Increasing Revenues by Improving Clinical Workflow with Tashfeen Ekram, Co-founder and Chief Medical Officer of Luma Health (transcribed by Sonix)

Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes, and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez.

Saul Marquez: Welcome back to the podcast. Today I have a special guest for you today. His name is Dr. Tashfeen Ekram. He’s a Co-founder and Chief Medical Officer of Luma Health. He’s also a practicing radiologist at the Redwood Radiology Group specializing in chest imaging. Dr. Ekram successfully built and currently oversees two patient programs for valve replacement and lung screening. In his role as Chief Medical Officer, Dr. Ekram serves as a strategic customer contact to ensure the company’s patient relationship management system, delivers optimal clinical workflows, and the company’s patient relationship management goal meets the goals of the company. Dr. Ekram also drives medically focused product innovation and identifies and leads partnerships efforts to further expand product application areas that help orchestrate the entire patient journey. He is an outstanding individual, also a self-taught coder. I’m excited to have him join us on the podcast today. Welcome.

Dr. Tashfeen Ekram: Thank you so much for having me.

Saul Marquez: It’s a pleasure. So is there anything in that intro Dr. Ekram that I left out that maybe you want to highlight?

Dr. Tashfeen Ekram: No no I think it was a good intro I think it’s hard to sum it up I split my time between kind of being a physician and taking some of that my experience of being a physician and driving some of the work we do a little well.

Saul Marquez: Love it. And so what does that get you into the healthcare sector to begin with?

Dr. Tashfeen Ekram: One of the big reasons I went into medicine was that it was a very unique way for me to combine my somewhat geeky interest in science but also helping people on my phone and early on in my career that I really enjoyed working with people and helping them solve problems. I Mean in a very intimate way but at the same time I saw that a strong interest in science and it was a very convenient way to kind of combine the two in one way that it kind of satisfied my academic interest in science and being kind of in the nitty gritty details of things. But at the same time using that science to get that science knowledge and driving the actual outcomes or patient satisfaction.

Saul Marquez: I think it’s a great combo and so you’ve obviously done some really great work around improving patient outcomes and now your work with Luma. What would you say needs to be front and center on today’s healthcare leader agenda and how are you guys addressing it?

Dr. Tashfeen Ekram: So I think one of the most important things that I think we as a nation as a U.S. healthcare system both at a very macro level and a micro have realized that the way our current healthcare system works it’s kind of broken. Just to give an anecdote what really drove the home we drove this point home for me was when I did a lot of my training in Michigan in Southeast Michigan. And so I was very intimately familiar with the car industry there. And although I didn’t actually work with them I had a lot of friends. And during that downturn when the Obama desperation came and bailed them out. One of the most important or interesting anecdotes that came out of that was that if you asked GM for example what was the greatest cost in them building a car, it wasn’t the manual labor. It wasn’t that I read those going into it it wasn’t anything that was physically in the car. It was actually healthcare. I don’t offhand remember that number that they gave. I think I was around 25 to 30% of the cost that you as a customer paying for a car actually went in paying for healthcare. Those are healthcare for their current employees and their retirees. And it’s kind of kind of an odd thing to think about when you’re buying a car you don’t think about that a lot of money is going to go for pay for healthcare but that I think that was actually a symptom of not something inherently wrong with GM was actually something inherently wrong in our entire healthcare system and I think we’ve known this. Anyone who’s been in the thick of it you look at the last 10 to 15 years the costs of healthcare in this country have been rising exponentially. But unfortunately our outcomes are pretty flat. So if you compare us to other Westernized nations…

Saul Marquez: Yeah.

Dr. Tashfeen Ekram: Our outcomes are actually worse. Or maybe on par with them but our costs are rising and so I think the greatest problem that we have is to address this issue. And there’s obviously a lot of many efforts that have gone into trying to solve this. We know where the solution rise. But I’m kind of looking at working with a lot of physicians working within Luma Health. One thing that I’ve become a fan of is what we put forth as value based medicine which kind of helps to balance the patient outcome. Looking at costs and kind of bringing all the stakeholders kind of on the same page. And so what is difficult about that as a provider is that most providers don’t like a lot of this legislation that’s come in around value based care whether it’s MIPS or any of the other kind of forms of value based care that’s coming. And I think one of the things that I’ve taken from my experience in working in the trenches so to say as a provider and seeing that the pains of trying to adjust our whole system from what we are currently on a fee for services model to a value based model is that there’s a lot of change that needs to happen. And so I’ve tried to embody some of that experience and some of the pain that comes from that into what we’re trying to do at Luma Health and that our platform itself is a messaging platform. But really what we’d like to do is just make you more efficient at what you’re supposed to do and make you a more efficient provider in healthcare system. And that’s exactly what kind of is embodied in value based care. And so our goal is to help you make that transition in a way on the patient messaging front from what you are doing today which is kind of more trans actually driven more you know you do something and you get rewarded for it to being one you’re driven by outcomes and that nicely transaction driven but driven for you actually rewarded for driving better outcome for the patient better patient satisfaction and lowering costs.

Saul Marquez: So let’s let’s dive into that a little bit. Can you give us an example of how you guys have done this at Luma?

Dr. Tashfeen Ekram: Yeah. So for example we look at some of our endocrinology practices. If you look under the nitty gritty details of MIPS you’re rewarded on an annual basis to see your patient, to have their put examined documented, to have their eye exam documented. Now in a traditional model you’re still rewarded for bringing those patients back in but you’re awarded purely based on that visit and then you’re billing for that visit. But what happens of fortune in most of these practices that there each providers may be covering 5,000, 6,000 patients. And it’s very difficult to keep track of who has come in who hasn’t come in and not just that the barriers of getting the patient in are not just merely about let’s just find a time slot for them it’s all about you know do they have a ride. Are they engaged? Are the educated? Does the patient know that they should be coming in? And so we extract all that and we try to understand where the patient is and they’re kind of in their employment lifecycle and get them back. And so for example we’ll go to a diabetic practice and say “we will help you identify all your patients that haven’t been in for your annual foot exam and not only will we message them and engaged them and educating them about what it is that they need to get in for.” But we like to make convenient for them to book that appointment. So for example we sell them educational materials saying “hey look you know getting in for your annual foot exam can save you from a life threatening foot infection. Here is an easy way for you to get in” and we’ll message them and put a little link on there for our web scheduler. And so the idea is that we can help take the existing data that’s existing in their EMR’s and help them make sense of it and be able engages patients with other practices having to really change much of what they do.

Saul Marquez: I think it’s really neat and just working on the patient front, trying to help leverage sort of the gaps in care and creating some sort of way to bridge those gaps I think is really key. You talk about value based care it’s definitely on the mind of a lot of the listeners and a lot of the healthcare leaders. And so it’s great that you guys are working to make it granular and make it actionable. Can you talk to us about maybe a setback that you had early on and what you learned from that as it relates to value based care?

Dr. Tashfeen Ekram: A setback relates to value based care. I can tell you about a setback I had before this which actually helped me drive some of what we’re doing today.

Saul Marquez: Love it. Let’s do it.

Dr. Tashfeen Ekram: And so during medical school one of the challenges that I found was and because I work in Southeast Michigan, patients didn’t have access to cheap medications. And what would happen was we would send them home we discharge a patient from the hospital and give them a medication that’s most appropriate for them not realizing that it was way too expensive and it was out of the financial capabilities. And so I thought hey look I need to solve this problem in my back off some of it. As you mentioned earlier is someone technology. So my guess I look at all problems if technology can solve it which is not always true. But that’s my tack at a lot of things. And so I decided to actually build a website that curated pricing information across a lot of different pharmaceutical websites and then also try to layer on top of that therapeutic equivalent. So for example if you were on a particular medication I could help surface to you a cheaper equivalent of that medication. And the idea being that the patient would say “hey look I can’t afford a brand name drug but here is a therapeutic equivalent or a cheaper drug that I can get.” So I got a little bit of you know initial traction with that. The one thing I realized was that the decision maker wasn’t the patient. But my important most important learning lesson from this was I spent a lot of time curating the web, collecting a lot of data, and I realized that the best way to solve problems is to actually talk to the patients and figure out what’s the best way for them to sort out what’s what you do it from that customer and ask them before spending a lot of time and investing a lot of effort in trying to solve the problem. And the best way to solve problems is not to put a lot of money into it or technology into it but actually get a fix of it to understand what the real problem is and then to build something that’s really small and easy to shorten the time and effort that goes into solving a problem.

Saul Marquez: I think that’s so insightful and you know there’s definitely I think a lot of people tend to go to the sort of hey let’s build it and then see if it solves the problem” and it sounds like definitely the solution brought out from this was talk to the patient, get some solutions first, and then build that right.

Dr. Tashfeen Ekram: For sure and I think we’ve embodied a lot of this now as we’ve built at Luma Health in our first days. Our initial product was a lot around getting patients scheduled but a lot of it was driven by just working directly with providers and trying to figure out what was a core problem they’re trying to solve rather than us assuming that this is a problem that they want to solve and this is a solution for it rather we kind of work around figuring out what exactly is a problem with that and kind of solve and trying to see if we could solve that problem with too much effort to really validate what we’re doing. It was gonna drive that early for our customers.

Saul Marquez: I think that’s a really great call out. And so we’ll now that you’ve worked through some of the bugs, you’ve gotten some major strides ahead of you. What do you say is one of your greatest accomplishments or one of your proudest moments in medicine?

Dr. Tashfeen Ekram: Yeah that’s a great question about my proudest medical accolade. I think one of the problems that I had in my practice and I think this is what really shines for me because a combined some of what my personal experiences as a provider and some of the work we’re doing at Luma Health was a problem that some in my practice which was that it was a great percentage of patients being a radiologist who weren’t coming in for their annual mammogram. And this was particularly challenging to me because there’s good data around how effective annual screening is for a mammogram, how many lives saves it equates to. And so this was actually a challenge that we took up at Luma Health saying “hey look we can help these patients.” And so we set up a messaging chain or messaging platform for one of the local practices that I work with and help their patients get engaged which the educational message and a way to drive them to becoming schedule. And what was the reason why I see it as one of the proudest moments for me as a physician is because it helped me combined between what I was seeing on a daily basis it was patients who were not being seen and combining what we’re trying to build at Luma Health which was trying to get these patients back in the door. And what was most exciting to me about this was that the baseline adoption rate for a mammogram in our mind look we’re just almost around 30 or 40% we were able to drive this up 10 to 20% depending on the geographical location and what’s most exciting to me about this is actually equates directly with lives saved. And so I think this was for me as a physician you know we look at one patient at a time we’re addressing the patient and their issues. One of the most compelling things about wanting to start something like Luma Health was that I saw problems in my practice that were systemic that were broader than what I could do as a physician. And for example that was our own health illiteracy the patients just don’t understand why for example getting an annual mammograms is effective for them to reduce the risk for developing breast cancer and improves their longevity. And what Luma Health did was and which is what I motivations in wanting to this is address some of these systemic problems that are in the healthcare system whether it’s health illiteracy whether it’s in patients access to care. And I think that one of the things why this was kind of a proud moment for me personally satisfying for me I should say was that these are patients I was seeing every day and now I in my own local community I was able to drive greater adoption of demography by just using a simple messaging platform that combined between open next giving patients access to scheduling and patient education.

Saul Marquez: I think that’s so powerful yeah just finding a way to broaden that impact that’s that’s so great that you’re able to implement those systems and and came up with a great way to save some lives. So you guys are doing some cool things over there no doubt. What would you say one of the most exciting things that you’re working on at Luma is today?

Dr. Tashfeen Ekram: Yeah I think the one went the one direction we’re trying to push our product is into further automating a lot of the conversation that needs to happen around the appointment lifecycle. So a lot of the communication that happens between a patient and a provider or provider in a patient depending on extraction or talking about is manually driven or it doesn’t happen. Some of it’s just something as simple as just a pre appointment reminder. But some of it could be some of what we talked about helping patients understand hey you need to get in for your annual diabetic foot exam. But I think what really we are really excited by is probably broke into two categories one driving some of this conversation and making it even more personal. So understanding a lot more context about what’s going on with the patient and being able to deliver that nudge to get that patient to the next step. So for example we understand that a patient was recently discharged from a an episode of mycarreon valve or a heart attack. My understanding for example what were what actually happened with the patient while they were inside the hospital and to drive some of that conversation and deliver the content that they need to make sure that their recovery outside of the hospital happens. So I think what we’re trying to do is basically create and scale a physician and their ability to give advice and provide or deliver healthcare but be able to capture some of that in an automated way so that the physicians to focus on things that are much more in front of them. So that’s kind of one thing where we’re trying to drive some of the conversations that has to happen in a more ordered way or more but driven the way the other is. And I think this is kind of a general trend we’re seeing in a lot of different companies that physicians regenerate tons and tons of data on. Unfortunately we actually don’t use a lot of the data. And so one of the exciting things that we’re trying to do is trying to help practices understand what are the gems that are existing in there and all this data that they’ve collected. And so one of the projects we’re working on right now is doing some sort of some cancelation modeling to help understand for example can we predict patients not showing up to an appointment right before it actually happens. And this is kind of important on two fronts. It’s important one front because if the patient doesn’t show up they get lost to care and they might not get to ever get connected back to care which then means that they can have potential bad outcomes. The other thing is which is equally important is that data has shown is that patients who have poor adherence to appointments are showing up at appointment are actually a target to poor health outcomes. And so we can help to do is by just looking at scheduling behavior we can help you model for your practice or for a healthcare system. Who are the high risk patients for you that are going to get the sickest. And so that we can do more targeted outreach to them, we can make sure that they get it for their appointments, we can make sure that they’re getting the annual foot exam whatever it is. So I think broadly speaking what we’re trying to do is really help to further automate a lot of that engagement or conversation that happens around it and it had to be really data driven.

Saul Marquez: I think it’s wonderful and it’s so great that you’re approaching this Dr. Ekram with such passion and also optimism. I feel like there’s a lot of people that have lost faith and have stopped trying to be honest. And it’s great that you’re looking for ways to continue finding opportunities to better engage patients, to empower physicians. And so kudos to you for staying focused then and solution oriented in the thick of it. So I just definitely want to give you huge huge kudos for that.

Dr. Tashfeen Ekram: Thank you. Much of it. I’m definite an optimist maybe but I think that there isn’t a problem that can’t be solved.

Saul Marquez: I love it and that’s great. I definitely agree. We have to be looking at this with a solution lens folks. So if you’re feeling like you’re down in the dumps and that there are no there is no way to do it, take some inspiration here with our talk with Dr. Ekram, getting close to the end of the podcast here we’ve got four questions. Lightning round style for you followed by a book that you recommend for the listeners. You ready?

Dr. Tashfeen Ekram: Let’s do it.

Saul Marquez: All right. What’s the best way to improve healthcare outcomes?

Dr. Tashfeen Ekram: I think getting patients, access to care, and educating patients. I think there just there’s so much health illiteracy out there the patients don’t understand. And I think if you empowered them and help them understand why it’s important to get access to the care they would do it.

Saul Marquez: What’s the biggest mistake or pitfall to avoid?

Dr. Tashfeen Ekram: I would say is by really so what we just talked about assuming that the patient understands and talking over the patient. And I think unfortunately we might not spend enough time trying to educate patients. And so we assumed that patient understands what the next step is and not realizing that that’s actually not the case.

Saul Marquez: How do you stay relevant despite constant change?

Dr. Tashfeen Ekram: Putting in processes that won’t always be actually let me step back maybe data driven and I’m putting in process to always look at what your data looks like and being always open to change.

Saul Marquez: What’s one area focus that drives everything in your organization?

Dr. Tashfeen Ekram: Being patient focused.

Saul Marquez: And what book would you recommend to the listeners.

Dr. Tashfeen Ekram: I’ll answer this with two books if that’s okay.

Saul Marquez: That’s fine.

Dr. Tashfeen Ekram: So one of my favorite authors Atul Gawande. So it’s better A Surgeon’s Notes on Performance and he’s got several books. I think one of the most important takeaways from his book is that he emphasizes always learning and he actually gave my graduation talk at my medical school and that was his takeaway point. Even though you’ve finished becoming a medical student you actually have just begun your educational process. Nothing that’s great for anyone. It doesn’t have to be in just in healthcare. And the second book I would say is Lean Startup and although that book is focused on helping individuals start a company from scratch I think one of the important lessons that we kind of touched upon us earlier is that if you’re looking to solve a problem look to solve it in the cheapest way possible before spending too much time and effort into it.

Saul Marquez: Love it. Great recommendations there, would like for you guys to do is to go to outcomesrocket.health and look up Luma Health and you’re going to find that the entire podcast interview with Dr. Ekram, show notes, transcripts, links to all the things that we discussed, it’s all there. Just go to outcomesrocket.health, Luma Health and so before we conclude Dr. Ekram, I’d love if you could just share a closing thought and then the best place that the listeners could get in touch with you.

Dr. Tashfeen Ekram: Yeah I’d say that if you’re looking for a way to drive patient engagement embrace value based care and see how patient engagement and patient messaging fits into that. Please feel free to reach out to Luma Health. Our website is lumahealth.io

Saul Marquez: Outstanding. Dr. Ekram, just want to say thanks again for spending time with us.

Dr. Tashfeen Ekram: Thank you for inviting us.

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.

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