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: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I really thank you for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have an outstanding individual in health care. His name is Blake Marggraff. He's the CEO at Epharmix. Over at Epharmix, they're focused on keeping the toughest and most expensive 20% of patients in touch with their outpatient care teams at risk bearing health organizations. They're really focused by using their digital health platform to make this hard to take care of group even easier to take care of and to take costs out of the equation all at the same time while improving outcomes. He worked so hard to do this. We had his co-founder and chief medical officer Avec Sam on the podcast and I'm thrilled to be able to have Blake carve out some time with us on the outcomes rocket. Blake, welcome to the podcast my friend and maybe fill in any of the gaps that I missed in your intro.
: Thank you, no, say it's a it's it's a pleasure to join today. My background is still relatively brief and I'm 25 years old and my passion in healthcare started kind of paradoxically when I moved from through medicine research into the technology side of things back in 2011. I ended up participating in a winning something called Intel Science Engineering Fair and that frankly it gave me the chance to meet folks like folks like you and having conversations. I mean you're surrounded by these mind that Medtronic right. But it is pretty rare to have conversations about things that are impactful but impactful and really scalable way. And I fell in love with the idea of spending every moment that I could. Working not just on making the world a better place for some people but for as many people as possible and jumping to the point really the two ways to do that or help people live better lives or to help people live longer lives and health is two birds with one stone in that regard.
: That's awesome Blake. You know you guys are so passionate about what you do there at Epharmix and there's no doubt your leadership and what you bring to the table is a big part of that. What today in your mind is a hot topic that needs to be an every medical leaders agenda. And how are you and your team at Epharmix tackling that?
: Oh great question. So I'm first going to stand on my soapbox for just five seconds. I think that a lot of folks cite AI as the hot topic of the day and really artificial intelligence machine learning those are means to an end and multiple ends, right? I think that the real hot topic the crux of it is data and specifically the rare data that enables those AI engines if you will to run the most powerful way possible. So my focus and I think for a lot of health care leaders should be focused is on asking the right questions and then collecting the pertinent data to help inform the answers to those questions. That's why our team is focused on not just all the data we can get but the right pieces of data.
: Getting the right data. And it's not easy right? And so maybe you could talk to us about what you guys are doing at Epharmix to get clean data and how you're doing it and maybe some of the results that have come out of that.
: Absolutely. So Epharmix keeps the toughest patients engaged for a really long time. As you said and it turns out that it's pretty easy to get most patients to answer a few questions once or twice. It gets much more difficult when you look at engaging chronically ill especially poly chronic populations that are not tech and able and you keeping those patients engaged for months or years on it. And that's where we specialize. So by the numbers Epharmix has more than 63% engagement for a full 52 week window. We're over 50% engagement for 100 weeks. So pushing that 2 year mark which is pretty striking given that in some of our populations the average income is $12,000 a year and I think very humbly made made all the more impressive by the fact that independent clinical researchers now shown that Epharmix tools drive real outcomes when combined with care management. It's not just Epharmix but Epharmix is a necessary piece of that puzzle. And an example there we reduce the hospitalization likelihood for COPD patients versus control by more than 60% drop A1C for patients with diabetes by more than one absolute percent. So starting with an A1C of over eight even help get hypertension patients under control and moving about half of the hypertensive patients back into the prehypertensive state. And we do that to your point and to your question by not just asking all the questions that we could ask but instead by almost sniper picking the right questions and collecting those rare data that are then related to the care teams. The care team can reach out use their clinical expertise and inform care.
: That's pretty cool Blake. And so you guys have a very thoughtful approach. You're getting results. The evidence is is in the numbers. You've also been featured in a lot of different publications like entrepreneur Moby health news, Bekkers and so you're definitely creating some traction out there and you're getting some attention through the process. What would you say has been one of the key learnings right I think as the listeners that tune in that our digital health entrepreneurs they are going through the trenches and the peaks and so maybe you could share with us a time when you had a setback or a failure what you learned from that and what you do now as as a result of it?
: Just picking one time as the challenge to spend at least 15 minutes those since my last one so I'd say a theme of failures. Not only that we've experienced to be Epharmix but I think that a lot of folks coming in to try to be really good industry partners struggle with is health care is not a turnkey industry. Most enterprise sales have some level of complexity but I would say that healthcare has to rival the most complex ones. So going in and saying we have this fantastic software as a service offering we're going to throw it over to you. You're going to buy, you're going to pay us money then we're going to stay hands off and watch it as it delivers tons of value. That's unrealistic to say. So big failure is acting that way. And then of course the converse of that is by being really hands-on, by treating every health system has its own unique entity with its own flaws and opportunities. We can help them succeed. Maybe a more specific failure. I think something that's fascinating on the research and development side is Epharmix also supports populations such as Mothers on Medicaid or feeding postpartum depression and a number of other related indications or stages. And our first attempt at EPX breastfeeding which was intended to increase the number of months for which a new mother would breastfeed her first child. That first attempt flopped. So it was a blaze of failure. It was incredible. Folks stop using it within days the feedback was that it was almost offensive and we were applying all of our best design practices to this. Right we gone through the same. So we pulled back really embraced the patient centric design mentality. We even brought in ... to begin providing feedback on the product. And finally landed on something that wasn't good academically or at least wasn't driven by the academic best practices but was instead driven by real feedback from those new mothers and the folks who helped support them right after you know immediate postpartum. And it was night and day. The engagement the theme.
: That suddenly became a tremendously positive,so.
: That's such a great share Blake and friends. You listen to Blake's passion you know even when he's talking about his setbacks he's engaged he's all in and you know this topic of high tech versus high touch. There's no versus. You got a little bit of both. If you're going to really succeed in this field and for those thinking that they could just throw on software and walk away like Blake said you're making a big mistake. So Blake I'm glad you highlighted this very common misconception that people make when they come from tech into health. And it seems like it's something that you guys learn very quickly and you're implementing very quickly as well to scale.
: I appreciate that. Hopefully we keep learning more and more.
: Hey Blake, so tell us about what are your proudest leadership moments to date with Epharmix?
: We've helped a lot of patients. Well into the high thousands of patients now across the range of disease states and I think one of the most impactful moments was early on as a team. But you won't have a company and now we're more than two and a half years old and we had just closed one of our first commercial customers and one of the care managers shot an email to one of our managers saying hey I have some feedback for you. Essentially explains that Epharrmix had helped a patient who later admitted that he had given up on his self and helped the patient to begin tracking blood sugars. You know really simple just basic diabetes management and had really fundamentally changed the trajectory of that patients health by empowering the patient which was our focus really is sustainable outcomes long term outcomes. But seeing that shift in someone who frankly had been failed by the healthcare system not through any malice but simply as a result of the of the conditions and incentives that surrounded that patient. That was pretty powerful. That got smiles on our faces for a few days afterward.
: That's awesome. Yeah and you know specially when you're impacting the lives of people and you're seeing them come through your system and you know that you're actually making the lives of folks better. There's nothing more awesome than to be able to do that. So within Epharmix, you guys are working on a lot right? You already have a lot of specialties that you focus on. But what would you say today is one of the most exciting projects or focuses that you're working on?
: Sure. So a couple of categories. One is really making the most of the rare data that we have and that generally means we have an excellent tool for patient engagement and we're able to drive outcomes as a result of that long term engagement. But the next two stages are predicting adverse outcomes and then helping prevent those outcomes. So a lot of team energy in the background goes to baking those capabilities into product. For instance we have a couple of publications in the pipeline that show really compelling outcomes you know meaningful, high area under curve predictions with relatively straightforward machine learning models and we find the right model out of dumpsters that we try that can even predict for instance suicidality within a set timeframe for a pediatric Medicaid population or adolescent population really really powerful predictive models. That's one category. I mean it's amazing what you can do if you have the right data at the right time. The other area that's got me very excited is helping to make scalable some of those. As you would say high touch elements of service delivery. Right. So we have these fundamentally very strong, very robust product that helps care teams keep patients engaged. But what can we do to go upstream and make sure that patient enrollment and initial engagement is painless almost enjoyable for the provider and then go further downstream and deliver insights almost management oriented analytics to the economic buyer to the V.P. or the management level individual to not only showed that Epharmix is delivering value but also help them make strategic decisions based on those trends. So that upstream downstream I'd say it's another form of vertical integration of our product and our service offering that's got me pretty excited.
: That is pretty exciting Blake. And as you look at you know you guys are focused so clearly on getting the right forms of data. What would you say a good thing that health leaders need to focus on to get that data and maybe not just health leaders but also other tech companies right. How do you ask the right questions and how do you come up with those questions?
: Fantastic question. So that cuts to the research and development approach that Epharmix uses to try increasingly convinced it's a very strong way to build a product especially for a complex industry like healthcare which is a combination of standing on the shoulders of giants do a literature review understand what's already out there and then be comfortable iterating and failing and iterating and failing through until you have product is demonstrating itself and its value. In other words start with the best possible position you can, learn from the experts and then go through the process yourself embrace the experimental method and I would say to folks who are looking at all of the data that come from their AHRs all the way to hopefully potential partners such as Epharmix in the industry that are smaller innovators lean into the real reality that you will fail 85-90% of the time and that only by going through that process until you have a solid product can you deliver real value to your own workers.
: That's pretty cool Blake and what I love about what you guys are doing while you're a young organization. You guys are so focused on delivering value and putting together those randomized controlled trials and implementing the solutions to your different partners that you already partnered with. And it's so cool to have met you guys two years ago and now seeing where you're at today is just so awesome you know so.
: I appreciate that. You've been there for pretty much the entire Epharmix story come to think of it.
: And it's pretty cool you know. And I love seeing young companies succeed and there's no doubt in my mind that if you guys keep doing the same thing you're going to keep having the success that you've had early on.
: I appreciate that.
: So let's dive into the 101 course of Blake Marggraff. This is where we are is where we talk through what it takes to be successful and healthcare through business and technology. And so we're going to write out a syllabus using some lightning round questions I've got for them for you. And then we're going to follow that with a book and a podcast that you recommend to the listeners. You ready?
: Awesome Blake. So what's the best way to improve health care outcome?
: I think the single best way is to intelligently distribute risk and I say that because right now when you look at the perverse incentives that arise there are usually there because either over a certain period of time or just an order of magnitude risk is not distributed among all stakeholders.
: What's the biggest mistake or pitfall to avoid?
: Don't assume people want to change let alone that people will change if given the opportunity and when you're making clinical improvements. Keep that in mind.
: I love that Blake spoken from experience right.
: Unfortunately, yes.
: And listeners if you're hearing this is all too common with new products and health care do not assume people want to change and Blake I'm glad you brought that out. How do you stay relevant as an organization despite constant change?
: So this one kind of has a logical corollary that's pretty obvious I guess which is make yourself irrelevant as long as you're the one making your previous so obsolete then almost the fact that you'll continue to grow and prove it.
: Love it. Why and what is one area of focus that should drive everything in healthcare?
: So I have to say we're all speaking the same language here from outcomes rocket. It's sustained outcomes. It's driving meaningful clinical value and thus financial value and not only driving it for weeks or months but for years on it.
: And finally what book and what podcast would you recommend to listeners on the syllabus Blake?
: So Peter T.L. released a book that was co-written by Blake Masters called Zero to One which stands out and says one of my favorites. And I'd say in terms of podcasts I'm going to go away from the healthcare side just a little bit and recommend to all who had not discovered it yet Radiolab which I can describe as morphiscience fantastic treasure trove of mental models and an impactful memorable stories.
: Amazing sounds very intriguing one that I'll add to my list and it's called Radiolab?
Awesome. Fantastic. Listeners, there have it. You have the one on one of Blake Marggraff and also some of the best resources in the industry here that he just shares some great resources and also we'll have the transcript there for you. Just go to outcomesrocket.health/blakem. Blake M. and you'll be able to find all that there. Blake, great times here with you today. Before we conclude I love if you could just share a closing thought and then the best place for the listeners could get a hold of you.
: For everyone out there who's part of a team leading a team anything consider asking yourself and your team the simple question. If we weren't already doing X would we start doing it today? And I think a lot of a lot of the fundamental flaws in health care would at least be solved a little bit. If folks would ask that question and getting in touch is pretty easy. We've made my email very tricky it's email@example.com. Drop me a line and I'd love to set-up time or follow the company or me at Epharmix or at @blakemarggraff.
: Oustanding Blake. Listen this has been a blast. Really appreciate the time that you spent with us today. Folks if you haven't checked them out Epharmix they're doing some pretty amazing things so definitely check out the show notes, click on that link. Find out what these folks are up to because they're really taken health care to the next level and Blake again, just wanna say thank you on behalf of all of us my friend.
: Thank you all. Really a pleasure. Appreciate it.
: Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.
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