’s not. And if you think of it from that perspective, how can your players actually enable you to find a physician better? Like, that’s a simple way to do a member right. And we can start there, but there are so many things to peel back the layer. And the reason I said like, what problem are you trying to solve? That’s a problem for me. What’s a problem for other people when it comes to things that they can’t find across the healthcare ecosystem? I think that’s where we need to start, and then we can actually have our health systems and our payers actually then enable us to start solving those problems.
Matt Troup:
Yeah, I guess, would you say that that’s maybe the biggest opportunity for innovation for health plans in 2023?
Aman Shah:
I don’t know if I would say it’s the biggest opportunity. I would say that if I was a health plan looking to innovate in this space, I would peel back the layers as to what are my consumers searching for, not through calling me, but what are my consumers searching for? What do my consumers want? What do they need? And then solving those problems. I think what we do too often is believe what they need and then solve for that without spending the time of actually understanding what it is. So if I came out and said that’s the biggest problem to solve for, I’m sure people would start peeling back the layer and say, oh, let’s go solve for that problem. But I don’t know if that’s the biggest problem to solve for, because we have this from the time and truly understanding the problem, because I’m an N of 1. I’m telling you my biggest problem across healthcare, but I don’t know what the true problem is.
Matt Troup:
Yeah, that makes sense. Just want to pivot a little bit, just for a minute. Both you and I have been clinicians in healthcare. We understand the weight of being a care provider currently in 2023. Where do you think we can better inspire clinicians and care teams? You’ve talked a lot about culture myself, moving from the bedside after a decade into tech now, and outside looking in, I realize the cracks that are starting to form. What’s the opportunity there? Is there an opportunity to innovate?
Aman Shah:
There is so much opportunity. These are actually my shower thoughts, Matt, like, how can we maximize clinicians? We’re estimated to have a gap of 18 million clinical workers by 2030, and the gap is also going to increase, so how do you actually take better care of your clinical teams is a huge passion of mine. One thing is I think technology is actually truly going to help in this space. I told myself I wasn’t going to mention AI on this podcast because we hear it way too much, but with AI, I think there’s a lot of actually good work happening with clinical documentation space, which is going to enable us to do our jobs by the bedside a lot faster and reduce pajama time. I believe that will be a fast innovation that healthcare can pick up and actually do. The other side that I am peeling back the layers on today is how do we actually reward and incentivize different types of care teams across the healthcare ecosystem for all people, right? We all work for corporate. My biggest pain point is that we’re all treated the same, right? You’re always incentivized, with a bonus, or you’re always incentivized with a certain thing, and what Matt wants and what Aman wants is so different. I think what we need to understand for our health clinicians is what drives a physician, what drives an EMT, what drives a personal care worker, what drives a nurse, and then how do we create reward systems to drive … There’s statistics that show that if you actually bonus someone $10,000 versus if you do something really, really nice for them, they actually value the nice thing you do for them over the $10,000 because that’s culture, it’s team, it’s all of those things. But if you break down the healthcare clinician space, I’m sure everyone’s different. And a big thing that I’m personally looking into is how do we incentivize these people? How do we incentivize them to love what they do every single day? Because no one got, when you became a clinician, I don’t think you got into clinician saying, I want to get burned out. Tell me if you did that, tell me if you did.
Matt Troup:
Yeah, no. No, did not expect that as an outcome. But you’re right, we don’t incentivize empathy often, right? We incentivize how quickly are you getting patients through the system. What’s your billing rate? What’s your documentation look like? And I think that is where there’s a significant opportunity.
Aman Shah:
When I first became an EMT, I did it because I think everyone has an emergency like they want to drive change and you become a first responder. When I became a first responder, I loved what I did because I got to walk into people’s homes at the most difficult time for them, it was the hardest time for them, and I loved everything that I did. I would then go back to the squad house and after the call, I had to spend 2 to 3 hours filling out paperwork, that I didn’t care to do. And there’s often times where my lieutenant would be like, make sure you triple check that one just in case you get sued. I was just trying to save someone’s life as a volunteer EMT, now you’re threatening to sue me. I’m 18 years old, I’m happy. So how do you like, those are the challenges I love diving into and really figuring out back to what I was saying when I was 16 years old, there has to be a better way, something that I always think of.
Matt Troup:
Agreed. On that note, as we wrap up here, if there’s one thing you want people to know about healthcare, what would it be?
Aman Shah:
There’s one thing that I want to learn about healthcare, it’s that I truly believe that we can drive change, but we have to do it together. There’s a saying that if you want to move fast, do it alone, but if you want to move far, do it together. And we’re always constantly looking at, what is this person doing in healthcare? What is that person doing? And we’re constantly creating that competitive mindset. But in healthcare, our outcomes should be about the patients. And I truly believe that the only way we’re going to go far is that, if we come together as a healthcare ecosystem, if we align incentives amongst each other and really are able to drive that change together.
Matt Troup:
Yeah, I so much appreciate your time today, your insight is really inspiring. And I think keeping patients at the front and center is the key to this, so Aman, thanks so much for the time. I hope we get to chat again soon. Anything else for the listeners today?
Aman Shah:
That’s all. Thank you all. Thanks for listening.
Matt Troup:
Awesome.
Manav Sevak:
Thanks for listening to the Memora Health Care Delivery podcast. For more ideas on simplifying complex care for care teams and patients, visit MemoraHealth.com.
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