Category: Access

Creating Value Creation in Healthcare by Innovating Thoughtfully with Ashim Roy, Co-Founder & CEO, Cardiotrack

Creating Value Creation in Healthcare by Innovating Thoughtfully with Ashim Roy, Co-Founder & CEO, Cardiotrack

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 low. 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 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 because we have an outstanding guest for you. His name is Ashim Roy. He's the co-founder and CEO of Cardiotrack. Ashim champions the cause of value creation in every activity and uses innovation as the key tool for such value creation. After an illustrated career in the telecommunications industry with successful deployment of several generations of products from PSTN through 4G, Ashima is now working to bring I.T. solutions to healthcare industry health care technologies of the past have created access barrier for people in the developing economies. His focus is development of disruptive innovation to challenge the dominance of standalone medical technologies. On the podcast, we've had the privilege of having several international guests and Ashim is here to round out his experience and talk to us a little bit about what it is to create health care solutions for this international world. He has worked in several countries like Australia, Canada, USA and India where he's coming to speak to us from. And he's created talented teams to deliver technology and business solutions to clients across markets in these areas. It's a pleasure to have Ashim on the podcast. Ashim, welcome.

Thank you. Thanks for the great introduction. I really appreciate.

Absolutely esim. Now that I leave anything out of your introduction that you want to share with the listeners.

Oh sure. Actually what happened is that since my graduation undergrad is in India I had left the country. I did my Ph.D. in Australia and then I stayed overseas. I most stayed from Canada to US and I came back to India about 30 years later. It was a different country. Fortunately I had the opportunity at that time to travel to some of the areas from where I live. I live in Bangalore India at the moment and within a hundred kilometers you see a lot of rural territory and what I realize to many journeys in these areas is that affordable healthcare education and financial services were really significant barrier for many of the people living in those communities. And I wanted to do something about that. And I just wanted to add that and you know as part of my reflection.

Now and that's a really important factor Ashim, and so kind of gets us to the first question that I want to ask is what got you into the medical sector to begin with? You've highlighted why you're focused on what you're focused on today around the globe journey that's brought you back home. But what got you into healthcare to begin?

Ok looking at some of the challenges that face people living in rural communities in India and I'm sure similar conditions exist in many of the developing economies. What I saw was something interesting. I come from telecom background as you told your listeners and I have seen the effect of Moore's law being applied to telecom industry and the computer industry. You know the cost comes down every two years and the performance goes up every two years. I don't see that. I didn't see that in the healthcare sector and I felt intrigued by the fact that the healthcare solutions are being provided in silos there. There was no opportunity to bring innovation into healthcare industry particularly in a country like India. And that was a challenge and I felt that if we applied some of the principles of information technology and telecommunication etc we would be able to bring down the cost of healthcare. We would be able to deliver better care to communities in the rural areas because people in the urban area are generally taken care of. There's lots of infrastructure available expertise available etc. If you take a look at a simple problem not so simple for people living in the religious but cardiovascular diseases which is very common in India. And yet the cardiologists are only available only in the top 25 cities. So I felt that something had to be done and that brought me into the medical sector.

That's awesome. Hasheem and you know what. It's great that you identified this need. Like you pointed out even in developing countries we do have that care gap and it's important that we start looking to different ideas and technology to bridge that gap and so I'd love to hear your thoughts Ashim on an example of something that you and your team have done to create results to address this really what it is it's it's access right access to healthcare. So I'd love to hear your thoughts and any stories you have to share in that room.

Some of the things that I feel I feel that healthcare to the right of every citizen, everywhere, every country. Healthcare leaders need to shift their attention from primary care from tertiary care to more into primary care. If you look at many countries today particularly where there is love healthcare solution that is a larger importance to primary care. I'll give two examples. Either the NHS in the UK our health services in Singapore they probably are among the best in terms of healthcare being provided to the citizens of the country and there is adequate not only adequate it's really been established network of primary care physicians etc. and services available and I don't see that in countries like India developing countries like India. If there's a huge amount of infrastructure available in urban centers you know from the place that I live in Bangalore within 3 kilometer radius 2 mile radius then 6 major hospitals so I'm really lucky in case something happens to me that I got good services. Whenever I go out not even 50 miles maybe 30 miles outside of the city and that situation changes drastically. Finding a cardiologist is a prayer. Finding a specialist of any kind, finding simple diagnostic capabilities which are taken for granted in developing countries like USA will not be available.

So how do we address that?

Yes. So very good question. So let me kind of come to the main point that I'm trying to bring here is that to provide quality health care you need new technologies. Innovation in healthcare and design for developing economies like India. We cannot use the technologies that are available in the US or many of the developing countries because they would be too expensive for deployment in a country like India which is affordability that it would not be possible. However there are lots of things that can be done little things that can be done. Take a simple case of cardiovascular disease where it's a chronic illness get worse and worse over a period of time. If a simple EKG capability exists at the primary care level in these rural communities what happens is that all of sudden we are able to diagnose people early enough and early diagnosis on basics like and it's always less expensive. By no means it's rocket science. It's a very simple solution and yet we don't have those kinds of solutions today and that's exactly what we are trying to bring to the known urban areas to communities that are underserved. We want to provide those kinds of solutions.

I think that's great achievement. And you know we recently had a guest. His name is Rani Shifron. He's over in Israel and his organization Global health is very much focused on the impact that you're working to effect then one of the examples that he provided much like your example is you know the technologies that exist in developed countries really have a ton of bells and whistles that aren't necessary for basic functions like an EKG for example. And so what can we do if we want to address the needs of the broader global population. This is a conversation really kind of at the government level. How are we going to address it? Right. And so to ashram's point we've got to take a look at small shifts small things that can be done in order to make that type of impact an EKG for example is one of those things that can be done. Have you guys Ashim started any programs anything that's yielded results thus far?

Okay so I think thanks for pointing out that the technologies that are developed. You know you can look at it better developed in the Western countries and to fit the budgets of the developing communities. And just to illustrate that in another way. One example I would like to give is everyone most of your listeners will be Mulier that Microsoft Excel spreadsheet. I'm a power user of Microsoft excel and I think I use only maybe 3 percent of the capabilities the bells and whistles that are there. I rarely use them.

Yep.

So that's either actually thing that can be done in healthcare. And what you have done the EKG. There are expensive solutions that are available which are suitable for IC use. That's the market that we want to go to because for us the diagnosis must happen at the primary care level.

Yes.

If One actually will reach the ICU so we can provide very simple solution hand-held solution robust solution that's been worked in that pressure are the other environmental conditions that exist at the primary care level. There's no air conditioning. You know the temperatures can go up to maybe higher than 10 degrees Fahrenheit. The device has to work under that condition. What we can take advantage of certain things that are actually coming down in price so fast that it's amazing take for example that smartphone. We don't really need a printed piece of paper to give you see the output because what is patient going to do with it instead. If that information is available to it on an Android phone which cost less than 100 dollars all of a sudden we have the capability of displaying the mission. That information is available electronically that can be sent to a cardiologist hundred miles away or maybe across the world. And all of a sudden we have created a solution based on existing technologies around us. And yet the solution is very low cost.

Yup. So taking this example is a great way of doing things and so tell us a little bit about a time when you tried one of these things and maybe you ran into some obstacles, Ashim. What did you learn from those obstacles?

We ran into lots of obstacles and I'm glad that we did because we come from myself and my other co-founder both technologies come from nonmedical background and as a result of that we made assumptions that were not necessarily correct. So I'll give you three or four examples or maybe two or three examples depending on how much time we have but a simple one was that during the early testing of the product we had given the product to ambulance driver and he was driving around the whole day with the device. And India is very hard most of the year and his palms would get sweaty. He's getting the device that could slip out of his hands and fall down. So by the time he finished his trial two weeks later he was very apologetic he was like sad face. And I spoke with him through a translator because I didn't understand his language and he figured out that it failed on multiple times and has been very sorry about it. And yet it's a simple feedback that actually changed the way it is now. We actually have per day silicone rubber grip around it. It's easy to hold very very comfortable. It doesn't slip out of the hand and more or less. Moreover if it falls down, nothing happens to the device. Another one I will tell you is we made the assumption incorrectly or maybe we were too naive and those days that we thought that if we allow our device and the information from our device to travel from the primary care physician to a cardiologist, our job is pretty much done. We got a cardiologist come on line provide guidance to the primary care physician. They will talk to each other. Everything is great. And the patient is taken care of. What we didn't realize is how imbalanced the situation is in countries like India. There are 60 million people with cardiovascular illnesses less than 10000 cardiologists. So guess what? Every time a primary care physician wanted to get in touch with the cardiologist, they will be busy somewhere else and so they wouldn't get any response on their query from the cardiologists or maybe a few or maybe never. In some cases because the cardiologist is really the busiest person under the sun. So what we have to do is that we have to rethink our solution. And that's when we realized that interpretation if we want to deliver a solution that would work under all the circumstances then the solution has to be on the basis of either machine learning or the IBS and the patient that we can deliver to the primary care physician on time every time without hearing you. And that's exactly what we ended up renting. So these are the market feedbacks that we got these are mistakes but in the end it's actually all a better solution.

That's great. Now at this point how far is your reach how many are you working with clinics with hospitals?

I have to use a much used the phrase call out of the box solution. So let me explain what I mean by out of the box solution is that our solution is designed for primary care. All the work that the hospitals. And I'll explain to you why we work with the hospitals because the intervention with reluctantly committee happened in the hospital. Hospitals have the maximum affordability in terms of deploying these kinds of solutions. So what we do is that we actually work with the highest cardiac centers we deploy our solution. These devices at the primary care clinics around let's say one or two mile radius of the hospital through this process and the hospital basically is a payer, meaning for us they are the customers they pay for the devices on a subscription model for this deployment number of scans are taken at the primary care level primary care physician doesn't fairly have the affordability to pay for this kind of technology. So hospitals pays for it. The primary care physician is the user and the patient is the beneficiary. So now what happens is that when the patients come and they complain about a test ban the primary care physician says come on over I'll take the scan. He tells the nurse to take a stand. Innovation happens by the time the patient is up after putting on their shirt. The information is already available and then the plan to get decides if this case is acute care case in which case they'll call an ambulance and send a patient or to the hospital. Otherwise they'll say that come back later on or whatever the case may be or maybe prescribe them some medication. But the end result is that now we have created a new flow of patients for the hospitals which didn't exist before because the hospital didn't know which patients are walking around the acute care condition.

Absolutely. And so now you've got a good workflow established. What would you say is you started this company and you're impacting the health of your community. Ashim, what would you say one of your proudest medical leadership experiences has been to date?

Actually there are several but.

If you have to pick one.

Yeah ok I'll pick one. So in the early days of our testing what happened is that we found a primary care physician and somewhat rural community where 50 miles away from Delhi, the capital of India. And what happened is that I had to talk to him at least three or four times and then I'd visit him one time to request him to use the device because we really wanted some rural experience in our side that okay. This device is being used in the rural area. This is how things happen. So after about two months or so when I checked back that this primary care physician I heard something that totally blew me away. First of all he told me that he had identified two patients who had acute care requirement and he shipped them over to a hospital and then he told me that you have given me something wonderful but I cannot use it. And I was totally blown away. I said doctor you have saved lives already. So I want to use it. And he said that you've given me a device where I actually found the patient could not afford to go do it at tertiary care facility. And a month later I found out from her case that her family that the patient passed away and the doctor felt really miserable. I had to sit down there and talk to the doctor for next half an hour ,maybe 45 minutes to explain to him that that's a condition that you can control is beyond your control to be able to take care of everyone but just think of the number of life that you are saving for a primary care physician to save three lives in their lifetime. In India a particular country like India. People go for coffee gold etc. etc. some simple things. And yet he managed to save lives. That's like getting three Oscars. So I had to extract every ounce ownself positiveness that I had inside me and not to this doctor to convince him that he should continue to use it. He's been using this device since 2014 now and it still operational.

That's awesome. Yeah. You did a really great job Ashim of putting it into perspective. Right. I mean it was it wasn't in his control and ultimately if he didn't use it who else would have died if they had. Yeah exactly. So that's great and kudos to you for sort of getting him to see that side of the picture. Tell me a little bit more about an exciting project that you're working on today.

So we haven't had a provider of solution. We have always been afraid of government organization because the issue is that with government organization requires a different mindset different level of patience etc. which at the start of organization we don't have that in our DNA. Well what typically happens is that we get afraid but finally actually this month beginning of this month I happened to meet a very dynamic government official in this small town somewhat farming community in state of Gujarat which is in the western part of the country. So what happened is that I had a conversation with them after the interruption someone actually introduced me to him and then I had a conversation with him for 10 - 15 minutes. And next thing I knew is that a week later I was visiting him and following me. He actually launched the program. He got so impressed looking at what we had done. Obviously we tested it in front of him and showed him how this could be useful etc. We did all of those things and a week later he basically invited me for a launch of a program for heart health patients in rural part of the community and I was so blown away by that and this is a good example of a public private partnership. He is on the side of public healthcare side of things and we are a private organization patient that the deployment is all at the public health clinics. Are primary healthcare clinics where the art equipment is deployed and any time a patient is found they who require requires intervention are actually referred to a private hospital because there is no government facility available in the surrounding area where patients could be treated for calculus illnesses. So for even you have made it's a really really good model for public private partnership and I'm very proud that we had a few of it. And I'm just amazed at the you know the dynamic gentlemen at the Public Health Center in that state who took the initiative and understood the solution and implemented it is really fantastic.

Yeah that's great. What a great success story Ashim and just kind of a reminder to us hey you could be afraid of something but you know what. Feel the fear and then just do it anyway because that's how great things happen. In healthcare you just got to go forward with it. And like Ashim did you know what. Him and his organization were a little fearful of what could happen with working with government. But they did it anyway and partnerships have been made and great things to follow because of his courage and also the government's foresight into their technology could do. So kudos to you my friend. Getting close to the end here of the interview with time flies. I want to build a leadership course with you through a lightning round. We've got four questions. We're going to call this the 101 course of Ashim Roy. And so we're going to form a syllabus for the listeners four questions that you'll answer quickly and then we'll finish it up with a book that you recommend to them you're ready?

I'm ready.

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

Preventive care close to the home.

What is a biggest mistake or pitfall to avoid?

Technology is not the answer to all health care challenges.

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

Key thing here is to go the extra mile whatever the responsibility the person has. Every person has that and a lot of responsibilities. They should begin this possibility and to go the extra mile.

There is no traffic in the extra mile right, Ashim? What's the one area of focus that should drive everything in a health care organization?

I think there are lots of people who are underserved just saving life for the people in the under subcommunities is the best thing that one can do.

Love it. What book would you recommend to the listeners?

Only the paranoids survive

Very interesting, a very fascinating company in healthcare the way that they manage their health portfolio as well as their insurance. Only the paranoid survive folks check that out. You could find all of our show notes. links to Ashim and his company go to outcomesrocket.health/ashim which is ASHIM you can find all that there. Ashim, before we conclude. I'd love if you could just share a closing thought and then the best place where the listeners could get in touch with you.

Healthcare innovation from developing economies really can change the way the healthcare is delivered in developing nations as well because the cost of healthcare is rising very fast. The frugal solutions coming out of developing economies can bring the cost down.

Love it. And what would you say the best place for the listeners could get in touch with you is?

ashim.roy@gmail.com.

Outstanding. Ashim, thank you so much for your insights and visiting this really key topic of health in the rural areas and also access to health care. Keep up the great work. I know that you and your team will continue doing great things and we really appreciate you spending time with us today.

Thank you very much indeed. Thank you for the opportunity. And I'd love to hear back from anyone who is listening to this podcast.

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 low. 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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Recommended Book:

Only the Paranoid Survive: How to Exploit the Crisis Points That Challenge Every Company

Best Way to Contact Ashim:

ashim.roy@gmail.com

Link:

http://cardiotrack.io/

 

 

Lowering Cost While Addressing Baby Boomers and Millenials in the Same Business Model with Keith Figlioli, General Partner at LRVHealth

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 low. 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 once again to the outcomes or rocket podcast where we chat with the day's most successful and inspiring health leaders. Today I have an outstanding guest for you today. His name is Keith Figlioli. He's a partner at our LRVhealth ventures where they do a lot of venture investments in firms in the healthcare space. Most recently Keith was premiere's incorporated senior vice president of Healthcare Informatics. In this role he oversaw the company's enterprise healthcare technology business unit spanning strategy sales, marketing, clients, support, development, delivery and operations. Most notably he was able to as part of the leadership team helped this firm and its members raise 820 twenty million dollars in its IPO. It cochaired premiere's member technology improvement committee. Before that he was able to be part of many different companies including one that was acquired by scripts where he provided many different leadership roles. Bottom line he is a shrewd entrepreneur. You'll mind a leader at many organizations and we're super excited to get his perspective here today on the capital side of healthcare so Keith it's a pleasure to have you on.

I appreciate it. Thank you very much.

Absolutely. Now Keith, anything that I left out of your intro that you want to fill in the listeners on.

No I think he did it. I think he did it nicely and had a lot of good detail so that's appropriately. The only other thing I've I have done in the past is it has done a little bit of regulatory work with the federal government as part of the open NCAA standards committee which was important work back then and continues to be.

Very cool very cool. You know health care is one of those industries that is just tough to navigate. So folks with the experience that he has I think you're going to get some really great insights today. Keith tell us a little bit about why you decided to join the medical sector to begin with.

Probably go way back which is I don't tell the story much but I was a economics major at undergrad but ironically had a minor in neuroscience. And don't tell me how I got there but I got there about how effective that college career and I quickly realize I'm like wait a minute maybe I just don't want to do business. Maybe I want to get into more of a deeper science kind of healthcare background. So it actually started way back then. And you know I came out of school that your body came out of school. I came out of undergrad in 93 so I can what part of my background as I came up with kind of the Internet and it bounced around a bit with some consulting work in a variety of industries and quickly kind of found my way back into health care and that was always my focus and kind of married the best kind of business the growing of the Internet technology and healthcare and that's sort of how I got my start. And more important for the last almost 20 years purely focused in the medical sector.

That's awesome and said it's really been at the root of your interests. And fast forwarded. I mean the time fly doesn't that's crazy. It's 20 years already.

It is a little nuts. Yes. I just actually had my 25th year college ring. Oh yes. I'm dating myself here.

Hey man that's experience that's experience for you. And it counts that health care for sure. Now talk to us Keith what do you think. A hot topic that needs to be on health care leaders minds today and how are you guys approaching it at LRV.

Yes a little talk about maybe start with a little bit about LRVhealth and it plays right into that so and maybe even sort of my time at Premiere. So premiere which a lot of people don't understand is actually almost like an association back in the day where it had a 180 a different health system owners as the actual equity owners of that and we took a lot of the concepts from there and LRV health has been investing with strategic investors meaning health care payers and providers for 17 years and we kind of put that on steroids with our latest fund. So at the core of our strategic investors meeting our limited partners as well as our partners are currently 10 health systems and payers that deliver care across 23 different states and deliver care about 45 million lives. So at the top of can tell you how many people we've talked to between my premier time and obviously my time and energy health you know were consulting with healthcare administrators and leaderships of payers and there's sort of two major focus areas for focus right now if you break it down at a demographic level most people talk about the baby boomer generation and what's happening as their age group ages and gets more chronically complex from a medical sort of use pattern. So there's a lot of people within the system trying to figure out how to use service that group as they go from commercial plans down into lower reimbursement plans like Medicare and Medicaid and have a plans. How do you serve them as their utilization of the system goes up but at a lower cost rate. So the emphasis on cost right now and so we talk a lot about that with folks that thing that people don't realize is the age group that actually just you clips the baby boomers is the millennial generation and that millennial generation now is bigger than the Baby Boomers and they want a completely different service offering from health care system they want self service they want all the different things they expect from their mobile phone and less access until that point so people talk about those independently. We actually talk about those together and I hope you find opportunities that while you can take down costs. But then you can deliver a new care experience to a different age group that's coming into the system now and also start to utilize the system. So both of those intersections circles if you will are sort of what we call our north star and we think it's top of mind for pretty much every leader across the health care sector.

Very cool Keith and definitely a great point right I mean we're dealing with two very different consumers and I think with the approach that you guys are taking given that it's driven by investors that are the provider payer space it's a really kind of frontline approach which is very differentiated. I would say I mean that's a huge advantage that you guys have.

Yeah I think I mean for us this is as much about being good investors and providing a solid return for investors. But it's really about operational intent can we partner with our healthcare systems and our health care payer leaders to really drive different operational changes for them. And then also obviously get some kind of return back from them given that it's a venture capital platform but you know all of us myself and our other partners at LRV health you know collectively we have about 70 plus years of operating experience in the healthcare space.

Nice.

To bring a whole different lens to this problem if you will rather than just a pure financing lens.

Now it's really. Now there's a lot of companies in your portfolio. Keith maybe you could walk us through one and sort of a success story something that you guys have done differently that yielded results.

So I guess I talk about one which is called intelycare.. It's an investment we made in our last Farnes when I first came into LRV health about two years ago and had a pretty big service line. When I was a premier around healthcare labor we did a ton of rounds labor productivity as well as labor benchmarking. And the thing that was interesting there is that I don't know how much you guys follow the trends but you know health care labor has outpaced every other labor class in any other industry through the recession. So there's a tremendous amount of opportunity that sits around labor. So we spent some time in that market and found a company called intelycare which is all around basically oversimplifying it Oubre 5 million higher per Diệm or the by our.

Interesting.

Workforce in post. Q So in skilled nursing, in assisted living type facilities there's an average 50 to 75 percent turnover. Most of these facilities there's about 2300 regional staffing firms around this country and the largest staffing firm has about a 7 percent market share. So this is a industry ripe for disruption it's all phone calls emails analog takes forever for people to sort of find people and these guys have actually built a technology enabled with a lot of predictive capabilities to understand what the temporary market looks like and each one of the geographic regions that they plan to they plan for states are going to about 6 in the next couple of months and they have a you know a national footprint goal to sort of really think through a different way to deliver high quality and safe care givers meaning nurses and caregivers to these facilities that really have a hard time finding the right type of people in the market so almost think of it as a matching principle and each one of these markets where there's a ton of people that have flex resources and have flex needs but they don't know how to match up with the ideal type of facilities. These guys enable that all through technology.

I think that's brilliant. And in this post to keep space with such high turnover I mean it is definitely a great platform. What are some of the things that they've been able to achieve as far numbers and not necessarily revenue but just kind of outcomes and stuff like that.

Yes. So the average is just a couple ones. So the average time it takes to have somebody find the caregiver at some of these facilities is typically a week to two weeks. So if somebody has a shift that goes unfilled they need to go out to the market. They typically use five to six different what is called staffing agencies today. And it takes them about at least a week to two weeks to do that. These guys are doing it in 30 minutes with a push of a button. A ping goes out to 3000 nurse network. You know each one of the geographic markets and you can quickly sort of find the right type of resource. And it sits right there next to the actual scheduler and the person that actually runs these facilities. So that's a big deal. Secondly most of these folks get about a 60 percent efficacy of being able to fill a shift and intelycare is doing it at 90 percent rate. So it just changes the dynamic. It's classic use of you know technology disrupts and where it's still a tech enabled services business but it's using technology in a smart way to disrupt what is a very big business. I mean this is a 4 billion dollar market that people don't really even know about. So we've had some great success and it's still very early but great success.

That's great. And now folks if you're a provider, a leader at a provider institution take a look at an telecare this is a fantastic solution for your post acute areas. Intelycare so it's intelycare.com. Take a look at that really great resource shared by Keiht today. Now Keith, talk to us about a time when things didn't go so well a setback that you had or one of your companies had what lessons did you guys learn from that.

Yeah I think it's an early lesson more from my operating days and I think when I first got into healthcare I came from a general technology background where we had helped build a company that worked with most of the Fortune 50 businesses around this country and world with places like Philip Morris places like Procter Gamble. And I think my use pattern or my thought pattern coming into healthcare like I think a lot of people when they first come in and I think a lot of people are experiencing this now because they have a lot of newcomers in the space. You don't fundamentally understand the social system and how things really work. And I can remember building technologies early on during my days at eclipses which is now part of all scripts where we thought was like the cat's meow or use the latest technology rebuilt like a clinical documentation module and literally people threw up all over it. And what's the other use pattern. We spent years you know probably a year and a half doing that work. And so I think he learned very quickly that's a very specific example where I learned very quickly that if you don't fundamentally understand the workflow the social system what actually goes on day in day out. And I think that's what we have in a lot of areas of healthcare technology today where we have a lot of great technologists building a lot of great infrastructure but they haven't thought through the use case and the social demographic side of the equation as best they can frankly and you know you can look at that even in the broader H.R. space today there's a reason why there's so much angst in that space today is because you know those systems were basically built for billing they were built for their workflow and things to that degree.

Now that's a great share. Keith and one that that listeners go back rewind relisten to it. The purpose of the podcast model for you to be able to access these notes when you need them. Keith, what would you say at one of your proudest leadership moments in healthcare has been today?

You know so it's interesting when we were at Premier early on this was 09 in 2010. You know the ACL movement the value based care movement took place under Obama and what was so interesting for me was working with 70 different markets and 70 different health care leaders to sort of figure out what an ACL was and what value based care was. Nobody even knew what this was so we used to get all these people in a room in DC and things like that and get hundreds of people huddled around at the health care provider landscape and the first question was always like what is this. I think that was a pretty proud moment to be part of that leadership team to try to drive to an understanding of what value based care is and that's still obviously morphing today but being really on the front lines on something that was completely unknown had been tried historically including a state that I live in Massachusetts many many years but at a scale level of what they were thinking about and specifically what CMM Ohio was thinking about at the time. You know we had partnered with Dr. Rick Gillfillan we now heads of Trinity out of Michigan. And it was a fascinating time. It's a proud time because you know we didn't have all the answers. We didn't figure everything out. But being able to work in what has stuck with me forever and big part of why I love what we've done at LR health is this idea of working hip to hip with health care leaders the people who are delivering the actual care day in day out on these complex problems because you know the shock waves that happen in the healthcare industry literally every couple of years and most people don't really understand what the shockwave is you know MIPS is a perfect example right now where you know people don't even understand what that really is but they're having to deal with it more openly the reimbursement is tied to it.

Now that's a really great call out and it's tough to navigate these waters and maybe we could dive a little bit deeper into that experience. Keith what is it that helped you guys navigate this definition and trying to figure out and land on on an idea. Because oftentimes I feel like as a group you could land on an decision what something means but it really doesn't mean that. How did you guys vet that out and how did you land where you landed?

Yeah I think that the vetting for us. And the nice part about the premier platform at the time is just access. I mean I think yeah we by design have a tagline at LRB health which is called Inside healthcare. And the reason why we use inside healthcare it's very deliberate. Meaning you need to be inside the game and really understand the game and have the right type of people around your platform to truly understand and solve these problems. Because these are not simple high level issues. These are very complex. You know there's reimbursement issues there's regulatory issues there's all these issues in healthcare that people in my opinion a lot of times I'm going to gloss over. But the effort get into it for a while though like oh wow this is a lot more complex than I thought. I mean even take a Trump quote from about a year ago he's like oh I never knew health care was as complex as soon as you get into it. You quickly realize that. So I think for us what would solve that a lot of our issues during the ACA and the baby's care ramp up back in those days was having people like doctor Rick your phone which when you know was a consultant for us. But then he went let's see my under cims you know having those type of people front and center with you is second to none. So to do that you know we take a same approach we help when we invest and when we think about problems you know we're getting the best minds of the people that have lived this for decades. We have advisers that have been in the health care space for almost 50 years. And so you know their entire careers have been spent on this stuff. In my opinion the key to these problems.

Love that. That's a great way to approach it. And so now you're here today. Keith you're working on so many great things a great portfolio companies. What's an exciting project that we had to point to one thing that you and your team are working on today that you want to tell us a bit more about.

Yeah I mean it's talked about a lot of Oliver Wyman a lot of credit for this terminology I'm about to use but we're spending a lot of time around sort of what we call in a call and I've used as well which is the digital front door to healthcare into you know when you start thinking about what's really happening back to this idea of delivering sort of the front end of access. And when you think about healthcare access and how hard it is when you think about navigation when you think about sort of even Rev's cycle from a patient standpoint it's all very opaque. And so we spent a lot of time over the last six months or so and will continue to spend a lot of time and then ultimately invest in a few of these type of companies that are helping people think through a different way to navigate sort of the front door to healthcare. And they run the gamut. They can be things that look like health savings account type applications they can be the front door of physician practice and how that actually extends out to a mobile application and then connects back into the system. It could be scheduling. There's all different things that this could shaped on you know during our annual meeting this past April. We had brought in you know one executive from an employer to executives from health systems and executive from a payer. And then we brought in the woman that leads this area for all the women in purposely sort of had this open discussion which was a very kind of interesting discussion with all those type of characters and a very hot topic around this like who's going to own the patient and who's just navigating principle so like typically when a payer calls you on anything that they see that you've accessed the system most people don't call the payer back. You always called doctor bag you always call you know your practice back but you know who's going to own nettled somebody as the employer don't know that given what obviously the tools reach an appointment and what JPM is doing and Amazon Berkshire and you know health care transformation alliance young employee to ramp up now because the problem is so big in terms of their cost infrastructure. So this is really a huge problem right now and it's not something as simple. This again goes back to the depth of really understanding the problem and finding the use cases that actually are going to matter and more importantly deliver real jobs.

I think that's a really interesting project that you're working on and I love how you tagged it. The digital front door to healthcare. And if you're listening to this today and you're working on a solution that is the digital front door to healthcare Keith and his team are obviously looking at this seriously. So at the bottom of the show notes you'll find a way to reach our LRV and potentially even collaborate with them with your idea. Keith, This has been fun man we're getting close to the end here. Let's pretend you and I are building a medical leadership course on the Capitol side on what it takes to be successful. The 101 of Keith and so we're going to write out a syllabus. I've got four questions for you lightning round style followed by a book that you recommend to the listeners. You ready?

Sure

What's the best way to improve health care outcomes getting capital?

Got to show our wife if you can show proven or awide typically the old 10 x factor. It's very hard to get capital these days.

What's the biggest mistake or pitfall to avoid?

Think the technology is going to solve it.

Love it. How do you stay relevant despite all the change?

I think you have to be a ferocious reader and if you're not a ferocious reader and healthcare you're pretty dead in the water.

Do you do all your reading books stirred you do audio.

I do pretty much everything from podcasts of videos to books to not from Kindle to the hard copy book.

Love it man. You know one of the things that so we do a five day week podcast on health leaders are always recommending their best reads I found an app called Blinkist. I don't know if you've heard of Blinkx just know this they basically give you synopses of the book in audio and in written form. So I've got out my books through Blinkist and it just saves me so much time.

Very cool.

Yeah and there are like 80 bucks a month. But really cool resource. Listeners if you haven't checked out blink. Check them out. They're a fantastic app and I'll put a link on about bottom on the podcast as well so you could check that out. But last question here. What's one area of focus that should drive everything in a health care organization?

Understand the social system more than anything else.

Dive a little bit deeper into that what do you mean?

So I just mean the end of the day the social system and health care drives every decision and drives every workflow. So what I mean by that is you know we're constantly painted that we're slow costly painted that we adopt technologies five to 10 years later. If you don't understand the pace of adoption and the pace of usage so give you a perfect example of giving all the details. I built the technology stack during my career days that was fairly expensive thought it was absolutely right in the middle of a sweet spot and the social system refused to adopt it. And it's a no brainer. The whole reason why Amazon is coming in the space right now and it's no different than what Amazon house. So it just you really got to understand how people adopt certain new ways of doing things.

Got it. Very clear very clear. Thanks for clarifying there for us. Keith and very helpful. Well what would you say a book you recommend to the listeners is in this space?

Yeah a lot of people are talking about this book right now and I hesitate to say but I'm going to say because it is that good. And I would say it's not. It's not one book. It's actually two books. So if you look at all know as books sapiens in Homo deus. OK. Read them both and they're big books but they're quick reads but they are fascinating. Saipan's is all about the history of mankind and then homo Deus is really about his predictions of where mankind is going in the future of our planet and it opens up your eyes to the reality of what the human race has actually done to society let alone the planet. And it's really good stuff.

Wow. Very cool listeners check those out. You could find all of the resources links to the books book's links to Keith's company go to outcomesrocket.health/LRV. You'll find everything there. Keith, this has been a blast. Before we conclude I'd love if you could just share a closing thought with the listeners and then the best place where they could get a hold of you or follow you.

Yeah so I think I'm kind of to the title of your podcast outcomes just everybody you know there's a lot of I just wrote an article this past week about maybe there's too many people in health care now trying to solve these problems. But I think everybody that's focused has to continually focus on this is not about making money. I talk a lot about health care being sort of capitalism running amok which is this is about delivering care and bringing society up it's the reason why I do what I do. I could easily do technology type things and it complicate things and many other industries. But I decided long long time ago that this is what I want to do because every day I wake up and I feel good about trying to drive a societal benefit. And I think people cannot lose sight of that. And I think a lot of people do when they get into space because they're sort of chasing what is the latest greatest trend. You know I've been doing this so long that you know digital health wasn't even a word ten years ago. No one no one at the venture capital community would even invest in a company. Our firm has been doing it for 17 years. We did our first patient gauge investment in 2003. So it's just a different pattern. And to get a hold of me you know the best way is you know either my Twitter account @KeithFiglioli or you know ping me on LinkedIn by all means I typically respond to that pretty well.

Outstanding. Keith thank you so much for spending time with us. It's been really insightful diving through some of your thoughts on on the capital markets but also on the social aspects of medicine and things that today's healthcare leaders needs to spend on so really, really appreciate the time you carved out for us today.

No problem I enjoyed it. Thanks for the opportunity.

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 low. 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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Recommended Books:

Sapiens: A Brief History of Humankind

Homo Deus: A Brief History of Tomorrow

Best Way to Contact Keith:

@KeithFiglioli

Keith Figlioli

Episode Sponsor:

Why compliance is not the safest cyber-security strategy with Grant Elliot, Founder & CEO at Ostendio, 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 low. 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 once again to the outcomes rocket podcast for we chat with today's most successful and inspiring health leaders. Today I have an outstanding guest for you today. His name is Grant Elliott. He's the founder and CEO at Ostendio, Inc. He's an entrepreneurial leader with over 20 years experience in a variety of operations, customer service, product dev and most importantly in the executive capacity. His track record in this space is really attributed to what he's been able to do. He's been able to create significant growth, development and change for those seeking to make positive change in cyber security and at his work right now at Ostendio, they're actually working to change the way companies look at and manage their cyber security risk management and compliance programs. Today in healthcare, it's such a big focus for everybody to make sure that cyber security is in a positive state and that it's not interrupting our healthcare operations. So I think the topic we're going to dive into today with him is going to be very pivotal to anyone running a health care organization. So it's with a big privilege that I open up the microphone to Grant. Welcome to the podcast Grant.

Thank you Saul. So it's a pleasure to be here.

It's a pleasure to have you here. Now Grant you obviously span various industries but you do have a niche in the health care market. What got you interested in spending more time within the sector?

Yeah it's a great question though from my perspective my background predominately was telecommunications as I'm sure that you can tell from my accent or not native to the U.S. And so I work for a Brit British Telecom for a number of years and based on incapacities protoplasmic marketing operations etc. That kind of brought me over to U.S. had for a short period of time for AT&T so I always had up the networking event to why that rolled over the mid 2000s. I had the opportunity to work for a digital pioneer and digital and tech company and the connection really was that they were doing a lot with the SMS. they were building health information systems and in rural countries you know Eastern Africa, Indonesia, India. We are the general infrastructure wasn't mature. And so they were actually using cell phones and internet particular the method communicate and manage drug inventory. that built to those et cetera. And so that was the kind of connection you know this telecom background to digital health company that we've seen using communications as a primary means of channels. And really what got me into the digital space and then from that point on you know I've just been really fascinated with you know obviously the security aspect, the risk management aspect to be able to do that and what the chief operations officer and chief information security officer of digital health company and that is really what got me involved and you know conducting audits for you know some of the major peers, providers pharmaceutical organizations and really you know ultimately to recognize that our journey just Hoboken the security of supplies managers peacefully voice within this particular segment.

Super fascinating Grant and you've worn a lot of hats and you've seen the various scenarios that could happen and you've helped organizations plan for that have helped protect them against these these types of cyber attacks but also weaknesses in their own network. If you take a look at the entire arena of cyber security and health care what do you think is a hot topic that needs to be done on these leaders minds listening right now?

I think that people need to understand that the world we live in today particularly in health is very different. And what I mean by that is if you think that where the data are stored, you know 15 20 years ago most organizations which store data on prem they would use the basic perimeter security. And so to some degree you know whether this is correct or not they had this greater premise that can't fully protect that information using the only Caslen Mortell technologies. Well today with quote technology is all over, right. You know we no longer have a single copy of data. You know when you go to your provider or you work with your peer and they're interacting with a complete list of increasing list of vendors who are providing daily different services on. So that data that you providing them, the data defeated on your behalf isn't necessarily just sitting in their premise, they themselves may be using some that call based service to be so store data and then increasing number of their vendors are using call-based services to provide services to the organization. So when you think of that way you're very sensitive person dataset as you're interacting with any healthcare organization. You know it's no longer just sending one place. It's really. You know and that's really helped us aesthetically been exacerbated but that's the whole meaningful use that push to make sure that and health information digitized to make it more accessible. And the very nature of healthcare is that in order to provide services we want ease of access to that data. The providers, doctors, physicians, they all want you to access to manage the treatment of care to process payment etc.. And so we live in this world today where it literally can be anywhere. And so the question then becomes you know has the industry itself woken up to the dangers that we're seeing through the media. I mean breaches are occurring to accomplish the rise of which are just shortie practices. And so really I think people need to wake up decide that this is a much different environment in terms of how these organizations are managing data and really the onus on those organizations and the people using this onus is that this organization really should be asking much more stringent questions but how are these organizations adapting to this change and what additional steps will prevent measures are there to try and protect this more complex environment.

That's really insightful right. And as we think about data as it sits today to Grant's point it's no longer. It's with the customers vendors payers that we work with. Now everybody is using cloud-based technologies. So how do we get smart about protecting this information and grants really highlighting some things that we need to be focused on. Grant can you give us an example of how you and your organization have created results by doing things differently?

Absolutely. So I mean again part of the reason I got into this space is because when I look at organizations we're building the security programs and I look at the types of services that were available to those types of organizations there ar e various principles, right. Used to look at the market to specific ways those are am I gonna secure in my market and not very much the agent who wouldn't have an I.T. security where people want you to think that firewalls low gadgets solution becomes a very tech centric approach to security. Even our law a lot of data doesn't allow is ethically and software or applications that actually use it often is process or link it to you know ex employees so having access to information, people misposting information etc. So there's the aspect of you know how organization are prepared to that. And then there's the counter component called a compliance and so obviously everyone's familiar and most people familiar with that and there's a general assumption that because I think because it's written into federal law that these organizations are now doing a really good job at protecting into the legal they are supposed to. When actually what we may gonna do is this compliance programs to meet specific compliance requirements and then put the things together made them compliant to, being compliant doesn't necessarily make you secure these a lot of these regulations that they put me right and they're protected in different ways. So all of organizations have a successful plan. Compliance programs. But really what they're focused on doing is trying to meet those regulations that rather the security organization. I single battle of agendas have got really most these a regulations. They're not there for the sake of being there really they have to drive the organizations into the program. So some of the compliance programs that could almost say their original purpose was not to be a means to an end but to make sure these organizations are building a safer security. So what we do is we basically try and bring that together. We try and focus these organizations on building in a safe secure program. We will map to the compliance requirements. You can just me these objectives and then we think of a people-centric view to do that because again, we don't take up solution based perspective and technology security tools to just tools. We really try and map those across each individual within the organization, give them a score, help them understand who contributes to else huge portion of the organization and then give the organization that grows that tools for them the measure of course of organization what they are doing audit is more effective to secure their data but also match that to whoever stand the regulations that happened to as well.

Very insightful. Grant and just as we think about what we're doing within our business, the fact is if you're compliant doesn't necessarily mean you're you're secure. And I think this is this is something that I'm walking away with here Grant because I know a lot of friends that are running businesses and they think, hey you know I'm I'm I'm following the rules, I'm compliant but that doesn't necessarily mean you're safe. It doesn't necessarily mean you're secure and it sounds like what your company does is really helps them walk through not the compliance piece but the safety piece. And we have to consider them individually of each other.

Absolutely. And you know we use this expression you know everyone was familiar with the colander right. You can have a name. Yes you new go on there. And we talked to lots of companies talk about how robust and how firm and who are the colander them there, the security program actually is. But at the end of the day, a colander they get that shot. As you know less not for more has it was Colander is you have to be in place of their removal something basically basically protect more holistically across the organization. And I think that's the mistake of all organization of today are really more focused on how you I basically obey some base of security matters in my front door. But then forget that the fact that will met through the window if even a face where you go everybody has leveled at the cause. So it is a much broader approach.

That's interesting yeah and for the folks in Inmet devices saying a big reason why the FDA is pursuing the unique device identifier. There's been many cases of cyber security threats that happen through medical devices and so definitely on the radar of a lot of us in this space and Grant, Grant Elliott here is talking to us about some of the things that we should be keeping in mind. Again Grant Elliott is the founder and CEO of Ostendio, where they help folks with their cyber security risk management and compliance programs. Grant, I'm sure you've seen some ugly stuff out there. Can you tell us a story something that you saw. And what that customer or what you learned from this security breach?

Yeah I think that they can increase the price of the number of years I've been doing this is basically a little motivation there are for certain organizations the base with those in a data security program. A couple of years ago I remember speaking to an organization and there were smaller organizations that when I was talking to the principal organization and they were talking toys about how they can improve their security. And this particular organization actually ran a very simple EHR it looks when in health record that was heated that was calling at that point call-base that went through the conversation discovery I realized that he literally is running this thing on a server under his desk. We do the testing for the new server to know that's scary. And and but it's actually more common scenario than you might think. We speak to, the tools we speak too she's compliance officer BBC news organizations every other day. No we will leave them. Legally what they're supposed to do maintain the security program. You know I spoke, I had dinner, a few months back with the CIO of our major health system. I'm not going to mention the name but there are basically seven or eight though in the health system and this CIO told me that I read the information security wasn't on the top ten list the. Right. And so there as you know a huge gap in the motivation factor of organizations to do this because a lot of healthcare systems you know you go back to first principles. What is the motivation to do that. Why do we need to do this. And you know part of the challenge is we've seen major breaches to which we see pervasive breaches all the time. And the question is does that actually change people's behavior or will you stop going to health system because they've been in the media for having a major breach. Do you even know who your insurance providers is? I know that you know when the Visa card I didn't even realize that they would appear for the pervaded that We actually had so there's an open question what more the these organizations the doldrum more effective security program. And that's not to say they're not doing anything but there's no doubt that you know if you compare the stain about healthcare systems or the healthcare industry compared to other industries that financially ill, it lags significantly there's not necessarily enough broad support and pressure to an organization I'm looking even on the digital health space. Some of these I.T. services organizations that are growing with you know 10 20 30 40 50 million dollars worth of investment will be made in them. And we talk to them in the security program in place whatsoever. So as it I mean I think you know from our perspective the seal the the road that we see a lot of this kiddy stuff. And it is frustrating to was that we can persuade them to the advantage of a technology's error that really makes sense. But the flip side of that also there is well we work with many organizations that really embrace what we have to offer a message to try and provide the best service they can and this be a third they understand the business impact of having a breach and understand how that can. And so there's certainly not organizations out there doing the right thing. But you know my perspective is you know because we see it as a regular basis. There's way too many of there that really are motivated sufficiently to fill this program mortal interested to see rather than actually backed up by actions.

Grant This is really interesting and it just kind of you know again forces us to think about how the general economy works and how the healthcare economy works so differently. If you had to sum up a plan if you had a three step plan for the listeners that maybe don't know where to start. What is it that you would tell them. Quite simply like Look here's Step 1 2 and 3 what do they have to do?

So we have a simple analogy, right. You know I equate building a security program to it running a marathon right as an ongoing on exercise. Now the first step to running a marathon is not signingn up for marathon necessarily force you just got to earn a lot right. Right. It doesn't matter if you're running today in the street, it doesn't matter if you're going to go and sign up for a 5k. You just need to start running, Right. Because at the end of the day if you run a 5k first of the March and already kill. So we focus on this that it really doesn't matter. The biggest excuse is that we get why people are going to you know this without too small it's too early. But the reality is what you do is all relative the rest of the organization here a smaller organization your risk is relatively more and therefore what you have to do for the most part can be a little less. There is a exemptions but for the most part that's true. And so just start doing something or you know really focus on voting some very basic courses of seniors even though most. These procedures from the Web to basic training, training people regularly do security practices and really trying to identify some sort of framework measurable sounds like support seven thousand one hundred 171. There's loss of security standards equal training the Web to basically and map then just gradually the week that we will start voting our plan and just allocate more of a pain to year budget. a small amount senses that this is the organization to just focus on this so it really doesn't have to be a huge task it just has to be bold and it's part of your business process and you'll be amazed. Over the course of a week a month a year just how much progress we can make. So when that client comes down and suddenly says you were ready to buy your service that we just need to get through security or that it doesn't need to be a scale as perhaps otherwise may be if you really just started thinking and toting that said from day one.

Well I've got some great takeaways folks from Grant on how to get your cyber security up and running at its best and you to just take small steps. It's really a call to action. Grant What would you say one of your proudest moments here in the cyber security space in healthcare has been today?

As an organization we started off with the premise of you know I mentioned the other one that you know I was somewhat surprised how complex how difficult this was perceived to be by organizations and sadly by men and the stakeholders of the organization that are serving in this community. So we start with the simple premise that we wanted to make the ability to organize to be compliant and manage risk accessible and available to any organization regardless of size and resource. So you know if you're a small, 10 person staff or if you are a large organization. We wanted to make sure that we need that forces that are more accessible to everyone more cost effective. So for us, when we come across a company that is using our services reputation sales through an audit or we get a senior or an organization Rayno it is all good teams and it was 100 percent compliant. Why they go nails and we have partners coming back to their base saying to their ability for their clients has been significantly streamlined to our platform. I think those are the things that really help us get a read. I can confirm that we're on the right path and that we are actually you know obviously working towards achieving our original mission. So I did that for the most satisfying thing we have because that means it proves we're on the right track.

Absolutely. And how about an exciting project or focus that you're working on today?

Yes there's a lot of great stuff going on and said you know when we started voting our platform we decided to do a slightly different way than most server kind of tools in the space. One of the things that we do is unlike maybe a GRC tool or some sort of a risk management too we actually enroll everyone within the organization to our platform so everyone has interaction with that platform. Everyone can see how their contribution contributes to the overall security Porscher. And so we're transacting with tens of thousands of transactions across a platform for people taking training courses to completely audit its access abuse vendor reviews saying it ignores poesie so that's happening everyday within the organization and because we can map that to various different standards regulations, we can try again maybe to an organization that has to go through hydro in an organization. Is that too to or or with with that when we actually map the behavior of each of those organizations against that sort of framework. So we've actually started a project that we were actually looking to we'll see if I can map out the daily basis and I can literally take almost that the security to comply the any of a company and ability to direct that into some form of digital contract to basically use blockchainin a digital age to basically try and manage the organization. Should I work with certifying authority to comment if we can second the platform and the right way against ever free market that they will basically step decided yet long as we are tracking that rate lever behavior and that's going to get rent to that digital wager that would ultimately allow organizations. No Gozi their costumers and say, hey listen not only are we racing your barman against a free market. But we will actually contract with you and give you access to a digital ticket. We will build the penalties for failure to meet that security threshold and that would significantly streamline the whole order process. Again it makes competitive advantage today that the companies themselves because they can't differentiate themselves to the customers from customers that are simplified there's been divergent process along the paper trail. They don't necessarily have to conduct audits because again as being end of the tail and certified so we are really working to try and simplify our securities fighting say the phone from a contracting perspective. And again it all builds off the core functions that you have with their existing platforms today.

That's awesome. Grant sounds like you guys are really streamlining the approach and just tackling it. Killing two birds with one stone so to speak. It gets really exciting.

Yeah I mean from our perspective what we're really pleased with the progress. You know whenever you're coming out and you think of the end of doing something slightly different in a market, you obviously have been trained persuading people that you have a slightly better way. You know people have been doing a lot of this stuff long time right. And people tend to be slaught, they don't change. But again you know we also running a business right so we know we're not just an idea shop. So we have to do this and we have to evolve that we have to bring customers, bring in revenue we have to pay salaries. So as we continue to grow as we can be more successful we know have these opportunities to kind of take that original version and enhance it as I've discussed. And yes definitely. You know a really exciting journey of degree I'd love to see what we're going to be in five years seen by this time that you know we're within all our supply agreements through blockchain after digital contracts that would be an amazing place to be.

That's awesome. So getting close to the end here. Grant let's pretend you and I are building a leadership course in cyber security. It's the 101 with Grant Elliott on cyber security. So we are going to write out a syllabus and get your answers for brief questions. Be ready for it?

Absolutely.

All right Grant here we go. So what's the best way to improve healthcare cybersecurity?

I think the key thing to focus on whatever premise you're trying to over I mean as I said we sat with this premise of really trying to make cyber security compliance risk management affordable and accessible and achievable for any organization. And we come back to that mission statement on a regular basis because everything we're doing has to be basically support that. So we continue to validate that with customers with the father of the family. So just being really focused on what you're trying to do the long term vision I think is the best way forward.

What's the biggest mistake or pitfall to avoid?

Assuming that the service you prevailed in itself is actually going to make a difference. You know this is really true particularly within healthcare because if there's not an economic value to what you do if you can demonstrate an economic value, as long as it's going to pay for what you're going to do then it really doesn't matter who give an idea. Healthcare in particular to me because that whole concept they're saving lives including health really in the marketplaces setting rates. The concept of making money and that goes with any business you really have to validate not just do I have a good idea. As can I persuade people to pay me enough money to be with facily and promote the idea and that's fundamental to you know what we need to keep focused on and I think too many people too many organizations sometimes forget that Clinton called for the idea itself that there's not enough people in the market there's not enough people within the target area to be sufficiently money to make that reality?

How do you stay relevant despite constant change?

It's really listening to our customers and ourselves we have an expression that you listens to everything your customer the same thing today used to 95 percent a way because 95 percent is useless. The remaining 5 percent is essential. The kernel of knowledge you're going to get from that 5 percent is fundamental to being to keep your business on track because if you ignore that 5 percent then you're absolutely going to go off the rail and your going to go in a different direction. And you know as an organization, remaining focusing continually listen to your customers even though a lot of it's going to be so essential because that kernel within the 5% knowledge is absolutely key.

Awesome. What's the key area of focus that should drive your organization?

So we completely focus on platform as a source company platform because it everything. We will not be able to grow evolve and reinvest in Apple if we don't get it profitable. So there are lots of things that we would like to do most things that we think would be great. Customers who regularly come in and if we can do ABFC we really drive that to the point that do we believe that's going to drive profitable. And if we do then we'll basically consider it and it's not going to drive profitable and we can't. And that's fundamental because I think we don't really keep focused on that area of growth. And then it's very easy to be derailed and before you know what you're trying to be.

Grant, what's your favorite book?

Yeah. So I like to read, I like to read a lot. I really like reading all day biographies because it brings understanding how people love their and the lessons get and really for probably one of the books is the most fun and the need was Nelson Mandela, the autobiography a long walk for freedom. To me that kind of lessons from nothing really is just there to progress along and winding. Right. But human team belief in what you're trying to do if you can really just keep going through all the obstacles going to maybe soon and ultimately you can get really just a question of being really truly truly believing what we trying to teach. And you know and I think Nelson Mandela felt like a truly inspiring when you see someone from his background and education his formative experiences and someone you know in the middle of his life may just become this amazing civil rights leader you know eradicated.

That's super interesting Grant recommendation. And folks if you're curious about that book about the syllabus that we just put together on cybersecurity for you and all the show notes just go to outcomesrocket.health/elliott, E L L I O T T, you can find all that there along with a full transcript of what we've just discussed today. Grant, Before we conclude I'd love if you could just share a closing thought and then the best place for the listeners to get in touch with you for more information.

Absolutely. Yeah I guess from a from opposing perspective you know the journey we've been on all of them devote five years ago. And you know it really has been an incredible an amazing journey. And we definitely appreciate the customers we have and all the prospects we talk to and from me, the biggest part of this is basically the team that we've been able to build here and the owners. There's some amazingly talented people we have on board that has made all this responsible. And if people want to learn more about our journey, learn more about this and you know feel free to go to Ostendio.com, our Web site. There's lots of great information, resources about cyber security compliance, framework and if you want to tweet me they can do so @Ostendio_CEO and you can see my marketing team and they gave me my source of handbook for the future rather than give it my name. So @Ostendio_CEO. Yes feel free to tweet.

That's awesome Grant. Hey listen this has been fun. I know that you dropped some major nuggets of wisdom here on all of us and we'll be walking away with some good calls to action but ultimately start small start now and looking forward to staying in touch with the Grant.

Great stuff, it's been a pleasure Saul. Thanks very much for inviting.

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 low. 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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Recommended Book:

Long Walk To Freedom: The Autobiography of Nelson Mandela

Best Way to Contact Grant:

LinkedIn: Grant Elliott

Twitter: @Ostendio_CEO

Mentioned Link:

Ostendio, Inc.

Episode Sponsor:

Embracing a Retail Medicine Strategy to Ensure Success with Mike Boblitz, Vice President, Planning & Business Development at Gwinnett Health System

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 low. 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 outcomes rocket podcast for we chat with today's most successful and inspiring healthcare leaders. Today I have a special treat for you today. His name is Mike Boblitz. He's a vice president of planning and business development at Gwinnett health system. He's experienced in strategy marketing and business development. He's got a demonstrated expertise in the healthcare and hospital system industry with a strong foundation leveraging strategy and market analytics to enable strategic growth and competitive environments. He's done a lot for the health care system where he currently works as well as previous healthcare systems that he's contributed to. He's a unique leader with a diverse experience in leading academic as well as community health systems. And he spans many different types of markets health care management. He's done includes real estate construction services and facilities and he's also served as an adjunct professor at James Madison University for nine years. Such a pleasure to have you on the podcast Mike. And if you have any any details that maybe I left out would love to have the listeners have welcome.

Thank you saw. No I think that was a great introduction as you can tell I just just enjoy planning and strategy so much. I remember going way back to my first planning job planning analyst position at a place called Martha Jefferson Hospital in Charlottesville Virginia. Probably the second week on the job I was sitting around the table. Exactly. Even the CEO was talking about how that hospital had become landmarked. It was a 100 year old hospital and they continue to be declined by local zoning to expand in the city. And the time has come to really build a business case to build a new hospital to relocate and not something about that. I was hooked. Way back as a young recent college grad I said planning is what I'm about. I'm all I just want to have my career devoted to planning and strategy.

That's awesome. What a great story. Sounds like they threw you right into it from the beginning.

Did it. I was fortunate. Know that it had working at smaller it was a smaller 176 bed hospital that very well-managed. I've found that we work in smaller smaller organizations. You get to get broader exposure and for someone right out of college that was just what I needed to get started.

That's amazing. So you could have done a lot of different things Mike but you decided to get into health care. Why did you decide that?

That's a great question. So my middle name is Crile C R I L E and my office was got a picture of what I'm told is the last remaining picture of a gentleman named Dr. George Washington Crile who is the founder of the Cleveland Clinic.

No kidding.

That's right. You didn't leave. We've had a long. Obviously most of my family have worked in health. My dad actually still working as the chief administrative officer for orthopedics and sports medicine University of Virginia. My mom is the head nurse for the cancer center at UVA so we just always had a family focused around healthcare and I'm just fortunate to also be able to work in this space.

What a cool story. Mike so it's in it's in your roots. It's a tradition that you've honored and you've just continued with.

Correct. And you know I thought about going into sports medicine outer space as the young kid. A lot of people are heroes and people they look up to. And for me it wasn't necessarily athletes or entertainers. There is a Dr. Frank McHugh and Doc McHugh was the founder really the grandfather of a sportsman's medicine and he really wrote the book and before of managers it was dark. So growing up I had a chance to follow him around in the football field and eventually start working in the training room in high school and taping vehicles of athletes enjoying physical therapy treatments on athletes and kind of started thinking about going into a medical career and I'll never forget it it was probably my first year of college where your doctor said you know if you're going to make it and you really think about sports medicine and want to think about being a doctor you're going to be to start watching me in surgery and I'll never forget I went and watched him doing an ACL repair and all I can remember is just all of a sudden it getting very fuzzy and that's you know down the hallway and a nurse or something or you know quickly that the medical provider saw I really wasn't for me but I still loved it and my dad made a great career being an administrator. So I switched that James Madison University from kind of a medical path to a health care administrator path and just haven't looked back since. It's been a great experience for me.

Wow. Wow. So you had that episode but you found a way to stay with it. And Michael you had such an amazing career. There's a lot of health care leaders out there that are really just working to find the best way. There's a lot of change in health care right now and so in your thoughts what's a hot topic that needs to be on their mind and how are you guys addressing it there over at Gwinnett?

You know I think the hot topic right now is really changing your focus from historically healthcare has been really delivered from a provider's lens. And you know and you read it all the time it's all over the news that it really has become a consumer game and health care at least back when I was in grad school was what they call price and elastic. You can raise prices and demand is still there and now consumers and there's a lot of data out. A recent study said that as many as 40 percent of probably mature consumers are under high deductible plans. So it's become this retail medicine agenda really fast. So I've really worked hard at my organization and actually prior organizations to change that mindset from a provider lens to a consumer lens and really understanding the types of consumer segments that are in your market and changing up the delivery the way that they want it and try to build loyalty that way. And I think that's really something that is extremely important for healthcare systems around the country to really embrace and pay attention to.

Yeah Mike that's such a great call. You know and there definitely is that big shift you alluded to the rising costs of of those deductible plans that is forcing health consumers to really be more mindful about the dollars that they spend. Can you walk us through some examples of what you all are doing at Gwinnett to help address this market and not from a provider lens but from a consumer lens?

Yeah. Happy to give you some examples. So when I first got down to Gwinnett about four years ago one of my first orders of business was to develop a new strategic plan to carry the organization into the future and so I started saying step back literally understand not just the population but the consumers in this market. There's a lot of data out there Experian for example Truven has different segments in the top segment and our market is a group that I found called kids in quarter sacks and they have two really interesting characteristics that popped out right away. They really if you'll come this reach on medicine thinking that we've been embracing here and that the first is there are about 52 times more likely than an average U.S. household to want to have urgent care. The second there are about 50 times more likely than an average U.S. household one to have access to providers or mines more mine etc. So I formed a urgent care company outside the hospital because hospital pricing has been the barrier as you think about retail medicine. And we formed a joint venture called Choice One urgent care at the national partner and that just exploded right out the gate. So that when we first try to understand how consumers wanted health care in this case the top consumer wanted urgent care and by default, it's done very well. And then this past year we rolled out an online scheduling and same things just exploded. We're getting a lot of results out of that including in our market there have been a lot of population that just don't have primary care doctors and our markets growing two and a half times us average people are coming in trying to use iPad and iPhone to figure out where can I find a doctor. And we're standing out in that game because it's easy to help your dividers. Nationwide there are challenges they don't answer the phone well and consumers just want direct access. So those are some examples where we're really embracing this whole consumer mindset and finding some success.

Those are some wonderful examples Mike and one of the things that I feel like really differentiates you as a leader in this space is the ability to not only think about the ideas but execute them. You know execution is such a talent in our space it's hard to make it happen. What would you say is one of the contributing factors that has helped you and your team be able to execute on these ideas?

Oh yeah I've learned to live in fortunate to have worked with some really good organizations in the healthcare space. And so the key to me is really before you even get started about what should we do urgent care you know should we build expand product lines et cetera take a step back as I did when I got here and really engage your management team on a very thoughtful strategy and strategic plan and really get a senses to what that looks like in this case including urgent care and really get that bind up front. So then the execution becomes very easy.

So you get strategic alignment and then from there the execution just follows.

Correct. And you know the key is with any strategy this first step is really having a very thorough in what I call environmental scan and that's where the kids and Colla sites came up and really educate the management team as to what these fund is are and bring forward ideas that should be considered as far as strategy and get support for that and that to me has been my success and when others think of do it different ways. But to me that's that's the right path.

I think you just do such a great job of this Mike and listeners do as Mike is suggesting here. You know do a thorough environmental scan, understand what you're getting yourself into and align your leadership team to your vision and then execution just becomes secondary. So Mike there's no doubt you've had a lot of success. You guys have implemented some really great programs. Give us an example of the other side of the coin maybe maybe a program that didn't work and a setback. What did you learn from that and take us to that story?

Sure. I'm trying to think of a good example of a program I would say so related to the retail medicine agenda. My take is and I'm really working hard to leverage our success and urgent care where you know healthcare a lot of these outpatient services are now commodities right who are shopping, urgent care is a great example but also not forget about imaging and you've seen in the news nationwide payers are starting to really steer their beneficiaries away from hospital pricing to do commodity pricing right, and freestanding services. And what are those. I tried to push actually right after urgent care and the trend just wasn't right because the challenges on the financial front was forming a similar company around medical imaging and we just have not yet been able to launch that because of the challenge of transitioning from hospital pricing today to commodity pricing tomorrow and you know how do you make up enough volume on the demand side to last that price differential. Right. And so I'm still working on that agenda. I think that that hopefully we've got to get there because you're seeing all the news that I'm seeing that payers are over that. And if you don't start to integrate that it'd be that outside the hospital over time is just you know I don't see how hospitals can stay in that game. That's one example Takamine I can think of. I wouldn't say it's Baille just the time wasn't quite right but after my effort there since we're seeing now all these payers coming out and aggressively trying to re-steer patients away from hospitals maybe hopefully this next year we'll get another chance to reintroduce that idea.

Yeah that's fascinating. Thanks for sharing that. And you know I mean for example here in Chicago, Mike, I'm seeing these these MRI places pop up like and they're literally right next to the subway like the subway sandwich place or like next to the Red Robin and Mawle strips. So I don't know. I think your timing may be maybe on-point right now.

Absolutely. I think you know consumers want you know since they were seeing healthcare the way that the retail and how they shop right and you know our urgent care centers as an example we located in strip centers, we relocate and retail malls where you might have other services to shop in. And I think that's what consumers want. I think imaging is not on the equation as well as other commodities like physical therapy and web services.

Yeah it's funny that you mentioned physical therapy because just a couple of days ago I had a group of PT folks that are putting together think of Uber meets physical therapy. They're pairing physical therapists with patients through a mobile app. Wow. Yeah and they seem to be having some pretty good traction. So yeah I mean you're definitely your mind is in the right place here. And I think we are seeing this shift. I think it's so key that we get focused hyper focused on this folks. Take a note from Mike here. They're definitely skating to where the puck is going over there at Gwinnett. Now Mike tell us the other side. Give us an example of how I mean so the retail side of medicine has worked for you guys with the urgent care is there any other success story that maybe you want to share with us?

Yeah I'd say there's many memories back going back to Martha Jefferson Hospital way back when I had the chance to build a case to expand our network in my first primary care practice and got to take it from idea to execution and that was a lot of fun and then going forward. When I worked in a system that Mamun called up or just be help. I then kind of got a chance to build my first 40,000 square foot outpatient care center. And that's Mayor Simar more bigger projects and so every organization I've had proud movement I would say really at a high level what I really enjoyed the most current organization included is coming in and really trying to develop this culture of planning, really bringing your management team together so I have a team called Planning Council where I've got HR, I,T finance, marketing, operations, everybody together and leadership roles in those areas and I really take time to engage them about, hey forget about all the fires and all the challenges we're dealing with today and operations it's really dedicate time each month to focus on strategy and really how we need to think about the future. And then that really it's going back to what I mentioned earlier about the execution side get that by and it didn't have all the stakeholders with you so to have strength in numbers when it comes to how to implement and grow your organization.

That's pretty awesome that your approach is so thoughtful and with change in health care it's happening. There's no doubt that it is it's a wave and you're riding that wave MIke, like a lot of people are getting crushed by it but you're riding it.

Well thank you.

Absolutely. So tell us about an exciting project or focus that you're working on today?

You know I think right now our current strategic plan that I had was my first order of business when I moved to Georgia expires June 30th. And so for the past six months I've been working on what I call Vision 2025 that really sets a new course and helps us continue to take advantage of some of the things we've been already working on as well as focus on what's next. And that's been a lot of fun. We spent a lot of time with physician leadership meetings a lot of time with our board, a lot of time with our management team and you know that will start to take effect officially July 1 which is our fiscal year. So I think that I've enjoyed that. And in that it talks about about continue to fuel this retail medicine agenda as well as you know there's in our market still traditional organic growth and opportunities where focusing hard on how we you know continue to grow our service lines and we have three areas of focus and Vision 2025 one is developing and evolving this consumer-oriented network with ambulatory services front and center but also one one area of focus is expanding our product lines across the full continuum and they are trying to focus on now is how do we change our mindset from historically and acute encounter based delivery model to one that really focuses just as much on prevention and like for example we have historically seen as many as 70 patients in our beds at a given time with either acute or chronic heart failure. It's time to think about how do we start to better manage those patients outpatient and focus on cardiovascular disease centers of care and so these are some of the fun things that we're starting to kind of work on next that I think are the right models for delivery system in the future. As for us your better full. And so how do we better manage patients that could be prevented from an inpatient admission and how we'd better manage them without patient resources and really preserve our precious capacity for the most sick and complex patients.

I think that's really great that health and wellness approach and folks if you're listening to this and if you're in Georgia you probably already like all about. I got to get over to to Gwinnett if I need any services. They're definitely skating to where the puck is going and obviously Mike here is a testament to that. And so Mike for your efforts and everything that you've done there I mean it's definitely gone a long way for the system and the communities that you serve. Let's pretend you and I are building a medical leadership course on what it takes to be successful in health care strategy today the 101 of Mike BioBlitz. And so we got a syllabus here we're going to do it lightning round style. We've got four questions and then maybe you could share with us a favorite book or resource. You ready?

I'm ready.

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

So I think there's really two components to this. One is and I mentioned this a minute ago is how do we reengineer our product lines and our services from this acute episodic model to one that really focuses on prevention. Right. And what I didn't mention earlier is another example where we've been successful is we really study neuroscience in back pain and found that we have a large number of back pain conditions hitting our emergency department heading our inpatient facilities. And we study the marketplace and found that there's there's tons of spine surgeons on every corner and they're all really set up to really focus on surgery. At the same time let's face it you and I included surgeries the last thing that we want. Right. And so we focused on how do we differentiate in a super crowded market. We created this concept called The Back Pain Center and basically the Bactrian center basically set up to do everything we can and make surgery last on the agenda. And that's been extremely successful and we also realize nurse in our research that consumers need prompt access right. And that's why they're hitting emergency departments around the country and so we created a 24/7 call center that offers prompt appointments and we also created an online scheduling which as far as I can tell were the only neurosurgery program in the state of Georgia that offers that type of solution where basically we'll see now. And if you need to connect with an appointment in the morning through our call center or if you want to get the advice and just pick your appointment we'll be ready to see. And we set up basically a model where it's met by mid level providers who have very rigid protocols as an extension of the neurosurgeon to receive you, really give you that care plan and figure out a let's try physical therapy maybe you need pain management and then occasionally you might need surgery and that we're going to do all we can to avoid that. So that's kind of one example of when I talk about reengineering product lines that to me that that's the value proposition and are back in center that we launched this past year. Is that an example. You know what we need to do more of.

Now that's fascinating. So as you do these things what would you say the biggest mistake or pitfall to avoid is?

The biggest mistakes or pitfalls. I would say is really just not embracing a culture of teamwork and creativity. You know early in my career I found I saw a lot of organizations where they paid so much fear and failure to me Oh I've always said I'd gladly trade you know one failure for five successful projects that you know an improvement to our organization as well as the community we serve. And so I think that's the biggest mistake that some places can make as you've got to really focused hard and create this culture of teamwork in creativity.

For sure. I think that's so valuable. And how do you stay relevant as an organization. Despite all the change I think this is so key for you guys I mean you guys did such a great job but what would you how would you sum it up. How do you stay relevant despite all the change?

You know the key is wrapping this up right now but just having a very disciplined planning process that routinely steps back. Forget about all the stuff happening in the four walls of our institution and monitors how is the marketplace changing around us and really conducting a thorough internal assessment to understand how we are situated in that changing marketplace and what gaps exist that we really need to address in order to stay relevant in order to stay successful and we do that once a year through our planning process and I think that really helps us think about those key changes that are required in order for us to continue to move forward in New York in this very crowded market in a rapidly changing marketplace of healthcare.

Mike what would you say one area of focus that should drive everything in a health organization is?

Similar to our talk entirely today as you know having that culture of planning that includes all stakeholders. You know from operations, finance, marketing, human resources I.T. and bring all those folks together to really to embrace you know how this organization to evolve and grow and including all of those folks in that mindset in those parts and I think that's really something that you know we've done well and allowed us to have really a team approach to strategy and evolution. And I think others really need to focus you know in that regard to make sure that you have that buy-in then you know early on in my career I sometimes have learned the hard way and there's there's one overexertion that I found early in my career that really was siloed and really didn't bring in all the stakeholders and they're not surprised. The plan was not very robust at that particular organization and that's a major challenge. And so again as I mentioned earlier you know I've been very fortunate to work at great systems and really learn what works and what doesn't work and I think that you know this culture of planning is so important for us and for others.

I think that's great. Mike what favorite book or resource would you recommend to the listeners?

Or you know is not really your favorite book or resource other than I just think it's just so wonderful the amount of information now that it's available both digital as well as through books about you know strategy and this changing health care market and so on constantly as a sponge trying to embrace all that information that leaders around the country are sharing and really helping me think OK what are we doing wrong or what are we missing and incorporating that great information as part of our strategy for the future.

Love it Mike. This has been a ton of fun. We've we've covered a lot of things and we've gotten here to the end the time always flies when we have fun. But before we conclude I love if you could just share a closing thought with the listeners and the best place where they could collaborate with you if they wanted to.

The best place to collaborate or connect obviously you know length then we can connect that way and for anyone in Georgia obviously looked me up and let's get together. You know I think a closing thought just to really embrace the changing environment. I think you know a lot of folks who are somewhat uneasy about how fast healthcare is changing and you know how hospital services are moving away into these these retail models. So quick and do get excited about that to really embrace the changing environment and really think outside the box to help your organization, stay competitive and relevant in changing times that we're in, I think this is so important.

Outstanding Mike there's no doubt you guys are skating to where the puck is going. You guys are a forward thinking organization and you are an outstanding leader. My friend. I appreciate you spending time with us today and looking forward to staying in touch with you.

That's all, I appreciate it. You're doing great things. Keep up the great work that you're doing and bringing all these great leaders together to share best practices and ideas and continue to be a great listener to all you're doing and never hesitate to call on I come here to help you guys.

Highly appreciated my friend.

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 low. 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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Best Way to Contact Michael:

LinkedIn: Michael (C.) Boblitz

Mentioned Link:

Gwinnett Medical Center

Episode Sponsor:

Why We Must Focus Narrowly to Successfuly Innovate in Healthcare with Dr. Stefano Bini, Orthopaedic Lead at UCSF CDHI

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 low. 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 once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have a wonderful guest for you. His name is Dr. Stefano Bini. He's a professor of clinical orthopedics at UCSF Hospital. He's a professor of orthopedic surgery specializing in hip and knee replacement which their department is ranked top six departments in the U.S.. He's a founder and chair of the digital orthopedics conference known as Doc SF and a regenerative orthopedic conference, R O C S F both held in San Francisco Doc S.F. aims to bridge digital health and clinic orthopedics and thereby catalyze the adoption of digital health tools in a must good ole skeletal vertical R O C S F aims to bridge biotech research and the patient. Dr. Stefano Beeny is deep into this. He's so niche down and he has a passion for helping patients improve their outcomes but also a passion for bringing together the orthopedic community to take their practice to the next level so it's a pleasure that I have Dr. Bini here on the podcast. Welcome.

Thank you.

It's a pleasure to have you here Dr. Bini. Now what is it that got you into the health care sector to begin with?

Well you know being a surgeon and being involved with digital technologies basis since the late 90s it was becoming more and more obvious that as the technologies were maturing their potential impact and the delivery of health care was going to really help us get to the old triple aim and talk about for so long been sort of challenge for the U.S. health care system which is access improving access across the country to folks who may not be near major medical centers like University California San Francisco. Decreasing the costs by optimizing resource utilization and we're starting to see I really make an impact in that. And then we also have the issue of cost. So it's really that's a little bit harder to prove that with decreasing costs get such a fudging cost. How can health care is really difficult to measure. We're seeing some and we've done our own research on this area where some of these technologies are really decreasing the cost of providing care. So I think the vision is sort of working itself out that visual health will be one of the solutions to get to a point.

Now that's for sure and Stefano and as we think about these technologies, we've had several guests in the past approached this and one of the ways where costs do get reduced is access. Just having digital aspects of ways to access care. What are your thoughts on that?

Well actually I have a good example for you. So a couple of years ago when I was still at Kaiser Permanente, I did a study perspective randomised control study with a partner or capture proof and they had an asynchronous video platform and we theorized that if we're able to manage patients after surgery using videos that were created by our physical therapist that would send to the patient to use at home without coming into the hospital and then have them visited cells and have this video conversation with a therapist that it could be manage at home and it had a proven outcome. So we did a prospective randomised controlled trial of the surgeons like to do. And the outcomes were identical. We had no decrease, no change in the clinical outcomes but the patient satisfaction was through the roof. And when they graced stories around that was that one of my patients came back for a second knee replacement and a bonus to me. He was in the office and it was just going ballistic was really getting really angry with my nursing staff and I didn't know who it was I got up and get up and go. What's going on. That's a fictitious name. What's going on he said. Well I want I want my health loop Well what happened was that he had he had signed up for the research project but had randomise out choose standard physical therapy and it was a bit because he had experience the video experience and be able to do this at home. He didn't have the support system to drive him to the hospital for the physical therapy as it's there's a long way for him and he was live at the news of ex football player six for four he was intimidating all my staff. But he had the random I think him out of the research project and just give him the app so that he could be happy again.

That's a great story to follow. And then a great example of how these technologies are helping.

A 70 percent decrease in resource utilization.

Wow, and when we think about the strains on the health care system. We're talking about a 70 percent decrease. That's enormous. Can you give an example to the listeners of how you and your organization maybe we could shift focus to Doc S.F. How are you guys improving outcomes and the way health care is performing with that?

Well Doc S.F. The Detroit previous Conference is a event that's designed for leaders in health care space to come together in a networking event and share and actually hear from startups that have been successful in decreasing in establishing a foothold in the health care system. So we have a big competition. The then like four startups to 1 to 2 spaces that come and show not a Don't pitch not to pitch what they do allowed to do is to present a case study where they went into the hospital, impacted outcomes and shared the ROI with the leadership in the room. So then everybody who wants to get into that space sees how it works. So for example last year we had refocussing artificial intelligence and Leem tests which the computer presented came in with some of the work they'd done going into hospital systems and then basically we asked the U.C. Colorado one of the best examples they went into the operating rooms looked at a year's worth of eight or eight months worth of data that downloaded from the electronic health record and then they applied their AI algorithms and little machine learning to figure out what opportunities the operator had and they had with a relatively small investment something like a 16 million dollar return the first year just by optimizing. It wasn't even the complicated politically dangerous area of Block reallocation we take time away from one surgeon to give it to the other. It will was more about looking at some of the levers are easier to pull like lock release times. So that is when a block is a block a block of time in the operating room for the specific room. If a certain hadn't filled it within say that there's not a schedule for two weeks from now they'll give it to somebody else. That's a little bit easier to do. And like I said they're able to increase their margins by 50 million dollars and our programs only about 2 to 3 percent but still it's a big chunk of change.

It's a huge chunk of change that could be reallocated in a big way. Now listeners I had a chance to connect with Dr. Bini and he's definitely driving this innovation in the orthopedic space and one of the things that really sort of resonated with me is his focused approach right. He's very very honed into orthopedics. So Stefano I wanted to ask you is how did you land on that and was it something that you learned early on that maybe you had a setback that helped you say you know what I've got to focus clearly. How did you land and just being focused on ortho?

So much that I had a setback is that I've watched everybody else have a setback or you know as no one said I parked yet and you wonder why is it. And I thought as I look at that I have a chance of change management sort of my thing is to change that in large organizations is that a good bite off too much you are inevitably going to fail. And I care how big and how many resources you have. It's just the human condition can't handle too much change at once. Healthcares well if the U.S. economy. How do you tackle healthcare. Everybody wants to be the platform while you know things are different in Georgia Louisiana or New York. Everything from culture to the actual problem is to be solved varies. You just can't be that nimble it can be flexible within healthcare, the variation in practice from a surgeon to a primary care physician, there tremendously within surgery. We're talking early a cardiothoracic surgeons challenges and not the same as an orthopedic sort of challenges. So my thought was that, OK, well we don't even know what part of other digital economy within was going to apply to healthcare effectively. We've obviously the last to adopt all these technologies. So we don't really know what works yet. So if you have do that weren't you focus on one vertical. Why don't you focus on a what's already integrated where the patients themselves are relatively healthy so don't have the variable of patient illness where the cycle times just short enough that the U.S. can actually invest into a venture and have a short or quick return on investment because the cycle comes not 20, 30 years like this in diabetes. So for example in orthopedics most injuries are resolved within six months of the most a year. And you can actually get to the outcome whereas with something like diabetes which plays out about 20 or 30 years you can measure process outcomes like sugar control. But in terms of actually looking at mortality or some of the diabetic complications you have waited a long time to see which it did make a difference. So orthopedics also it's centralized, it's not in every single clinic. It's become even more centralized. The government is focusing on got the full power of the FDA and CMS helping you sort of drive change in that space. That's a really fantastic vertical to focus on and it's like I said it happens to be the one I worked in so that was an easy choice.

That's outstanding and folks if you haven't had a chance to check out Doc S.F., just go to docsf.ucsf.edu. You'll be able to find the tremendous work that's being done there at the moment. And fascinating right. Taking notes from all others that have failed. It is so important to niche down. We had a previous guest Gavin Théo. He's over at the Capitol group and one of the things he mentioned was poignant. It was health care is not a vertical it's an economy and much like Dr. Bini is now on us he chose a vertical within healthcare. And I think as as we look to innovate and move the needle forward in health care we've got to do like Stefano and choose a vertical with health care and focus, focus, focus. What would you say what are your proudest medical leadership experiences is to date Stefano?

The early launch of Doc SF has seen the resonance is how it was such a novel idea. When I started talking about four years ago this idea of asking people that run into a health healthcare system to focus their time and resources on one's vertical was a little bit out of the box and its success has been quite a source of pride I suppose. But I have to say that with then the beauty of being health care is the ability to actually impact patient lives and that's ours too. Some of the things that we've done. Actually you can go into a patient clinic visit with a lot of work UCSF recently deploying a patient gaged in platform called Healthloop and patients love it. And I'm sure that level the other platforms as well. But it's just so it's gratifying because you've done that work and you go and and people say buy a lottery like that health that thing. It's been great. The connectivity is super advanced within a couple hours a couple days. And that's gratifying. So there's no taking your skills that are planning to leading this sort of change in the world of healthcare. We are solving problems that people have. Were really truly making their lives easier. And I think that in of itself is very gratifying if you get a chance to see it like you know the front lines talking to patients about it. It's really wonderful. If you're the person creating the product you may not get as much feedback to direct but it's really part of the part of what makes us so we're trying to work.

That's awesome yeah. And folks you've heard a couple references to health loop. It is fascinating patient engagement tool. Take a look. That's healthloop.com. If you're curious, I know the story of Dr. Bini's patient wanting it really made me sort of want to figure out what it was. If you're trying to figure out what it is they have it.

It's definitely clear that the patient who is making a fuss was the capture proof which is a video platform.

Although it was different?

Healthloop is actually an engaging platform.

Got it, got it.

It's what additional e-mails every day. What you should do is you would expect was capture prove as a asynchronous video platform allows. Well done video but also photo to compare images over time and to create. I think you could call it a visual visual history that it pays for. Anyway it's a different technology but there are also all these technologies are getting to the the first mention about access and how you create, how do you optimize access in the world that now is all visual I mean and the idea that patients who want to take 15 years drive for an hour sit 20 minutes in my office before I give chances. Actually I visited with them then to drive home and have lots of their work in this in today's world where people are going to want us to hologram into their homes and track their sensors and visit them with these asynchronous technology. There's no question. So it's coming.

No doubt about it and it's cool that you guys are so honed into the Orthos space on it. So I know that you're a practicing physician and you also have this innovation forum with DOCSF. There's a lot of exciting stuff going on but if you had to pick one exciting project that you've got going on right now, Stefano, what would you say that is?

My favorite project now that revolves around my research. We are doing work with several wearable sensor technology companies. So we're asking a question we're aware that we can use these commercial sensors that people are wearing for their own personal reasons or their sensors are actually built into their watch or their iPhone or their phone in General opted not to take on and that information. Run it through a algorithms using machine learning to see if we can predict outcomes. But more the pretty dark as managing outcomes. So let's say you have surgery and you have a single repair or total knee replacement or shoulder surgery. And we know that you're going to have a certain recovery period today. My actual dataset is what happens after you leave the operating room. Your first visit after surgery usually a week or a month out but there's a timeframe then another timeframe.So the two and maybe the e-mails and phone calls we have. I mean that's it. Yeah but you take it you drive home and you have a card that has about 50 sensors five microprocessors a dashboard that's feeding information. But the second you can drive home safely. Why do not have a dashboard that from a lot of patients in 2018. The technology is there. So we have to see is what data points are useful. I mean the points you have to collect and over what time-frame. So we've been collecting hundreds of thousands of data points on patients and we're starting to see some real patterns emerge to the point that we're now predict the outcomes that will happen in six weeks and two weeks or two weeks on exactly or have a very good sense of where this particular patient will be in six weeks. So that if that's the case say look you're looking like you need to get any more help in the future. Can I intervene at two weeks and put you back on path right. For someone but not generically but how we get it down to precision medicine type stuff. In other words how can they get it down to the path that you're following. Is there a path for someone your gender, your age, that lives in your neck of the woods. Because in Japan and the United States going to be very different. That's the holy grail.

That's pretty awesome. Now the research that you're doing is sort of defining a structure for patient reported data that will help within the space?

That's the thing about where we are today. When you fight to the future there's a little bit more scientifically we don't have a clue even the basic like how many data points that we need is that every second every minute every hour, during every day. Is it OK to get an average how many of those data points as useful. Do you need step count, stair counting, how many how far you climb the heart rate is that we don't know any of that. It's really been slow to get to the point you just mentioned was sort of a far down the road. Confidence base I think we're at work on getting our infrastructure in place first just basics and that's what we're working on now to understand what the basics are and then there's other people working too. So I expect this will go relatively quickly.

That's awesome. And if people were curious about this work, where could they check it out?

Oh unfortunately we're not still on the same top community that we're presenting it to the abstracts to the American Academy of Plastic Surgeon, American Association at Plastic Surgeon wants to research published or present that then we are going to be making available on, I to put published info stuff on LinkedIn but uses some digital stuff so..

Got it.

Sort of Mention it.

No sweat and folks again talking to Dr. Stefano Bini digital health innovator Doc S.F. Conference Chair Professor of orthopedic surgery at UCSF. We're having a great discussion here getting close to the end though. We've got a little section of the podcast Stefano where we build a leadership course with the lightning round and then after this will conclude. So you and I are going to build the leadership course on what it takes to be successful and digital orthopedic medicine today. It's the 101 of Dr. Stefano Bini for questions here for you followed by a book that you recommend to the listeners. You ready.

Yeah.

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

Measurable metrics that people can control and focus on outcome in the process.

Love it. What's the biggest mistake or pitfall to avoid?

Focusing on technology acknowledging forgetting that culture change is a pre-requisite to successful the point of technology.

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

So will whole session of that at DOCSF last year for our leadership segment. It is really hard because you have to have in one hand a culture of innovation which is completely at odds with the group that's actually driving your day to day products that you've been famous for that made you popular. So keeping a foot on both is critical. It's the acknowledgement that you need to have a section of your company that's allowed to freewheel and free think there's a sort of given a different vibe and the resource allocation is set to get the work done. And then once they come up with a tenable project you have to have the leadership skills necessary to deploy internal. The last piece of that and I talked that thing that I say all the time to come is that there's a lot of companies out there that think that digital health and technology is something that they add-on that they sell to their customers whereas internally there's still paper-based. If the company expects to sell technology they internally have to look and say Where can we adapt internally what can we do better internally that utilizes technology because otherwise it's impossible it's like somebody selling you something to them you know anything about they have no experience with it. So I think that that's an important thing to take home. Okay that's great. I'm signed to acknowledge this for the established companies want to get into whether its block chain or virtual reality or whatever. But internally they're still doing email. They;re going to have a, don't even use their Slack. Say Okay where do you think you're going to be credible in five years.

That's awesome. That's a great message. So you got to eat your own cooking.

Yeah absolutely. You can't sell something you don't need. You just can't. At some point somebody who does walk the talk is going to get the business better than someone just talks the talk.

What a great take away there folks again. The beauty of the podcast is that you could always hit rewind listen to it again during your next run. Great, great discussion here with Dr. Stefano Bini. And the last question here what's the one area of focus that should drive everything in a health organization?

The patient.

Love it.

The short and sweet answer.

I love it. What book would you recommend to the listeners?

Besides mine?

Well tell us about yours. We'll put a link to the podcast and then one beside yours.

Oh, excellent. It's called The Team Engagement Strategy, and it came out of the learnings I had at when I was running large teams of Kaiser Permanente and then I resigned from a bunch of those roles and still have to be changed by the stripes on my shoulder and what it focuses on is it creates a relatively novel build on other techniques about how to engage different lines to solve their problems of oneself alone time to support the success. In that environment, he leader there as a supporter supports this as opposed to a driver of change distributed leadership model is frontal center. It's a short little time looking for except perhaps that assistance law partners for the action I should.

Get your glasses out people but it's a good one.

And the other one that's good sapiens sapiens, if you have all known Harare you know him. That was an amazing book about the human condition, I think that's pretty impressive.

Outstanding. Folks you could take a look at these books, Team Engagement Strategy and Sapiens along with a transcript of our podcast show notes everything could be found at outcomesrocket.health/stefano and check us out there, you'll be able to play it on the player. Some great transcripts or you could click on it right where you want it to start. Stefano, this has been a blast. I've really enjoyed having this discussion on digital health in Orthopedics with you if you can just leave the listeners with a closing thought and then the best place where they could get in touch with you.

Closing thought, the worst ever perpetrated by Silicon Valley is to fail often fail fast. That's fine for them. But when they fail they never call it a failure. They call it judicious use so resourced across multiple risky allocations. Truth is that we don't necessarily fail. There are options. We do the best we can as leaders in this space. But if such a negative concept the thing we have times it doesn't succeed. But that's very different from failure. So yeah. Fail don't often just do your best and succeed as much as possible. It's just that I love it.

I love it. That's a great message. And what would you say the best place the listeners could get in touch with you or follow you?

LinkedIn probably the best place to post the most to detract a fair amount and on Twitter as well that Linton is where posts are mostly interesting thoughts.

Outstanding, no, it's good. Listeners, if you were intrigued by today's podcast I'm sure you are. Just go to outcomesrocket.health/stefano and you'll find links to his twitter, LinkedIn, his DOCSF conference as well as the books that he recommended. Stefano and it's been a pleasure and looking forward to staying in touch.

Looking forward to. Absolutely. Thank you. It's been a pleasure.

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 is one tiny problem. Health care is tough to navigate and the typical sale 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 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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Recommended Book:

Tes: The Team Engagement Strategy: Unleashing the Power of Adaptive Teams

Sapiens: A Brief History of Humankind

Best Way to Contact Stefano:

LinkedIn: Stefano Bini

Twitter: @sbinimd

Mentioned Link:

Digital Orthopedics Conference San Francisco

healthloop.com

Episode Sponsor:

Solving Complex Issues in Healthcare with Data with Simon Fitall, Co-Founder & CEO at Galileo Analytics

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

Today I have Simon Fitall. He's a co-founder and CEO at Galileo Analytics. He's a specialist in knowledge management with specific interest in a longitudinal patient data, data capture and analysis techniques as well as the assessment and evaluation of IP and pharma and biotech, including all stages of drug development from discovery to death of the product. His expertises is in data integration, modeling and forecasting. Definitely a guy that you would want to have by your side. He is also fantastic at designing and building complex data systems aimed at helping to solve complex issues such as the longitudinal Bayesian analysis of patient data. Simon is a member of the Global Advisory Council to the Interprofessional Healthcare Workers Institute also known as I H W I at Rosalind Franklin University as well as being a member of the education committee of Intelius. He is a leader and a fantastic contributor to Health Care and it's such a pleasure to have him on the podcast. Welcome to the show Simon.

Thank you very much indeed.

So Simon, what is it that got you interested in healthcare to begin?

I kind of fell into it. It found me rather than me finding it.

Is that right? Yeah that happened.

My first job, I mean this is long long time ago, my first proper job was working for AC Nielsen in market research. Besides doing the television audience measurement stuff that they've been most famous for they also used to run a retail business unit basically looked to product sales across all different sectors and in those days this was before scanning before barcodes if you can think about that and they had hundreds of people who would go around the country to samples of stools and they would collect the data. So it will be manually calculated all kind of say thinks some of you will be going way way way back. But anyway, they have a client service operation. And I got a job in that kind of set of operation and one of my clients was an over the counter medicines company and they were looking to expand. And I developed a really good relationship with them and they ended up offering me a job as a product manager. So I took it went into that. Then from there I went into market research in a different field looking for a company called Tyler Nelson. Now part of Cantle and from there I set up a consultancy and from there my first major client was a big international pharmaceutical company and was working on one project with them got friendly with another guy in the department who was really interested in modelling, modelling and forecasting. And quite literally over pizza and beer with. We went where we were in Switzerland. This was an organization that used to be called Sandoz now called Novartis and we're sitting in a pizzeria which is no longer with one of those paper tablecloths and we were talking about trying to solve some problem, we ended up drawing the design of a modeling system on this tablecloth.

Awesome.

And at the end of the meal to the tablecloth and then that was what really goes with.

Was it a proper tablecloth?

Made of paper.

OK. Oh wow that was courageous you took the tablecloth.

And that was where I got sucked into it and wow I started to realize..

That's a great story.

About how important some of this stuff is because we were talking about that particular time I'm talking about a new drug for early stage Alzheimer's. Now the drug didn't actually go anywhere but in the process of learning about that product and then working on other projects with the same company and then developing small business with other big pharma companies which basically go completely and utterly hooked on healthcare.

Wow. Talk about a you did fell into it in a very interesting way.

Yeah yeah it was one of those things where you know I've been a product manager and I was really cocky because in those days over the counter was a really hot thing and I'd been on over the counter product manager for a few years so I figured I could set up consultancy and do over the counter consulting and I never got a single account a consulting job. The first that first project with sandals which was a description drug development turned into more and more and more prescription drug development projects and didn't do a single over the counter project my entire time.

And so well fast forward to today. You're doing some fascinating mark had Galileo, if you had to simplify it for the listeners who don't know as much as we do about the company. Would you say the problem that you guys solve and who do you solve for?

The problem that we solve is sort of two sides of the same coin segmenting and sequencing segmented is understanding all of the different types of patients that there are and sequencing is looking at all of the different things that happened to those patients had done for those patients in order to either fix them improve they just broadly speaking improving their health status whether that's aiming towards a specific outcome or preventing a specific outcome. The segmenting as you said in your introduction most of the work that we do now is with longitudinal patient data. It's very granular. It's I hate describing it as anything like big day because that there is no such thing but let's not go there. There are large datasets to cover whether it be medical records clinical trials, claims data or combinations of all of those three. And what we know and everyone in healthcare knows that patients are really complicated things and what we're able to do with this much more granular data than we previously had available is we're actually able to characterize and quantify the differences between those patients and we can then use those differences to look at the way in which those patients come into become patients and what treatment patterns and pathways they go through that aren't just related to the specific disease that you might be interested in but it's related to the patient's complete condition.

Yeah, for sure and offering some very deep insights on what may at first not be apparent.

Very much so. One of the things we found very early on I say we most of our clientele up in pharma bio companies will not work elsewhere but that's the majority of our business and the pharma bio industry tended to have a disease specific focus. You're developing a drug for Parkinson's disease, you're really interested in Parkinson's disease. Your focus is on Parkinson's disease COPD or breast cancer. Breast cancer has a slightly different but you're focused on the disease and what tends to happen is you frequently forget the fact that the vast majority of your patients that have got COPD for example, half of them have got anxiety or depression. A third of them have got cancer. Another third of them have got rheumatoid arthritis. So those sorts of coma abilities and they overlap so much that you end up with four or five or six or eight different conditions all of which are trying to be managed. And what we're able to do is to look at the way in which that combination of coma abilities creates a creates difficulties for the treating physicians but also creates in many cases conflict conflict of outcomes conflict of treatment because you might be physicians trying to treat one condition might be wanting to use drugs or procedures that are actually going to be if not beneficial possibly harmful to other conditions that the same patient has got.

For sure. So this in-depth look. And the sad part Simon is that as much as we try it seems like we have such a difficult time in doing what you're saying. What would you say the biggest thing that's holding would there be providers or medtech companies. What's the biggest thing that's standing in the way of being able to see all of the insights versus just kind of being that siloed one track mind?

At the macro level quarterly reporting because you have to report quarterly. Have shareholders that you're worried about therefore your quarterly results are important. Therefore all of your decisions end up being made on a short term basis. It sort of cascades through the entire system and so you end up with managers who are more than capable of seeing the bigger picture because of the short term focus they end up focusing on the things that are right in front of them every day. At the same time they are trying to make strategic decisions obviously drug development processes is a hugely strategic issue which means you then trying to forecast out 5 10 15 sometimes 20 years which is extremely difficult to do at the best of times. And when you then overlay on that the fact that you've got a market that you think of as having three or four patient segments and you then realize that it's got so 10 or 14 patient segments. The complexity of that becomes overwhelming and it's actually easier to say you know what we're not going to worry about that today. We're going to stick with our 3 or 4 segments. We're going to concern ourselves with that group for the time being and we'll deal with everything else later. And part of the problem is all too often later never actually comes.

Yeah, that's so interesting you know and it does happen and that is a big challenge Simon, I mean even at hospitals right, publicly traded hospitals which is not a majority of them but you know a good segment of them were faced with definitely at the company level. You know the fact that we are held to quarterly results and taking that big picture approach is not always incentivized so how do we get the incentives in place to encourage people to take this thoughtful and insightful approach?

It's very difficult again at the macro level you have to think about the way in which we we fund healthcare as is fairly obvious from my accent on British originally. And so I have a very positive experience of single payer healthcare and where we see single payer health care working within the U.S. system which it does and we've got a couple of very, very good examples of single payer systems Kaiser Permanente is probably the biggest commercial single payer system that exists only in single payer in the context that they may not only manage the money like all of the insurance companies but they also employ the physicians they and the hospitals and so on and so forth. I mean they're even setting up their own medical school so they are a single payer system. They get really good results and they do that by having the beneficial feedback loop of looking at the data good not only looking at it from a financial perspective looking at it from a patient outcomes perspective and that feeds back into procedures and processes across the board whether it be using checklists or training processes or team protocols at the individual hospital unit level. They identify ways in which they can beneficially manage patients and then quantify that that turns into incentives that turns into measurement protocols and the whole thing becomes this large snowball because the continuously looking for ways of improving the process because they've got the incentives to do it because they are a single payer system where you've got individual physicians who are coming under increasing pressure from reimbursement that forces them to think in terms of spending less and less time with their patients more and more time thinking about how do I maximize my my reimbursable time. We end up in the process where we're doing too many tests because there's an incentive to do tests. We are probably treating too often because there's an incentive to treat were not following enough because there isn't an incentive to follow up on it being very broad and there are lots of examples of ways in which there are all sorts of really good things going on in the system. Broadly speaking we've got an incentive system that is built around physicians and hospitals doing stuff because they get reimbursed for the stuff that they do.

Right.

When we all know that there will be huge benefit from actually doing nothing. The problem is how do you get people to pay other people for doing nothing.

That's the nature of the beast.

It is it's the nature of the beast. So you end up with these misaligned incentives. That's something that I'm always looking for whenever we work with hospital groups or with patient advocacy groups. We're always looking for areas where we can properly align the incentives as opposed to the current broadly misaligned incentive.

Now you bring up some great points Simon and here's a thought. What about approaching payers. Right. Because I think employers are also their own insurance providers. They're interested in aligning and ensuring that their patient populations are being treated well and it's in their best interest to keep them healthy. Have you guys approached employers in this space?

We have and where we get the positive outcome generated motivation. And if I can use that phrase There's a very high level of acceptance of the ideas. You're absolutely right. The large employers who are interested about genuinely interested in both the health benefits for their employees and their families as well as of course the financial benefits for the corporation. Very interested in this whole approach. And there are some super examples of companies that run really effective systems that do have an impact. The problem that we have from a system one perspective of course is that although employer based insurance is still a huge part of the market the vast majority of the employers are too small to be able to have their own healthcare unit working centrally doing the research doing the assessments and so on and so forth and then not in a position to be able to to fund additional research outside that. So again there's a there's a complex limitation there as well.

Makes a lot of sense. I was just curious about what that look like sounds like you guys have gone down that path and seems like maybe not not the right amount of traction because of the capabilities that the employer has.

I don't think there's an area in healthcare at the moment where isn't some interest in a process of improving the way in which we manage healthcare the way in which we manage patience the way in which we we strike out with the objective of achieving better outcomes. Everyone's looking for that. But all the different places that you look they've all got their own constraints that in many many cases prevent them getting to where they really need to get.

For sure. So what would you say. Simon is a time when you had a setback. I feel like we learned more from our setbacks than our victories. What did you learn from that setback that you had?

Oh basically there's no such thing as an irrelevant variable. There are variables that do and don't affect the outcome that you're looking at. Just about everything is at some point in the in the equation going to turn out to be relevant and this specific example I thought of was that there was a situation where I was running a business development project for a client and we'd gone through thorough analysis of the market products all the players. We got a strong recommendation and they rejected it because there was some critical internal issues that had been considered but they had been determined by the team as not relevant to the project. The problem was that there were other people higher up who consider them to be important and relevant to the project and so the proposal got rejected. There was nothing wrong with the proposal it was the way in which we managed the process that was wrong and essentially the thing that that taught me more than anything else was make sure that you've asked all the questions at your briefing and don't make any assumptions about what you've been briefed. If there's a gap there's any sort of perception of a gap in what you think you've been briefed. Go back and confirm because there's a good chance that there's a bear trap there and if you miss a bear trap you could be in trouble.

That's a great call. Simon ask your questions. Make sure you definitely don't leave any bear traps uncovered. The expertise here being shared by Simon from Galileo Analytics. It's crucial folks so definitely keep yourself tuned into this episode. Now tell me about Galileo thermometer?

Oh that's a product. The idea is very simple. We created an analytical approach that we call Galileo Cosmos and when we apply that to data sets, we're able to do some analyses really very quickly very much more quickly than traditional methods. So what we did was we said in the business development world we very frequently running up against extremely short deadlines, it's possible to do a much more detailed appraisal of the data prior to making your Bidi decision. If you use a system that combines good quality data with fast and detailed analytics and that's the idea behind thermometer.

Very cool. So listeners if you're on the provider side or the business side, we're looking at some pretty advanced ways to analyze your number one be it variability if you're in the clinical space or if you're simply a company looking to vet out what you're doing to provide value to the market rather than sinking millions of dollars in, maybe worth a Galileo thermometer on your idea where they take a look at demographic's psychographics. diagnoses, treatments et cetera. And it's a fascinating way to get short term results on your idea and decide whether or not it's something worthwhile to pursue or not. Super fascinating things that you guys are doing there. SIMON What would you say an exciting project or focus that you you're working on today?

A couple of really interesting things going on at the moment but I'm not allowed to talk about them publicly so I'll talk generally. The red space is one that's a lot of interest around the industry at the moment particularly with all from drug sites as being something that people are seeking out because it has significant benefits. But in the process by definition you've got a disease that has relatively few patients. And so one of the major questions that comes up is how do we find those patients in order to analyze them and what we found, again using Cosmos very efficiently is that if you have a large claims or medical record dataset probability is that you'll find some of these patients as well because if you go to a disease that might be a subset of depression for example if you've got a dataset that covers patients with depression then you've almost certainly got patients with your subset. And what we're able to do is to find those patients very specifically and then analyze them in the context of not just the subset of patients themselves but also in the context of other patients who are quite like them but don't actually have the rare disease that you're particularly interested in. So you can get a good picture of the way in which those patients are managed if they're being managed at all what the opportunity looks like. But also what the opportunity just immediately around looks like which can make a big difference when it comes to the way in which you communicate to physicians because frequently with these diseases they are conditions that physicians are very very unaware of. And if you can describe the patient these patients look very much like one of these other patients but they're not quite. And the reason of the different is because of this this this these particular characteristics. You can help the communication which helps the physicians to understand what it is that they're looking for because the rare condition that you're dealing with is something that is rare some by definition. Most physicians haven't seen very many of.

That's fascinating Simon. And listeners one of the key insights that Mr. Fitall is offering us here is that oftentimes we don't look at the missing pieces of information. You have certain data sets and you assume that maybe this isn't it. The reality is that maybe it is what you're looking for and the capabilities that Simon and his team over at Galileo Analytics have put together. They really offer you the ability to look beyond the what would be apparent. And so Simon this is really great. I think you guys are doing some fantastic work to help improve outcomes and I'm excited to see where your new projects take you. It's definitely exciting work.

Yeah we were enjoying it. In another area that we're getting involved in as you mentioned in my bio The Interprofessional Healthcare Workforce Institute. What we're looking at there is ways in which we can improve the quality of the workforce in healthcare beyond the traditional training lab technicians for example. They are very well trained to be lab technicians but they also need an understanding of data analysis. Now they don't need to be data scientists but they do need to have a good understanding of the data that they're dealing with on a day to day basis. So one of the things that the I H W I is looking at is internationally recognized certification programs that expand the professional training of individuals in healthcare. So that's another area that we'll be getting involved in which is fascinating.

It really is. It really is folks if you have any curiosity about the things that we're discussing just go to galileoanalytics.com you know fine. Now the things that Simon and his team are working on to provide that insight that is certainly required in healthcare to take the next steps to get the results that we have gotten before and improve outcomes. David getting close to the end here. We've got some lightning round questions and a book that you recommend to the listeners. This is what I'd call the 101 of Simon and so how do you make analytics work for you and healthcare. So here are the four questions for you. Lightning round style. What's the best way to improve healthcare outcomes?

True sharing of data are across all disciplines and locations.

What's the biggest mistake or pitfall to avoid?

Falling for the latest fad-old buzzword at the moment. It's artificial intelligence and machine learning.

I love it. I love it, straight to the points.

Three years ago it was big data.

Yeah yeah I love it. How do you stay relevant as an organization despite constant change?

Well I think you just have to treat change as the only constant. It's the only thing that never changes is the fact that we always have changed. If you accept that and build that into your thinking then you have a better chance of coming out the other side.

Wise words. What's one area of focus should drive everything in a health organization?

From our perspective quite simply yes. Creating analytical capabilities that genuinely affect results.

Fantastic. And what would you say your all time favorite book is?

This is a good one. You very kindly sent this through. I was thinking of things like thriving on chaos by Tom Peters and the creative gap on the Joro and books like that kiss or shake hands is a terrific book on international cultures. But I ended up coming back all the time to a book that I read many many times and it's all about how we treat each other and how we think about the world rather than a specific business thing. And funnily enough it's Winnie the Pooh.

Really. Yeah. All right now is there one particular book. Because I've seen many books on Winnie the Pooh out there.

Yeah. The best one. There's an anthology. Basically there are two books one is cool Winnie the Pooh and the other one is called The house in Pooh's Corner and they're based on this very simple philosophy of a relatively simplistic way of looking at the world but actually what you derive from it is the kind of understanding of the way in which personal relationships should be managed in order to essentially foster the kind relationships that can lead to success and in health care the one thing that's true of healthcare more than anything else is that it is both local and personal. The only person who truly cares about my health is me and the same applies to everybody. But when I'm dealing with I'm dealing with a CEO of a big pharma company we're talking about drugs to treat tens of thousands hundreds millions of people and each one of those individuals is an individual. And if we can keep that philosophy in the back of our minds I believe we end up making better decisions.

Outstanding. What a great point and an off the beaten path recommendation on the book. I really appreciate that Simon.

It's just one of the things that I'd love to do is reading stuff that isn't business related because everything I read you end up with thinking about when I like reading books some physics for example and it just helps you broaden the way in which you're thinking about stuff and it allows your subconscious to be working on the things that you have to work on.

What a great message listeners for the show notes the transcript link to the things that we've discussed just go to outcomerocket.health/galileo and you'll be able to find all the things that we've talked about today. Simon, I wish we had more time to chat but I'd love if you could just share a closing thought with the listeners and then the best place where they could get in touch with you.

Well take the the last one first. The easiest way to get hold of me is simon.fitall@galileoanalytics.com. And I'm pretty good at picking up most of those e-mails. I'm also on LinkedIn as you'd imagine so please connect. No, I think my closing thought, I appreciate the invitation to come on I've enjoyed it very much indeed. And it's actually made me think about some things I don't normally think about. Point I was making just now about the subconscious is the ability of the brain to work on an issue without consciously thinking about it is something I think that's very important. It allows me to take a break when things aren't working properly. I'll take a break. Go for a walk, go get a coffee. Don't even think about the work because the work will catch up with you and if you force it you end up forcing the thinking which frequently are more frequently and in my experience ends up with a bad decision.

What a great call out there and as leaders that want to affect change we tend to take the opposite end of that and focus even more. And I think Simon's words of wisdom here will definitely do us well. So do as Simon says. Simon, this has been a pleasure my friend. I really enjoyed our time together and I just want to say thank you so much for spending time with us.

It's my great pleasure. Thank you.

Thanks 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 could get together to 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 and be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book:

Winnie-the-Pooh

The House at Pooh Corner (Winnie-the-Pooh)

Best Way to Contact Simon:

LinkedIn: Simon Fitall

E-mail:  simon.fitall@galileoanalytics.com

Mentioned Link:

Galileo Analytics

Episode Sponsor:

Improving Access and Transforming Healthcare Delivery with Rosemarie Day, President of Day Health Strategies

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

Welcome to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I have an outstanding guest for you today. We have the privilege of welcoming Rosemary Day, president of Day Health Strategies. Rosemary has over twenty five years of health experience in the public private and non-profit sectors including 16 years of leadership experience in state government. Most notably Rosemary served as the founding deputy director and chief operating officer of the Massachusetts Health Connector where she played a significant role in launching the award winning organization that established the nation's first state run health insurance exchange. In 2010 Rosemary founded day health strategies to focus on implementing national health reform. Her company now serves organizations across the entire country that want to transform their approach to offering or delivering health care. She also holds a faculty appointment at Northeastern D. A more McKim's School of Business. Previously Rosemary was a chief of staff to the dean of Harvard Kennedy School. She also served as chief operating officer of Massachusetts Medicaid program and has held several senior leadership fiscal positions. She holds an MPP from Harvard Kennedy School and AB from Stanford University folks. She's got an excellent background to be diving into policy government. And it's our privilege to welcome Rosemary to the podcast. Welcome.

Thank you very much Saul. I'm delighted to be here.

So Rosemary anything that I left out there that maybe you want to fill in the guest on.

Now actually I think he really covered it. I appreciate that great intro. Very thorough.

Thank you very much. Thank you very much. Well it's you're definitely doing some impressive things when you go back to the genesis of it all. Rosemary what would you say was the catalyst that made you get into health care?

Well I think I had always had an interest in kin of some of the inequities in our society. And the question was where would I actually apply my energy to because there's so many opportunities where you could work on the issues and you could work on housing policy or you can work in healthcare any number of areas. And what happened was I entered state government and worked a lot of welfare reform initially. But the Medicaid opportunity actually kind of presented itself after I had different leadership. And I kind of left at it because I just saw that program size and importance and complexity as just being like the challenge. I wanted to take on. So I said yes.

That's awesome.

That's really where I got my start. And then it went from there. That's how I took the plunge.

That's fascinating now. And so you took the plunge in a big way. You've obviously you've served in many different capacities. Today, Rosemary out of everything that should be on the agenda of medical leaders would you say that one thing is that can no longer be ignored?

I really think it has to do with making sure that all Americans have access to affordable and quality health care. And I know that that can sound almost like a campaign ad but I don't want it to. I just really fundamentally believe that the best way to improve our outcomes is to give people access to that health care coverage. And we have made some pretty significant gains frankly thanks to the Affordable Care Act. But those gains are at risk of eroding and while we're starting piece with that. So I worry about how that will affect the whole system because if you are running any sort of business in the healthcare industry. You need customers and..

Right.

We need customers who can pay. And as we all know health care is expensive and not everyone can afford to pay for stuff out of pocket. So the fact that we've got no significant gap still today is something I think we need to continue trying to address.

That's a really interesting point. Rosemarie so what would you say some of the key areas of erosion that are happening?

I see it in two ways. One is just that some people who had insurance are losing that coverage or are choosing to stay choosing with quote are choosing to drop that coverage because they find it to be too expensive. If they don't have the benefit of employer sponsored insurance and they're buying on their own for the open market and don't qualify for subsidies, they're going to find the cost will be increasing at rates that that could be unsustainable for them. So that will force some folks to drop coverage. The other is that people who do have health insurance coverage are really worried about whether they're going to lose it if they lose their jobs and insurance that goes with that job. Could they afford to buy on their own or even even if they have employer sponsored coverage that's facing a lot of cost pressures a lot of the time employers are moving more of that the cost sharing onto their employees will so they see you know higher deductible health plans in other ways. To kind of lean in and it again that could start to be a bridge too far for folks who are living from paycheck to paycheck.

And there's a lot more of folks that are living from paycheck to paycheck than we like to think. And this is a very real issue. Listeners, if you think outside of your day to day this pool of folks that are uninsured and are looking to be insured is a growing number. Most recently as I recall there is a sort of a shortening of the sign up window and a decrease in the marketing budget for the government insurance programs. I think he went from 100 million to 10 million. It went from I think five months to maybe 90 days or 60 days. So you know other things that Rosemary is referring to are very real. Rosemary what would you say right now like with the practices that you're leading here with your firm is the key to making a positive change?

You made some good points about places that were the you know the Affordable Care Act. It felt some pressure it certainly as you said the outreach period kind of shortening it was actually down to 6 weeks though. I think there had been a plan for that to happen over time anyway even if the Obama administration had still been in office that they didn't want to get it closer to where commercial openable that periods are. But I think more significantly has been that the cost of insurance is going up so much because of a number of different things that have been decisions made by this administration to not support of the subsidies that existed under the original Affordable Care Act and also to kind of loosen some of the market standards. These are proposals that are imminently going to be coming out around short term health insurance policies that will kind of take have the effect of taking some of the healthier people out of the marketplace and leaving those in the exchanges probably the folks who need health insurance because of their health conditions a little more which can then increase the cost of that insurance. So there's a bifurcated risk pool risk that we're going to be facing and for a number of reasons a lot of uncertainty. Insurers say they find it hard to keep the prices down. And so that will hit folks harder. What I'm seeing though and this is what is so interesting in the world of of health policy is that state depends on always kind of swings and when the federal government is doing things that they felt like, they can look for ways to step up and kind of do some countervailing measures and that can happen with any kind of administration that. States will look attempted to counter what's happening and I think we're seeing some of the States stepping up to look at ways to shore up what was built in the individual insurance market. And that includes contemplating implementing a state based mandate and working with the state right now that is taking a serious look at that will came out last week with New Jersey just pass one and that's to mitigate the effect of the mandate repeal mandate penalty repeal that happened last December under the Tax Act which will also have the effect of driving up insurance rate.

Yeah that's really interesting. So the effort of states is definitely you're seeing it increase as far as trying to get the mandate back.

The mandate is probably one of the most controversial aspects but there are other things that get into that whole world of insurance regulation where state insurance commissioners have an opportunity to take a look at their markets and set their own regulatory rules around things like the short term health plan.

Yeah, that it's interesting. I mean as we think about the health of communities and populations there's no doubt Rosemary's point is so true that you got to give people access. You just have to. So what would you think Rose-Marie is an example of maybe work that you've done that's helping us get closer to that?

So I'll get to that with one second I want to make the point that you don't want your only point of access for people to be the emergency room because that's highly cost inefficient. And if you if your health condition is really a manageable chronic condition like diabetes, you don't want to manage that to the E.R.. You want to be able to manage that through preventive care and that's really where I think you make the case for coverage so that people can avoid those really acute conditions and be able to manage stuff at the front end. So that's my plug there in terms of..

Such a great point.

Yes. So the things we've worked out with organization is to help them to understand in this changing environment and there's policy shifts. How do they strategize about what's going to happen with their patient population and what's the best way for them to proceed in this kind of very changing environment. So we've worked with a lot of organizations to look at those kind of major political and market force changes and strategize around that. And I also really like to work with organizations around how they actually develop what I like to call their own maturity to deal with these kinds of changes and so we have a model that we use that allows organizations to kind of see where their strengths and weaknesses are. And that way we can hone in on what are the areas that really will get the work done to bring them up the curve of managing and as we say ever changing environment.

Well you're definitely at the heart of our reform there. Rosemarie and what has been one of your biggest takeaways in the many years that you've been involved in and this type of health care reform that you want to share with the listeners?

I think it's amazing. It's interesting that you can accomplish so much actually with very few people. And you know I had originally worked with very large government programs like Medicaid. But when we were launching the state health connector that first one out of the gate, we had a very small pool to begin with. And what we were able to accomplish with a small number of people but were extremely motivated to make something successful on a very tight timeframe. Having everybody energized and rolling the same direction it just kind of phenomenal what you can accomplish in that regard. And that that was for me kind of breathtaking to see where we didn't have the usual kind of larger organization bureaucracy and we actually had bipartisan political support. You could just accomplish a great deal with relatively few resources. So that was a big left word for me like how back is the living how that can actually happen and it was very exciting.

Now it's inspiring. And so when you looked in the rearview mirror of that when you're just like wow it doesn't take many but it takes committed few.

And not having people working at cross purposes.

You know the alignment piece is key right?

Yes, very.

Love that. Now Rosemary you've had a lot of wins on your record. Can you tell the listeners of a time when you had a setback and what you learned from that setback?

Yeah, it actually is kind of the other side of the when. So I would say the launch of our of the state's Health Connector here in Massachusetts and what that begat was with very exciting for somebody who started out as a policy student and thinks about the state of a laboratory of democracy and being able to seethat it had the potential to go even beyond our state which I didn't even imagine when I first took the job. But I think during the really rough and tumble of startup stage that we had and I was there for the first four years we got to a more stabilized place. And what was interesting in the arc of that of getting out of that crazy first year start out and more into like the way a real organization should run. Not putting out fires every second but trying to get a more sustainable low. I learned that there were people who were absolute that we brought onto the team who were just superstars in that very hectic kind of crazy stage of the year one startup and then when you got to a place where the organization started to run more and more I would call normally the way I was used to much more established organizations running. Some people were not as good of a player in that stage. Some people could make the transition and some people couldn't. And I it took me a little bit to understand that because I hadn't been through that transition before. And usually when you're giving people reviews you're thinking well they're so great at. Like they got us through year one but now we're like in year three. And you say, huh, OK. You know people can can be great at multiple stages but some people are really probably better for year one day. That was a real lesson learned for me.

And that's a really interesting thought too, right because if we're as we're thinking about these types of transitions you know health leaders wearing our hat. We've got to deliver on a certain metric or a project and Rosemary's point is interesting right because the person that could help you in startup mode really may not be the one that gets you through the next step. How do you plan for that Rosemarie. Like what suggestion would you offer listeners that are maybe potentially going through that change right now?

Yeah well I should also mention the flip side was there were a lot of people I tried to recruit who I knew were really great producers who didn't want to take the risk of coming to a startup and yet keep them in your contacts list because they may be the ones who are great for when you're more established right that they just weren't comfortable at the super risky stage and then kind of that Converse is what I was you know the other point I made which I think is just being aware that you need to kind of think about that risk takerness and it's been almost like a personality inventory and I'm not going to recommend one product or another but that at least in the back of your mind keeping out awareness of like it's not just the expertise around a particular knowledge set. Of course we needed that too. But that appetite to lead and manage through change that you're looking for and then naturally to sustain change. And I think it's OK to say well you know what. I'm glad we hired who we hired in the beginning because we needed them for the launch. There were a lot of people who just give or take that kind of thing on but understanding that you're going to need more and more for your leadership team and your need change.

Such a great call out and personally a big fan of doing personality and aptitude assessments when forming teams whether it be the Myers Briggs or shrink's finders whatever it may be. It definitely helps. And they always say always be closing but I always tell my my team always be interviewing and the Rosemary's point right if it doesn't work like you got that year three person and you're at the beginning keep them in your Rolodex.

And I think we are one. Yeah as got to say Rolodex not to date myself here but thank you for saying that.

I am old school.

I get it. I think that as you get to know people over time you get more you're able to kind of gauge whether somebody is just a really strong individual contributor or they're a really strong team player. And I think when you're doing crazy days in start u,p it was OK to have really strong individual contributors there wasn't even time and time to do really as a team. But over time you need to. So that's a quick gauge.

I think that's so great so great Rosemary great notes for our listeners that are leading organizations and building teams and businesses. So that's a great callout. How about one of your proudest Healthcare Leadership moments that you've experienced today?

I think it's really been the fact that we were able to successfully launch you know the Health Connector in a bipartisan fashion. And one day and that framework became a model that can be used across the nation. I wish it had been launched in a more flexible way so that states can really tailor it more because I do think there's such tremendous variation across states and we do respect that and have some national standards but not necessarily superimpose all that. So I do wish there'd been a little more of that flexibility but because you know Massachusetts Well we set out a framework. We can't speak for the nation on everything. I get that. So I'm proud of it. But I would be a kind of a man that asterisk say hey wish we could have made a little more flexible.

Yeah in retrospect but you guys did a great job obviously served as a as a template for the rest of the nation to follow. So you've left a really really great fingerprint on the way that things are done. Health coverage is obtained at the state level so kudos to you. Thank you so Rosemary. What's an exciting project. Our focus that you're working on today?

So you know there's a couple of things. One is that we have as a firm been looking at how to really help folks once they do have coverage. And I'm really excited about the Accountable Care Organization World and really trying to get care to be very patient centered and tool oriented and all those good things the collaboration to help patients manage their care across specialist and their primary care provider. We're excited to be doing that in Massachusetts actually to the state Medicaid program and that's just like this year. So that's been a base project we're working on and I think it's the life extension of get you know once people have coverage and really tried to help them use that coverage effectively to improve health. My also alleged to have two things the other project on a personal level that I really want to try to encapsulate what we learned from launching the prototype for the ACA and what we've learned and kind of this whole debate about in our country about health care coverage and really try to get this book together that will give people an action guide of how we can continue to make progress.

Very cool. Say a book on the horizon. I do love it. And you have a launch date or publish date?

Well it needs to happen in 2019 at some point. That's my goal. I can't pinpoint the day but it's an aggressive deadline and I'm just trying to find more hours in the day.

Well Rosemarie I would pick that book up. So when you launch it and I know the listeners would too. So let's make sure we get you back on because we want to hear about it right?

Fabulous thank you.

Absolutely. Definitely some some great learnings here folks. If you haven't had a chance again we're talking to Rosemarie Day. She's the president at Day Health Strategies. Very experienced leader in health care and also government health projects. You want to hit the rewind button if you missed the beginning of this because we definitely have been talking about some really value added things that you could be considering for building organizations and even the impact of the things that are going on with the ACA. Getting close to the end here. Rosemarie let's pretend that you and I are building a medical leadership course on what it takes to be successful. Let's just call it health policy today. The 101 of Rose-Marie day so four questions lightning round style followed by your favorite book that you recommend to the listeners.

Great, sure.

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

Coverage.

Love the brevity. Haha. Love it. What's the biggest mistake or pitfalls to avoid?

Making it to pass work and confusing complicated and throwing in like skimpy coverage. People need adequate health care coverage, not stuff that's masquerading as that.

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

You know I'm going to say people need to embrace change and I know some people are more change averse. But you've got to have a critical mass of folks on your team who are excited about change and want to learn so that you can truly create that learning organization environment. That's how you can be really successful.

What's one area of focus that should drive everything in a health organization?

I think the mission orientation to really truly improve health care whether that's a patient centered perspective or making it more affordable and accessible more efficient, better solutions through technology. Any of those kind of things that stay focused on that mission because you'll attract great talent folks who really do want to make a difference.

What book would you recommend to the listeners Rosemary?

So I know you originally said to many about your all time favorite book which is a super hard question to answer. I'm just going to focus it on a really great non-fiction book that has been on the bestseller list for a while now for good reason and that's called being mortal by Atul Gawande. And I don't know if he's had a lot of other interviewees mentioned this book but I highly recommend it. Atul Gawande has written a book that I think has gotten us out of the kind of unhelpful rhetoric around death panels and really into a place where we can have a conversation about what should be happening at the end of life. From a personal and you know a policy or societal perspective. And he was courageous enough to put it in the frame of the story that he could tell them not to her world practice but his actual personal life be to be his father. And I think when people are willing to personalize things like that who are you know as smart and informed about the broader issues packaging that into one book it's very accessible for people and it opens up the door for a lot more conversations both at your own family level and in a more systemic level.

But a great summary Rosemarie and yeah you know the book's been recommended by a few I guess but nevertheless the recommendation here from you cements it as a must read. So listeners if you haven't gotten to On Being Mortal by Atul Gawandi, you have to. This is this. Yeah. So if you want more information the transcript, links to the book that Rosemary suggested, links to her work and her site. Go to outcomesrocket.health/day, as in Rosemarie day, D A Y. You'll be able to find all the show notes and transcript there. Rose-Marie, before we conclude. I'd love if you could just share a closing thought. And then the best place where the listeners can get in touch with you or follow you.

All right well to find me and you can send me your link and my name Rosemarie Day and I'm also fairly active on Twitter both through my company and personally so @DayHealthStrat or @Rosemarie_Day1. So just a closing thought. I'm very struck by I think the power we have if we want to improve our health care outcomes and as I said I think coverage is a big key step to doing that. I think we can achieve that with the power of collective action and if the people understand how it pertains to all of us that will individually and collectively as a society benefit from putting more in that direction. I think that's really what I'd like to leave people with as a thought.

Some great shares there Rosemary and inspiration you left us with to not settle and find those people like minded that are willing to do what it takes to make these programs succeed. So really again just want to say a big thank you to you. Thanks for carving out the time for us. And we'll be in touch for when your book launches.

And thanks so much, I really enjoyed it.

Thanks 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 could get together to 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 and be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book:

Being Mortal Illness, Medicine and What Matters in the End

Best Way to Contact Rosemary:

LinkedIn: Rosemarie Day

Twittter: @DayHealthStrat, @Rosemarie_Day1

Mentioned Link:

Day Health Strategies

Episode Sponsor:

Using Technology to Transform Healthcare Delivery Models with Matthew Fenty, Director of Innovation, Strategic Partnerships at St. Luke's University Health Network

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

Welcome back once again to the outcomes rocket where we chat with today's most successful and inspiring health leaders. I have an amazing guest for you today. His name is Matthew Fenty. He's a director of innovation and strategic partnerships at St. Luke's University Health Network in Philadelphia Pennsylvania. He brings passion and perspective to the dynamic intersection of health systems, life science and technology with a focus to transform health care delivery models through an innovative use of technology. A system search approach to design thinking and iterating on legacy business models. His perspective stands from a significant experience with healthcare and life sciences sectors spanning end to end healthcare delivery including translational R and D scientific informatics and analytics, due diligence corporate development product operations strategic planning and execution technical product management and digital health technology and adoption. I had the pleasure of meeting Matthew at a health care meeting and I was just blown away by his passion for health care and I thought man I've got to have this guy on the podcast and he was very generous with his time. So now I have the pleasure of welcoming Mr. Matthew Fenty to the podcast so Matthew welcome.

Well thank you very much. Not a physician that I wasn't playing early on but nothing more. On the technical side kind of behind the scene is the way to go.

Matthew you have a doctor and results in my eyes and that's why I wanted to call your doctor you know. But definitely a pleasure to have you on here. Matthew is there anything that I missed in your intro that maybe you want to fill in.

No I think you covered it quite well. Just one other comment. So we are actually based in Dublin Pennsylvania. It's about an hour north of Philly. But we do span this entire area. So you know one little while OK. Yes.

Now good clarification. Appreciate that. What got you into health care to begin with Matthew?

Yes sure. So you know health care has really been kind of a passion of mine you know going back to a grade school, elementary high school. I think a lot of the folks in your podcasts have always had that passion for health care either kind of behind the scenes or frontline medicine. It's always been a big focus of mine. And you know think about it in my undergraduate days very much focused on bench science kind of more analytical behind the scenes. I think you know kind of you or other some of your other guests thinking about going into medicine seeing where that takes and kind of taking a step back and say you know on the provider side kind of boots on the ground isn't the right path but there's a lot of opportunity a lot of I think work to use my skill set to kind of think about how do we improve operations and how do we improve the business and the kind of the nature of health care and medicine and care delivery and that's kind of really my passion. So kind of what you alluded to. I've been in the translational R and D side, at wet lab, pharmaceutical operations strategy. Now on the provider side and really I think there's a lot of opportunity to take those different perspectives and I think how do we fix and how do we improve this entire beast of healthcare delivery and medicine within the country.

Matthew that's such a great summary and appreciate you sharing that. Some meandering road that got you to where you are but very focused in your case. What would you say today is a hot topic that needs to be on every medical leaders agenda and how are you guys addressing it?

There's answers I can think of you know easily hot topics and precision medicine you know makes things like that early. I think one of our big focus and you know a big focus of mine is adoption and changing management and kind of supporting our clinicians, our leaders for change that's happening regardless of if it's new models of care delivery, new economic models of care delivery ways that we engage with our patients in a remote or virtual setting but it ultimately comes back and stems to how do we get people to adopt change and how do we get patients to think differently and help them manage their own health care. How do we get our physicians and our clinical teams to redesign what they're doing and how they deliver medicine. And a lot of it goes back to change management, education workload change, engagements by and support. These are health care types of issues. It's really you know there's a lot of change happening some mandated externally through policy but a lot of it is you know we need to prepare for how do we go back to care delivery and how we go back to the human touch of medicine. And it's a big effort. And you know I think if we focus on those outcomes like precision medicine and genomics et cetera we always need to go back and say How did we get this to work and how do we scale this within our health system?

Now that's really interesting Matthew. And what do you think is at the center of change management. How do you move the needle on that?

Yeah. It's a trick and it's really kind of it takes a team you know a lot of it goes back to organizational readiness and thinking about engagements of the people that you need to work with. And so it's communicating, its understanding and translating why change is happening. Think about why successful EMR launches have been so successful but is it because of the technology. No you can look at and read in the news a billion dollar or 500 million dollar failures in a very public launches. Mars, they think about the ones why things were successful and why things were not in my perspective my point of view a lot of it doesn't have to do with the technology or the systems. It has to do with engagements by and and communication. And if you can get your frontline staff and you can get your physicians and your administration and patients all kind of thinking about why change is important and health benefits them in a way that it makes sense in a way that they can kind of pull it in themselves. That's the only way that I think that you can really have successful adoption of new processes new technologies new ways of evidence based medicine protocol delivery. It's been able to articulate why something is changing and why say impacts me versus why it impacts you.

That's a great call out Matthew. And you stress that the beginning of the interview the importance of operational excellence and you know the theme that keeps coming up is just communication rank communicating the relevance of this the why and then the how. And you'll get to that end result that you and your organization are looking for.

I think you know we are it's an industry that we're in that you don't go into lightly and you're not. It's a very self-selective industry to be in healthcare and we're all in this to really improve patients. Now I want to improve experience. When my mother goes to the hospital that she has both the best care as well as the best experience,.

Yes.

And that her care team are physicians and her nurses and support staff. They feel part of the team are compassion and kind of the human touch is back in the healthcare. It's not a machinist on an operation it's not a process or checklist that this is really how do we get people to go back to the practice of hand touch, human touch medicine and you know we can do that with technology but a lot of it has to do with educating and get people to really think about compassion and empathy. And it's a lot of work and it's a lot of things that we all want to do and this is why we're in the industry.

Yeah it's a really great call and you know a lot of people talk about Matthew like hey you know what. Why can't health care be more like hospitality like when you walk into a hotel. The front line staff smiles at you and they receive you they take care of you, their service. Why can't it be more similar. Like what's the gap?

Well that's the million dollar question I think if you ask is you're going to get wildly different answers and you might ask a physician say a trauma doc in the E.D. his job isn't to make you smile, his job.

That's true.

Her job is to keep you from dying on the table and then they can think about there is the inherent difference of a sort of a pure service industry where at the luxury of that organization that they're getting that customer with think about the job and the goal which isn't really highlighted as much as it should be is to treat patients who are who are dying. It is to find the best care to support patients at the end of their life. There's ways that we are interacting and working with our patients and their families that is in a hospitality type of relationship.

Right.

Now with that said, we do need to think about how do we put the human touch and how do we make it more empathetic. So when patients are calling us and they're concerned about their bill, they could be thinking well you know maybe they lost her job or maybe their parents are dying or have recently passed away or maybe their kids you know just got diagnosed with something. And so ends up being you have to put that and retrain staff and retrain some of our any frontline persons to think about this is the most intimate point of relationship that you have with your customer with your patients with their family. And they don't necessarily want to be working with you. When I go to the doctor, that's one of the least happy things that I want to do in my day. Something's wrong. I feel sick.

I agree.

I or my parents in the hospital. It is a high stress, high type of emotional environment. So we need to make sure that our people are ready and equipped to deal with our customers and our patients in a high emotional type of setting. And I think kind of go back to your point, it's not going to be a hot the pure hospitality type of mindset. But choice how do we put empathy back into health care for anyone who interacts with patients or their families. Or you know with anyone who's part of the care team.

Now that's a really important distinction Matthew and I'm glad you brought it up. Definitely not a place where you go to get a smile. You get at a hotel right if you're broken they're going to fix you the bones or whatever you know your heart. So I think that's very very great distinction to make. But let's find the empathy. So can you talk to us a little bit about some of the things that you guys have done and maybe some examples or things you've done to create results or improve outcomes as it relates to this?

I mean sure, as you know as it relates to empathy you know a lot of that is. I wouldn't say that's that's innovation that's education. That's things like how do we get our patients to be able to speak with our staff in a non-clinical environment? It's having a patient centered forums and bringing in patients who talk about their experience to talk about their patient journey so that our staff can understand holistically what's going on when a patient either say a newly diagnosed patient with cancer or maybe someone who's recently pregnant. We want to know kind of what is what's going on and what's your journey and what's your experience like so that we can help reshape what we do retool what we do help kind of meet your expectations and exceeding expectations as well as provide the best clinical care and services that we can offer you. So when we think about things that we've actually done so you know we're really focused on our key patient populations ones that have very complicated patient journeys. Not your come in rate fixed types of things so could be things like your maternity or obstetrics types of patients oncology pediatrics states that are high super high stress and super ambiguity in terms of what's going on. So we're putting in technology we're putting processes we're putting in kind of people to help support patients in these care journeys in these kind of these pathways that they go through. So that could be from outside of technology innovation or profit innovation that's where managers and nurse navigators and kind of people helping you navigate all the different paths that you have to go through to come and see our physicians to see our care team. We're also technology enabling a lot of those services. We can think of patient journeys in unstructured in prenatal planning a lot of it is how do we ensure that we're providing digital access as well as physical access to our care teams so that when our patients need to access our services or have questions or have general anxiety about what's going on, they can reach us on the phone, text message, e-mail, chat, video-based. So providing multiple points of digital access to anyone who has a question or concern about their condition, their parents or themselves have a way to reach out to us.

Now these are these are definitely important, right? You want to make sure that you feel like you're not on an island as a patient. Sounds a yes I've been very mindful about how to give patients more than just one way of getting in touch digitally and physically. In your journey. Matthew have you had any particular setbacks that you've learned like key learnings from that you want to share with us?

You know I would say key learnings is the upfront education the upfront diligence the communication and with your end users and stakeholders, whether that's you know having focus groups of patients. Or having focus groups and kind of workflow sessions with your clinical staff or operational staff. It's thinking and being very mindful of what solutions you want to deliver as it really impacts and aligns with what is currently done now and how should we redesign that workflow in the future. We're then engaged into the future and if we don't have that by and if we don't have that strong operational engagement from whomever that end user is and there could be patients or it could be our clinical staff or frontline staff or back office staff. Having that by and up front as early as possible is the only way that you know be successful and we've had some the projects initiatives and pilots that now haven't been successful. And it's not because of the technology it's not because of the idea it's because there hasn't, there wasn't a clear expectations in the beginning, there wasn't clear operational buying. Now we might give a tool to a patient but if they don't know why or they don't see why it aligns with what they need it's going to sit on the shelf. And I think that's similar. You know regardless of industry, our job is to provide the best way that we can help deliver services in our physicians or our staff to our end users and our patients that we don't be very mindful. Be very empathetic and have those discussions with the entire value chain and people and things are going at work. And you know we're going to say well the technology didn't work or we didn't hit our end goals and our objectives. But really it goes back to the beginning, engagement, communication, by an acceptance of change.

Matthew great lesson that you shared with us there. And listeners and you know it's a great point and you can't throw technology on top of a broken process or a misaligned interests or lack of by-in you get to achieve all those first. And that takes time and I think a lot of us want to hit the easy button and just throw some technology on top of things and it doesn't work that way. And this message is really poignant message for not only providers but also technology companies and device companies life sciences companies, you can't just throw your solution on top of broken process, you've got to work on that. Get the buy-in first. What a phenomenal lesson to share Matthew, really appreciate that. So what would just say one of your proudest medical leadership experiences has been to-date?

Well it's really I think getting our organization thinking about change and thinking about what's possible and thinking about how do we collaborate and how do we make sure that when we're looking at change or we're looking at putting in systems or technologies that we're thinking about it holistically kind of enterprise wide or organization wide and not just individual hospital or individual service line or individual practice because you can think about where the majority of health systems were maybe 10 years ago. Smaller, fewer hospitals many more private practices kind of individual decision making and lack of coordination. And so where we are in our maturity of critical coordination. we manage you know 10 acute hospitals with more than 300 physical locations in our area and our patients are very tightly within our scope of clinical care. So by our very nature there has to be significant collaboration and coordination between all of our locations, Family Medicine specially allied health. And so having our clinical leadership as well as administrative leadership thinking about scale and how do we take a piece of technology or service or product and have that scale to multiple patients, multiple service lines and really you know one of our big wins. I would say is that recently we we're putting in a secure communication capabilities within our clinical staff that ends up just being secure text messaging and you can think about you know this is a market mature capability and this is the things that have been around for many years. But what we haven't done is really think about how do we look at communication and clinical communication as a network or as an enterprise type of function. You can think about where we were in many health systems where they are now of having individual points of communication routing messages to operators using pagers, being on hold for hours in a day trying to track down providers. And you're kind of your care team. What we did is say hey let's do a small pilot of 2500 people a base of a size and say we're going to put a piece of technology and we're going to get people thinking about what's even possible. And so going back to innovation, adoption. Sometimes it's it's very difficult to understand the value of a piece of technology or innovation until you start playing with it until you stop using it and the boots on the ground.

Then you can start getting people to say hey this is really important but if we tweak it this way and it's even much more important ten times as valuable so what we typically do with our with our pilots who are kind of we call Phase 1 deployments or phase of launches it's to get a very narrow core group of individuals checking out a piece of technology and saying here's why it will benefit our organization. And then they're going to be the champions. They're going to be the stakeholders and they're going to be the ones buying and selling it through their peers across the organization. So from a communications perspective we realize that this was a significant opportunity within our organization to improve all communications. Things like console's a critical page alerts like rapid responses in codes and milers Sroka alerts in a way that our clinical staff at the functions that we have are physicians cover all of our facilities. So you can think of a much larger system or even a smaller system where physicians are only deployed at one hospital. The nature of our area that our physicians cover all of our hospitals and all other services. So we need to be very tight and very nuanced in how we do communication especially when we do things like Kotzer alert. And so we are completely redesigning with support of our entire clinical leadership staff and operational staff. If we could redesign this in the future let's forget everything that we do now. What would it look like and it takes that level of buy-in innovation kind of help perturb the pot and kind of say here's what's possible. Then they going back operations say this is a great idea. This is how the ancient run with it.

That's interesting. So in your vision Matthew, what does it look like 10 years from now if you guys could build it.

That's a million dollar question. You know things are changing so quickly so you know you can think 10 years from now in terms of value-based care or provider rates contracting things like that that you know the economics of healthcare is incredibly going to be different. I think the way that we engage as a provider network, engage with our patients outside of the four walls of our facility is going to be drastically different. Now there's a lot of adoption of telemedicine, types of capabilities within health systems and in my view that's kind of table stakes at this point. So that's like Telad stroke, telecom faults, Kelud behavioral health and just the way that we think about the point that it helps us scale our physicians to hit a much broader patient population especially if you're thinking of things like stroke or.. Now we need to have that diagnosis instantaneously and maybe our patients and our way are two hours away from a physician but we need to make sure that we're doing eye care. So I think the way that the technology's becoming more mature that helps us scale are impact and our reach to treat and manage patients wherever they are either within our facilities or outside. And I think kind of lastly, there's a lot of technologies and lot of things that we're considering to improve just basic operations. So how do we streamline care delivery. How do we streamline documentation. How do we make sure that the encounter with your physician. You know it's not a permanent encounter whether it's 9 1/2 minutes of them typing on a piece of paper or typing.

Yeah, that's a great point.

We want to put that human touch in that connection back into the visit. And so what can we do from a technology perspective to streamline that to do as much of the behind the scenes as possible to let our physicians be physicians and let our clinical staff do what they're trained to do and what they want to do.

Now beautifully said Matthew you're asking all the tough questions and tackling some really pertinent issues. I'm excited to even continue the discussion outside of this podcast with you and because there's no doubt in my mind that you're thinking about these very difficult issues. Tell us a little bit about an exciting project or focus that you were working on today?

Yeah I mean I think I'll go back to the communications one because it's a valuable project. Really thinking about this is not just communications. It ends up also looking that if you're a physician, imagine a scenario where you're the E.D. trauma Doc and you need to find the on-call or the you need to do a consult with orthopedics and consult cardiology and consult with the behavioral health.

Yes, okay.

What we currently do and what most physicians do is what we call the operator they find who is on call and they might track down people. But what we're doing is saying can we blow up the entire thing and make communications completely self-service for staff. And so it ends up being how do we blow up our operator call center. How do we make all of our encore schedules easy to view.

Like a dashboard of who's available. Yeah.

So what we do now.

That's cool

So we have a dashboard also linked within our text messaging system. So right now you can text the hospitalist who's covering the 5th floor in a main hospital. You don't need to know who they are. All you needed knew as a physician I needed to reach the hospital who is covering the patient on the fifth floor. And so what we've done is redesigned the workflow to allow our clinical staff and support staff to be able to outreach and communicate directly with those types of clinical roles.

That's awesome.

So that thing is like our patient transport center or care management or behavioral health toxicology. So if you need to rapidly communicate with the One toxicologist who we have working within the organization, it doesn't matter where they are. You can send a text message to toxicology on-call and they get that message instantaneously wherever they might be.

Amazing.

So that allows us to completely redesign how we do things that console and patient transfers and transition of care between their hospitals and it's gold message, so it be. It allows us to shrink that time that it takes to make that clinical decision seconds or minute versus hours. So we don't think about this as an enterprise function or holistically. What are all the nuances of communication. And you just put in a texting system, you're only going to scratch the surface. So ends up being you need to get significant operational engagement from all of these different functional areas from different clinical areas that say hey, we need to be managing this and look at this big picture. And I think that's something I always push back to your listeners and to any of the innovations that we want to put into place. Is that how do we get the capability to scale enterprise wide? And what will it take operationally technically as well as boots on the ground and who's going to own it and how is it going to be governed. Because what we want to do is make sure that we have significant impact with the technologies or process that we put in place not just at the good presure release. Or it's interesting technology but there's no adoption there's no long term value. So we always want to push back and say operationally who's going to own this and how we're going to maximize the value of some of these technologies that we put in place. And without that buy-in that operational engagement stakeholder management that things are going to sit on a shelf or do nothing to be used to the fullest potential.

It happens so much things sit on the shelf so often that the words of wisdom that you're sharing with us today Matthew are just hitting home with me as I'm sure it's hitting home with a lot of listeners. Listeners, don't worry we're at the end of the podcast here. Matthew will share the best way to get in touch with them. It's something that he said resonated with you, maybe you want to collaborate with him. We'll give you the best way to get in touch with or follow him at the end here because we are getting close to finishing up today. I always wish I had extra time but these 30 minute slots are are short of that sweet spot and listeners, time frame commutes and all that.

They did go by quickly.

They do man. I mean it's amazing. So let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine operations, the 101 of Matthew Fenty. We're going to write a syllabus. I've got four questions for you lightning round style followed by your favorite book that you recommend to the listeners. You ready?

Sure, sounds good.

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

Connection. connection with your patients, connection with your peers, connections with patient's families. Because it's a team effort and if you don't fully engage your clinical team and your patient's family and personal support team then things aren't going to work well. It could be things like did the patients get to the appointment on time. And so maybe it's you know it's their children or their parents are helping them doing that. So having that connection with everyone is part of the patients care team needs to be a part of it.

What's the biggest mistake or pitfall to avoid?

I guess the opposite going rogue. But really it's thinking that the patient knows what's going on. So you know personally I've been to the hospital before they get discharged in the emergency room when I've been to the emergency room. And you walk out the door and say what did the doctor want me to do. What would happen next and a follow up, when the next step, what do I need in terms of medications and going back to what I said earlier this is a high emotion, high stress type of environment that we put patients in. So thinking that the patient is a type A person who is completely literate know medically literate who is only focused on what is my next step. That's a big pitfall. So you have to be very empathetic of what's going on in the patient's head. Now maybe they don't understand, maybe don't speak English well maybe there's other things going on behind the scenes so not being able to sit in the shoes of your patient is. No I think going to be a major downfall.

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

It's relevancy is I think a couple of different areas it's you know you have your clinical relevance and you're not seeing evidence based practice in medicine. And I think you know that's something that people takes for all health systems to have to do. I think from a from a technology side and innovation side here that's kind of the bread and butter within our organization working stage 7 organization most wired. So from an organizational readiness perspective and technology and how do we leverage technology is really in the minds and culture of everyone within our I.T. organization. So relevance, you know that's going to conferences that's listening to podcasts like yours that seeing what other organizations are doing and being able to think about how do we adopt that here? And it could be something for another sector to be from a consumer CPG, from end it from insurance from the hospitality and say you know that's a really interesting way of doing business. And that's a really interesting capability. How do we get that type of thinking internally? And I think that relevance is that always push for learning is relevant. Whether you're a provider or even if you're on the IT side.

Interesting, that's a very interesting point. What would you say is one area of focus that drives everything else in your organization?

Well from an organization perspective I think quality quality and access. So we very much focus on 3 pillars within our organization. Quality, access and cost. And so when we think about either technologies or clinical processes, there's a big laser sharp focus on how this is impacting or improving our patient access to our system. How improving total quality outcomes, long term outcomes, short term outcomes. How are we looking at value-based care and value-based contracting as well as how do we ensure that we are providing the appropriate cost. How are we ensuring that we're managing those costs. Because we do realize that I think as an industry that health care costs are going up and it is in our interest to ensure that we're providing a service that our patients and our customers continue to use and afford. It ends up being costs and price transparency as well as quality and clinical goals as well as access to services as always everything that we do either from a process or technology or innovation, always aligned to one of those goals.

Outstanding. What book would you recommend to the listeners?

That's a hard question. There's a lot of things I read that actually aren't books so a lot of like blogs from physicians, articles blogs, a lot of blogs from the venture space who have interesting perspective on healthcare. So you know I was always for an education or learn and read those types of blogs I can share with you some of the ones I check out weekly or monthly. It's a really interesting book. I really like the Google Ventures design Sprint book because a lot of it what that does is get people to think about problems and opportunities. And how do you articulate what you're trying to tackle and not trying to identify solutions. So a lot of what we do internally is exercises and discussions to really identify and need the value of a business processes to change versus what's the value of a new tool or new piece of technology. So that book really helps us kind of get that frame thinking and then I think on the other side I really like The Martian that's a fantastic book. It's really funny. I think it's a lot funnier than the movie with Matt Damon that anyone who has you know a couple hours to kill. You can blast of the Martian pretty quickly.

That's a good one. Matthew great recommendations. Listeners, you don't have to write any of that down. You could find our entire show notes the transcript today's interview as well as all of the Q&A and links to the resources that Matthew just shared with us. Just go to outcomesrocket.health/fenty, F E N T Y, it's Matthews last name. You will find all that there. So this has been so much fun Matthew. So glad that you made time to do this if you can just share a closing thought with the listeners and then the best place where we can get in touch with you?

Of course I appreciate the time on your show. I would always, regardless of where you are within healthcare either pharma, in a provider research. Think about we're in this for for us and our parents. Think about how does what you're doing is going to improve the experience for your parents or for your children. And so I'm putting empathy and putting that personal experience and personal touch in research or drug discovery or surgery or behavioral health or care management. At the end of the day we are treating our family and our friends and our neighbors and our community and healthcare is such a local type of industry that we're going to see people that you know work that come in. Are you their services on a daily basis. So we want to make sure that we always put that human touch a human focus back into what we do and that every decision should be based off how is improving our community and how this improving our neighbors.

Great message Matthew. And what would you say the best place for the listeners to follow you or reach out to you is?

E-mail me directly. I'm pretty accessible. I don't tweet a lot. I follow a lot of people who tweet a lot but my social media it's, also in LinkedIn or e-mail or just a phone call would be always the best way to reach out to me.

Beautiful. Well this has been a ton of fun. Matthew really appreciate the words of wisdom you've shared with us the tips on operations, the tips on just putting empathy first and some of the examples that you guys are doing there at St. Luke's, really inspiring. So keep doing what you're doing man. This has been a really fun episode. And we're looking forward to staying in touch with you.

Of course. Glad to help.

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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Recommended Books:

Sprint: How to Solve Big Problems and Test New Ideas in Just Five Days

The Martian: A Novel

Best Way to Contact Matthew:

LinkedIn: Matthew Fenty

Email:  matthew.fenty@sluhn.org

Mentioned Link:

St. Luke's University Health Network

Episode Sponsor:

Making it Easy To Sign Up for Medicare with Joseph Schneier, Founder and CEO at Trusty.care

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

Welcome back once again to the outcomes rocket podcast. Really appreciate you tuning in again. And I've got an amazing guest for you today. He's a health care leader that specializes in the aging population and how do we best optimize resources. His name is Joe Schneier. He's the co-founder and advisor at cognitive mission and he was also CEO for five years. Now he's off to his newest venture where he's the CEO at Trusty.care and at Trusty.care they're making it easy to sign up for Medicare Medicaid and Medigap. I'm really excited to have him on here. He was a member of the hive as well as other really up and coming hubs of medicine that really build leaders that grow companies to the next level and so I'm privileged to host Joe on the podcast and welcome him. So Joe. What I love is if you could chime in a little bit there on the introduction. Fill in the gaps that I have missed.

Sir. So I'm a serial entrepreneur. I actually started in the education space with a focus on behavioral change in the education space and about 10 years ago I got approached by some behavioral research scientist to start building out products for the digital hot space and in the beginning we were really sort of bridging the gap between those two spaces and then I made sort of the full leap over into digital health about nine years ago and since then I had the honor of doing some incredible work with researchers which the incredible part was on their site around drug adherence and addiction and then five years ago I founded cognition with my co-founder Jonathan Dariyanani and the mission of Cognotion center was to look at how do we solve the problem of the talent shortage in healthcare for the aging population specifically. So areas in the health care market where you're seeing these massive talent shortages. I spent five years working on that and then most recently founded Trusty in January of this year said brand new,.

Congratulations.

Yeah, thank you, I'm very excited. It is scary but exciting time of a startup. So yes, I guess that brings us today.

That's wonderful. And Joe, why did you decide to get into healthcare?

So I've had a real passion for looking at how you can get people to change their story about themselves to sort of drive behavioral change started with a focus on the cognitive behavioral therapy sort of focus to see if you get someone to start to say I can do something, can they actually do it? And in the beginning I was I was really looking at just direct applications in the education market things like early childhood literacy and didn't have health care in my mind at all. And there was a coach by this one researcher at NYU and she saw what we were doing in education and she had the first vision of bridging that gap and bringing us over in the healthcare space into the first products that we started putting out with her were designed to work with really complex communities. They were real disenfranchised and to see how we could positively impact them in health care and it was just a trial run from me I had no idea it was going to work. But the results were phenomenal and really caught my eye. And one of the things that's like a real driver for me is is that the sensors can measure what are doing and to know that it's actually effective and healthcare that so much clearer than it was in education. So I really enjoyed that piece of it and that was sort of what pulled me over the on into healthcare space.

What an interesting story Joe. And so you haven't looked back since.

Yeah. I've I've done some work on this side where we were still modeling out different components that we then folded back into our health care products and I'll just give one example of that. So we did a couple of products in hospitality that were also around behavioral change really with the intent of looking at how do you apply some of the components of hospitality to the healthcare space. We did them directly in hospitality to test them out there and then ported them over. So we've done some things in some other arenas. But I'd say 85 percent in healthcare.

Wow. Very interesting. And so I love that you have thought about you know what can we pull from hospitality into into healthcare because today we really don't treat patients as as consumers. But I also feel like we're heading that way. What would you say a couple of the insights that you gained through those projects were?

So the insight of at other industries and there areas of excellence is something that I've thought a lot about throughout my entire career because there's things that are assumptions and hospitality that are just not assumptions. In healthcare like if you smile at a customer in a hotel they're going to smile back and they'll pop and have a better experience. And so just like some basic things over there and looking at how we could for them over into healthcare. Now, some of that is really difficult in healthcare because obviously the dynamics are completely different and speed are different and the pressures are different. But there's actually more similar than people would think. There's a lot of really high pressure moments with customers. So that was one area that we really focused on was how to get people to navigate the emotional intensity of dealing with a customer. And then over on the other side with patients who were really agitated and how to sort of calm them down and move that into a different space there was one clear thing I guess that we we we worked on.

Yeah. It's really interesting. We definitely need to start seeing more of this as we transition into a more value based healthcare system is definitely important for us to start thinking about the people that we take care of as more than just patients. So it's super encouraging to see that you guys have worked on products in that realm. So tell us a little bit more about your current venture and the vision and sort of where you see this going.

So one of the things that happened in Cognotion as we were working on this talent shortage was I got to see sort of what it was like for the workers so we were not just focused on improving the patient but we also really wanted to improve the worker experience and one of the complexities in that company was that we didn't have as much control over what happened to them once they got hired. So my initial vision for Trusty was to look at who we create a system that would enable us to upscale people to work in the healthcare space to provide a value to consumers that was valuable enough that they would purchase it. And that's a tall order. And I think I think we've hit on something but we're still working out some of the pieces. But essentially what we're doing is creating this system that is a streamlined version of applying for all the kinds of government services you need in healthcare starting with Medicare and then Medigap and Medicaid. And the reason for that is sort of known to anybody who's ever tried to sign up for any of these things. But for those of you who haven't it's extremely complex and it's catastrophic if you do it wrong then the penalties and the things that can go wrong if you do it wrong can last for the rest of your life. We knew that people some percentage were going to want to use just a pure technology platform that sort of like similar to what kind of a Turbo Tax kind of thing. But we got the news people were going to want to talk to live people. And so we said why don't we create a new wall like a new health care roll that is like a Medicaid Medicare expert, a person who knows the ins and outs of that and create a new space. And can we look at other places in the market where there's a market need and develop worker groups that have value where the salaries could potentially be higher than they would be in other spaces. So that's sort of evolution has going in that direction of again providing a real benefit to our customer but then also looking at how we can get more people into the space because it's really necessary.

You're asking some really great questions Joe and you know it's interesting how you've approached this, it's kind of taking a look at the market need. I mean give you an example I recently had a colleague retire and she was just trying to figure out what to do with her Medicare Medicaid and it was confusing and she didn't know what to do. And it was a very opaque process. And like you said there is always if you do it wrong could be detrimental for a very long time. And so I think you're definitely on to something here Joe and the other thing that I really liked about the way you're approaching this is searching for a market of underutilized workers and so very cool approach that you've taken here for I think a segment of the population that's going to be needing more and more of these services.

Yes. And there's one thing that we know after working in the states is that the aging market will really need some smart minds to be focused on it. I don't think that we know how much it's going to impact the economy over the course of the next 15 years but the numbers are staggering and we're already sort of behind the ball on it a little bit. So we're trying to get out in front of that a little bit. I think there's a lot of room for innovation in this space and people are looking at the space from different angles.

Yeah and you're definitely taking a really great crack at it. Just so can you describe and I know you guys are early on with this one but maybe share a story from Cognotion of a time when you guys created results or improved outcomes by doing things differently?

Sure. So I'll give one example when we early on in the company got hired by the Ministry of Health of Saudi Arabia and they had an RFP that they basically put in front of us because nobody else would take it. About four years ago I guess it was the height of the Ebola issue, right. And this was four weeks before the HOZ where millions of people were going to descend on Saudi Arabia from Africa. And they had done no preparation with the country to prepare for what could have been an outbreak in Saudi Arabia. So they asked us to build out a complete training program for all of their medical professionals and staff a call center for the ..that had to be aligned to the CDC standard of which we're changing every single day at that time. So we had to create this whole system like very quickly that had to embed in it the information had to be presented to the doctors and the nurses and orderlies in a way where it would really stick because the consequences of us getting it wrong could be just terrible, right? So we can't say for certain you know this is all attributed to us obviously but there was no Ebola outbreak and the use this did function exactly as it was supposed to do. That was one thing where we felt like, hey that was what was good. So that was sort of a larger one but then we've had a lot of other really interesting successes so in part of our program was training people to become certified nursing assistants. And one of the first things that we observed was that there's a real problem with retention which is a known thing but people haven't really looked into in detail why that was happening. And so we spent a bunch of time just following and CNN's around and realized that a big reason why they were leaving the job was for things like dealing with racism or dealing with families like screaming at them or time management and some things we can control or preparing them emotionally to be able to deal with those things. I was told that in a much higher retention rate with the people that we've trained. And it's surprising. It's like all you're doing is showing people that they are capable of doing this thing. And then when they show up if they've already gone through it and some of that we've had the theory that we based on a lot of work that was done in the military. They've really pioneered a lot of this type of training which is kind of odd. But yeah but it's effective.

That's fascinating. And there's been a theme here Joe and you know in our conversation but also in conversations that we've been having with other health leaders that are having success. And that theme is that in healthcare, true innovation is actually amazing implementation. So if you could implement things well then you're the innovator. And there's no doubt in my mind that you're a master implementer. What's your secret?

I again don't give up, my secret. I think I think I joke but not completely. I think that a big mistake that younger entrepreneurs make especially in seeing this in digital health is thinking that they've come up with an idea and that they have a brilliant idea maybe they work in healthcare even they have a brilliant idea, they see a problem a build something to solve that problem and then they try and push that solution onto the system and it doesn't really work that way. It's a lot of like a feedback loop of iterating and iterating and iterating both on the product itself but also on the business model and sort of looking at how you can have the entry points that are actually going to stick. And I think that if I could say anything to myself from 20 years ago that would be the thing. Don't think you're so smart from the beginning. Look around it okay to take in new information and phase shift accordingly. And even with Trusty we started out with we we were very clear we're like we have a very clear idea of what we're going to do. We tested it for two months and realized that out of the 40 things we thought we were going to do 39 of them had about 600 a hits. And one of them had 15000.

Wow.

So even in this short period of time we had to come. We said OK I guess the market is speaking to us. So I think that that kind of thing as not not being afraid to go where the market is leading you.

What a great message. Listeners, if you didn't catch that, I would recommend that you hit that rewind button. Look one with 15 seconds and hit it about three times and relisten to that because I was gold right there. Joe appreciate you sharing your wisdom there. There's no doubt that it's it is a pathway to make these ideas work because these things are not going to work on the first run. And so did you just put your ideas out there through like Google Ad Words or how did you get the hits.

So with Trusty we're we're looking at two different models of selling either to end enterprise with partnerships which is a long road and we knew that because Cognotions sells to skilled nursing facilities and those are very long sales cycles. We also wanted to see if we could do direct to consumer and our initial concept was really much broader than what we're doing now. Initially we had thought well all get people connected with the entire ecosystem of people that can help them as they're aging from eldercare lawyers to financial advisers and caregivers. Sort of a one stop shop which would have involved a lot of build up of a two sided marketplace where you're getting in workers and consumers which is very difficult. But we were like, Lets put this out there. We tested using Google Ad Words, Facebook, LinkedIn we also went to different message boards where users were located and did some advertising there and then did some advertising in person saying you know what kind of word of mouth effect we could have.

Could be generated.

Yeah. And so it was really it was really interesting. There were a lot of reasons why I said data makes sense to me now is that out of all of the different services almost everybody was asking about how do we navigate Medicare which we had put in almost as an aside because you know an interesting thing I was like I was like oh let's put that in a friend of mine said that that's a problem for her. I'm very grateful for her.

That is amazing. Great thanks for sharing that. Yeah, and listeners, you got to listen to the market right, and be persistent and much to Joe's great example and walking us through his process. I mean it's so key that you don't just put it out there if you build it, doesn't mean they're gonna come. And so, Joe thanks for walking us through that. That is a very helpful lesson.

Absolutely.

So share with us a time when you had a setback or a failure and what you learned from it?

There are so many. So I will give one particular failure which is sort of built on the last thing that I was saying know so about six years ago we've built out a product and it was in the foreign language space. And so again this is one of the side projects. We raised a significant amount of capital for it. We saw that there was a clear problem and the problem that we were trying to solve was that Americans don't believe that they can learn a foreign language. So we said OK we're going to create a system that is going to be really effective mechanism to learn a foreign language spent a ton of money on it spent a whole year building out this program. At the end of the program, we won all these awards for it because the people in the industry thought it was great. Nobody bought it and it was one of those things where like it's beautiful. It's in an ideal world. Now people would use it. It's really great but are they going to buy it. Probably not because it's not it's not essential. And I think that that lesson is sort of what has you know whether it was a real moment of understanding that you, like it doesn't matter how many times you've done it I've already had to exit that at that point. It's easy to forget the humility of like you don't know anything until you see stuff actually happening. And that was a big one.

And Joe thank you for sharing that you know I mean I've been in that in those shoes before as well and what was the miss on that one?

A couple things. So the first one was our channel partner that we had a distribution deal signed before we started building. So we thought it was a sure win, a large distributor. One of the largest publishers in the country. What we didn't realize was that for them there was really no incentive to push it because it wasn't going to drive their sales, the individual sales people would get such a small incremental increase. There was no benefit to them. So first of all our sales channel was not incentivized. Secondly, people were not purchasing foreign language products in the school system as much as they said that they would wanted to. So a lot of times people say that they want to purchase something but if you don't test to see are they going to actually do it then it's not really worth it. I think that with the second and the third piece and I think that this isn't really applicable to digital health is that there are a lot of things that seem nice on paper but if they add time to teacher's in this case as day or doctor's day it doesn't matter how good it is, they're just not going to do it. And I think those are the three components and the time factor is I think a thing that gets really overlooked especially in healthcare.

What a great call out. Some great lessons there. Joe, how about the other side you took us to the darkness. Take us to the light and tell us about one of your proudest leadership experiences that you've experienced to date.

About two years ago. We brought in a man named Dennis and we're in New York based company, Gary, LGBT friendly very diverse. And Dennis is from Kentucky he lives in Kentucky, is salt of the earth. But very sort of from Kentucky person, one is like best people I've ever met in my life. And so if we say ironically that he was our diversity.

That's funny.

He hadn't been the sales person. He had run some nursing home himself but he had just this really great touch. And we had this idea of what if we hired people from the region they were selling into and see if that would work more effectively. And watching him grow into his leadership role and seeing him close our biggest deals, I mean it's just beautiful when you have that happening. It's like if you have kids and you see them surpass you it's just a great feeling to see that somebody brought on who didn't even know if they could do something steps into their strength and it's resulted in the biggest sales for the company. So the both of those things. It's more that I'm proud not to visualize that but I'm proud of actually doing something. But I but for sure.

That's great. You know Joe that speaks to the leader that you are. I ask for one of your proudest moments and you go to in a moment that you know was obviously good for your company but it was seeing this person grow and listeners if you catch anything from that. You know you've got to be very focused on both your business but your people because if your people are doing well so is your business and and Joe you identified an unlikely person as it related to your firm but you did it in a very very eloquent way and you've found a way to make it work for you guys.

Yeah I mean he's just one of the best people I've ever met him.

That's awesome man. So tell us a little bit more about an exciting project or focus that you could tell us about within your current venture?

Yes. As we started mapping out what it is that we're working on it became clear that the problem that we're trying to address is something that will benefit anybody in the country will benefit from and that the deeper that we sort of dove into it the more that we realize that this is a pretty green field and that is pretty exciting. So it's pretty rare as an entrepreneur to approach a space and to see that innovation could really be applied to a large market and that there aren't a lot of people already doing that. So I would say that's pretty exciting and part of the reason why that is the case is there's still a lot of the holes around the data have changed and have gone into effect in the past couple of years. And then there's a lot of interesting things happening related to Medicare because of the tax code and the new tax bill and how that's going to change everybody's plans. So I get really excited when you see a big problem that is a crazy complex puzzle but then you start to sort of see how you can map out pulling together different fragmented pieces to create a simplified solution. That's my that's the thing that really gets me going and is motivating to me and the other thing that I'm really I guess I'll say just a quick brief personal story about why this is meaningful. So about a year and a half ago my brother a year younger than me got into a severe car accident and he is fine now.

Oh,Thank you. Thank God, that's glad to hear.

I remember telling people that he's on the road to recovery. He's OK but he broke his neck, shattered his pelvis, broken his jaw. It was just he was a disaster, it was horrible and he lives in Nashville and I flew out visit him the next day the next morning since I could get the next flight and the surgeon comes in that morning and he looked at me and he said well it looks like we're going to have to release your brother because he doesn't have insurance and he still needed more surgeries. So we were of course like yeah no that's not going to happen.

Right.

Those two things happened in us, we had to go through all of the headache of getting somebody signed up for Medicaid retroactively. You're out all the system try to figure out how he could get the care that he needed. Meanwhile like is he going to make it and going through that experience of realizing like how the complexity of bureaucracy intersects with people's lives. My brother was lucky he had me, he had my parents there advocating for him but a lot of people don't have that. And so when they go to face signing up for these different offerings that their government has for them it's just daunting and overwhelming. And in that case if he hadn't have that. Who know what would have that would have happened to him. So for me the idea of being able to address something that is a real technical problem really. It's like a system problem. Yes but that it will have that kind of impact on families lives. It's a rare opportunity and I'm pretty excited about it.

That is super exciting Joe and I'm glad your brother's doing well. And it's sort of the silver lining in this whole thing is that this hardship that you experienced that your family experienced in your brother is now going to be the beacon that helps others make it easier for them. So supercool.

Yeah we're pretty excited.

And that's awesome. I mean I'm so thrilled for you and your team definitely looking forward to following you guys. Getting close to the end of the interview here. I always wish that I had more time. But all good things must come to an end as well. Close this interviewing. So this is the part of the interview where we do a lightning round. I've got four questions for you and we're going to follow that with a book that you recommend to the listeners. So this is the little mini course that we're putting together for our listeners it's the 10 of Joe Schneier and so on how to be the best in medicine. So here we go. What's the best way to improve health care outcomes?

Transparency. I think that that's the biggest thing that needs the best in the market and with companies and the whole system.

What's the biggest mistake or pitfall to avoid?

Thinking you can sell easily into hospital systems.

I love that.

You can but it's possible. I've been there..

What was that?

It's possible.

It's possible, that's right, good distinction, good distinction. How do you stay relevant as an organization despite constant change?

I think that .. this shift between big data to rich data which is kind of just you know jargon that people are throwing around but really looking at how do we use all of this data in a way that keeps it relevant. And there are lots of ways to do that. Now there hasn't been a time before in the past where technology has it where it hasn't been easier than it is today. So I think that's the biggest thing.

What's one area of focus should drive everything in an organization?

That's an interesting one. I think for us and this is just for me on my surface will be relevant for others. But I always try to remember the humanity of the people I work with and the people that we're serving and not forget that there are real people on both sides of that. And I think through that you can really develop great products that keeps you closer in touch with your customers. It gives you a better feel for what they are going to want. But it also is just a better way to live I guess.

Totally. What a great share. And Joe what book would you recommend as part of the syllabus to the listeners?

I really enjoyed reading the book, An American Sickness so I highly recommend that. I am not good with names and don't remember the name of the author, I'm sorry.

No problem.

It gives a really good overview for people who are not professionals in this space about how the healthcare system in the U.S. got to this point. And it's quite good.

An American sickness and I just like that up listeners it is Elizabeth Rosenthal. So there you have it some amazing recommendations from our friend Joe. Don't worry about writing any of them down. Just go to outcomesrocket.health/trusty and you're going to find all of the show notes, a transcript as well as the best places to get in touch with Joe. So Joe what I'll do is leave it to you to give us a closing thought. And then the best place where the listeners could get in touch with you.

So my my closing thought is just that there is definitely desperately in need of great minds that are willing to look at how do we solve real problems that both sides of the equation need both the doctors as well as the patients and especially in the aging space. It's not a space that seems sexy but it is one of the largest fastest growing areas of the industry. And I am looking for smarter people to come alongside us and join up with this. And I can be reached at. We've got a Facebook page. That's your trusty care or feel free to reach out to us. My email is joe@trusty.care.

Outstanding. Joe this has been awesome. This has been insightful and we really appreciate your time here on the podcast.

Well thank you. It's great being here.

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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Recommended Book:

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

Best Way to Contact Joe:

Facebook Page: Trusty Care

Email: joe@trusty.com

Episode Sponsor:


Andrew Ray Director of revenue cycle for Stanford Children’s Health physician services. This includes approximately 1,000 faculty physicians that are part of the Stanford School of Medicine as well as approximately 200 community-based physicians and 18 different practices throughout the Bay Area. Stanford Children’s Health physicians practice in over 200 locations across eight states through satellite locations, health system joint ventures and other affiliations. Stanford Children’s Health is the only network in the Bay Area, and one of the few nationally, dedicated to pediatric and obstetric care. 
 
Hot Topic that should healthcare leaders agenda:  Access is not only a financial hurdle.  It is a financial, geographic and efficiency problem.  Access in Healthcare and engaging patients throughout the journey.  Think geographic expansion to increase access.  Also, think revenue model shifts like shifting hospital vs. clinic/physician driven revenue model.
 
Setbacks that you learned from:  Today, we are in process of making a large edition in San Francisco, it has brought about a tough year financially.  Must drive efficiency and revisit cost structures to ensure we fulfill the long term vision.  Staying focused on the vision and weather the storm and become a stronger health system.
 
Proudest leadership moments:  During expansion to improve access, getting operations to work well to achieve economies of scale, efficiencies, and collaboration with people all while integrated 3 EHR systems.  We went from 160,000 to 550,000 ambulatory visits, an almost 400,000 increase that was improved by access.  What is your future state?  Be clear about that and how it ties the organization’s mission.
 

Andrew’s 101 Course on Outcomes Improvement:

1.  What is the best way to improve healthcare outcomes?

Measure and reward sick care prevention through population health.

2.  What is the biggest mistake or pitfall to avoid?

Avoid knee jerk reactions.  Maintain your focus in the long term vision.

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

Easier ways for patients to access and understand their healthcare experience and the hospital.  (Using tech helps)

4.  One area of focus that should drive everything else
Access is King.

 
Andrew’s Recommended Books
 
Resources:
 
Closing Thought:  Being able to reflect on what we’re really doing at the end of the day is key to ensure we achieve the long-term mission.  Being able to reflect on stories and the WHY will ensure success.
 
The best way to contact Andrew:
aray@standordchildrens.org