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Why Communities are Key to Patient Satisfaction with Lynda Brown-Ganzert, Founder & CEO, Curatio.me

Recommended Book:

Being Mortal by Atul Gawande

Best Way to Contact Lynda:

Twitter

Company Website:

http://curatio.me/

Check out this Link:

https://outcomesrocket.health/podcast

Why Communities are Key to Patient Satisfaction with Lynda Brown-Ganzert, Founder & CEO, Curatio.me

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

And welcome back to the podcast. Today I have Lynda Brown Ganzert. She's the CEO and Founder at Curatio. Lynda's a connector, serial entrepreneur, and health innovator, and award winning digital media leader, recognized as an international experts. She is also Chair Emerita at SFU and a Director of the Canada Foundation for Innovation. Through her various senior positions across almost every platform, TV, web, telecommunications, videogames, mobile yet she's involved in a lot of things she's pioneered over 100 products and projects that have uniquely use digital media for the purposes of improving health education and business. Today she leads a team at Curatio and that's what we're going to be diving into today. They're the world's first socio health prescription and their aim is to make everyday better for patients and their families all from the palm of their hands. So without further ado I want to welcome Lynda to the podcast. Welcome Lynda.

Thanks so much. Happy to be here.

Hey it's a pleasure to have you here. Now tell me what made you get into the health care sector?

I think for many of us it comes from that personal experience and so you know my background has been using technology to connect people that's my passion. But it wasn't until I became the patient went through a complicated pregnancy and some challenges with fertility that I saw some broken parts to that experience. And in a small way coming from a technology perspective I thought I know how to fix this part and that's just one part of the overall puzzle. And that's really where Curatio came from. And I ended up sort of hitching it to the back of the napkin idea to a dear friend of mine. And together we sort of worked out the initial concept and he further helped me out by having a heart attack about two hit flater. He's great now and...

That's good.

He is all good by but he became my first guinea pig. So you know the start of Curatio is a very personal and patient-base experience and looking at what sort of tools. Not just me but the entire team has an artful kit and how that helps in transforming health care.

Very cool. I think it's really neat that you have taken a personal experience then your dear friend and an experience and you guys have pieced together something before the interview folks, Lynda told me Curatio means health circle. Is that what it means in line?

It means healing circle.

Healing circle. I thought that's more appropriate.

Thank you.

So this healing circle is this community that Lynda has built for patients that are you know going through a healing process. Is it mostly post treatment that you're helping them out or is it through the entire journey?

It's through the entire journey. And we have users now in 70 countries and 4 languages so you can see the global need is pretty massive. But really what we're doing is that end to end and what we would call sort of patient acquisition, retention, and engagement. So we're a platform that can be plugged in that type of social plug to any offering whether that's a chronic condition, a rare disease whether that's helping on the provider's side in the hospital to home transition or on the pharmaceutical side and supporting adherence. We're really if you think of us as a type of social plug in that anyone can use alongside their existing offering to really help build that that community of trusted trusted private community for patients and you know attract and build that community with patients being very patient centric and then retain and engage in a way that really improves quality of life and health outcomes.

I think it's valuable and in today's age where people are used to groups, online groups you know on Facebook, on LinkedIn it's great to have a platform where somebody like an employer or a provider could guide their people to. That's really a guided group that it's not like "hey anything goes and I'm going to give you some herbs and snake oil or whatever." This is really good stuff. This is diet, diet.

Yeah exactly. It's curated evidence based. We have you know human community managers we have an AI health body that helps you navigate through the system and it's privacy compliant which is really important to us. They really like Data from the users and a patients perspective around protecting privacy. So hip, GDPR, now Paquita compliant worldwide. And that's an important part and it can also be branded to look and feel like you're offering. So it's not meant to be another walled garden. It's really meant to be a social private experience that can integrate into what you're currently doing.

Love it. So give us an example in how the platforms creating results improving outcomes.

Oh sure. So we've we've had some great published clinical evidence that shows that patients using Curatio have found statistically significantly improved outcomes using a research tool called the HEIQ and that was published clinical evidence that showed that our users were performing higher and 5 motivate areas. What does that mean? It means that they were better able to navigate and self manage, they had improved outcomes, psychosocial, and wellbeing. So we're really excited about that. We're now into the second year of a three-year national study using our platform on that hospital those are home transition and how to help people stay connected and empowered and improve their self-management as they go from hospital to homes. So we're quite involved in the research area that's just two examples of what we're doing. But it's important to constantly show so that the improvements we're moving the needle on improving health outcomes and we do that in a very patient centric way. So we are talking to our users and their families and their caregivers on a weekly basis and really dialing into what do they need. What's that experience need to be and then translating it back into what we're building a platform that helps manage daily health and capture some of those patient reported outcomes in a way that gives some valuable insights to patient population health.

Yeah some great results thus far Lynda. Super exciting work that you guys are up to so yeah and so curious you know we don't always succeed the first time around, we have setbacks. Can you share with us a setback that you had and what you learned from it?

Well that's a great question because you know we talk about in our company sort of a failing forward as the term so you know we're very thoughtful around certainly protecting the patient the customer experience so you know we always have that first in mind. But the notion of trying and being nimble and making things better for the patient in incremental ways. So I'm mentioning that because every week, we're learning something new and I don't consider it failing as much as really learning. Like okay this patient population is really needing this and so how would we build that for them or how do we you know articulate for for them there. I think one of the big learnings that we've had for a Curatio is it really comes down to engagement and meeting the patient where they are. So that is going to be a really different experience based on what part of that health journey you're on whether you're a patient, or a parent, or a caregiver, it's going to depend on what your learning style is, what your personality trait is and so we're very focused on making that experience personalized. And that's been a key learning for us over the years that we've been developing now. And you know I think some fits and starts there and in terms of really dialing into what the user needed and where we've arrived at is I think really getting into that personalized experience that is tailored to each individual.

Congrats on finding that sweet spot.

Thanks as you know it's trial and error.

And a lot of work and it changes and just get a stay on it always right.

Exactly.

So thank you for sharing that I think you know a lot of a lot of technologies that are developed and you know put out there are definitely pressure tested and those that stand the test of time are the ones that focus around the patient. What would you say your proudest leadership experience has been today?

Oh gosh there's been so many. I mean I have a fantastic team and a great board and investors. So it's been an amazing experience but I think the fact that we are used in 70 countries that, we have a master service agreements in place with some of the largest healthcare partners in the world is great. You know I am really proud of all that we've done to do that. For me personally, what makes my day every single day is hearing from a patient or a future user around not only the value that we're providing but how much it means to them. And so you know people share with me on a daily basis pretty personal and insightful conversations on why what we're doing is important what it means to them and how we're changing the world around, how we approach self-management.

Nice. So tell us about an exciting project that you're working on that obviously Curatio is exciting and results are very good. But what would you say within what you guys are doing there is an exciting project?

Oh sure well we're pretty excited about our AI agent right now. Our Health Buddy and back to what I was saying earlier really being able to personalize that experience and recognizing that people are coming into their health journey at different points and so leveraging the power of AI that can really provide that buddy. You know that first friend for any user or their family or their caregiver to help guide and navigate them along the way. So without getting into too much of the secret sauce we're really excited about our development there and what that's going to mean for both our users and our customers. As everyone is focused on, how do you empower and engage patients as you know as quickly and as personalized as possible.

Love it. Love it. Excited to see when you guys come out with that. And folks if you are curious about Curatio and the things that they're working on. Visit their website there at Curatio.me and you'll be able to find that we'll also included in the show notes so you could click on it and check out what the cool things that they're up to are. Lynda getting close to the end here, let's pretend you and I are building a medical leadership course and what it takes to be successful in the business of medicine. The ABCs of Lynda Brown Ganzert.

Sure. Alright.

Ive got four questions for you okay and they're going to be lightning round style.

Okay.

And then I'll follow that with the question about your favorite book.

Great.

All right here we go. What's the best way to improve health care outcomes?

Empower the patient.

What is the biggest mistake or pitfall to avoid?

Gosh not not listening to the patient.

How do you stay relevant as an organization despite constant change?

Keep learning.

What is the one area of focus that drives everything in your company?

Passion and love for the patient.

What book would you recommend for the listeners on this syllabus Lynda?

Being mortal by Atul Gawande was a paradigm shift for me and how we help patients at every stage write their own stories.

Love it. It's a great book folks if you haven't check that out definitely make that high on your priority list. And for this full syllabus and transcript of our interview with Lynda go to outcomesrocket.health/curatio you'll find it there. Lynda before we conclud, I love if you could just share a closing thought and then the best place for the listeners could get in touch or follow you.

Oh for sure so I love hearing from people so Lynda with a Y at Curatio.me or through our website on Twitter curationme. So easy to find us. Closing thought would be anything that you build with love in the center and wanting to help someone else will be successful. So go forward with that. And there's so much work to do in the world so if you approach it from that perspective you will find followers and success.

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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Simplifying Medical Device Cybersecurity with Mike Kijewski, CEO at MedCrypt

Recommended Book:

The Secret History of Cyber War

Best Way to Contact Mike:

Twitter

LinkedIn

Company Website:

https://www.medcrypt.co/

Check out this Link:

https://outcomesrocket.health/podcast

 

Simplifying Medical Device Cybersecurity with Mike Kijewski, CEO at MedCrypt

Welcome to the Outcmes 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

And welcome back to the podcast Saul Marquez here. Today have the outstanding Mike Kijewski. He's the CEO at MedCrypt. A San Diego based company that allows medical device vendors to secure their devices from cyber security threats, patch vulnerabilities, and monitor device behavior with a few lines of code. Mike is passionate about new advances in the intersection of Internet, technology, and health care. Is a hot topic that a lot of us need to be concerned with a lot of things are changing the FDA requiring a lot of different things. Got the unique device identifier. I mean there's a lot of stuff going on here and Mike's at the center of it. Prior to starting MedCrypt, he was the Founder of Gamma Basics which was a radiation oncology focused software startup. He sold this company well that was acquired by various medical systems in 2013. Mike's got an MBA from Wharton School of Business and a Masters in Medical Physics from the University of Pennsylvania. He knows what he's doing. He's got a great team behind them and a lot of interest is sparking in his work with some good seed rounds of capital being raised there so it's my pleasure to welcome Mike from MedCrypt to the podcast. Mike welcome.

Thanks Saul. Thanks for having me. And that is a very generous intro there. Thank you.

And it's my pleasure man you're doing a lot of good things and I'm excited to dive into this topic of cyber security and med devices. But before we tap into this conversation, I'd love to know what got you into the healthcare space to begin with?

Yes when I was in high school my mom was actually a med student while I was in high school. She started medical school later in her life. And my dad was a vice president at a health care a tea company that was called Shared Medical Assistance which became CEO of Siemens Healthcare. I remember as a teenager anything I have no idea of what I did my parents do. But I don't want anything to do with. I want to do my own thing with Bob. What if they get so excited. Once the culture is next thought I was going to be a high school physics teacher for a 35-year career taught high school physics for a couple of years after undergrad and really loved being in the classroom with students. I genuinely felt like I was having a positive impact on the lives of some number of people on a daily basis. But I had two main issues with my situation as a teacher the first being the obvious financial ones you know when you're starting to think about owning a house and having a family and wanting to have my wife be able to stay home for a little bit if we had kids it's hard to do on a teacher's salary are harder to do than it would be on other salaries.

For sure.

I was teaching the same thing three years in a row and starting to get a little bored of material and was looking for something a little more intellectually rigorous in the day to day basis and thought of going to med school. Realize it wasn't a good fit for me. I wanted to do something sort of entrepreneurial and really at the end of the day wanted to know that the end product of of my work was helping people in some way. And if you think about not to pick on the financial services industry because they do important work as well. But buying and selling stocks. Maybe it's a less direct positive impact on people's well-being than health care. So I found this field called medical physics which is the the technical underpinnings of Radiation Oncology and diagnostic imaging and thought that it was sort of a perfect combination of my interest in physics. My interest in wanting to help patients directly or indirectly through healthcare and it was also very forward thinking, a technology-driven treatment modality you know basically everything going in radiation oncology and imaging today involves a computer and software code and it started to be a great environment to get involved in and started that process 11 years ago to this point really couldn't be more happy if you really really love thinking about healthcare.

That's awesome man. Well you've done a great job thus far and now you're paving the way into a new era of of helping people. And so what do you think Mike as a hot topic that the listeners need to be thinking about today? And how is your organization approaching it/

Yes so we are involved in the cyber security aspects of healthcare specifically focused on the patient safety implications of cyber security. So in 2014 I was working for a big medical device vendor and was hearing a couple of different healthcare delivery organizations expressed concerns about patients being physically harmed if the cyber security vulnerability and a connected medical device were exploited. And at the time I hadn't spent much time thinking about the physical harm coming from cybers ecurity vulnerabilities of course. You know I heard about Hibiya and heard about patient data privacy issues but the notion that you could make it a medical device to something that was not supposed to do and physically hurt somebody was scary but also interesting to me. And while there were definitely pockets of people working on this problem as early as the late 90's, early 2000's. It wasn't until a couple years after we started really 2015, 2016, that the regulatory agencies and the media large started thinking about the problem. So we're really focused on ensuring that the companies and teams building healthcare technologies that rely on software hardware are building products that will not malfunction if the bad guys hacks a vulnerability in one of these devices and you know the flip side of that is ensuring that medical device vendors can build devices that are effective and profitable for them and don't become liabilities long term to the cyber security issues.

Now this is great information Mike. And you know as manufacturers of devices it's important that that we consider all of the things that are available to make these devices secure. And then as as providers and as you start thinking about what requirements you have for your vendors selling these these technologies, making sure that your patients are safe. All these things matter. And so Mike is definitely tackling this issue head on with his firm. So I'd love to dive a little bit deeper, learn a little bit more about how you and your organization Mike are creating results by doing things differently as in this arena.

Yeah absolutely. So a lot of good stuff to unpack there so the first meeting is an anecdote from somebody that I had worked on for a couple of years ago and how that's inspired are doing today. In 2011 I was running a software startup called Gamma Basics, while I was a graduate student at the University of Pennsylvania and we were making an income of different products for radiation policy you know crinkles or flow situations and we had the idea for a product of wanted to believe that we were a cash strapped sort of resource in a resource constrained organization you can hire an engineer to build stuff. And as a physics graduate student I had done some programming is not allowed to process data and so look at Thaicom images and stuff like that but it wasn't it wasn't a software engineer. And I started to look into a couple of different software development frameworks that make it really easy comparatively easy for somebody to build a web application. Then in 2010 I guess this was a framework a Web application framework a ruby on rails and I know a little bit of each you know how to make a website that it never built you know back and application. And as I started to dig into some of my tutorials learning how Ruby on Rails work it amazed me that people had taken processes that previously were very complex and wrapped them up into a very easy to use piece of software that other developers can leverage and not have to reinvent the wheel. I think a good example of this is the notion of a database records actually relatively complex idea that in the late 70's early 80's and probably a huge deal to get a database. But then companies like Oracle and Microsoft came out with its consumer facing databases like Microsoft sequel server which is much easier to set up the figure that you still need to write a lot of code to really interface with that with that database you need to understand it or sequel query and all of this other complicated stuff. And then there are other layers of software that come out that say okay well instead of worrying about counterfeit data is directly going to do it easy set of commands where you could type something like patient dot last name and hit enter and we'll figure out how to read the screen for you on the backend and those sorts of abstractions allowed. Me a physicist but not a software engineer to build a product that ended up being launched commercially and acquired by a big medical device firm has other developers have had you know taken on some of the heavy lifting and abstracted to really some boxes. So the things that we're doing and that create is looking at the problem of today medical device cyber security and saying what sorts of security features really should be in devices. And if you ask security experts you'll get a relatively standard set of answers and it will be some very instance of disagreement about but the educators with the most are people would say you should have strong usernames and passwords you should have. You should use encryption in various forms deputy encryption keys and all these devices and setting up all of those technologies. Well it's not rocket science is time intensive for engineers building these products. So we say hey if we can take those sorts of technologies you know encrypting data, assigning encryption keys, figure out signing things and verifying that the deed has been depleted and make it easily accessible via an API. We can allow engineers in a medical device firm to spend more time focusing on clinical features rather than implementing the sort of DeMentri security framework.

I think that's super super fascinating and and I think it's it's a great value add Mike because you're right the device company goes through their specialty which has clinical which is engineering and these API. I mean if you're applying a turnkey solution this is great. This is so much off of the Pinney's books so much off of you know an expertise that maybe isn't baked into that company.

Yeah and this is a struggle that we that we went through when we were first receive funding for this company. We would have investors say well know engineers that you know who are your favorite big medical device company is engineers that companies that are really smart engineers. They could be right if they do this on their own and they wanted to. And our answer is yeah but why should they focus really why should they spend any time that they don't need to setting up the security stuff when there are real competitive advantages. No and you know the most in the world about insulin delivery or imaging or cardiac rhythm management or whatever. Nic lots of good examples in other areas of technology companies be successful by allowing their companies to focus on their core competency. So for example my favorite analogy here is that this company stripe that does payment processing API and if you're if you're building a website and you're selling t shirts with something you've got to T-shirt designs you need to get the website to sell the T-shirt. And part of selling the shirts is you need to accept payments. So ten years ago the engineers in how to build the credit card processing stuff on their own and they'd have to set up a merchant account with some you know credit card processing company and straight along said you know here's an API to open these seven lines of code in their website. The worry about this I'm better t-shirts and they're now practicing something like 5 billion dollars of payments a month or something not because credit card processing was rocket science or no we hadn't figured it out. They just made it so much easier to implement. Then why would you do anything else. So that really is our approach to a subset of the security issues and medical devices if we can make it so easy for engineers to implement cryptography directly to these devices. Why would they want to do this.

That's a great analogy Mike totally love the way you laid that out for us. And so you've worked through a couple iterations. Share with us a time when you had a setback in the development of this company or maybe the previous one that taught you some big lessons.

Yes. So it's hard to think of one not because there are so few. But really you know we're running early stage companies. Nothing ever goes perfectly so there are plenty of opportunities where. So a couple of come to mind for the first is when we're starting Gamma Basics and we were selling Ratio and possibly workflow software into hospitals. We were really literally four guys in the basement with some really good software but nobody had ever heard of our company before and I remember having these long protracted halls with businesses and hospitals and they'd ask us questions like yeah you've done X but why don't you also do y or issues other than the year before and I can probably do this better internally. And it was a very sort of uphill slog to get some of these customers on board. And then we ended up selling the company to Varian and Varian is a leader in radiation oncology if only by market share. Right there their market shares. It's quite a process. The company very forward thinking and they tend to have customers that I really love their product. So you talk to a physicist at a hospital that he uses the various machine and they probably love that Varian machine. So we went through that integration process at Varian. Then we started selling that same product as Varian. And I had physicists coming up to me at Pomper just saying oh my god this software is amazing. We need this tomorrow we not our help set up. And I said you're never going to believe this but we have an hour long phone call several months ago when I was with another company. And you told me a hundred different reasons why this wasn't going to work. And now you want to use your star variant for habesha just goes to show that when you're doing something innovative and you're a smaller company the brand recognition and the trust that you build with consumers is so important because if you get to the point where your customers trust you and you don't profit so they love it has become so much easier to sell things later. Later down the road and as a smaller company when you hear that the fifty reasons why the thing you're building aren't going to work. They're not necessarily accurate right. You know if you told people ten years ago we had electronic minute medical records are going to be used everywhere. And by the way they're going to be hosted on the scarce servers of an online bookstore. You would say that's insane. No one's ever going to store medical data not online bookstores spare servers. Here we are 10 years later and lots and lots of healthcare and technology companies are hosting applications on Amazon Web Services because it is so easy to do why would you run your own data center. So yes I know that the haters aren't always right.

That's such a great great message Mike and cool that you are able to live through it and sort of stay on and see that that impact right because now you can definitely take this message listeners take it to heart, learn from it. What about what are your proudest medical leadership business moments that you had today?

It's really fulfilling to have been in an industry long enough where you can make certain conjectures about the way things should be and the way they will be and help make decisions based upon that view of the future and then be around long enough to see those those sorts of things come to fruition. So you know I remember it's a it's a relatively obscure example the working in the radiation Hall space and looking at certain things that should be automated and having discussions with people about the pros and cons of automating certain processes. You know the software and you know what if the software goes wrong if this thing happens to the patients higher and of course that would be awful. But we can we can build our code in such a way that will minimize the chance of that happening and by the way if this process is not automated what are the odds of a student making a mistake in having some bad outcome. And certainly you know fighting through some of those disagreements and trying to come up with data that supports that and then you know five or six years later starting to see industries adopt those sorts of automated processes because the data is in and supports that yes. These things has a net positive impact to patient outcomes. So having you know been in the space for a little over ten years is either a really long time or not that long depending on your perspective. But it's great to just start to see some of these hypotheses that I made earlier in my career start to be pretty true.

That's pretty cool. It's kind of like affirmation that hey you know what I wasn't too far off on what I was thinking and now what I'm thinking. Let's move with more bravado because likely it will happen.

Exactly. If you make you make 10 predictions and you're looking to those predictions and the first of four out of five of them have been right or you can be you know incrementally more counted in each and each additional prediction going forward that's that. It's also not an easy to get at it a little cocky there in a CNM necessarily the least in the world is the way that everybody everybody else sees the world are really like this notion of trying to have a beginner's mindset and really asking critical questions about things from first principles that make sure that you're not being influenced by the naysayers but also you're not Asperger's you know you're into our food and just believing it because because you think the way the world works.

Yeah such a great message. And definitely a key area of the market that you're working on. Mike tell us about an exciting project that you're working on?

Yes we've got we've got one company of we're working with that has very complicated medical devices that's used and that just coincidentally happens to be in radiation oncology space. My current company MedCrypt are focused on the health care industry at large to everything from insulin delivery to imaging the surgical robotics and everything in between. We have a good relationship with this. This is one startup called reflection epical that's building a PET imaging based radiation delivery system and some of the clinical ramifications of that could be quite impactful once they actually hit the market. I think they're not too far away from getting their piping and having their first burst in in person treatments. But one of the most satisfying things about that particular engagement for us is it's a very complex treatment system.Their treatment system because both imaging and treatment delivery sort of at the same time. And they have a very small window of time in which they need to process data, make decisions about that data, and then and then design the patient treatment in less than a second. In fact submitted in the U.S. in a second. So it's a very sort of a critical in this case with very large computers going very quickly and it's the kind of use case where we were told early in the MedCrypt's life that you know these sorts of systems that reside at a hospital and are big and powerful that they're behind a hospital firewall they require the sort of real time reallocation between the various endpoints surely not a good use case for encryption because encryption takes some sort of time. So you're going to be necessarily you know decreasing the overall performance of the device. And by the way security is not really that important because this thing's behind the hospital firewall and we all know the bad guys can't get behind that. The hospital's firewall. So to have some big companies tell us that years ago and then move ahead with a company like reflexion which has a you know a really it's sort of a cliched expression but a next generation version of this stream treatment reality and see that number one you can put in place the security features and still have that device function the way it's supposed to clinically and number two see that having these sorts of security features isn't evidence of it's about that you add for the user for a variety of reasons but not the least of which is you're are building a device that is secure by design and not creating another thorn in the side of the hospital CIO that now needs to lock this thing down to the firewall management and all of that. So it's been a really interesting project working with them and seeing a really revolutionary device take security seriously from the start and show that you can have a device that you know that has any security features in place but also is doing really amazing things technologically.

Mike that's cool and you know the thought here is you always got to be questioning your assumptions especially with the way technology is moving just because once you felt like hey you know encrypting something or was slow me down or slow down the way that this device is innovative doesn't mean that's going to be the way moving forward because all these technologies are advancing and this great example is goes back to the basics and says hey you've got to question your assumptions and dig before just assuming.

That's exactly right. And it's hard to look forward in time and see that no computing power will increase and the ability to do the sort of cryptography will you know will get easier comparatively. It's much easier to look back at that time and look at some things that people could have said that would have seemed rational at the time but now in retrospect that's right. So if you look at credit card processing I'm very interested in any crypto currencies and watching and Bitcoin actually not but that is because I'm a little skeptical about the whole market and the whole approach to things that I heard a lot of people say the bitcoin of block chains is not a tenable premium system because the visa credit card processing network transact some ridiculous number of transactions per minute. I don't know the exact numbers but you know you're talking of millions tens of millions hundreds of millions the actual date actually. And if you were to look back in time and say you know we've got all these transactions so many of them are happening per second and we really don't have the capacity to also correct all of those credit card transactions. Well in retrospect that looks ridiculous right of credit card transactions are happening in an uninterrupted fashion that the amount of fraud in the system would be rampant and it would be incredibly expensive. So it's just looking back of course you need that sort of cryptography and you know process wouldn't be tenable otherwise. I do wonder if at some point in the future we'll look back in healthcare and say you know I can't believe that we had healthcare information systems on a hospital network communicating with the neonatal severances and not using any encryption because we thought that it was too computationally intensive or you couldn't get the colors aligned or something. It's just you know looking back in time it's easy to see how some of those sorts of objections would be, what would be ridiculed.

Yeah some great thoughts here Mike and and definitely something for all of us to think about whether you be a CIO at a hospital or an entrepreneur managing your own company in this space really have to be thinking about security and thinking ahead of the game. So Mike getting close to the end here let's pretend we're building a medical leadership course on what it takes to be successful in cyber security of devices. The one on one of Mike Kijewski so I've got a syllabus that we're going to construct for the listener's lightning round style followed by a book you recommend to the listeners. You read?

Sure. On it.

Love it.

So.

So I've got four questions for you right. These are going to be lightning round style. So what's the best way to improve health care cyber security by design?

Two words by design. There's a there's a lot of focus being put on devices out there in the field. I think it is securing devices when they're developed is really a much better way to approach from.

What's the biggest mistake or a pitfall to avoid?

The only two patch when medical devices have vulnerabilities and companies put patches out there are a million reasons people give for not amplifying them but that's the number one mistake you can make.

How do you stay relevant despite constant change?

Having a beginner's mindset constantly asking questions and being aware of what is on the horizon.

What's one area of focus that drives your organization?

Patient safety.

What book would you recommend to the listeners?

I believe it is called The Dark History of Cyber War. Maybe the Secret History of Cyber War a fascinating conversation about the U.S. federal government and the federal governments how they've actually been having cyber warfare along with physical warfare for the last 30 years and what it looks like in the future.

Fascinating. Folks there you have it, the outlined the syllabus with Mike Kijewski you could find that and outcomesrocket.health/medcrypt along with a full transcript of our conversation today. Mike this has been a blast. I'd love if you could just share a closing thought but the listeners and then the best place they could get in touch with or follow you.

Yes I really love it. The conversation's well thanks for having me. The final closing thought a lot of people say will medical devices ever be hacked? Is this really a legitimate concern? Shouldn't we to focus on bigger issues? Do not underestimate the probability of patients being physically harmed by cyber security vulnerabilities and medical devices being exploited for various reasons. Some of them being financial or others others not being financial. You should check out medcrypt.co we're active on Twitter, LinkedIn sharing lots of relevant industry information that will be useful for both medical device vendors and medical device users.

Outstanding Mike hey we really appreciate your time. This has been a blast. Looking forward to staying in touch.

Likewise. Thanks for having me.

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

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Helping Employers Add Predictability and Control to their Healthcare Spend with Allison De Paoli, Founder of De Paoli Professional Services

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.

And welcome back to the podcast, Saul here and I have a special guest for you. Her name is Allison De Paoli. She's the Founder of De Paoli Professional Services where they help employers add control and predictability to their employee benefits. And we know this is probably one of the single largest line items outside of labor and employers spend. So it's important. She's one of the few who knows how to manage your benefits budget to reduce health care costs which will drive emeraude to your bottom line. Successfully challenging the benefits and health care status quo is what she does. She's a contributing author of a new book called Breaking Through the Status Quo, how innovative companies are changing the benefits game to help their employees and boosting their bottom line. She's a veteran of the insurance and benefits industry and she's going to cover all the things healthcare and benefits that you're going to want to hear as an employer but also as a provider. So without further ado Allison welcome.

Thanks for having me. Pleasure to be with you today.

It's a pleasure to have you on. Now did I leave anything out in your intro that you want to cover with the listeners?

No I think you've got it all.

Awesome. Well how about this. Why did you decide to get into the health care sector?

So I've been in the benefits world for way longer than I like to admit. My family owned a boutique benefits firm and we did a lot of, we helped middle market which sort of as an industry is of our group of employers about 100 to 5,000 lives and we did a lot to help them control their costs. And that kind of provide good benefits control their costs use a benefits plan how it should be used as a recruiting and retention tool to drive employee engagement and morale and to help employees. And I moved to Texas about 20 years ago, went into another part of the industry and as the years went on I started seeing things happening and I just thought well no that shouldn't be that way. And why are we doing it this way and we can do this thing now and generally just decided that I had to do something about it. The increase in health care costs is killing businesses it's killing the middle class. Employers offer benefits as a benefit and there are so many employees that are effectively uninsured because they can't afford their own their part of the cost. It's not working for anybody and I have some tools to fix it and I think that needs to happen.

Allison I think you are touching on something that's very important for a lot of people listening. So within this realm of benefits from the employee as well as the employer perspective, what do you think a hot topic that needs to be on every leader's agenda today? What is that hot topic and how are you and your organization approaching it?

I think the number one problem in health insurance today is misaligned incentives. I think there is an incredible distance between the payer of care and the user of care. And if you can shorten that distance you generally eliminate some of the middleman costs and you ensure a better user experience for your employee and a lower cost for yourself.

Excellent. So so let's dive a little bit deeper into that. Right. You know a misaligned incentives. Give us an example of how your company and the work that you guys are doing has created results by shortening the distance.

Sure. So there are a couple of ways that you can shorten the distance. One is by reviewing contracts and making sure that all of as the employer that all of your providers have fiduciary responsibility to you meaning that they owe you they are obligated to you to provide the lowest cost and the best quality at the same time. And let me give you an example and I'm going to pick on everybody's favorite whipping boy right now which is pharmacy benefit manager.

Let's hear.

We had an experience not too long ago where the TPA brought it to our attention where an employee was taking a generic medication that cost 50 cents a pill it was 50 milligram medication. And that's fine. And all of a sudden the price just went out of control and it took a little digging to figure out what had happened and what had happened is that the employee needed to increase the dosage and the dosage for the 50 milligram pill was 50 cents and the dose the cost for the hundred milligram dose was ten dollars. Why?

Nah.

And why can't the employee just take two and there's a couple of things that play here. So one almost never has a physician aware that that the difference in dosage is going to cause that kind of price increase right. How is it that they're going to be aware of that the employee is not aware of that because their copay has not changed their copay for generic medication is the same. So they're not aware of it either. But when you pointed out both parties kind of go oh we'll just take 250 milligram. That's fine.

Yeah. Which would be the smart thing to do.

Exactly. But unless something that comes through your claims you don't know to be looking at that or asking why. And I think that's the biggest thing. Why? Why is this this way? Why can't it be that way? What happened? And then you kind of go back and peel back the layers of the onion and figure out what happened and find a better solution. So fiduciary contracts will help you do that. And that is your pharmacy benefit manager, your TPA, you're ASO provider if you've got one and any other services that you have attached. And I am a huge...

Interesting.

Believer in care management. It does cost a little bit. Generally it will save you a significant amount of money in two ways. It will provide better care to your employees or make sure that they have access to better care and that they're following their protocols and generally better care is not the most expensive care.

I think that's such a great thing to point out Alison and some very great ideas here. You know typically I think of fiduciary contract and my mind goes to to finance write like a fiduciary adviser. I think a lot of people minds go there. But to think about fiduciary contracts within healthcare I think hey let's just say it's kind of like a novel concept that shouldn't be a novel concept you know. So tell us a little bit more about this. Educate us on fiduciary contracts and how these can be drafted.

Sure. So I think one of the biggest one of the ways to get the most to head of that is to use independent providers. I work with a number of third party administrators or TPAs that are independently owned and have written already into their contracts that they are transparent in their pricing and transparent in the information that they passed back to the employer. And I think that's so important, you get full claims detail almost on demand basis and as an employer if you are funding your claims and really even if you're fully insured you're funding your claims and everybody else's. You want to see that you want to have a handle on what's coming you know with the advent of big data. You can start to track what's happening in your plan and compare it to what's happening with you, with your locality and perhaps on a state nationwide level and you can start to tailor initiatives to help educate employees about diabetes. I live in south Texas diabetes and metabolic disease are one of the biggest problems we have here. You can start educating employees and helping them maintain their medication regimens and start eating better and understanding the role that exercise plays in that without a lot of expense and without a lot of drama. And if your pharmacy benefit manager has a fiduciary responsibility to you as the employer not to the insurance company, not to the TPA, not to any other party, then you know that you are paying one the best cost and you're paying that over time and that the medication is correct. And you know I've reviewed some contracts not too long ago where the pharmacy benefit managers' responsibility was to the TPA not to the employer paying the bill.

Gotcha.

And I'm a little challenged by that.

Totally and therein lies the misaligned incentive.

Absolutely.

Example. Some great examples here Allison. And as you've been working through this you guys have obviously a great amount of experience your family business was into this from a different angle now you're taking a different spin on it. What's a time when you had a setback, a big lesson that you learned and now you apply over and over again as a result of what happened?

So I think that you have to meet people where they are. You know I can talk to an employer and say well we can do this and we can do this and we can do this and we can do this. And I'm a little bit of a nerd. So that's very appealing and exciting to me and really all an employer may want to know is that "you know what? Can you just take care of my employees and make sure that this cost doesn't increase at all?".

Yeah.

And I've had many conversation where I have literally bowled somebody over with enthusiasm for this subject and not met them where they are and totally unnerved them.

Yeah.

And I think many of us have had that experience before.

I think it's such a great call out. And so how do you meet them where they are?

I ask a few more questions now. I don't assume that I know what their challenge is. Their challenge may be something different entirely. I mean you know healthcare is a pretty. Health insurance is a pretty broad and diverse subject. Make sure to get to the root of the problem and just take a minute and listen to people and it has helped tremendously. And I've helped more employers that way starting that way than by just bowling them over which I think is with somebody who's engaged in her subject and in the sales arena a pretty common problem.

Love it. What a great example. And yeah you know we tend to get excited for our ideas and the things that we are sort of knee deep in doesn't mean that our customers are going to be as excited about it. It's a great call out there, Allison. What would you say one of your proudest medical leadership experiences has been to date?

I've been asked to lead in my past life as an owning and enrollment firm. Some pretty large enrollments and I've been pretty fortunate to be able to pry people away from other opportunities to come work in my enrollments. And that means that I'm providing good work for my enrollers and it also means that I'm providing a quality enrollment experience for both employers and employees. And I think that one thing that employers forget is that employees have budgets too and if you teach them how to use a health plan to their best advantage, almost all of them will do it and that is your first line of defense.

What a great call out.

It can yield some pretty significant savings.

That's a great call. And today with rising deductible costs I think it's that more doable. Wouldn't you agree?

Absolutely. It is much more important today than it was. You know even five years ago when you had a 250 dollar deductible and a thousand dollars out of pocket max that was not as scary as having a 1,500 or 2,500 or 5,000 dollar deductible and a 6,300 or 6,500 or 13,000 dollar out-of-pocket maximum when 80% of employees have less than a thousand dollars to cover an unexpected expense let alone an unexpected medical expense and the fallout from that is not just that they don't seek care. They're often non-compliant with their medication and that will lead to bigger claims down the road. So the sort of oxymoronic thing is that the way to control your cost is actually to deliver care and make sure your employees are getting and using care so you avoid the unexpected spikes.

So true and you know I was doing an interview Allison with a gentleman from Denmark. And you know we get to know a conversation about taxation and you know that our tax rate is pretty high but university and health care is included and we got the hang of this conversation like hey you know what I mean what is our net tax here in this country. When 66% of bankruptcies are happening because of health care related issues. You said 80% of people don't have more than a thousand bucks to pay for out-of-pocket stuff. I mean that's scary.

That is scary particularly if you're the employee.

Right. And then as the employer you know what are you doing. Because when people get into this situation it becomes stressful and you can lose talent. So definitely a very important topic that Allison is approaching with us here today. Allison what about your book. Tell us a little bit about your book. What gems can people find in there? Obviously we only have 30 minutes today but what kind of preview could you give them?

The book is a collaborative effort of a group of advisers that want to remain relevant and useful to their clients and we're all independent. We all do things a little bit differently but we all have a common theme and that is we want to help employers offer the best benefits that they can at the best possible price. And there's a ton of ways to do that. So my take is in there and there's 28 other takes in there and there are how to manage your self funded plan how to move along the healthcare glide path into further control of your plan. And all the strategies to do that. There are ways to manage short term disability programs so that your employees are getting the best benefit with the least possible tax consequences in the least possible premium. There are ways in there to use enhanced or voluntary benefits to help pad packages and not overburden the employee because that's a real problem sometimes. There's tools in there or discussion about how to enter a captive or a coalition, when you should be self funded. What things you can do as a fully insured employer to help control your costs? How to manage an enrollment effectively? How that is really a year long effort and not a two day effort? And if you make it a year long effort the two days will not be nearly as stressful as they typically are. All kinds of statistics about how employees use benefit, how important care management is and helping direct people to the best places for care and best does not necessarily mean the least expensive. It does mean the highest quality and that is normally not the most expensive.

Awesome. Folks this is like a desk reference that you can have. And bottom line is this you know you hire an accountant to do your books. You hire an attorney to do your contracts. Today's age if you're not investing in a professional to help you with your health care benefits you're leaving money on the table and that's the bottom line. So the book is Breaking Through the Status Quo. We'll leave a link to that on the show notes so that you could take a look and buy it for a desk reference for you or whoever's helping you with these benefits. And if your provider. Something to think about too right. You've got to be understanding how to work with employers today. Tell us about an exciting project that you're working on today Allison?

Well we're doing a couple of exciting things but one thing I do want to talk about is direct contracting and how helpful that can be both of a provider a hospital facility or a large physician group as it can be to an employer and we have a couple of systems in San Antonio that have direct contracts with some of the larger employers. And what that looks like is let's say that a large employer contracts with a particular facility to handle all of their knee surgeries. And that's just a small specific example.

Yeah

What that means is that the facility and the provider and the employer have agreed on a protocol and a cost. And the facility has to meet the requirements of the employer and when an employee needs a knee surgery the price is agreed upon ahead of time the employee goes to the facility has the knee surgery gets all their follow up care physical therapy whatever it is that is part of the protocol, the provider is paid quickly usually just on an invoice without providing any notes or having any sort of negotiation about what was done and what wasn't done. The employer pays a lower cost for that and may pass some of those savings and often passes those savings onto the employee. So the employee may pay nothing or a much smaller copay rather than their full deductible. So it's a win for the employee. It's a win for the employer and it's a win for the local facility which is probably delivering good care anyway to go direct and receive quick payment and a regular stream of patients.

I think it's great to consider these these types of contracts. And you know what the sweet spot Allison gives. You know I hear that the numbers 2,500, 3,000 employee type companies. Are second smaller companies do this with their providers?

It depends on the TPA. And I think that's where a well qualified adviser can be so important. Those contracts with the larger employers are managed direct but with midsize employers those contracts can be managed through the third party administrator so that a smaller employer. One hundred eighty two hundred five hundred even down to 50 lives some times can have access to those sorts of benefits. And...

Got it

That's a big difference if you're going to pay thirty six thousand dollars for a surgery or 75. That's a lot of money.

It's huge. So it's kind of like a pooling type of mechanism through the TPA.

So TPA is a third party administrator and they administer your plans so they act sort of like your insurance company. They follow the rules that you've established and there's some pretty standardized sets of rules which you can customize and to make sure that claims are being paid appropriately and in a timely fashion and that the diagnoses are correct and that the service was actually delivered. So all that fiduciary kind of stops and then they provide if they have direct contracts with it they have other cost containment solutions. That all happens in the third party administrators office not the employer because most employers have enough to do. And then when you're self-insured that claim run just goes to the employer or the employer will review it. They generally review it in a diagnosis and cost containment cost way only not necessarily identifying who the employee is and they then they release the funds. So a TPA can do a lot of things for an employer whereas when you're fully insured you pay your premium and you hope for the best.

Got it makes a lot of sense and definitely a valuable review here. Wish we had more time to dive in, Allison maybe we'll do a part two. We're going to head into a part of the podcast where we do a lightning round with you. It's the syllabus on Allison's De Paoli being amazing at your health care plan. And so I've got four questions for you lightning round style Allison followed by a book that you recommend to the listeners. You ready?

Sure.

What is the best way to improve your health care outcomes with your insurance?

Eliminate the misaligned incentives in your plan.

What's the biggest mistake or pitfall to avoid?

Thinking that you are controlling your risk by remaining fully insured. All you are doing is managing the financing of the risk you're not managing the risk itself which is riskier.

So good. How do you stay relevant as an organization despite constant change?

Always be learning.

What is one area of focus that drives everything in your organization?

Employees have budgets too.

Love that. And besides Breaking Through the Status Quo, what book would you recommend listeners?

I think anything by Malcolm Gladwell. Outliers is one of my favorites. Blink. I think it's particularly useful in our conversation today, following your gut, and practice practice practice.

Love that. I am a big fan of Gladwell as well. Check those out folks if you want to access the show notes go to outcomesrocket.health/paoli and you're gonna find all that there. Allison, this has been a ton of fun. I love our time today. If you can just share a closing thought, and then the best place for the listeners could get in touch with or interact with you.

Sure it has been a lot of fun today. Thank you. So as a closing thought I would say don't be afraid of taking on your health plan and you managing it and not it managing you.

Amen. Love that.

And to get a hold of me you can go to my website, allisondepaoli.com/rocket. I've got an e-book there that people can download if they wish. All the steps the 5 steps that I use to help employers gain control and predictability and there's some video on there that talks about that as well. Sometimes that's a little bit easier and I'm happy to answer any questions at any time.

Outstanding Allison. Hey we appreciate your time and folks take Allison up on that e-book. Go to her website and we'll provide a link on our show notes as well. outcomesrocket.health/paoli. You're going to find that. So check out that e-book. Allison it has been a true pleasure. Appreciate you spending time with us.

Thanks for having me.

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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Why Wellness Should Be The Core of Value-Based Care with Adrienne Nolan-Smith, Founder at WellBe

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Why Wellness Should Be The Core of Value-Based Care with Adrienne Nolan-Smith, Founder at WellBe

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.

Welcome back to the podcast. Today I have the amazing Adrienne Nolan-Smith. She's a Founder at WellBe. She's a speaker, a board certified patient advocate, and a wellness activist. I'm excited to bring her on the podcast today because the fact is wellness is important and as we turn a chapter from fee for service to value-based care, wellness is starting to become more important. So it's with pleasure that I invite Adrienne into the podcast. Welcome Adrienne.

Thank you so much for having me Saul.

It is a pleasure. So Adrienne let's chat about WellBe you know tell us a little bit about what it is. Tell us a little bit more about you. Anything that I missed in the intro let's hear it.

Absolutely so my hodgepodge of titles came from several decades of different experiences with health and wellness to just start from the beginning. I was diagnosed with Chronic Lyme Disease when I was 11 years old and basically my mother was told that there wasn't much that could be done after the antibiotics didn't work because I'd had it for too long already for the antibiotics to really be able to cut off. And so it started my family down a new path which was integrative medicine and you know this is in the mid 90's and it is very different from how it is today and definitely was seen as sort of hippie and wuwu and off to beaten path and all of the practitioners that I saw I definitely felt that way you know I was like a middle schooler and they seemed weird but the difference I realized was that through doing all these different treatments and therapies with them and we did a whole bunch of both things that you know you may have heard of. And things that are you know really out of the box but are actually becoming more popular today like hyperbaric oxygen therapy and things like that. I was healed. My Lyme was inactive by the time I was 13. And this is pretty remarkable because people really don't heal very much from Lyme once they've had it for you know a couple of years undiagnosed. So it kind of changed the course of my family's living habits and lifestyle as far as what we knew was important to both keep that disease in remission but also to just boost your immune system to prevent other health issues from coming up. And so you know we only added health food stores and saw a lot of different practitioners as part of a general protocol and took a lot of supplements and things like that. And you know nothing. I was in fantastic health until I was about 18 and I went to college at Johns Hopkins which is funny because now that I'm in the health and wellness world people always ask me you know if I'm a doctor and I'm the only girl in my sorority family who's not a doctor because so many people go there for that. But it just makes sense of course now that I got into this field. But when I went I you know again eating in the dining hall and within six months I had completely lost my menstrual cycle. And this was really bizarre you know and having never happened to me before and having one since I was 12 and went to see a whole host of endocrinologist and gynecologist and trying to figure out what was wrong. And you know they they just kind of run some blood tests and they said you know we can't really see anything you seem to be in good health. No changes in your weight whatever. Just take the birth control pill like this was you know the solution that I was given and luckily because of the Lyme experience I knew to do a lot of research before you have any kind of encounter with a doctor. And I said you know with all due respect like that that's actually not a solution. Like that's a bandaid. That's kind of masking a symptom. You're going to give me a fake period but I want my real one and I want you to help me get it. And if you can do that? Thanks, but you know I'm going to be on my way. And so you know I went through several of these maybe eight weeks and finally both at Johns Hopkins and back in New York where I'm from. And finally my father found me a naturopath after I'd exhausted a lot of the conventional options and we looked at the blood so differently together and spent you know more than an hour on it. Going through it all and talking about my different experiences and living in China and whatever and even emotional stuff that I was going through at the time as my parents were getting divorced and whatever and within six months of diet and supplement and Chinese herbs protocol that I was on with her. It came back and it's been you know totally normal for the last, over a decade. So...

That's awesome congrats.

That was like. Thank you. It was like episode number two of like whoa you know this is a messed up system. Right. And what am I missing, what are most people missing? Like thank God I had the stubborn attitude to actually go in and the finances honestly to go see all of these different intake appointments and a lot of them you know don't take insurance. And my family so believes in health that it was something that you know my parents would still pay for but I can't even imagine getting to the root cause of things without that. So that's a whole note of topic. But the biggest thing that happened to me and the reason that I'm founded WellBe and I'm doing what I'm doing today came when I was about 20 years old my mother had a manic episode and basically paranoia, delusions, middle of the night to put her to the back of a cop car. She thought we were trying to kill her. Was like a really crazy thing. She ran away from us all the way to Queens and we had to sort of like restrain her and basically it started you know a real nightmare. It was five years of the revolving door in and out of mental hospitals. And she was diagnosed with schizo affective disorder which is a combination of bipolar and schizophrenia and I've never had anybody that I knew have any mental illness per se maybe depressive or anxious symptoms but not like this and this was a really rude awakening to the mental health care system which if we think the regular health care system is bad like that system is just...

Another story.

A whole nother level of you know just kind of not getting to the root cause of things. And so when I was 25 she was so heavily medicated and such as zombie from all these drugs and she's drooling and shaking and all of that. That she you know I totally understand she found it not to be a suitable solution. Like it wasn't actually a better way of life at all. And she took her life and...

I'm so sorry.

It was thank you, it was a couple of days before Christmas. And at the time I was applying to business school. I'd been working at IBM and I knew that wasn't my calling. And I knew I wanted to do something that was meaningful to me and where I could really tap to change something worth changing and be a part of something that was important. And as I'm not even sure how I'm going to finish my applications because it was about two weeks before my applications were due and I kind of my friends were incredibles, came together, helped me edit drafts, scott you know one or two out the door and I was very fortunate to get into the Kellogg School at Northwestern where I went in Chicago and I told myself if I got in I would dedicate the rest of my life and use business school as the transition tool to work on transforming the health care system into one that actually gets to the root cause of health issues and doesn't just bandaid the symptoms. More my mom had a ton of other sort of gut issues and early traumas and things like that that I had no idea could be connected to mental health issues. Of course a lot of us didn't with the Microbiome Project hadn't even the results really hadn't come out. We didn't know about the gut brain connection and so had anybody kind of dove deeper and started to peel back the layers instead of just the drug drug drug you know we could be in a really different place today. And so my whole thing with that I'm trying to do it with WellBe which is a media and lifestyle company dedicated entirely to helping people prevent and reverse chronic health issues and really see the hundred choices are making everyday as health care. And then when they do have a health care experience of any kind in the conventional system understanding how to advocate for yourselves so that the people you work with get to the root cause and heal you rather than mandating symptoms for indefinitely I guess. So that's all of why I'm doing what I'm doing now. We make all original content I film people's stories of health recovery through integrative medicine but also a lot of experts that are MDs and naturopaths osteopaths who sit at this intersection between health care and wellness to try to show that there are people doing great work here to try to destigmatize it a bit. It's not all hippies but also bring a lot of research to the conversation that I'm able to see and Medscape and pub med and all of that to show that you know the whole argument is oh wellness isn't science like no it really is and a lot of great work is being done right now to show that.

I think it's such a such an inspiring story Adrienne and it's wonderful that you're doing this. Folks if you want to check out some of the work that Adrienne and her crew are up to, go to getwellbe.com that is their website is. An incredible story and now very mission-driven business that she's running here. I think it's a beautiful thing because at the end of the day not everybody gets the results that they want from the health system. And so it's great to have another option and this option is there for as Adrienne mentioned chronic illnesses that you know you just can't seem to get the source of and I don't know and you know it just seems to me like there's a lot of things in the gut that sort of don't have all the clear answers right.

Oh yeah I mean the more we learn the more I'm realizing I would say like 80% of chronic health issues somehow relate to just an imbalance of good and bad gut bacteria and how that then spreads into the brain and affects the immune system and creates chronic inflammation which leaves all these other things and it's like honestly peel the onion and somehow there's always that gut at the bottom. Seems to be controlling most things with just extraordinary. And I forgot to mention in my story that after I graduated from business school I worked in conventional health care for three years with hospitals on the patient engagement software side of things so I was working in health tech so...

That's pretty cool.

I was able to see kind of in these hospitals because I worked on chronic disease management programs and when you were talking about value-based care it actually might be because that's what I was working on a lot trying to help hospitals reduce 30 day readmission. And you know really get people bundled payments and all this sort of thing with population health management and it was originally I thought maybe I can solve this from the inside maybe I can work in a way that that does that. And I just saw that there were just so many incentives to keep the system to be you know not only fee for service but really based around a disease code. Right. And we all know that a lot about preventing chronic illnesses. It must happen before you have a disease. And a lot of the treatments related to healing from chronic illness aren't seen as a disease code right. So acupuncture or supplements those are not exactly seen as I did seem like complimentary treatments or something right. So if the system is constantly related to this DRG thing this disease code thing there's just no way that people can really pay for any steps they might want to take to heal or prevent chronic health issues and those can even be the things that we know of that start in a small way. Right. Like you just have migraines or you just have a little bit of pain that you're kind of like take a lot some Advil for and then more and then more then more and the sade's end up really harming your gut bacteria which leads to a whole bunch of other things. So something that small can really, you know we talk about chronic disease but it's really just chronic health issues because if you don't get them and heal them and you just manage them whatever you're doing to manage them can end up causing a host of other health problems so that's something I think that is really important. And what I learned when I was working within the conventional system.

Yeah and it's cool that you had that experience obviously you're coming at this from from a very informed perspective both as a patient but also as a as a professional within traditional health care system and I think you sort of highlighted a very important thing that the way that our system is built and the way that we do billing and procedure codes it's not set up to pay for a lot of things that could potentially be helpful. And so you mentioned earlier in your story "hey you were fortunate to have an ability to to pay for an alternative let alone know what the alternatives are" right. I think it's cool that you're doing this because part of the battle is understanding what the alternatives are. And so folks if either you or somebody that you love is going through some chronic illnesses and I'm sure you could think of firsthand somebody that you know I know to three people right now and so I'll be referring them to your podcast and to your thing Adrienne because folks by the way Adrienne also has a podcast. She's podcasting with folks that are you know doing well after not having solutions to their chronic illnesses. She's covering things like integrative medicine and the microbiomes so definitely check out that podcast. Again you can check her out at getwellbe.com you'll see a link there for it. But yes so kudos to you for bringing forth this forum of discovery that I think a lot of people are needing.

Thank you. Yeah I know when I was going through my own health issues as well as taking care of my mom. Where do we all go to search for information about health. We go to the Internet and so but when you Google something it's really both an SEO game and just you know whatever happens to be there in the way that you put it in. But a lot of the best information you know is either kind of behind research walls that you wouldn't necessarily see in Google or in some of these smaller more mission-driven sites. And so what I found was being able to see what other people, what had worked for other people who may have had my exact health issue or even like as you said I know now so many friends and family are going through things now. So being able to help them and you just how are you what's going on there like a you know my skin. I feel like I can't go outside. You know one of my best friends it's just this ongoing saga and dealing with it is not only exhausting. She's sort of given up because she's been doing it for so long. But emotionally so trying because it's now this kind of like it's part of your identity. Right to have whatever that's chronic health issue is and it feels like climbing Mount Everest to think that what you'd have to do to get rid of it it may not be that complicated. Just maybe one more person that you try to work with. One different kind of practitioner you hadn't thought of or one treatment that is interesting to you. But you know somehow you never read about it maybe just you need and so this is what I've seen with these videos when people share their stories and they truly did heal people. Look at that. So differently and say well I have rheumatoid arthritis. I didn't even know it was possible to reverse it or I have Hashimoto's. Like how did they get over that or systemic lupus like are you serious you went from chemo to existing without drugs and she's fine. Like how is that possible and so by sharing both these stories but also coupling it with a lot of the research that we cover and a lot of the experts whose work life work is just these particular topics whether it's the gut microbiome or acid reflux ENT Dr. I covered who now only treats patients with diet based on you know having been a head and neck surgeon and saying that's not the answer. I don't want to take out tumors anymore. I know it's all diet. I'm just going to work with patients that way. So lots of different kinds of things but all related to this idea that our bodies are incredible. And for chronic health issues or diseases it just takes certain therapies and practitioners and lifestyle changes in order for your body's immune system to kick in and really heal. Now of course there's emergencies and there are life long genetic conditions that you're born with that maybe can't be solved that way or they. But I believe the statistic is that 80% of all of American health care costs are related to the ones that you can do something about. And you know really only five percent of June mutations are actually determinant or you know unchangeable. So I think that's just an amazing opportunity for the majority of people who right now are like "I don't want to take all these drugs. I don't want that surgery. I don't want to have to get so much radiation. I don't want to I don't want to say try these other things first like get to that choice 10." You know when you really have exhausted everything else. But before that can you imagine you can live your healthiest life just the way that your body is without having to be dependent on anything.

Yeah not a... some great thoughts being shared here Adrienne. And you know I would even extend this to people that don't have chronic illnesses because at the end of the day if you want to be well you really have to start looking at what you are consuming and the treatments that you're getting because a lot of things that end up affecting us are the things that we think are good for us or that we don't know and that ultimately gets us. So some great shares give us an example maybe a story of somebody that was inspired to wellness through your work.

Yeah I'd be happy to so we get you know some terrific comments and people writing and just on the forum on our site when they've seen something and then they you know go to see that doctor and they didn't really know something was possible before. But one of them is a friend that I have and you know her child has asthma and she had no idea that it could possibly be related to diet. And she saw some research on our site where we covered this connection between asthma and the child's microbiome. And the mother and things that related to nutritional deficiencies which comes back to diet and she sort of just had this whoa like and then she's now kept reading and she saw another research piece that we had covered relating a lot of plastics and other toxins within the home to asthma and she was surprised to see that as well she always thought it was just a respiratory condition. But what people don't think about that much is that asthma is just your blood and your lungs are are quite linked hence why these other cancers develop elsewhere in the body when you smoke right. That's not it. The lungs are not isolated. That's what I mean. So these other toxins were getting into her child's lungs and causing this disease via not really thinking too much about what she ate and using a lot of toxic household products and you know even her diapers were generic and had lots of chemicals on them and she really hadn't thought about it and it kind of started to unravel for her the idea that something she thought she was just going to have to treat with steroids and inhalers and things like that for the rest of her child's life that not only were those steroids wiping out the small microbiome that he has and the good gut flora there but also there were things she was repeatedly exposing him to every day with these products as well as with his diet that were continuing to cause inflammation and therefore cause also asthma which is just inflammation of this particular lung condition.

So it was just a really neat way for you know not having to even push it. Exactly. But just it was one of the topics in our research research piece. And she wasn't reading it even thinking about her son per se but yes she's my friend and all of a sudden these things started to click and she started to kind of realize that she had to really clean out things in her home and in her kitchen and especially the product she was actually using on her child which again from a marketing perspective we thought, these are healthy, these are American household brands. Yeah. And then oh my gosh. And using environmental working group database and some of the other things that I told her. You know look out for in the agreement she discovered actually not at all. I am exposing my child to a really big array of chemicals and I need to get all of that straightened out and let's see if the asthma you know just clears up that way. So that was just a few weeks ago and I thought that was kind of a really neat turnaround in that hearing about it. Yeah. So that's one that I know of so far. And then most of well anyway I'll let you ask me another question.

And that's good. So for the folks out there that you know have basically tried everything and you really don't know what to do. I feel like this opportunity that Adrian has created and get well be is is really something that will offer inspiration to those looking for a solution where they haven't been able to find one in the traditional health care system. So definitely something to consider if this is you I'll be putting on the show notes as well as a full transcript of our discussion at outcomesrocket.health/getwellbe just as it sounds and just like the website so you'll find that there. Give us an observation that you've made Adrienne of a setback something that that happened that you learned so much from that now you don't do things differently.

Sure. Would you prefer. Like you mean one in like a work experience or one that I went through and my kind of health journey?

You know what I think I leave that up to you because we definitely have been discussing a lot of both. So whichever one resonates with you the most.

Yeah well I guess I sort of mentioned a setback certainly was my mom's experience. That one is the kind of clearest setback that I can think of as far as different things that I experience and how I, so I didn't know anything about the mental health care system before. And I would say that my biggest takeaway from that is that as I'm sure people on your show have talked about before but the disconnection between all the different specialists in the healthcare system and not feeling like anybody's actually looking at the body holistically I thought was really interesting. We were just given scripts right away scripture scripts and each drug had a host of side effects that then required other drugs so then you're sort of on a cocktail and you know anybody who's taken antipsychotics knows that it's really it's like being drunk all day on your liver, as far as the damage. And so I was just completely shocked that there was nobody in this system and these were very good doctors at Clane Hospital in Boston and they claimed you know good good good hospital looking at actually her body and saying Whoa these are powerful like we need to be doing a lot to detoxify her organs at the same time because this is not just a normal toxic burden like this is heavy duty. And so also is she getting enough of these green vegetables which will help her to actually detoxify her pancreas and her liver and all these other things as well as are we doing things with supplements to really expedite that detoxification process. And then you know the therapist that she's supposed to be talking to really is hard checking in with the psychiatrist who is prescribing things right. So that was kind of funny and interesting. But then on the what I think is the most interesting piece is the gut, the blood tests and all the different testing that could have been done on these underlying viruses and conditions which we now know impact the brain. We're not even part of the conversation. So you know whether it was like a gut health protocol that they could have put her on or things like that. There was just no sense of understanding why is this happening. And what are the different things that we can do to improve the different systems in the body such that we maybe can get her off these drugs and use this and actually restore her to a life in which it's you know she feels she's living because the vegetable state was not really living. So I learned a lot about this kind of lack of communication between specialists and then I also learned about you know how little the whole body is taken into account when prescribing things and also hardly any mention of the side effects which one of them was suicidal ideation and that is what happened. And you know we really didn't know about that. So you know it's hardly spoken about before you actually give somebody a script and then I also learned about I say those are my three biggest takeaways and the set backs that I saw. Yeah those, is that?

No it's definitely clear and a lot of people go through this. You know you really don't know what you're getting into. And so it's important that you do the research and you get as informed as you can. But ultimately we have work to do in health care. We've got to connect these silos better and treat the body as a whole because it's definitely not being done as properly as it should be and especially with the cases that come up that are particularly difficult with chronic diseases. It does become even more more challenging. What would you say one of your proudest experiences in the healthcare space has been to date?

Well certainly my life's work and my mission is definitely WellBe it's you know everything that I care about. And I unfortunately think that we have enough work to do that I'll be doing this in some capacity till I'm 90 years old up unless you know I do a really good job and the entire health care system transformed before then I doubt it.

Me too.

There's just way too many people really invested in. Unfortunately the way it's set up right now it's lucrative in some areas and I don't think anybody really wants to change that. You can't patent broccoli right. Which is why I always say. And so I would say my proudest moment would comes routinely when I get this outreach honestly from people who say something that we've done has sparked has lit a light bulb in their head that they didn't even know they sort of either accidentally watched it or they weren't even looking for something and they just it was something in their life or their family's life where they thought that was just the status quo that was just never going to change. "Oh I have anxiety or oh I had acid reflux or oh I just have high blood pressure". It's hereditary or you know these things that they were just like accepting as fact and saw as either research piece or an expert interview or you know story that we filmed or even one of our like article guides to something and just kind of didn't realize that there was a different way of thinking about something and that this was not a life sentence and decided it was really impassioned enough about that realization that they had to write to us. We're very active on Instagram as well. So I get probably a direct message like this you know once a week on Instagram but also writing into our site and each time I get one all the anxiety and stress and complications that come with being a sole founder as I'm sure you know Saul they just kind of melt away for a couple of minutes while you realize like wow I'm impacting people and it is not just about growing a brand or growing a business it's about like as I'm doing all of that. This person is able to maybe save their life if they're having this issue in their mid 20's or 30's and they are going to never really think there is a different way of looking at it indefinitely. Maybe I just changed the whole trajectory of their life. And so for me that's definitely each time that happens I just like beam from the inside and then I go back to work because I have so much to do.

That's too funny. And for sure it's like that that affirmation that what you're doing is making a difference. And so folks the call to action they have something that you heard today is resonating with you. Check it out and share with a friend. That's the way that silos are connected right. That's the way that we are able to make a difference in this health care system is sharing it what you find impactful. And so I know I'll be sharing this interview with some personal friends and so I encourage you to take that as a call to action for today. I know are running out of time here Adrienne so what I'd like to do is just ask you for your closing thoughts and then the best place where the listeners could get in touch with you.

Of course. Yeah thank you again for having me. It was great to speak to you. And you know as I said before I started this not because I thought there needed to be more wellness content on the Internet. Lord knows there's plenty of it but it was more that for me having done just worked in conventional health care for several years and seeing the issues you know every week that I was in a hospital, I know that everybody has to interact with the conventional health care system at some point you know whether it's they actually have something or just checkups and screenings and things like that. And then knowing that the wellness movement is booming. But you know a lot of people think it's just leggings and juicing and you know all of that and like grain, lose weight and all that stuff and I'm like whoa you know these two things like have to come together or because we are in a chronic disease crisis. I mean it's an completely unsustainable amount of disease that we've created in such a short amount of time that we're going to literally bankrupt ourselves and all die way too early as this continues at this rate. And so I thought it was something very important that I could do to bring to the conversation look I've seen both sides. I'm a wellness and integrative health person by you know passion, by experience but I've also been working in the system and I know that once they come together, once you bring that data that research and science to these things that can prevent and actually heal the root causes of disease rather than bandaiding symptoms. All of this will start to change and will start to change pretty rapidly because you won't have these crazy costs and you won't have so much disease that we know that the health care system as it exists can't even handle it which is exactly was happening. So that's what I'm trying to do and I hope that you'll visit WellBe and find us at getwellbe.com. So as Saul said it's getwellbe.com and we're also very active on Instagram. It's also at getwellbe's you can follow us there and if you don't have instagram, also Facebook and YouTube all of our interview and interviews and other content is there. Our weekly newsletter on the website which is definitely the best place to serve get new content because it comes out every Wednesday and has only podcast episodes and things like that as well. So yeah. Any way that you want to interact whether you know what to listen to a story to be inspired or read some of the research that we break down and cover in kind of a quippy way I think you'll get something out of it. I say if you have a body you probably will get something out of it because...

Love that, love that Adrienne. Hey well this has been a pleasure. So folks make sure you check out Adrienne's podcast, her website. Again Adrienne this has been a pleasure. And really thank you for spending time with us.

Absolutely. Thanks again for having me Saul.

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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What it Takes To Succeed in Healthcare Entrepreneurship with João Ribas, Biotech & Life Sciences Investor at Novo Holdings

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.

Welcome back to the podcast today I have the outstanding Joao Ribas. He is the Co-Founder at The Future Labs Healthcare and Life Sciences Investor at Novo Seeds. He's a Harvard trained Bioengineer working at the intersection of Science and Business. He's passionate about empowering entrepreneurs and startups to succeed. Today he's phoning in from his new destination in Copenhagen Denmark which you know we had a great discussion about some of the happiest people in the world maybe otherwise their healthcare being part of it. He's an innovator he's done venture creation. He's he's got investment experience. And so I'm really really excited to have him here on the podcast so Joao welcome. Why don't you fill up that gap any of the intro that I may have missed out? Welcome.

Thank you Saul, it's great to be here and talking to you on the Outcomes Rocket podcast. I think that introduction was pretty amazing. I didn't even know I did all these things.

You're a humble man. You're a humble man. I appreciate that about you. What got you into the medical sector to begin with?

Yes. When I was growing up I always showed curiosity about how things work especially biology and disease do. And for me working in solving healthcare problems sort of ticks that curiosity box. So that was one of the factors and then at the same time working health care means that I can impact positively the lives of millions of patients which is something I strive for. So I think those two as what sort of draw me into work in this medical sector.

That's amazing. So now with the work that you're doing in this investment firm and with your own gig I think you have pretty good reach as you've looked at different companies Joao and you've done projects of your own like the X Prize etc.. What do you think a hot topic that needs to be on every medical leaders agenda today is and how you and your organization approaching it?

Yeah although there's a lot of very hot areas that one could look into. But I think in essence what we're trying to do here we are we're sort of creators of opportunity. So we're looking for and we fund compelling and very strong science-based startups which will then lead to development of new territories where some of the most pressing clinical needs that we have out there. But of course in order to do this well we need to start early in the lifetime of the companies and then the ideas we need to back need to be transformative. So I think this is what should be on everyone's agenda is to find these transformative companies in a lot of different fields because there's different medical needs in a lot of different areas and fund these transformative companies and not just companies that are adding on to previous technology or just smaller improvements over what we have out there.

So how do you how do you define that transformative?

So we think about ideas and companies that really disrupt the way we're looking at a treatment of a certain disease or therapies forced into a disease and can bring an angle that no one was really thinking of before. So you can think about the CAR T the cell therapy as something that was very different from what people were doing. So we're looking for the sort of opportunities where you see that there's a different approach to things.

Got it. Got it makes a lot of sense. And so as you've embarked on this journey to work with and fund transformative companies, can you give listeners an example of maybe one of those companies and their solution and what they're doing differently to improve outcomes?

That's an excellent question and it's kind of hard right now to give you a specific example because we often don't talk about some of the companies that we invest in because it's such an early stage and some of them might be sort of under the radar but there's plenty of companies out there that are interesting I can give you another example of a company that I know closely from the time that I was working in the U.S. there was sort of a very simple idea a sort of disrupted a little bit the way people were doing things and this was while I was working there in Boston so this company looked into the problem of compliance of adherence to medication which in the U.S. is a really big issue. A lot of people were developing a lot of different solutions. You know these little apps that remind you to take your pills or little boxes where you put your pills. And all of these were sort of not working as well as you would expect. So these guys came with a super simple idea to package these pills for every day in a single small little package so you have a package for Monday morning, a package for Monday evening, for Tuesday morning. Tuesday evening. And it's such a simple idea. But it kind of transformed the way people were thinking about getting medication at least in the U.S. and this company's name was PillPack and it was I think probably a month or two ago was acquired by Amazon and they can feel it. Yeah for a billion dollars. So it's a very interesting story. If you were interested you should look it up from where they start up and where they are right now and their approach of looking at a problem and understanding the clinical need first and looking at things in different ways.

Yeah you know and transformative doesn't necessarily have to mean complicated?

Exactly. And a lot of people think that transformative always means complicated events. It's very easy to complicate but it is very hard to simplify and some ideas are simple but transformative.

Gosh that is so great. What a great example and I love that you brought it back to today. John with this example of PillPack getting acquired by Amazon. It doesn't have to be that hard folks. It's just finding the right way to add value and so they obviously delivered value. They've been acquired. Great example there. Tell us about a story where maybe you know a company that you were working with Joao that didn't work and why that failed, a mistake. We learn more from those. I feel like...

Definitely we spend a lot of time talking about successes and very little time talking about the failures. But going back to my time in Boston, well as during my Ph.D. there I got introduced to Healthcare hack-a-thons which are sort of became very popular right. And I work maybe two or three projects in this hack-a-thon's and they didn't work. They really failed miserably and I think this was very good. I was able to really learn and understand how a strong and validate clinical need is key to further startup idea in healthcare. And I was really not aware of these. I just wanted to work on maybe as a special technology that I was interested in and not really focusing on the clinical need. And interesting enough after failing a bunch of times trying to do these Healthcare hack-a-thons now with different ideas I ended up joining MIT Hacking medicine which is a MIT group that teaches innovation methodologies around the world. And I was able to travel all the way to Ecuador or Austria and I organize events there to stimulate the creation of new health care startups with a strong focus on finding validating medical needs. So in this way and looking back I'm very happy that I failed early on and learned from various foreign mentors.

So that's so cool Joao. So the common theme with these three companies that they didn't work out was that there wasn't a clearly validated clinical need and then you spun around and MIT did clinical need based innovation hack-a-thons.

Exactly.

Love that.

So I've quickly understood that the way I was approaching problems was that was not the best I was trying to work with a certain technology and find what can I use this technology for. And instead of starting with a clinical problem and then trusting that I would be able to find a solution in a team to that problem and that sort of change the way I was thinking about problem and technology trying to solve a problem and looking at the problem first before thinking about the technology.

That's very cool. And while it seems pretty easy it's also difficult to stay focused on that because we tend to fall in love with technology, we tend to fall in love with the gadgets. So what advice would you give to people looking to work in this space looking to make a difference. You know like honestly make a difference. What advice would you give them so that they don't fall into these traps.

Absolutely, absolutely. You're very right. I think working in multidisciplinary teams is key and then these hack-a-thons I was putting together teams that as a physician, an engineer, a scientist, maybe a lawyer, or a businessperson,a designer and all these people bring really a lot of different perspectives. So when you're stuck in the love with a certain technology maybe someone else is not. And they're able to show you a different way of looking at a problem. And in this way you don't get stuck. So I think that's a tip I would give to people working out in healthcare startups is have a diverse team.

I think that's so valuable. So get your diverse team in place folks. You don't want to have people on your team with blinders or have them be too homogenous because it definitely could put your business model at risk. How about the other side of this Joao. Tell us about one of the proudest medical leadership experiences you've had to date?

So I guess following all these failures I started learning and learning more about them and avoiding these in future projects and in 2017, I was a Innovation Fellow at the European Institute. And I had the chance to travel around Europe and talking and interviewing physicians and patients. It was really a great experience that allowed me to learn more about these unmet needs on a hands on approach just by going to hospitals and talking to, talking and observing decisions and throughout this process I was able to work in a team and find a novel solution for a problem which is colonoscopies we're really not doing a good job in tracking all apps that can lead to cancer when we do colonoscopies and because of these we have a very high rate of colorectal cancer. And throughout this experience of identifying first in medical need we're able at the end to go out with a new idea and started working on a prototype which say novel modality, medical device to address this issue.

That's awesome man. So how long was your fellowship?

It was for a full year was really a great experience because we were jumping from Budapest to Barcelona to Poland to a lot of different places and getting these inputs from many doctors in many hospitals where culture is different. The way of operating is different was really key to understanding what will be the most relevant need to solve first.

Which is really cool. I mean I think it's really great that you had this fellowship tour and in general it seems to me like you're pretty jet setting kind of guy. You're not geographically bound by anything. Right.

And he is very right there.

You know you I'm from Boston now you're in Copenhagen so there's worldly perspective really matters. What were some of the common themes that you picked up you know you went from Mali to all these countries different healthcare centers, modes of operation, what were the common themes that you saw if you could highlight maybe one or two?

Well I think first there's a lot of great people everywhere after being in Boston which is a center of excellence with great research I found that in Europe we can find the same thing so we can find really really good research and inequality that is at the same level. But then in terms of the way we treat patients I found really big differences between the US and Europe mostly in the way healthcare systems are efficient. So in US it seems that they're a bit less efficient. They do a lot more exams which cost a lot more money whereas in Europe, things work a little bit differently and there's more outcomes-based healthcare systems other than in US which is getting to that point.

It's a really great great observation. And so folks from the providers side I know we're all doing a very very hard job or doing our best and in this transition to value-based care. I think taking on Joao's perspective you know he's been around the world. I think we ought to take a look at the folks across the pond in Europe to inform some of our decisions some of our pilots as we're adopting value based care. We have a lot to learn and I think our fellow Europeans could teach us some good things there. Tell us about an exciting project that you're working on today.

Yes we're right now doing a podcast and I'm actually also working on on a podcast...

Nice.

Which is called the Futurelabs. And the idea behind this was that I really enjoy thinking about what the future might look like in different areas not just science and technology but other fields such as education or politics. And I started thinking about it and together with a friend we decided to start a podcast and started interviewing key opinion leaders about how they think the future might look like. And we're going to include topics as diverse as what's the future of Meet, the future of these therapeutics, and the future of open innovation. So I think that people are going to get excited with this I think.

That is awesome man. Good for you. Now you have a name for the podcast then is it out yet.

The podcast name is the Futurelabs is not out yet. We should be launching towards the end of October.

That is amazing man. That's exciting. Good for you.

Yeah thank you.

We'll definitely do our part to share this project with the listeners because the reason why we started this Joao as you know is we wanted to make a forum where people could share best practices and connect with the people that are making a difference in healthcare. And so you're doing that. And so when you're done with that please let me know. We'll do a special episode on the release of your podcast so that we can get the listeners to check it out.

Fantastic. That would be great. Thank you.

Absolutely. Getting close to the end here John. Let's pretend that you and I are building a medical leadership course on what it takes to be successful in the business of healthcare. It's the one on one of Joao and so we're going to build a syllabus with a four question lightning round followed by a book that you recommend to the listeners, you ready?

Yup.

All right. Here we go. What's the best way to improve health care outcomes?

Investing in deep science companies to innovation that reaches patients.

What is the biggest mistake or pitfall to avoid?

Not considering reimbursement.

How do you stay relevant as organization despite constant change?

Embrace and lead change and pull yourself out of your comfort zone.

Finally what's one area of focus that drives everything in your organization?

We are very focused on finding and building extraordinary interest forming lifescience companies.

Outstanding what book would you recommend to the listeners Joao?

Well I think I would recommend maybe two. One that I read quite some time ago and the more recent one. The one I read a long time ago was called Creative Confidence from ideal founder David Kelley and it's basically about design thinking and it really changed the way I was thinking of our problems. So very very highly recommended. And the other one slightly different is called Shoe dog by the Nike founder Phil Knight. That's a very intimate story from like his early days and all the struggles that he faced. We know Nike right now has the bee corporation but it was not always like this. It's a very very interesting to understand how was Nike made and all the problems that they had in the beginning.

Love that. Great recommendations Joao. Folks again we have Joao Ribas. And so what I want you to do is check out these resources that he just checked out. We'll include a link to his podcast when it goes live. But also the books and an entire transcript of our discussion just go to outcomesrocket.health/ribas as in Joao Ribas. You'll find all that there. This has been a blast, Joao, I love if you could just share a closing on with the listeners and then best place where they could get in touch with you.

Sounds good. Well maybe I'll talk a little bit about what we do here in Novo Holdings we really invest with impact. So we are a very different VC compared to other more traditional VCs and the money that we make is then donated back to science and humanitarian purposes. So I just want to pass that message that you can make money at the same time impact society in this way.

You guys are doing great things there. So where would the listeners get in touch with you or find out more?

Sure you can go to our company website. So www.novoholdings.dk or you can also connect with me on LinkedIn or on Twitter @ribas.JC.

Outstanding. Joao this has been a blast. Really appreciate the time that you spent with us today and truly excited to hear your new podcast then and also keeping up with the cool things that you have going on at Novo. Thanks again.

Thank you.

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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How to Provide Value-Based Care with Arif Nazir, Chief Medical Officer at Signature Health

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.

Welcome back to the podcast. Today I have the outstanding Dr. Arif Nazir. He's a president at SHC Medical Partners. Dr. Nazir has established a career in internal medicine and geriatrics. He most recently provided medical leadership for the optimistic project an innovative CMS Innovation Center project to successfully decrease avoidable hospitalizations and improve quality of life of frail long stay nursing home residents. This is a key topic that a lot of institutions are looking to improve and he's headed this initiative in a big way. In 2015, recognizing his services to the state of Indiana. He was awarded the Tony Holeman Public Health Award in gerontology and geriatrics. He's board certified in a geriatrician and demonstrated experience in leading teams for improving post acute systems. He was most recently a speaker in our Health care Think A Ton conference and inspired the audience to be better leaders as well as practitioners so it's a great privilege to have you on the podcast here today Arif, thanks for joining us.

No you're welcome. And the honor is mine. I'm really really looking forward to our discussion this evening.

Thanks Arif. And so Dr. Nazir what is it that got you into the medical sector to begin with?

Before I get into that I'm just going to add quickly is that I'm also in the role of our chief medical officer of Signature Healthcare which is one hundred and fifteen nursing homes across ten states. And the reason I wanted to mention that is above a lot of inspiration for the work I'm doing right now is coming from that.

That is huge detail. Thank you for mentioning that. So one of the things that was really cool is sort of the way that you guys are approaching care at these facilities. I'm excited to share with the listeners some of what you shared during the meeting. So I'll open up that loop to discuss later but what is it that got you into the healthcare sector to begin with?

Yes. So actually I'm a foreign to this country for the last 20 years before I moved here, I was living in Pakistan and that's where really I got my early on inspiration to enter the health field and when the time when I was going to fast for you to do well socially and financially you didn't have many options other than pursuing you know the field of engineering or the field of medicine and your parents felt obligated that they had to push you to work. Those are two things but personally I did get a lot of inspiration from positions. I remember feeling very inspired and motivated going to my local primary care practitioner who kind of weak authority and problem solving and poverty and from falling just for something which I was very attracted to you know at that age and got a lot of inspiration home from just me visiting my primary care practitioner and feeling that you know someday I will be also solving some key problems for my patients. And I got very inspired and made it a point that I want to pursue the field of medicine.

That's wonderful and you did such a wonderful job of just making it a human thing. I feel like this connection and health care is something that is so important. So I really want to commend you for that talent and I think it's important in our practitioners today as it relates to addressing things on a broader scale Dr. Nazir, what would you say a hot topic that needs to be on every medical leaders agenda today? And how are you guys at Signature Health Care are addressing it?

Yeah it's a great question. And I think for me the answer is quite obvious to our for the last 30 years or more, our healthcare system has somehow just been a victim of a fee for service structure where physicians were and practitioners in general were under the radar, in the doctor performance. I remember when I was training in my residency and even after that when I was working at the hospital and seeing patients nobody really asked me as a physician why are you seeing this question every day. What was the value and the benefits you brought to this patient from your visit? Why did you put out notes to them on this patient? What was different about you note today and yesterday? And I think that what value physicians bring to the healthcare system needs to be documented clearly and we need to challenge our self sufficient community and the practitioner community to prove that value and because and that the reason I say that is because you know we do bring a lot of value. And what I'm worried is that we just don't have good ways of measuring the value. And as a physician leader I feel a lot of pressure myself that I need to create structures for my own organization so that I can create a great story for some of my superstar physician and nurse practitioner that we're providing care and even nurses that I should be able to capture that clearly. So I think we all are kind of in this transition from fee for service to value bits are dealing with some of the metrics with the health care system or CMA setting up for us. But I think we need to go above and beyond the individual organizations because we need more strategies to really really understand what traditional professional and the nurse value is in the healthcare system. I think understanding value and number two thing which we have to be on top of is how our healthcare teams are doing in the frontline because again exposed to all the changes in health care, they are feeling pressure and they are burning out and they're not having as much fun. But we didn't have to pay attention how they're doing and the tagline, make their role as fun as it used to be for me when I was training many many years ago.

So insightful and you know rather than respond to the wave, be the wave. And I think one of the you know Arif, the thing that you're doing that strikes me as really insightful is hey you know what value-based care is coming, it's here to stay. Why not work on communicating how you're adding value today? That's brilliant. I love that you're doing that. And so I'd love to dive deeper. Can you give us an example of how your organization has created results by doing and thinking differently because you do it so well?

Yes I will give you that quickly. Two different perspectives on that. Nothing more for me is how patients are doing and getting impacted. So signature health care and SHC medical partner. We are absolutely taking the bull by the horns when it comes to innovation. And coming up with new ideas to care and just to give you an example of signature health care we are the largest organization in the country both good organization the country where our facilities are Eden Alternative certified which basically means that we believe in the new way of providing care to our residents so that if not an institution there. But it's really a home like our homestyled care that they're getting. And also for example we are the only organization who believe in doing yearly Senior Olympics and all of our residents get the opportunity to select their own theme song. There are uniforms and some cheering in the field to really participate in events to win medals and really really compete and show talent even though if they are living in a nursing home and you know nobody could have imagined doing any kind of thing that way they could afford to risk you know the residents would fall and if you talk to an attorney you know like people like know you can do that. And you can do that. And I think we have taken a lot of pride in doing things differently challenging the status quo. And I'm telling you that we have seen the benefit of it in terms of resident and for the patient engagement and quality of life around. We actually are involved in a very cool project with an organization called Time Slips. Time Slips is actually a company which is founded by MacArthur awardee doctor and Hastings where we are working with their team of professional artists to bring terror to the residents in our nursing homes as actors so they can participate in acting for some of their famous plays. For example currently 11 of our Kentucky nursing homes are working on Peter Pan as a place and they will be they will be showing their talents around you know performing in that. So we are seeing significant benefits of both approaches in terms of quality of life and collecting data and we'll soon be publishing that. So that's just one example from the residence side and from the physician side and practitioner side, we are working on a whole process of setting expectations and providing impacted works to our practitioners and physicians so that they understand what their value is and it motivates them to be better in what they do and also really understand what the value they brings into our studio to daycare.

Man that's so inspiring and I love that that they're working on not only Olympic opportunities but also working on these plays in the arts and are just keeping them alive, keeping them going. A lot of organizations stop at that. No you can't do this from legal. What is your advice to a leader trying to make an impact and sort of that's facing these no answers from the typical responses from legal teams et cetera?

Yeah I mean it's basically a cultural thing right. I mean our CEO has made it clear that we are going to be an organization that talks about how it can be done rather than why it can not be done right. I mean you can kind of come up with billion answers of why something cannot be done. And one way I will tell you that we have, we excel really well is that if we run into a block where we say "oh my god how can we do this? how can we do this?" We really really put our stock in our residents and our families. And I'll tell you that some of the neatest idea that we implement really come from the residents and the families themselves. So whenever you're stuck in a problem like this it's always good to go to a resident council or a family council and say hey we really were trying to do this? How would you feel about this? Would you become an advocate for us in regard to doing that? And that way you know you can for a lot of problems in a very very outside the box way.

Outstanding great great piece of advice there. IAC you guys have created something beautiful something that's working well. You're starting to pull the data out of it to create the research to back it up. Can you give an example to the listeners of maybe a setback, something that happened while you were putting this together that you learned from that maybe you could help them?

Well in thinking about in my current role I don't know if I can give you a stark example where I've failed. But I mean believe me there have been many instances where I've failed and I think the biggest shock that came to me in regard to me being a practitioner and a physician was how blind I was in regard to how different the perspective of patients and the families about the care I provide. So you know I, like many other physicians who are trained in the 1990's or early 2000's. I am a product of a very physician and healthcare centric system and I was really trained to be that it was all about me and what physicians sees in regards to disease and what are the best outcomes in the perspective of the physician that he or she should be working towards improving. But it was not really like a one day and I shared the story a few days ago. The meeting also was that when I went in to see a patient whose son was absolutely livid on the care that their father received and kind of told me that I don't care about your five star rating of your facility but let me tell you from my perspective the cure you provide is worse than my local restaurant. And you know initially I didn't understand what he was trying to tell me but it took me a few days to kind of get what he was telling me that patients have a very different perspective on what care is based on their own needs and if the customer is not getting satisfied that's it. You know you cannot defended by saying oh no the physician thinks that this is good for you and your blood pressure is way more important and really it's not about the pressures not about heart failure it's about how they feel in a healthcare system and the delivery of the health care is that meeting the needs are not which were more important and that's where I realized that how wrong I was that if not the outcomes that are really important to me which are going to define the quality of care I really have to have an ongoing sensor on when communication my vision of the family how they are feeling and let me tell you that a few days after this event happened a few years ago I kind of realized that there was a big patient acknowledgement board where patients would leave letters and cards for their thanks to the staff. And I realized that on the big board where we have dozens and dozens of great cards and thank you notes from patients there was not even once I was mentioned. They didn't even think about what the blood pressure medicine I gave them they don't really care about the heart that I treated. But you know who was mentioned on the board? It was a frontline healthcare team. The CMA, the health plans do you know the dietary person the housekeeping person who had given them what they really needed who had given them a hug and all those things then kind of really really validated that you know we have to see health outcomes from our patients who are really out to customers and kind of we have to have an idea on how health outcomes are and how we see them. What will be the big focus needs to be on how we are making the patients feel as a person. I think I was really really wrong and how were approaching healthcare onto 5, 6 years ago when I had an epiphany that I really have to be an advocate for person centered care and I think that really kind of started a new phase for me as a physician leader.

Yeah it's so inspiring and folks when we were at the health care meeting. He and his team put together a video to demonstrate this point and I took it home I felt like that was such an effective way of doing it. But it was basically what a restaurant would look like if it was being served as a typical health care system would take care of their patients and it is definitely eye opening and you continue to do great things like this and this point I think we'll go a long way. And so tell us a little bit about a proud experience that you've had. You know you went to that learning about a proud experience that you've had today.

Yeah I mean when I was practicing a full time clinician. I mean I still have a few patients but when I was reckoning of a full time job geatrician I would say that one thing which was really cool about my job was that I was having many many proud moments in any given day. As a geriatrician, you really really focused on a holistic patient care aspect and some of the simplest things makes you a hero in front of the family. And let me give you an example. You know it was quite a simple proud moment for me when I was sat down with a family and spend just ten minutes without any agenda and just to listen to them and their frustration with the healthcare system and then address simple things. Why are you taking this medication let's discontinue this medicine. And the smile that you see among the family members and the patients because they were like sick and tired of not understanding why are they taking all these extra medications why they had extra tests in the hospital and just sitting down and having the ability to listen to a patient for a few minutes and their family and understand their frustrations, really made them feel so much more satisfied. And there was nothing more proud to be able to do that. So I think nothing beats that kind of a proud feeling with you as a physician leader. I'm very proud to be a Chief Medical Officer of a very very innovative, very progressive health care organization, signature health care where I am working with the thief weighed in every given day of creating some innovative personal care models which are really needed for the future which are health care system.

And no doubt you're doing some amazing things. And he had that listening. It said, "What can you do to listen to connect?" So take these notes from Dr. Nazir and think about how you can really fit them into the things that you're doing day to day. Arif tell us about an exciting project you're working on.

So you know physician engagement is something which I'm really interested in particularly around the medical engagement. You know I'm a leader in postlude long term care side of healthcare and we have almost 16,000 skilled nursing facilities in the country. And every single facility is required to have a medical director. But here's an interesting thing, that we have as a healthcare system no idea what these medical doctors are doing on a given to a given day and if we have no way as a result we are not able to nurse them to do those things that will improve care that we really have no control or understanding what is going on in regards to the physician leaders performance in the facilities. And I've talked to hundreds and hundreds of physician medical leaders. We're quite frustrated sometimes because they have no real mandate to them is what they should be doing. So that's an issue which I think leads to a lot of dissatisfaction among our physicians and the folks who lost their sight. And I've been very passionate about this issue and wanted to solve this. So over the last two years I've been working on a digital application or a program to enhance medical doctor and physician engagement in government facilities. And the good news is that we have finally completed our pilot and now this application called CareAscend is available and is being implemented in dozens of nursing homes to really guide medical doctors and physician of what they should be doing as a part of the health care team and to be able to report in a life fashion what they are doing on a day to day basis, provide them outcomes of their facilities, and nudge them to be better at what they do so that that product has taken off well. And I'm really excited because I think it's a disruptive innovation which will change how physicians and physician leaders perform in their skilled nursing facility.

Man that is so great. And you know it's wonderful that you put this together is CareAscend something that is only available to Signature Health cCre or is this something that can be used more broadly?

Well the exciting news is that we already have external customers. Even though Signature is one of the stakeholders in it but Signature being one of the most innovative organizations was a long term care would never have the intention to really restrict the use of any innovative technology themselves. So you know we have a couple other healthcare systems that are implementing the program, the physician engagement program at this point as we speak. And the other exciting thing is that society of both the acute and long term care medicine is also supporting this approach and is also a partner in this approach.

That is wonderful and is so great. And so folks if you want to check out some more about CareAscend or any of the work that Dr. Nazir's up to just go to outcomesrocket.health/signature as in signature health care and you'll find all of the show notes there along with links to the resources that have been discussed here. This is a ton of fun. We're getting close to the end here Arif. So what we'll do is we're going to build a medical leadership course, a syllabus on what it takes to be successful in health care, in value based healthcare. So this is the ABCs of Dr. Arif Nazir. We got four questions lightning round style fired by a book that you recommend the listeners you ready?

This is exciting I'm ready.

Awesome. What's the best way to improve healthcare outcomes?

We have to empower our team as to be a better team and we need to know what value they bring to the table and what is resulting in negative hygiene and burnout.

What is the biggest mistake or pitfall to avoid?

I really would like to quote Tim Cook here the CEO of Apple. Now that he says that my fear is not that machines will start thinking about humans. My fear is that humans will start thinking like machines and I think we really need to understand where technology is really suited and needed and we can not trust technology everywhere without understanding how the team is doing what they need to do and then adding technology on top of that.

Wow. That's insightful. How do you stay relevant as an organization despite constant change?

You have to spend 30% of your time thinking about the future and investing your time and resources in building ideas, products that will keep you relevant for the future and there's just no other way around it.

What's one area of focus that drives everything in your organization?

Person-centered outcome. We want to be the best from person and patient perspective and everything else is secondary.

Love that. What book would you recommend to the listeners as part of the syllabus Arif?

Well until now I have had a favorite book. It's called Drive: The Surprising Truth About What Motivates Us from Daniel Pink.

Yes.

Which currently changed my mind and my attitude to worse behavior change. So I highly recommend that and the one which I'm becoming a huge fan of as I'm reading it. It's from Yuval Noah Harari is the book called 21 Lessons for The 21st Century.

Love that. Two great recommendations, a syllabus, all available to you at outcomesrocket.health/signature. Arif this has been a ton of fun I really have enjoyed our time together. I love if you could just share a closing thought with our listeners and then the best place for they could engage with you or reach out.

Well my closing thought would be that we just need to challenge all the status quo and we just need to make sure that we all understand why we do what we do. Life is short, time is limited and we should not be investing our energies in any initiative until we really believe that it's going to lead to some gain in the mission you are living for. So be very thoughtful in that and do a reflection more frequent. You know very frequently on that aspect and in regards to how to get hold of me. It is very easy. It's my email which I'm sure will be available I answer almost all my emails within a day or two but very easy to get hold of me.

Outstanding. I'm always inspired when we when we talk. Dr. Nazir. So keep doing your amazing work and just don't stop inspiring others to follow your steps. Again just want to say thank you for spending time with us, has been a lot of fun.

Well the pleasure has been mine. Those have been really really exciting. Thank you so much for having me on the show.

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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Recommended Book:

Living with a SEAL by Jesse Itzler

Best Way to Contact Brandon:

blee@meshcoalition.org

Company Website:

http://www.meshcoalition.org/

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https://outcomesrocket.health/podcast

Disaster Preparedness Tips for Today's Healthcare Leaders with Brandon Lee, Chief Operations Officer at MESH

Welcome to the outcomes rocket pod cast 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.

And welcome back to the podcast. Today I have the outstanding Brandon Lee. He's a chief operations officer at the MESH Coalition. He's also a nurse practitioner with extensive experience caring for patients in a variety of settings but not limited to Vascular and Thoracic Surgery, wound care, ICU, trauma. At the MESH Coalition, he's the Lead Administrative Officer and provides leadership to the largest Emergency Management Healthcare Coalition in the United States. Outside of this Indiana National Guard, he's doing outstanding things for our country, for our health system and it is a true pleasure to have Brandon on a podcast. Brandon welcome.

Saul thank you so much.

Hey my pleasure. Anything that I left out of your intro there that you maybe wanted to fill in?

You hit all my highlights. I think what's now my profession is father of five wonderful children and actually married.

That's awesome man. Congratulation. Boys? Girls?

4 Boys and one girl.

Amazing, amazing. Congratulations to you. That's a true blessing. And you and I had a chance to connect at the Health care Think A Ton it was a fun event. We got to chat about some of the cool things that you guys are up to. What do you think is a hot topic that needs to be on every health leaders agenda today and how are you guys approaching it Brandon?

You know it's interesting. So I'll talk on the MESH side with the MESH Coalition is a disaster preparedness organization Coalition of multiple hospitals in the downtown area. And one of the things that with all of the disasters that happen. Unfortunately tragedies happen every day. Whether it's a natural disaster with a hurricane that we see that happen again all the early disasters shares the stage. So it really is just thinking about how to get involved and try to minimize as much energy as possible. And really that's through preparation and education.

Very cool. Now the work that you guys do Brandon is it centered around Indianapolis and the surrounding hospitals? Or does it expand from there?

So it is centered around Indianapolis as of right down Marion County is the county which Indianapolis' house so...

Okay.

All our Health care coalition partners right now are there alone. We didn't have a nationally, we actually host the National Health Care Coalition's practice conference once a year. So it is a health care, its a conference for health care coalition across United States. So typically all 50 states in United States are work-centered. Typically at this, there is going to be enormous play in November.

Very cool. Very cool so your work is focused locally. But you're organizing at the national level to help others deal with disaster preparedness.

Yes.

Very cool.

And actually the unique thing is this unique partnership because actually some of the guys it's from the assistant secretary areas which is called usher. And the one of the main agenda I just decided he has is getting state partnerships and coalitions formed to help disseminate the information in training that needs to happen. So it's going to have a Federal Strategic Plan however it's seated at the grassroots state level.

I think that's phenomenal that you guys are working on this because you're right. I mean you never know what's going to happen. You have to be prepared and you know when our health system gets the pressure of something that happens with a shooting or with you know be it where your geographical area is you'll have your given problems right. Earthquakes, fires, hurricanes, it's important that you guys are ready. If you're curious about the work that Brandon and his team are up to check out their website go to meshcoalition.org. You'll be able to see that they've got a nice social media feed as well where they post the things that they're up to their calendar. And so you obviously have a varying degree of interest right and you're doing different things man. And what got you into the medical sector to begin with?

Well I initially thought I grow up wanted to be doing business and I didn't want to worry about other people's money. Mostly it's just the fascination I had after I laid everything out and working with the phenomenal opportunity and career.

Yeah.

And from there it just kind of expanded I was also joined at a college, the National Guard and it was a medic. And I think that two kind of helps nearer together. And I could just continued my career of both . So I have continued my education and became an nurse practitioner based on love for helping people and the I think with the nullitary dimes and the view of trying to make things better, faster, quicker is just kind of come around.

I think that's so wonderful,you've really tied them together quite nicely. And so with the work that you're doing at MESH Coalition or even at the National Guard now, what would you say an example of how one of those organizations has created results by thinking and doing things differently?

The exception like MESH is essentially thinking outside the box actually get after problems really what MESH stands for some of them are missing saying it's Manage Emergent Search for Health care which basically means how do you avoid what you describe the disaster? How do you avoid individuals from going to the hospital because the very innate nature that people do is like I cut my thumb I want to go to the hospital. I mean in a hospital, if you're in the hospital for too long you'll have the chance to getting sicker than getting better. We're working on that. So therefore what are the things that we want to do to avoid you from getting having to go to the hospital you know whether it's your social needs, fixing social determinants of health. That is an overview. The key inception of measure is actually through along the training that they've inducted that's help health systems come up with these plans to avoid those issues.

I think it's important. So many people like you're right. I mean your first instinct is to go to the hospital. So who disseminates this information? How does the community get a feel for what to do?

So it truly is a coalition. I mean one of our main staking Health Care Partners is the Marin County Health Department and with the health departments and actually with our preparedness division under the state's health department and basically they have separates coalition entities throughout the state as well that are there under the direction of state government. We worked with them to help get the information out that training exercises needed for the average person.

Very cool. I think it's so great. Yes you are partnering with the public health institutions to help disseminate this very important information and some to think about right listeners. I mean we're faced with that disasters. You know here and there. So when you think about how to address this may if you don't have a pathway forward I think this is a good way to start. You take a look at the work that Brandon and his team are up to and find an inroad to a solution for your community. So it's not always smooth when these things come up, Brandon. Can you share with the listeners a time when you guys had a setback and what you learned from that?

You know I'll just go with the most recent you know sore that we just had...

Let's hear it.

Who are a Grant by the Assistant Secretary of the State or a preparedness effort and this Grant was awarded the two pretty much state entities to help regionalized plans for the dash of preparedness

So their purpose is everyone has which is really in this space you know communication is the key. And it seems like everyone has played those plans on their insides so the primary purpose is of Grant was to actually bring those plans together, make a functional make the communications happen. But it's actually a regional base meaning it's supposed to be a multi-state level and I think what happened was that are we're very competitive application. The assumption is we weren't. We were too nearer because our assets that we could actually work with were all in the entire state of Indiana. And we really needed to incorporate Ohio, Michigan, Illinois, and Kentucky to remain safe. And I think at other time we had a little bit more time than able to do unfortunately and we do that for you.

Yeah yeah that deadline kind of drove you to just put a close eye on it. How could you have known differently?

We didn't. Actually there was some feedback that we got was actually great feedback. I mean the whole purpose is to actually take these plans than actually replicate these plans that's the ugly face two of the Grant for like next year or something.

Okay.

So we'll get after it then.

Very cool. I love your resilience and thanks for sharing that. Yeah you definitely don't know and you know I'm a firm believer, Brandon you're either winning or learning. And you guys definitely are doing just that. You've created a nice culture within your own team of that same attitude.

Yes.

So what would you say one of your proudest leadership experiences has been to date?

Oh so I am a believer of paying it forward and I think a lot of individuals were you know resources and time into me. So that is probably my base actually that I absolutely love to do it. I, is help others achieve their goals whether to professionally academically. So I'm typically, I have a kind of a mud trail. However we come together will be better when we leave. It maybe playful but it will be better. So I have a personal goal of every soldier that I had basically here you want to plan to actually be better whether that's to achieve you know your academic career, finished college, be a better husband, father, daughter or son and just go with that work simultaneously to actually achieve that result. Because most people ironically that the my physician colleagues and high academic standards it is basically they have the vision of what the end goal is and something that's not taught and being able to help others achieve that vision is the proudest moment that I have.

That's so great. And I know that there's multiple instances of you doing this with physicians, with soldiers and I think it's so wonderful that you look at the world through that lens, Brandon. I think it's great as you've done this work and you've helped others achieve their goals. You know it's led you to where you're at today and the wonderful work that you're doing. What's an exciting project that you're working on today?

I guess one of the things that we're happy at MESH is so there are there's different levels of preparedness and you know most entities. Sometimes you have to comply with certain things and hospitals and large students have been in compliance and they've done that over time because it's mandate. Well few years ago the mandates changed to post acute areas such as nursing homes, rehab centers, and dialysis centers, and hospitals. And actually we worked on a program to do exercises so that they can should be compliant and learn that preparedness. So we're talking about earlier with you know bringing those planes together what we have. Sometimes we know that they have plans or they don't have plans yet. So we help implement those plans. Teach them formulate those plans and their ancillary so that's the fun project we had going on right here in MESH.

That's pretty awesome. That transition from just a cute centers to the ancillary services. So you know you work on a lot of cool things Brandon, what keeps you up at night?

Ooh the thing that's missed. Meaning that unfortunately bad things happen and we we've learned retrospectively.

Yes.

And it's those things what we can avoid to mitigate those things. That's basically it is just going to be casual. That is, it can get scarier you know just very superficial. But the more you think about health environment not to be a worrier. So if it does keep me up at night it's probably pretty serious.

And that's why I asked you that Brandon because I'm like you know this guy worked with some pretty cool stuff. You're doing some amazing work for Disaster Preparedness Summit. What really does keep you up at night? And it's just really kind of staying ahead, going with where the puck is going on and some of these disasters and potential threatening situations it sounds like.

Yup.

Very cool. Getting to the end here Brandon, this has been a really fun time with you. I'd love if we do a little pretend here we're going to build the medical leadership course and what it takes to be successful in health care, the disaster preparedness piece. It's the one on one of Brandon Lee and so we're going to build a syllabus lightning round style four questions followed by a book. You ready?

Okay.

All right. What's the best way to improve health care outcomes?

Listen to patients.

What's the biggest mistake or pitfall to avoid?

Not listening to patients.

How do you stay relevant as an organization despite constant change?

Ooh that's a good one. Always thinking outside the box. once you do a couple of times that the status quo but the how do you make it better?

Love it.

Optimization.

Love it.

What's one area focus that drives everything in your organization?

The want to help. Being a part of mankind and just wanting to help me you notice when there are disasters. All the great phenomenal stories that it seems from the Red Cross, in the news. in hospital and just being part of mankind where nothing else matters except helping your fellowmen.

Love that Brandon. So great. What book would you recommend as part of the syllabus?

Ooh. So this is a little crazy.

Let's hear it.

Books I've recently you know the traditional leadership book that I could actually say but i think Living With a SEAL by Jesse Itzler. Completely different aspect of what it is if you never heard of David Groggins.

Okay. No.

David Groggins is a Navy SEAL who is just insane. .

Literally?

Yeah true I mean literally truly insane. He was a obviously for being one of the hardest professions Navy SEAL. But also the first Navy SEAL in Army Ranger and also in the Air Force Tactical Unit as well.

Wow.

But one of the things that just put him on the market map was he was an individual who to help out his fellow man. Basically there were Navy SEALs who were killed and he started a foundation. In order to build the foundation he thought well "I'm start with ultramarathons so...

Jeez.

A week before he had this idea. He basically signed up for ultramarathons and literally run with no preparation whatsoever ever trainee, never did a marathon, did a hundred miles.

Oh my God. That's amazing.

So that's...

The thing insane is the word.

He's crazy. What happened was Jesse Itzler who was a entrepreneur business person who is, he's always reinventing how can it be better, actually at a race he reengage gallons and basically said "Hey would you come live with me?"

Oh my gosh.

So for 30 days.

Oh my gosh that's so crazy.

We think it's crazy but it's amazing.

Wow. Wow. And it's called Living with a SEAL.

Yes.

Outstanding. What a great recommendation. I feel my adrenaline pumping here Brandon. So thank you. And I'm sure you listeners are feeling it too. All these awesome recommendations can be found on our website. But in particular go to the show notes for this episode with Brandon Lee. It's at outcomesrocket.health/mesh and you'll be able to find all that there including a transcript and links to all the things we've talked about. Brandon this has been a ton of fun. You leave us with continuing to want to help our fellow man and continue doing the great work that's being done in health care. I love if you could just share a closing thought and then the best place for the listeners can get in touch with you.

Okay. Closing thought is you know everyone keep doing the great things you're doing in health care. Some of the previous people you saw are meeting in relation to changing health care. So just keep up the great work. And how do you get a hold of me as if anyone needs to as mine as Brandon Lee my initials are blee@meshcoalition.org we'll be happy to answer any questions or chat with you.

Outstanding Brandon. Hey this has been a ton of fun. Thank you so much for your unique perspective. And we're excited to stay in touch with you.

Absolutely Saul for just chat again soon.

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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Recommended Books:

Cutting for Stone

When Breath Becomes Air

Practicing Excellence

Best Way to Contact Stephen:

Linkedin

Company Website:

http://practicingexcellence.com/

Check out this Link:

https://outcomesrocket.health/podcast

Taking a Break from the Physician Grind with Stephen Beeson, Founder of The Clinician Experience Project at Practicing Excellence

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.

And welcome back to the podcast. Today we have Dr. Stephen Beeson. He's a nationally recognized author, physician, and speaker, who's provided approaches for developing clinicians and leadership for hundreds of medical groups and hospitals across the country to transform care for patients and those providing care. Today, it's super important to have a background of somebody that has been there and done that at the frontlines both as a clinician and as an Administrative Executive. And Dr. Beeson is just that he's board certified in family medicine. He's been practicing with Sharp Rees-Stealy Medical Group in San Diego for over 18 years. His tenure with the medical group. He was selected by Sharp Healthcare Leadership to serve as the Physician Director for the Sharp Experience and Organizational Commitment to serve and operational excellence. He's an author of a book called Practicing Excellence and it's also the name of the practice that they are doing this work in. And so it's a true pleasure to have Stephen on the podcast. I want to open up the intro for him to fill in the gaps of anything that I may have missed. Stephen welcome.

A great thanks Saul. I'm delighted to be here and I think the only other gaps outside of the fact that I'm father of two and a husband is we have recently done some really compelling work in helping and supporting and engaging and supporting physicians in something called the Clinician Experience Project with thousands of clinician members across the country and just super excited about the kind of results that we're seeing and what happens when you help and support and create practice conditions that allow clinicians to love the work that they do and do it really well. So super excited about talking to you and dive it in.

Thank you. Yeah the work you're doing is truly impactful you're working with some big names. And really the feedback that I've heard from your work is inspiring. What is it that got you into health care to begin with?

Well you know when I was in high school I wanted to be a musician. I was playing trumpet my parents really like imagine a living doing that and after I finished high school I actually spent some time with my uncle Dr. Robert Hazelbrook who's a neurologist and he told me about a day in the life of being a clinician and what that's like and the ability to diagnose, manage three, and sometimes cured disease and the master endeavor of learning a body of knowledge that allows you to make an impact in patients lives. And I was so intrigued by that day in a life that in that moment, on that day I switch from music to a biochemistry major at University of California San Diego now and the journey was on.

That's a big shift.

Yeah.

That's a big shift but a good reason to do it. Wow. So the years have passed and now you've sort of given from the front line and now you're taking a much more macro approach through what you're doing. Obviously there's a big void in what clinicians need and tell us how you're feeling that?

What we've seen and dating back to Around 2001 I began and was selected and appointed to coach trained to develop clinicians in a very competitive health care marketplace driven by consumers and patient choice. And we as a group were in bottom decile in terms of patient experience. I was tasked with how do we help and support clinicians to provide better care to patients? And I really for the next 15 years became a student of what are the things that physicians need to really become the kind of clinicians that they want to be and really what I discovered that drove me into the work today is that clinicians make massive sacrifices to get into positions that they are and they are 90% of all clinical activity. There are 80 cents of every dollar spent in healthcare. Their principal cultural drivers and the fundamental skills by which to make health care better are never developed. Yeah and we're in a field now where over 50% of clinicians despite what I consider to be the most beautiful precious profession that there is anywhere to make a difference in the lives of those we serve. And over 50% are experiencing symptoms of burnout. And I consider that now to be a life calling. And again the night is for the work that we're doing now is helping supporting clinicians to do the work extraordinarily well, to connect to the patients they serve, to collaborate with their colleagues beside them, and to lead in a way that brings the very best of each other, and to use that to drive not only patient experience, harm reduction but also at the end of their day week month year life. They look back over their shoulder and they say this is everything I hoped it to be and that's the essence of really what we're trying to do is help drive the clinician experience and the clinician experience being the gateway to all the other health care imperatives in front of us and harm reduction, patient experience, patient loyalty, clinical excellence, and all those things.

Well you know I think this is a truly inspirational work and very mission-driven. Folks when you're in the airplane and you're getting ready for takeoff, the flight attendant will tell you to put the oxygen on your mask before anybody that you love that's next to you. And really when we're working with clinicians it's so important that their gas tank be full and the work that you're doing Dr. Beesob is truly dedicated to keeping their gas tank full. So as health care leaders listening to this, looking for ways to improve, what would you say an example of something you and your organization has done to help say a health care executive improve that leadership culture for physicians?

It's a great question and I think it's a complicated answer. What are the conditions and what are the personal approaches that clinicians take. So they love the work that they do. And we we are able to create and generate and execute on something called the clinician experience. We define the clinician experience as this is everything I wanted it to be. I provided the kind of care that I believe in were driven by evidence for getting great outcomes. And on Sunday night before a clinical day, I'm excited about tomorrow. That's the essence of the clinic. The question is what do we have to do to help support that? And if you look at that data in terms of what are the greatest influences on the clinician experience. First and foremost it is the conditions in which physicians work under it's not their personal resilience or their endurance. It's the conditions that clinicians work under so as I speak with leadership teams there is a composite of what leaders do where clinicians say I love it here. Number one they are out front and authentic, leaders are deeply committed to what's right and best for patients and they communicate in a way to their clinical body that connects with physicians values system so when we as leaders say hey you need to improve your patient satisfaction scores and see as regulations say we have to do this that and the other and the payer feel that saying we have to see more patients for less money. That's not what engages us to change. Well it prompts us to sit in the back seat cross our arms and say this is not at all what I thought was going to be. But the leadership approaches of outfront authenticity of a commitment to what's right and best for patient, we found in our research that the clinician experience project that when physicians feel as though their leaders are deeply connected to what's right and best for patients the probability of burnout among those physicians is 4x less than what leaders are not led by that nature. So number one they're outfront authentic and deeply committed and communicate in a way that's consistent with the position value system. Number two they tap clinicians to help solve care delivery problems. They don't mandate, dictate, and bullhorn solutions, they say "here we've got a challenge in regards to or start times you've got a challenge in regards to patient access. We've got a challenge regarding variance around diabetes composite. What are your best ideas? For us to innovate solution?" So they're tapping team intelligence and accessing the innovation of clinicians at the front line as a way of leading the organization. So physicians feel like I've got a voice, I can participate, and we're getting results done together. That's what leadership teams do. The third thing that leaders do where clinicians say I love it here is they simply appreciate their clinical team members, they recognize them, and they appreciate them, and they take it to a hospital as to get a phone call from their CEO who was rounding up patients up in the hospital and said hey I'm talking to patients and talking to nurses about your multidisciplinary round. You're making more impact than you can imagine and what patients and team members are saying about the difference that you're making and as this hospital was telling me the story of the CEO calling her she was welling up some it's just it's unreal to get appreciated for the work that we do. So what do we do to advance a clinician experience, we lead in a way authentically committed to what's best for patients. We tap the ideas of clinicians at the front line. We appreciate them and we take on administrative burden, reduction, as an imperative of leaders. We found in our research that when physicians believe their administrative burden is not reduced and taken on by the leadership team, connectivity to patients from their angle is reduced by nearly 80% and organizational cynicism doubles. So our ability as leaders to say what are the tasks that we can take off their plate to allow them to practice medicine? So four things reduction of interim, administrative burden, appreciate your clinicians have their ideas to innovate care solutions, and communicate in a way that's storytelling and authentic regarding what's best and right for patients. And we're seeing unreal results when leaders do that sort of thing.

That's amazing. So folks here's the blueprint for creating that engaged culture. It's tough right. I mean you could have a blueprint but how do you follow through? So a question for you is what are you guys doing and maybe you provide an example Dr. Beeson of how you guys have helped an organization take this blueprint and make it actionable?

No for sure. And again part of what we've done we've formed this community called the clinician experience project which is a learning collaborative community with over 15,000 clinician members across the country with some of the biggest names in health care and they're using this community as a catalyst, as an enzyme to allow the individual clinician to better connect with patients in the exam room meaning when I am interacting well with my patients. My love for the game is fundamentally different and driver number two is we help teams form communities a collaborative culture and getting better together. The clinical micro system level where they feel like there's esprit de corps and getting better together. And the third channel is what we talked about initially is developing leaders with skills to best engage their teams so we're using the Clinician Experience Project as a programmatic progression of how do we better connect, do we better collaborate, and how do we lead. We consider those things three legs of a stool and a stool does not stay on two legs.

Right.

If you've got positions that are deeply connected to patients with toxic top-down administrative leadership you're going to destroy that clinicians. So they, the clinician as we've defined it is about connecting, collaborating, and leading, and then we use the clinician experience project and we've got fantastic results out of Kaiser Colorado, fantastic results and Centera Medical Group with measured outcomes and improvements in things like patient experience, physician engagement, and attrition reduction in documented case studies.

So that's outstanding. Congratulations that's huge. And one thing that I really love about your approach Dr. Beeson is the database approach, your outcome-based approach, you're documenting everything, you're doing the research, you know this isn't like a feel good exercise although part of it is but you're really getting the data to back up what you're doing.

Yeah I know for sure. I mean I think it's you know data is the currency of healthcare today. And if you're not in metrics it's not it's not why we're we're not here to move metrics. But it's a consequence when we better connect with patients and better collaborate with each other and lead more effectively. There's quantitative metrics that will move. One great example we're doing some work with Beth Israel Deaconess and they had one of their strategies was building a community and a collaborative sense of we're in this together. And what they had done and with some are worked together was started monthly meetings where they carved out one hour work clinicians and clinical team members could get together and talk about solutions to care delivery problems. And they did shorts rounds where they had a chance to sort of take a bow for what they flailed on that we do create vulnerability. And I'm not alone. And that once a month one hour they were able to reduce physicians sense. I went to women's organization from 78%. They had a five year plan that 70% of their physicians when to leave within five years that's not good. And just a year later got it down to around 35% and drop their physician turnover from 30% to 5%.

That's amazing.

So these are the kind of quantitative impact of what happens when we build collaboration and when we give physicians tools to connect with patients and when we start to lead in a way that brings the very best of our teams. And you know we are so deeply committed to helping clinicians love their work. And as you said you get to take care of your own oxygen mask I mean the literature on what happens to physicians and the care that we deliver when they're burned out from medical error to cost of care to patients were poor to med mal risk to care coordination and all those things that we consider to be imperatives all are significantly harm. But I think most importantly you use clinicians us we have sacrificed everything to get here personally, professionally, financially. And you finally get to the place that you dreamed of and 400 of us commit suicide because of the misery that we're experiencing. I mean it's like it's hell we can't have that in this sacred profession of impacting lives, collaborating with each other, and making diagnosis. I mean it's got, it should be great. And it's not. And that's why we're here.

That's amazing. That's amazing and I love your commitment to it. So as you've built this and you've been thinking about these problems and the solutions to these problems you've been implementing things you've written a book on it. What have you learned a setback that you had as you were trying to implement these things? What did you take from that setback that now has become a principal of your organization?

Well I think that if you had a 7 or a podcast we could talk about all the mistakes you engaging physicians. What I have learned and the learnings emerge from mistakes is that almost every clinician that I've ever met wants to be a great clinician and is deeply committed to it and sometimes it's so covered up by burnout and dismay and cynicism. But I think I think one of the big mistakes that I was part of number one not including physicians in key decisions and skipping that step and telling them what they need to go do. I think that would somehow be faster better easier if that had massive consequences and delayed improvements wherever I've been witness to literally years and the other mistakes that I think was part of of getting giving physicians data on patient experience, patient complaints, and even clinical data and not giving them the tools by which to improve that data. I think it's cool. I've shadowed over 600 physicians. We have 15,000 I have never met a physician who could articulate why the patients say what they say about and they go I'm not what. It's just unfair to give data when and again data is important without giving specific tangible. I can move the needle on this by virtue the solutions that I know I have. And so that was a big learning.

And now it's a core principle. It's one of the three stools, are one of the three legs of the stool.

Absolutely and a library of human contentment is mastery. Now our ability to accomplish achieve, improve, whether it be a golf swing, playing the banjo, or better connecting with their patients or leading in a way. I mean when you watch leaders learn skills that allows them to practice team intelligence and watch the innovation and enthusiasm emerge, leaders go "I wish I would've started doing this 10 years ago.'.

Yeah.

It's easier and we're getting better results and everybody's on board. I'm dropping the bullhorn. It just doesn't work. And so but one of the things that I wanted to mention was all this composite of the clinician experience we have recently year leaders I would love to get their feedback. I wrote in my next book it's an e-book called The Clinician Experience which is the data and the approach for how do we tackle the Wellness Challenge. I would love for your...

That's really interesting.

Yeah.

So the best way folks that we can get you to engage with this e-book. Check out the show notes and I'm going to get a link from the team over there Practicing Excellence, Dr. Beeson's team. So you could get a copy of this book when you go to outcomesrocket.health/excellence you're gonna find that link and we'll provide a way for you to leave feedback for Dr. Beeson and his team.

Yeah that would be fantastic. I mean we're trying to start a movement here of supporting those that care for others. And then when we do that everything anything becomes possible.

That's outstanding. So we're getting close to our end point here Stephen, let's see if you could give us a little bit of maybe a sneak peek on a project that you're focused on today and I'm gonna roll into the lightning round part of the podcast and will conclude.

That sounds great. One of the things that we do within the clinician experience project is we partner with organizations and we ask the question "what are the things you want to achieve and how can we help you as a enzyme to help and support clinicians to get there?" And we've got some really exciting projects that we're working on with some great organizations on how do we reduce harm and the safety culture. We've got some really exciting things coming in high reliability and patient connectivity and leadership development that we're doing in placing inside the clinician experience project and beginning to expand and deepen our research and assessing and tracking and measuring the clinician experience and always looking for collaborative partners to figure out innovative solutions supporting not only the clinician experience in terms of I love what I do but also clinician contribution to I now know how to better connect collaborate with my teams and provide really great care.

That's powerful stuff. Now for the folks that want to engage with you and your team Dr. Beeson where did they reach out?

Yeah I think probably the easiest way is just you know our website which is practicingexcellence.com and you can get a hold of any one of us through that site. And the book will be there for free as well. And I think with it the e-book in particular it begins to ask a different question. I mean there's thousands of publications now on burnt out. We've seen it, heard it. We wanted to ask a different question which is "what is present in organizations where clinicians really truly love what they do?" Of course there's tremendous overlap in addressing the principal causes of burnout. No question but the connect collaborate lead and all the literature and research behind it is very compelling. And again it's a different way of looking at a very high profile threat to American health care which is the wellness of the care team. And again we'd love to get some banter and chatter regarding how to approach this challenge differently than I put it on e-book.

Thanks for the invitation. Folks go to a practicingexcellence.com to get access to that, for the show notes outcomesrocket.health/excellence. You'll find all that there. All right. This has been a ton of fun Stephen. We're in the lightning round okay so we're going to build a syllabus with four questions for the listeners on what it takes to be successful in the business of medicine and happiness and medicine. I got four questions followed by a book outside of the two that you've already written that you recommend to the listeners. You ready?

Okay I'm ready.

Alright. What's the best way to improve outcomes?

Lead your teams with relentless passion.

What's the biggest mistake or pitfall to avoid?

Lead by a regulatory call to action.

How do you stay relevant despite constant change?

Tap your team and their innovations in what they think you should do differently to create value for the patients and serve together.

Love that. And what's one area of focus that drives everything in your organization?

Commitment to making a difference in the lives of others. Constantly telling stories about impact this is to be accessible.

Yeah stories are powerful. What book would you recommend to the listeners?

Well one of my favorite books is Cutting for Stone. It's a fascinating story about empathy and the journey of surgeons and how it's really one of my favorite books I've read it twice.

Oh that's a good book.

That's my recommendation. When Breath Becomes Air. I think it's another great book if your, that was hard to read but it's a beautiful, beautifully told story.

Awesome. Some great recommendations there and a great syllabus for us to use as a framework to drive the things that we're doing. Again find the syllabus and the full transcript go to outcomesrocket.health/excellence. This has been fun and what I love Dr. Beeson is if you could just leave us with your closing thoughts and then the best place for the listeners can engage.

I think the most important thing we can do as leaders in health care is to care for those that care for others and you know we frequently skip that step and we go on to the list of things on our scorecards that we're accountable for. But I can tell you in 15 years of experience and hundreds of healthcare systems and tens of thousands of clinicians that the headwind and friction of getting those things done is overwhelming when clinicians are overwhelmed, burdened, and not supported. So help and support and engage your clinicians, make their wellness a number one imperative. And when we do that, harm reduction, clinical variation reduction, patient experience, talent retention, top and bottom line, can all follow. And without that all those things are really hard.

That's amazing.

And again you can practicingexcellence.com. We'd love to help and support anybody that's looking to take the. We want to take care of our clinicians journey. We get some incredible stories that are emerging and data that's coming forward when we do that right.

So they have it folks. That is your call to action. If something today resonated with you, take action, don't wait 10 years like Stephen mentioned. Do it now because the results will be a ripple effect of greatness. Stephen this has been great. I really appreciate your time and definitely looking forward to staying in touch.

All right thanks Saul. Appreciate it.

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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Improving Outcomes by Improving Sleep with Michael Kisch, Founder and CEO Beddr Sleep

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.

Welcome back to the broadcast. Today I have an amazing guest for you. His name is Michael Kisch. He's a founder and CEO of Better Sleep. Mike likes to make the complex simple engaging and accessible to more people. He's passionate about applying this philosophy to health care. Previously Mike was the founding CEO of Soundhawk. It's a wearable hearing enhancement company that developed the first connected hearing device. He led the company from concept to commercialization and multi million dollars in revenue. He is a bright mind in this space and it's super exciting to be able to connect with you today, Michael. hanks for joining us.

Well thanks for having me on. I'm honored to be here.

Hey so tell me what did I leave out of your intro that you want the listeners to know about you.

Proud father of three. I have three kids: twins and I have a 11 year old daughter as well and that's sort of the personal information. I've spent time on the East Coast. We've just talked to you about Midwest and in California in the last 18-19 years and I've seen a lot and hope to continue to see more.

That's awesome man. You've trekked the country, you've seen the cities sort of the differences and now you're back in California and you've taken a dive into this health care sector even deeper. And so I'm curious what got you into it to begin with?

Sure. So I spent the first 15 years of my career largely in consumer packaged goods. I worked for Kraft Foods outside of Chicago Anheuser-Busch and then I moved on to Cisco Systems where I worked in there sort of emerging technologies group. And so I was part of the team that would incubate lots of new products. And it was everything from connected video cameras to sort of video conferencing systems and one of the things that was consistent across a lot of those products was taking the complexity out of the experience for the user and making things simple accessible and easy for them to use. And about six or seven years ago I had an opportunity to come into the health care space with the company mentioned Soundhawk and you just saw that there were a lot of opportunities to deliver better products, better experiences that were placing the patient really at sort of the center of the experience. So when I looked at the skills and the experiences that I had acquired it just became really logical for me to sort of begin to apply those to healthcare. First on hearing aids and now sort of in the realm of sleep tech which is another area that there's a lot of very well intentioned people but I think everyone agrees that these products and experiences need to get better if we're going to deliver improved outcomes at lower cost.

Amen to that brother. So yeah you know like the user interface of healthcare as one of my previous guests mentioned is broken. And so your skills are highly valued here my friend. Talk to us about Beddr. What do you guys do there? And then let's dive into what you guys at Beddr think a hot topic in medicine is in how you're addressing it.

Sure. So at the highest level our mission is really to help people understand and solve their sleep problems. So pretty obvious pretty basic but there's two components of that that I think are critical. The first part is understanding like how do we empower an individual on their own to really get a view into what we spend a third of our life doing because we're asleep while we're doing it we really don't understand what's going on with our sleep and how good it is, how bad it is and what choices we make are actually having a positive or a negative impact. And what we've just brought to market is a product called the sleep tuner which is the small wearable sensor about the size of a stamp the weight of a nickel and you wear it for multiple nights while you sleep. And it tells you some really interesting information about your blood oxygen level. If you've stopped breathing, your sleep position, your heart rate in a range of other things. This is the first product along sort of a pathway that we're going to really give people sort of accurate and affordable and accessible products that help them understand their sleep to a greater degree than they've ever been able to in the past on their own. The second thing that we're building out is just helping someone understand is not a solution. It's sort of the onboarding an entree if you will to how do we actually direct them to the appropriate treatment path that's most likely to be able to help them and this is really the second part of what better is doing is we're building on a way for people to get a formal diagnosis if they have a sleep disorder. But also we're using data along with the intuition and expertise of sleep physicians to direct people to a therapy path that stands the greatest chance of actually being successful for them. That's I think in a nutshell the crux of what we're going to be building and rolling out here over the course of the next six to nine months.

That's exciting and I don't remember the statistic but I know it's pretty high. I think it's something like 1 in 4 people have sleep apnea or even two out of one out of two.

It's about 54 million U.S. adults out of 219. So roughly one in four. You were right the first...

One of four. Yeah that's a lot. And of those a very small percentage are actually diagnosed or even no. So this is pretty cool stuff. Now folks better sounds like Better But it's actually better Beddr kind of like bed doctor. Pretty cool play on words there. So the device actually goes on the forehead right.

That's right it goes on the forehead for three reasons one which is not a lot of nerves in your forehead. So you don't feel it. So one of the things we will do is when people are taking assessments there's no observer effect, there's no impotence of their sort of sleep or were disrupting interrupting it or causing it to be worse because of the actual testing sensor. The second reason is for people who have breathing issues when they sleep. One of the biggest determinants is the position of their head which therefore is a proxy for the position of their airway. And so when we sleep on our back gravity works against us and it generally leads to more sensations and really and then when we're on our side and then the third reason the forehead makes sense is that we get a really good signal for Sp02 or blood oxygen saturation on the forehead. So there was a lot of scientific logic that went into us choosing the forehead as the place where you were the device.

Very cool. Very cool. So folks take a look at this pretty cool. https://www.beddrsleep.com/ you'll see what we're talking about here. So as we dive into this Michael tell us a little bit about how you guys see this product improving the lives of those with sleep apnea.

I think there's a there's a number of fronts where we already see this making a huge impact. One it's just about giving people access to sort of accurate information that helps them understand what the risk factors are as it relates to the cause of their sleep issues. So with our product a person can test each night for tens of dollars versus if they have to wait to go into the traditional sleep medicine system just to get it sort of an early indication of something's wrong. That could be thousands of dollars that could take them up to six months to actually get scheduled. We do it for tens of dollars and people are able to do it within just a couple of days.

It's pretty amazing man.

Yeah this is I think this is where there's a huge opportunity and in medicine is if you look at sort of any chronic group of people there's just some people who are relatively simple to ascertain what's going on and then to ultimately get them to a diagnosis. And then there's another group who have much more complex cases and there's lots of sort of comorbidities and there's lots of conditions that are interacting in a way that look may need to go through a much much more robust and comprehensive sort of assessment. And we really see ourselves as helping physicians and the overall medical community. Let's work on the easy there's more simple to classify people and let's address them in a simpler more straightforward way so that more resources are being applied to the more complex the difficult to diagnose cases and that's a way we really see as an opportunity to drive efficiency and the system is put the resources on the hardest cases and then allow technology to really play a more active role with the more straightforward and simple to understand situations.

Fascinating. And you know one of the things that just rises to mind Michael is as we see more digital technologies infiltrating our health space. I think it really becomes the responsibility of providers to stay on top of it because these technologies they definitely are useful and customers are used to interfacing with things that are simple partnerships are great and opportunities to see how how these technologies could better impact workflow are key because if we don't consider them then they can become very disruptive. Would you agree?

I totally agree I think this is having now been a CEO to digital health companies. I've seen it sort of in two different examples. Our perspective is we're not here to disrupt we're not here to put somebody out of business or to take revenue from someone else that is just not the objective that drives our view is that there is just a simple or better way to do things for a certain group of people. And I think by being perhaps more narrow in our focus and being clear about what our ambitions are both what we're going to do and what we're not going to do we've actually seen a lot of advocacy from the sleep physician community because they've looked at us as well. You're actually going to help solve the very problems that we've been trying to address for a couple of decades and they also understand that there are some boundaries that we've put in place. We're not trying to put a sleep lab or a sleep position out of business. What we're trying to say is look you know there's a huge population of people out there that are never going to make it to you that we now will have access to and that we can bring them to you or we can at least give them access to you in a more efficient way that improves things for everybody that allows sleep physicians to be able to impact more people and that allows people to have more ready and easily available in affordable access to true expertise. We see ourselves as kind of that bridge between the individual, the consumer, the healthcare and the expert and we serve both of them. By serving both of them we think we can build a better solution that brings both of them together in a more efficient manner.

Now for sure. Now very eloquently said and think that it goes back to those partnerships right. You guys are not here to disrupt. You guys are here to partner and a lot of people go on diagnosed so I think going the consumer route is a great way to capture that. What would you say the main thing right now that that is going to be what improves outcomes with what you guys do?

So I think there's two areas that we're really focused on. One is if we look at this broad population of 54 million people just getting them made aware that they may be at risk and then actually getting them to a formal diagnosis that's going to improve the outcome for that undiagnosed and tested population. There is absolutely no doubt.

For sure.

I think the second area that is going to become very powerful is how do we harness the data that is being sort of cultivated across our system to assist in what we call sort of patient therapy magic. And so if you look at a condition like apnea there's four or five different therapy paths that could have a positive impact. What people don't really understand now is who is going to be best suited to each one of those paths. And there's an absence of data that exists to be able to do that in a more accurate predictive fashion. One of the cool things that we've done by making the sensor both accurate but affordable is a consumer now owns this product so they can test to establish a baseline but they can also test once they've started therapy to actually determine what's the impact of the therapy on the quality of their sleep. And so it's the ability to bridge that sort of lifecycle of the consumer and the user of this product that is going to drive a much more efficient matching of patient and therapy which should improve what we call compliance and as compliance goes higher outcomes will go higher as well. And so that's where I think we get really excited passion about what we're doing. It's this concept of access and then also driving greater engagement from the user because we know those two will actually contribute to a real significant improvement in outcomes.

That's awesome man. I think that's a fantastic idea and the numbers are there. Am excited to see what you guys create.

You just go to our website you can see it it's right there. We just had our first manufacturing run of product and it's now getting...

Congratulations.

Yeah it was. It's been an 18 24 month journey but we're excited where we're at right now and we were excited we just coming out of beta testing right now and the experience that people have had the reaction to the product has been overwhelmingly positive so we're we're ready to give birth so to speak. Greatest product into the world and hopefully help a lot of people that's really the primary motivation.

Well congratulations on getting to this big milestone man.

Thank you.

That's huge. So let's talk about you know you've had a lot of different experiences Michael. What would you say one of the biggest setbacks you've had and what did you learn from that?

Sure. Great question. So my first CEO role I was a CEO of Sundhawk which did some really interesting cutting edge stuff. So the whole basis of Soundhawk you would allow people to self fit a hearing assistance device versus have to go in for a hearing test and then sort of a battery of acoustic fittings and so killer person could simply place their finger on a smartphone screen and as they move that around it would actually change to sort of achieve a setting where they could hear things more clearly.

That's pretty cool.

You could also change a dynamically based upon the environment that you were in. And so you know it was the classic example of you're building a better mousetrap and you sort of expect the better mousetrap is going to lead to business success and ultimately it didn't. And when I look at why we did a very poor job at that company of understanding where we need to be different and where we need to be the same as sort of the status quo. And I'll give you an example.

OK.

We wanted to be different from a regulatory perspective that we want him to be classified differently therefore we will have the ability to make different claims. We want to have a different go to market. We wanted to have a different across a range of things and it was so different that it just was difficult for people to fully assess understand. And that really sort of extended the time period that we had to build trust and credibility and ultimately build up a successful sales pipeline. And so when I look at it in retrospect it was very clear that you need to be different in certain areas and in other areas you just need to sort of look very similar to the way things are and that's very much inform the approach that we've taken at Beddr where look the product is different the delivery model is different, the pricing model is very different. But the things that are the same are that the data we gather and the accuracy of that data is absolutely consistent with what a board certified sleep position has been comfortable with for the last decade or two. So that was I think the big insight from the Soundhawk experience is definitely be different in certain areas but don't go against the workflow don't try to convince people in certain areas where they have just grown really accustomed to the way things have been and they're comfortable with that. And I think that nuance is one that a lot of people when they first come into health care they don't understand. They just take the classic sort of disruptive mentality where it's like well we need to be different whatever they've done before we'll just be different. Yeah applying a lot of intelligence and sophistication and said that and I think you know I encourage people just really know yourself and know the market and know who your partners are going to be and know who you're going to be building relationships with and then factor that into how you think about your product you will go to market your overall business model.

Michael I think that's tremendously insightful and being different for the sake of different isn't going to get you there. So take a step back and think through that. I think his words of wisdom that I think everybody needs to take the heart. Definitely appreciate you sharing that Michael straight from the trenches. It's so valuable.

Happy to do so.

So what would you say the other side of the coin. One of your proudest and just awesome leadership experiences in healthcare that you've had to date?

I think it's I've been at the head of building to digital health companies completely from scratch into areas that are not meaningful but they're not the highest profile perhaps buzziest areas of medicine one being hearing loss and the other being apnea. But these are two conditions that dramatically impair a person's quality of life both in the near term as well as the long term. And I think in both situations we've been able to bring you know a much better experience to the consumer and we've enabled them to both understand more about what's going on but we've also given them a lot more control over their lives and their ability to sort of manage these conditions and I think that's what I'm most proud about is you know we're empowering people to live a better life. And that's sort of the mission that drives us both here. But it was also the mission that drove us previously at Soundhawk.

That's great man. And sleep is so important and I think the education piece will definitely be huge for those of us without apnea. And for those with apnea I think it's so key to understand the value of sleep. The days of being sleep deprived and wearing that as a badge of honor I think are starting to go away. There may be some pockets of it still but I think what you and your team are doing to get that education out there is pretty huge.

Yeah it's interesting. Definitely the mentality towards getting the right amount of sleep. You see this with thought leaders like Arianna Huffington at Thrive Global these people who are proudly saying that you know I need to get my seven eight hours of sleep per night because it makes me a better person. It makes me a better leader. I think it's exciting and I think it's sort of you know it's a wind in our sails basically anybody who's in the sort of sleep business right now. And I think when we look specifically at breathing issues when we sleep I think it's people are really starting to come to recognition that this impacts a much broader population of people and that it's these breathing disruptions that actually oftentimes are contributing to insomnia but they're also sort of accelerants to a range of other chronic conditions that people may have from type 2 diabetes hypertension to mental health issues and I think what we've been really excited about is just the since we've seen from the broader health care community because they see us doing something that certainly helps our particular group of customers in our business. They see the application to support the digital therapies that they have or the employer programs that where we're now. And that's great that just means we're doing the right things and we're working on things that have a broader impact perhaps in ways that even we can't anticipate this point.

That's outstanding. So I know that Beddr is about to have its official debut. That's an exciting project. Is there anything within what you're doing now. That's a very exciting project our focus that you're very very drilled into?

There is. So. When we thought about how we were going to roll out the business and specifically the product the wearable sensor that we call the sleep tuner was the first thing we needed to focus on because we needed a way to gather clinically valid accurate information. So the sleep tuner is designed to do that. Now what we're focused on is what do we do with that data not only what do we do for the individual but more about that community and how is this information going to be anonymized, aggregated, analyzed and then delivered back in a meaningful way to both the consumer but also to the clinician. And so this is really the next phase of the company that we're really focused on right now as we begin to see data flowing through the system. It's amazing what you can learn. It's amazing how much of an impact just simple choices like having two drinks within a couple hours of going to bed or when we have colds and allergies the impact that these things are having on our sleep quality. And now the ability to quantify that and then provide back to the individual thoughtful and actionable recommendations for things that they can do on their own that we know there's a very high likelihood that it's going to improve their sleep.

Man, that's exciting as that data piece you know that data piece is what differentiates.

We knew when we started the company that the sort of future of sleep medicine was going to be driven by data science. And what was required was how can you cost effectively gather that information at a scale that's never been done before in the past. And so you know right now there's really kind of two models. One is the classic overnight sleep test which is an incredibly accurate comprehensive test. But you'll only have a chance to do it once in an environment that is not your home.

Right.

And then on the other end of the spectrum you've got consumer sleep trackers which are not validated or are approved by the FDA and they don't gather the information that is considered gold standard. So they may have billions of nights of data. It's just the wrong data of probably questionable accuracy. So in the middle is this really fascinating opportunity that we've been driving towards which is can we gather the most important information that you would get from an overnight sleep test but over multiple nights in a very cost effective scalable way and even now when we see the data flow through the system you're seeing all these relationships that have been hinted at in sort of peer reviewed research but have never been sort of they never reached a degree of being considered conclusive. And I think we're going to be a huge agent in really helping drive greater understanding of these issues and the data we're gathering.

Love it. That's so awesome specially the patient level and then also the science level and the things that you guys are going to be able to contribute. That's awesome man. Congratulations.

Thank you.

So getting close to the end here Michael. Let's pretend. You and I are building a leadership course and what it takes to be successful in the business of healthcare the 101 of a Michael Kisch. So I've got four questions for you. Lightning round style followed by a book that you recommend to the listeners. You ready?

Yep.

What's the best way to improve healthcare outcomes.

Engage the patient as an active instead of a passive participant.

What's the biggest mistake or pitfall to avoid?

Don't avoid or go around the FDA or physician experts engage with them. Doesn't mean you have to agree with them. But a robust give and take will make a better product and a better business.

Love that. How do you stay relevant as an organization despite constant change?

Always stay focused on doing a better job of solving the customer's problem.

What is one area of focus that drives everything in your organization?

We are all about empowering our customers to understand and more importantly solve their sleep problems.

Love that and would you say the book you recommend to the listeners as part of the syllabus?

Can I give you three or do I have to give you one?

Give us three man.

All right so here's here's three books sort of three various points my sort of journey. So the first one is by Clayton Christiansen. That's a different type of Clayton Christiansen book it's called How Will You Measure Your Life. I won't go into it in great detail but it was a book I read it sort of critical fork in the road as it related to what I wanted to do for the rest of my life. And I found it deeply informative, inspirational and it gave me the confidence to sort of continue on the digital health path when maybe I was questioning if that was the right path to be on. Second one is the Undoing project by Michael Lewis. So if anybody has an interest in the way that people human beings make decisions both for right and for wrong this to me is the most accessible book that you'll ever read about. Two Israeli psychologists one named Amos to be risky. One named Danny caught a man who basically did all the seminal work on heuristics and judgment and decision making. That's really a fascinating read and Lewis does a great job of taking the academic and making it accessible by the third one which I just finished reading on vacation with my family is David versus Goliath by Malcolm Gladwell. Yes I really like this book because I've been in startups now for the last 6-8 years and most of the time people think you're insane. Like how can you go challenge the incumbent. It's like this is a great book where you realize that there's actually significant disadvantages to being the giant with a particular category and that if you understand that as a startup there is some paths you can choose that really increase your rate of success.

Great recommendations Michael. Love that last one. One that I've definitely read and I think is so good. The other two haven't. So adding those to the list appreciate you highlighting these reads as well as the syllabus overview. Listeners you could find all of that at outcomesrocket.health/beddr and you'll find the transcript of our conversation. Links to those books links to the company. You wanna get yourself one of these devices or sign up before early release. You can do that there. Michael this has been fun man.

Saul thanks for having me on. I really enjoyed it.

Absolutely. Now before we go though I love if you could just share a closing thought. And then the best place for the listeners could get in touch with or follow you.

Closing thought. Well here is my closing thought. I think that we're about to enter a phase here where we're going to really see a rather radical acceleration change in the healthcare landscape and I'm assuming most of your listeners. They've been in health care for an extended period of time. They've heard that change is coming and they've wondered Is that truly going to happen. Or is the status quo going to continue to prevail. My sense now is that we are about to witness significant change and that there is new entrants there's new companies that are bringing even more force for change. I'm incredibly excited about that I think anybody who's sort of been in the health care space should be incredibly excited about that because I think a lot of the stuff that's frustrated us we're going to begin to see some really positive movement forward as as more people really come together to solve some of these big problems.

Love that Michael. And would you say the best place for listeners to get in touch or follow you is.

I'm on Twitter. So it's surfski.. The two things I use to do lots of I do not do as much.

Before you're a healthcare CEO.

You got it. And before I had three kids those two things occupy most of my time. Also feel free to just reach out and connect on LinkedIn or you know come to our website sign up for a newsletter we generate lots and lots of real relevant content related to sleep. So whether you have apnea or not we will certainly try to educate you about sleep problems and the impact of sleep on your overall health and well-being.

Outstanding. Hey sleep is so important to me, Mike. And I know for the rest of the listeners so keep up the amazing work that you're up to man. And thanks for carving out time for us.

Thanks, Saul. 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.

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Using Real World Evidence to Accelerate Development and Impact of Treatments with Jeremy Rassen, Co-Founder, President and Chief Scientific Officer at Aetion, Inc.

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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.

Yeah.

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.

Yeah.

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.

Okay.

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...

Fascinating.

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.

Likewise.

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.

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