Using Real World Evidence to Accelerate Development and Impact of Treatments with Jeremy Rassen, Co-Founder, President and Chief Scientific Officer at Aetion, Inc.
Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas, great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is slow. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.
: And welcome back. It's a pleasure to have you all back on the podcast today. I have Jeremy Rassen. He's a Co-Founder, President and Chief Scientific Officer at Aetion. Jeremy is an Epidemiologist and Computer Scientist with 20 years of experience in the Science and Technology of Big Data. It's this awesome combination that helped them put together the resources and plan for the work that they do there. He was an Assistant Professor of Medicine at Harvard Medical School where he developed cutting edge methods for developing quality evidence using real world data. Prior to that Jeremy spent a decade in Silicon Valley. He was the fifth employee at Epiphany Incorporated where he was involved in the creation sale and deployment of data intensive applications for marketing and customer relationship management. There's no doubt that the shift that we're having in health care is going away from the typical Hey devices life sciences approach. It's all about what you could do with data to improve outcomes and so it's such a pleasure to have Jeremy on the podcast today to share his insights in this space. Welcome.
: Thank you.
: It's a pleasure to have you Jeremy. Anything that I left out in that intro that you want to share with the listeners?
: No I think that was pretty comprehensive.
: Awesome. Well listen there's no doubt that paths lead into health care and a lot of different reasons a lot of different ways. But what was the way that you got that into health care?
: You know I think in your intro you almost had it as you mentioned at the beginning of my career I spent about 10 years on Silicon Valley working on big data applications I was computer science undergrad went back to where I'm from which is a San Francisco area after school and got engaged in all the tech that was going on there in the mid to late 90's and really adored the technology, I really enjoyed the technology of using data sets to find these interesting associations to find even interesting causal facts. I wanted to apply that in a way that was different than what I was doing out there which was large as you said in marketing and customer relationship management. So transitioned to health care and my first step there was getting a doctorate in Epidemiology at the Harvard School of Public Health. And if you think about public health my parents I grew up in San Francisco they said their father is an internist in San Francisco. My mother ran a large social service organization. So if you average out the two you kind of get public health. So going to school, public health and getting degree in epidemiology felt like a return home in memories but also return home in the sense of being able to take the kind of questions you were asking of the data and apply them to a whole new field that is to say effectiveness safety and value of medications.
: I think it's so fascinating Jeremy and it's really interesting how you sort of dovetailed all that into the public health and and with your background in Computer Science. I think now is the time and everybody is talking about value-based care. What do you do? How do you do it? What does it mean? And so I love that you and your team are are working to quantify and really find a way to scale these things that are essential to our business and for our patients.
: You don't have to say that was one of the first things I've worked on in Boston and identifying named Sebastian. Sebastian had spent the prior 10, 15, 20 years thinking about how to use the data sets that came to be as part of the running of the health care system claims medical records and other data to really evaluate safety effectiveness and value in particular out of medications. And he'd been thinking about that in a very structured epidemiologic academic way. I've been thinking a lot about data and really from that from the first moment we put our hands together and said how can we take that really strong causal thinking that's developed in the field of epidemiology and put that to work at scale which is the big part of it. Put that to work at scale for answering these questions of value that we all have.
: Super interesting. So you're taking a look at this data and you're trying to figure out how to make the best impact and health care. What would you say today is the big hot topic that needs to be on all the health leaders agendas today and how are you guys at Aetion addressing it?
: It comes back to value for me. I think the inside the healthcare field at this point and talking to friends and colleagues who are outside the health care field gets pretty clear that the rising costs aren't good for patients they aren't good for the health care system and you know ultimately they have to be unsustainable. So thinking about how to spend money in a way that improves patient outcomes it also sustains the system. As a hot topic in our wrap up and call that call it value.
: It's really important to look at this and some curious how are you guys looking at value and how are you helping health systems look and measure value. I think this is a thing that a lot of people struggle with.
: Yeah we really look at values starting with decision. There's a thousand decisions made. You know every moment in health care as a scientist I have to be careful with numbers but a lot of decisions being made. Every moment in health care and those can be small decisions at a clinical and for one patient large decisions happening at payers or for pharma companies or other places affecting many many patients and I think the vast majority of the decisions are being made today or done either with intuition rather than evidence or with evidence that isn't really pertinent to the patients and that decision will affect. And so I think a lot of what we do is intuitive. We have the data and now, we have the information now to do this based on evidence to make these decisions based on evidence and not just any evidence. I think there's a lot of evidence out there. Our's a randomized trial year. That's a very high quality but doesn't necessarily describe the patients that we're treating at any given moment. It could be that the trial was done in a particular part of the country or in particular patients subsegment with a particular set of comorbidities. We need evidence that supports decision making for all patients and for patients in particular who were treating in any given moment.
: So Jeremy that's really interesting and I think it's important that we start looking at that I mean I think of let's keep it simple right like cable. If your cable company doesn't deliver what you believe is a good internet speed. Guess what you're going to cut them out in the same way as kind of happening here in health care. You know rising health care premiums have got rising co pays. So now you go to your grocery store and you've got this like Smart MRI place. Now they're actually giving you options. You're going to pay less for it. Value is something that we need to deliver. Can you give the listeners an example of how your company has helped organizations create results through this value perspective?
: You know absolutely and you know I'm thinking about the MRI exam.
: That might be incredibly important for the treatment. One group of patients but much less important and perhaps even an important to remain powerful for another group of patients. There is certainly a cost of a certain kind of cost for patients with her procedure that he or she doesn't need. So that's in some ways the context that I think about value in. And so you know one example that we've engaged with here at Aetion is working with a pair here in the Northeast where they had a pretty general question and that question was, helped us better care for our diabetes population. Diabetes population at this pair large and growing and growing in terms of the disease itself the diabetes itself but also all that comorbidities that go along with diabetes and all the utilization and cost that ensue from the diabetes and comorbidities. And so those were the pretty big question. Now help us better manage her diabetes population and for us managing rather answering a question like that starts with really understanding who the patients are. Who is this population? And so to do that you want to break down the population using the data for the pair because that's representing ultimately the patients that they're caring for not national data not a randomized trial that 70 Ram payers data and really digging into those data to understand who the patients are? What kind of treatments they're currently experiencing? What kind of outcomes occur and how we could possibly change those outcomes or some or all patients? So with this particular payer we help them break down their diabetes population and show that it really wasn't monolithic in any way. They certainly knew that but described the ways in which it wasn't monolithic and in particular there was about 10% of the diabetes patients who were particularly severe particularly high risk and high risk both of a progression of diabetes but also these comorbidities type which I mentioned before. So as I said that's 10%. That's a relatively small number. But those 10% were being treated to guidelines and the way the other 90% work. And the guidelines say you start with the first line therapy that doesn't work. You move on to kind of something in the middle between first and second continue with second line therapy. And what we showed was having identified these 10% of patients if they're treated directly with the second line therapies which are more expensive they cost more but that cost is over the ensuing months represented much better outcomes for the patient and much fewer E.R. visits and hospitalizations, another kind of high cost services for the payer. So that's not everybody, that's one in ten. But if you think about how to treat the one in ten differently than the nine in ten, you end up with amazing results both for the patient and for the system itself.
: So yeah that's really neat Jeremy. And the interesting part. You know a lot like it's sort of a microcosm of the health care environment that we're in. Most of the spend goes the 5% of the issues that are out there. And the nice thing that your company is providing sounds like you're giving these people not a representation of the U.S. but a true analysis of their population.
: Absolutely. Every entity within health care has a certain group patients for whom they were responsible. A payer population, health systems, patients that they're treating. In this as you can get closer and closer to really looking at how to improve outcomes within that specific population under treatment, I think we can do better and better.
: Yeah and a lot of times we think of value-based care. Your mind and you know through conversations you typically go to like. All right. What value are you providing patients? And I think another way we should be thinking about it Jeremy and appreciate you for taking this up is what value are you providing to providers and helping them identify the best treatment for patients. As a payer for instance you're collaborating with the other stakeholders in health care. Value-based care is all about collaboration between all the stakeholders.
: Absolutely. And we see that as a very core part of what we do which is to help bring these stakeholders together on a shared and transparent and well understood evidence base that's pertinent to the patients being treated pertinent to the population is being cared for and to do that we need. Good data.
: And you know over the last 20 years I would say there's been a huge advance in a methodological basis for real world data analysis to real world evidence and say in 20 years that we are looking at randomized trials as not just a gold standard perhaps the only way of really getting at these important questions of just drug A work better for drug B among patients with very severe diabetes and substantial comorbidities. A randomized trial 20 years ago may have been seen as the only way to answer a question like that. Today we have the epidemiologic basis and scientists are sorry for going into the...
: That's all good.
: In methodologic basis for really doing that either with a randomized trial or with the data that's already generated as part of the health care system the real world data and I think that's the extraordinary evolution over the last 20 years that really gives us the opportunity to measure value and deliver value in real time. And for the patients who were being treated as I mentioned and I think that's extraordinary evolution of the last 20 years in our company Aetion in the software that we create as a platform for taking all of those developments over the last 20 years and putting them into software that can be deployed quickly and at the right points in the health care system to make these really important decisions that everybody through the system needs to make to make those decisions fully evidence-based at the highest level of quality.
: Love that love that sounds like it's a phenomenal tool. Folks if you haven't had a chance check out Jeremy's team and all the things that they're doing at aetion.com. You'll find all the software solutions they offer there as well as the team of outstanding contributors that they work with there. So things don't always work out Jeremy sometimes we hit brick walls especially in entrepreneurship and health care. So we learn more from those moments. So I want to ask you. Give us an example of a time when you had a setback and what you learned from that setback?
: Yeah I mean so we founded the company, Sebastian Schneeweiss, and I about five years ago and that's give us ample opportunity to as we go along. I'll say that there are a lot of things that that you know really came together over those first years and one of the first things that Sebastian did was to go and find just top top top down tech team to build out this software platform and we need to be able to do this fast and be able to do this scale. We need to do this on time. These are all things that you really need a top tech team to create. I think at the beginning of the outset, at the beginning we thought that our customers would have all the questions available and ready to go. And just you know we're needing software to input all those questions into you get the answers and what we learned over the ensuing years was that sometimes in fact even a lot of the time those questions were available but sometimes the questions were broader like I'm launching a new drug and I want to get ahead of any potential concerns that FDA might have about safety. How do I develop an evidentiary base around the safety of my medication or even something that was even a little broader like helped me understand my diabetes population. And so I think one of the things we've learned over the years is that the software and our interactions with our customers have to really start with all levels of questions and that we can really as an organization engage in these issues. And at any place in our customers thinking and that is something that we really learned over the last couple of years.
: And you know it's interesting because you often think like "hey you know we dive into some of these challenges that our customers have. And you imagine that the questions are already there but oftentimes as somebody coming in from the outside that's where we could offer the most value." Right. Just like seeing it from the outside and helping them formulate those questions.
: Yeah that's really interesting. You know I think coming from the outside or even coming from you know kind of just from the outside just outside right.
: You can see a little bit how a pattern of thinking can lead to a series of specific questions and that's something that we can really help our customers with and something that we do you know at this point.
: I think that's so cool. You know one of the things that happens a lot with me Jeremy is kind of like a long long lines what you just discussed is you know I interview a lot of awesome folks like yourself doing outstanding things in health care. Now reach out to me and just say hey you know what are you saying and just kind of being off on that not even I outside like let's just call it sidelines right. You're still very involved. You could really help clients have that unique perspective that they need to make those breakthroughs.
: Yeah I mean the answering these millions have problems in health care. You know how do we find optimal value for patients in the system? How do we you know really get these underlying questions involves first with exactly that stating the right question. And you know I was reading a book by Judea Pearl which I highly recommended called The Book of Why, where Dr. Pearl is a one of the true pioneers in causal thinking.
: Helping to break down the problem and express it in a way that is truly causal. Meaning not just if I switch a drug A versus B which is going to be better for patient BUT really identifying which patients you're talking about and what that switch will mean and really can what the alternative would be to treating with standard of care and that kind of causal thinking is really needed because at the end of it if you're talking about a decision that's going to change health care or change health outcomes or improve outcomes for patients, you need to be thinking causally. You need to be thinking about "What can I change that's really going to make an impact on the patient or on the system?" So framing questions in a causal way is something that I as epidemiologist think about as a really important first step in this book by Pearl, I think talks very nicely about how to think about questions of framed causally.
: Love that. What a great recommendation there one that I'll definitely add to the list Jeremy thank you for that. Let's look at the other side of this this question right. You took us to sort of a set back and what you learned from that which is super valuable. How about one of your proudest medical leadership experiences that you've had to date?
: Well you know just as five years has given us quite a bit of time to experience the first part of that we've also had I would say a number of really proud experiences our company has as mentioned is five years old started with three people in a little office here in New York City. And we've grown now to mull over 100 where you're in York City up in Boston on the west coast and all over the country.
: Amazing. Congratulations.
: Thank you. And really the company has grown and as the company has grown the needs of the company have changed quite a bit. So one of my personal proudest moments was working to recruit Carolyn Magill, she's our CEO. She joined us a little more than a year ago and she had just this phenomenal experience growing startups and working in the payer sector and really just a deep deep understanding over her years experience of how the health care system works and the dynamics of the system. And that really complemented an important way how we've been thinking about decision making and causality and the science and the software to support all of those questions and decisions. And so you know thinking about promised the leadership experiences. I think bringing Carolyn to our organization and being part of that is something that I'm deeply proud of and has been you know incredibly successful push for our organization as well.
: That's awesome. Well Carolyn shout out to you and Jeremy nice work on recruiting her. It's tough to get the right team put together. I'm a firm believer of hire quickly but fire slow. Well it's actually the other way around right. Fire quickly hire slowly because it's hard to find the right people.
: It really is. And one of the things I really enjoy my organization is how deeply engaged in the thought that's required to really bring powerful solutions to the health care field and that's something that at all levels from literally all levels of their organization leadership there should be really thoughtfully engaging at all times and Carolyn and the leadership team that she's assembled as and she joined a little more than a year ago. I think really represents at where we are for it.
: That's awesome. Congratulations. So Jeremy tell me about an exciting project or focus that you're working on today.
: Well we talked a little bit about randomized controlled trials, RCT's and talked a little bit about real-world data. And so the sister concept abroad evidence that the DNRWE to use the lingo. For me one of the most exciting projects working on is looking at how the methodological developments over the last 20 years that I mentioned, real data in real-wprld evidence have gained ability to really support causal decision making whereas in randomized trials were kind of the big game in town perhaps the only game 20 years back. I think one of the most exciting projects we're working on is looking at how real-world data can support a regulatory decision-making. So we were selected by FDA working in conjunction with Brigham and Women's Hospital and Harvard Medical School in Boston to kind of replay history a little bit to take 30 trials that the FDA had used for decision making said 23 leading to a positive decision and seven into a negative decision and to replay history and to see if we can use real-world data. The data, it's part of the health care system data that's available at the same time that those trials were being run with real world data analysis have led to the same decision that the randomized trial ultimately led to randomized trials. As I mentioned a gold standard in causal thinking and also very expensive limited to small patients, limited to very likely among representative group of patients, older patients, patients with extensive comorbidities, lastly under represented broadly speaking in randomized trials. Could we come to the same conclusion using old data. So that's a project that's on going...
: With FDA and we're also working with regulators around the world on some more kinds of projects. And to me this lets us get to the place of really applying real-world data and all the instances where we can apply it and I want to be clear that's not every instance not every question answered by a randomized trial could potentially be answered with real-world data but in those instances where we could make that switch, let's have the evidentiary base for making that switch and let's do it because that lets us get at really key really important answers all that much faster at much lower cost. Again sort of this idea of value and the health care system and really lets us affect positive outcomes for patients as quickly as we can.
: I love your conviction Jeremy and it sounds like there's some really great groundwork happening here. It's even, take a look at causal versus randomized controls methods to do things within our space. I think that's a very important work that you guys are up to.
: And as a scientist I'll say it's thrilling work. I, it's truly thrilling work as well which is awesome.
: Fantastic. And the cool part about it all is that on the back end of it this thrilling work actually impacts patient lives and there's nothing more thrilling than that.
: Undoubtedly so and being able to do that at scale I mean being able to put it into stuff that really leads to that quality decision making and health care system access to place it's really really thinking very carefully about high quality patient outcomes and value.
: That's awesome. I totally agree with you. And we're getting close to the end here Jeremy this is the final part of the podcast. You and I are going to build a medical leadership course and what it takes to be successful in the business of health care. It's a one to one of Dr. Jeremy Rassen. And so we're going to write out a syllabus. I've got four questions lightning round now for you followed by a book that you recommend to the listeners. You ready?
: I am ready.
: Okay here we go. What's the best way to improve health care outcomes?
: So for me this course is about data-driven decision making and health care and for need and the best way to improve health care outcomes is to start by really really carefully measuring and understand health care outcomes. I think only by measuring and understanding health care outcomes can we really improve them and really prove that we have improved them.
: And is that second part that I feel like is often missed. It's like sure measure them but understand them. I love that you just throw in the understands there because it really takes it to that next level that you really need to improve outcomes.
: And you know somewhere in the you know later later courses here , the later lectures of our course. I think you get a lecture on applying what you learn and really looking to take what you learned and turn it back into that next cycle.
: Love that. So what's the biggest mistake or pitfall to avoid?
: So I think through our conversation we talk a lot about causality. For me the biggest mistake to avoid is to confuse an association that we see in health care with something that's causal something that if you made a change it would truly affect that patient. You see it over and over and over again. And to me that's the biggest mistake and also perhaps the most probable mistake.
: How do you stay relevant despite constant change?
: As an organization, you know ultimately we're answering questions alongside our customers that improve health for patients and so you know relevance in that case is making sure that we're thinking about the questions and have methodologies ready to answer the questions that most relevant for patients. As time goes from today to tomorrow to many many years from now.
: What's one area of focus that drives everything in your organization?
: It's the seriousness of our mission. I think every single one of my colleagues here understands that the insights that we're unlocking are ultimately about patient health and that requires real seriousness of mission and of purpose. And I think I tried everything to do.
: Beautiful. And what would you recommend as part of the syllabus Jeremy?
: Well I guess part of the syllabus I've to say The Book of Why by Judea Pearl, which we talked...
: Talked about it earlier. Yup.
: If you ask me what book in general would I recommended maybe it's hard to look...
: Let's hear the extracurricular read listeners.
: The extracurricular read let's say I've just been really really enjoying the Trevor Noah audiobook, Born A Crime. I know this is in podcasts circles because I shouldn't say that this was one of my first audio book spoken word iPhone.
: Hey you took the jump though and that's what matters.
: It's linked the spoken word experiences. And I just thoroughly enjoyed it. His perspective is fascinating just the way he tells the story as he reads his own story. It's just phenomenal. "I couldn't recommend it more.
: Outstanding. There you have it listeners, check out all the things that we discuss. The transcript, links to those books, links to Aetion, just go to outcomesrocket.health/aetion and the website for Aetion is aetion.com. So make sure you check that out. Everything is right there for you easy to access. Jeremy this has been fun. I really have enjoyed our conversation.
: Before we conclude I love if you could just share a closing thought. And then the best place where the listeners could get in touch with or follow you.
: Well the best place for listeners to follow us is a Linkedin or Twitter or pretty much either. Closing thought, it goes back to the beginning. Ultimately as a field, we need to be thinking very deeply about value. And as we think deeply about value we you make really important decisions for the patients were entrusted, to care for. And so for me those decisions need based on quality evidence, that's pertinent, that's there, that's timely, and that's how we best serve.
: Outstanding Jeremy. Now for sure you guys are leading the way in a very important way. So keep up the awesome work one of the things that I think about Jeremy when I just kind of think about the lessons that you've shared is that we tend to overestimate what we could do in one year but severely underestimate what we could do in two or three decades. And I think the impact of that it's going to be huge. It's going to be huge. I love what you guys are doing so keep up your amazing work. Thanks for carving out time for us today.
: Thank you so much for the opportunity. We're, we appreciate it.
: Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas, great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is slow. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.