Category: Digital Health

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

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

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

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

: Thanks so much. Happy to be here.

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

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

: That's good.

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

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

: It means healing circle.

: Healing circle. I thought that's more appropriate.

: Thank you.

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

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

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

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

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

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

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

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

: Congrats on finding that sweet spot.

: Thanks as you know it's trial and error.

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

: Exactly.

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

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

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

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

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

: Sure. Alright.

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

: Okay.

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

: Great.

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

: Empower the patient.

: What is the biggest mistake or pitfall to avoid?

: Gosh not not listening to the patient.

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

: Keep learning.

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

: Passion and love for the patient.

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

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

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

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

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

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Simplifying Medical Device Cybersecurity with Mike Kijewski, CEO at MedCrypt

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Simplifying Medical Device Cybersecurity with Mike Kijewski, CEO at MedCrypt

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

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

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

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

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

: For sure.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

: Sure. On it.

: Love it.

: So.

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

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

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

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

: How do you stay relevant despite constant change?

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

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

: Patient safety.

: What book would you recommend to the listeners?

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

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

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

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

: Likewise. Thanks for having me.

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

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

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

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas, great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is slow. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

: It's pretty amazing man.

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

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

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

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

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

: For sure.

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

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

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

: Congratulations.

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

: Well congratulations on getting to this big milestone man.

: Thank you.

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

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

: That's pretty cool.

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

: OK.

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

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

: Happy to do so.

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

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

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

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

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

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

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

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

: Right.

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

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

: Thank you.

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

: Yep.

: What's the best way to improve healthcare outcomes.

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

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

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

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

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

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

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

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

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

: Give us three man.

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

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

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

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

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

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

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

: Before you're a healthcare CEO.

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

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

: Thanks, Saul. Appreciate it.

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Improving Heart Health and More with Mark Abrams, Head of Patient Engagement at Heartbeat

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Improving Heart Health and More with Mark Abrams, Head of Patient Engagement at Heartbeat

: Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas, great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is slow. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

: Welcome back once again to the podcast. Really appreciate you tuning in today, I have the outstanding Dr. Mark Abrams. He's the Head of Patient Engagement at Heartbeat. Heartbeat is a startup based out of New York City that uses a multi disciplinary team of cardiologists, engineers, educators, and more to help prevent diagnose and treat heart disease and its risk factors for people at any age. Through improving access to knowledge and clinical care in a modern way they hope to make cardiovascular disease a thing of the past. Dr. Abrams is a cardiologist in New York, New York and is affiliated with New York Presbyterian Hospital. It's a pleasure to have him on the podcast today. And I'm looking forward to the discussion. Welcome to the podcast Mark.

: Thank you so much.

: Hey It's a pleasure. Now tell me Mark what is it that got you into this health care field to begin with?

: Well it's kind of a funny story I guess. I always wanted to be a doctor growing up and it really started when I was in middle school. So we all know there are these TV shows on that portray doctors and various lights. But there was one that was kind of the first reality show about doctors that I could remember called Trauma Life in the E.R. on TLC and I watched it and it followed these doctors and surgeons around doing these emergency surgeries and things like that and really got me excited about the idea of being in the health care field. And then as I got older and a little bit more mature I realized the real impact that doctors have, not only on the individual patient but really on whole communities and that got me more excited to continue on that path and really do what I'm doing today which is helping patients but also helping populations.

: Well that's exciting man and I think it's really great that you decided to come into this space because it is definitely a need for some new ways of doing things and digital health is one of those ways. So I'm excited to dive into the things that you and your team have cooking over there. What would you say today is a hot topic that needs to be on every medical leaders agenda? And how are you and your organization approaching it?

: So the topic is definitely patient satisfaction and I think that really permeates to a lot of other ideas out there. But what we're doing differently than a lot of places is something that you mentioned in your intro which is that we really do have a multidisciplinary team working together everyone bringing their own expertise to focus on patient care. And we've started with cardiovascular health which is a huge issue especially in the United States. It's the number one cause of death kills more people than all cancers combined. And for the most part is largely preventable if people have the right information and make the right lifestyle changes so not to say that it's low hanging fruit because you know lifestyle changes are definitely difficult. But it's something that our whole team is very excited about doing better than as a nation we are right now.

: Now for sure it's definitely a big liter of mortality in this country so it's great that you guys decided to start in that niche. What would you say is an example of how your organization Heartbeat has created results or improved outcomes by doing things differently?

: Yeah. So it starts by thinking about what the endgame is and for us that's really to prevent heart disease before it happens. And so we're a fairly new company and obviously in order to prevent heart disease we're going to need a lot of patients to demonstrate that the good thing is that heart disease actually starts many many years even decades before people present with their symptom whether it's a heart attack or shortness of breath or they get referred to a cardiologist because their primary care doctor found something wrong with blood tests or an EKG. So what we're doing and how we're trying to create these results is by getting people in early and getting them excited about their heart health which is something that a lot of doctors have trouble doing. And part of the reason is probably a little bit of implementation science and how people interact with the health care system but also as a doctor and going through medical school and training and everything I've had a lot of family members just ask me questions about their health instead of asking their doctor. Even before I was even really qualified to answer those questions. So what we're doing a little bit differently is we're trying to create that atmosphere that makes patients feel comfortable approaching, us reaching out to us as if we were their family member to get reliable answers instead of trying to find the information on their own. So what we're really doing is preventing this cycle of heart disease that people are stuck in right now. And so a couple of examples of what Heartbeat is doing to attract these younger people and get them interested in their health before it's a problem. Are things that fall into what we call our heartbeat life category which is things like run with a doc where you can actually book an appointment and go exercise with a doctor and ask them questions about exercise, diet, and kind of normal lifestyle things that you might have questions about that really do impact your health. Another example that we've had some early success with so far is something called Eco Meditation where we take a typical heart test called an echocardiogram which is an ultrasound video of the heart eating that we use typically to diagnose heart problems with the way the parts valves are functioning or the way the heart muscle is functioning. And we've paired that up with a meditation where someone guides you through live imagery of your own heart and takes you on a journey as you watch videos of your own eating heart in real time to get you motivated about taking care of the thing that keeps you going every day. So those are just a couple of examples of how we're doing things differently to get people excited about their heart health because although it may be something where by the time you get excited it's almost too late for the current people stuck in the cycle we want to break that and really get people in in their 20's, their 30's when they can actually make a difference by doing things over many decades.

: I think that's pretty cool Mark and you know one of the things that comes to mind is the Insurgents of Wearables and now Apple having FDA approval for some of the things that they're doing I might open up the field for more of this. The challenge that we face is how do we pay for this? Have you guys overcome those obstacles?

: It's a great point and it actually gets us very excited when Apple had their announcement the other day about the ECG feature of the new Apple Watch. I think a lot of doctors out there that are working in the traditional health care systems are probably nervous about what that means and all the phone calls they'll get from patients. So we're actually excited about it because it's something different that's going to get people excited about their health and in terms of how we pay for that. I think there are two ways of looking at that. One is the short term and the other is the long term. Obviously everybody would love to see the health care system in the US have a cost savings but sometimes you have to put a little money out in order to get it back in the long run. And I think that's probably a phase that we're in right now where do you see consumer technology industry like Apple which hasn't really been in the medical device industry at all really breaking into an arena where not anybody has gone before directly targeting consumers with a device for medical diagnostics and although you are hear different opinions about that, I think it is something that's exciting and we do need to give it time to really see whether it's going to cost our system money or it's going to save us money. Heartbeat in general is where an organisation that thrives on that and we're excited to be involved in this process. It's a great time to be in cardiology.

: Yeah without a doubt Mark and there are a lot of these things are an accumulation of time and and they just they don't just happen. It's a process of build up and many years of keeping up with your health and what you're eating and getting excited about it is definitely a great way to go about it. Today, what would you say one of your setbacks has been as you guys have been building the company and what have you learned from that setback?

: Yeah it's a it's a great question. I think you know when I think about our setbacks as a company I really think about my own professional career so far and something that comes to mind is when I was going through my training process I really got to see firsthand how rising the system and in a medical center is typically about climbing the ladder as it is and many arenas. And when I started working with my colleagues at Heartbeat what we did differently is there really isn't a ladder per se. Everybody has an equal say and the fact that I have professionally I would say as a physician that I didn't get before I joined Heartbeat and it's a position called the Chief Resident. And what that is is an administrative role for a medical resident which is a training program where you really get to try to make a difference in the education and the implementation of training programs at hospitals. And when I didn't get that I was really devastated. Looking back on it though it actually has helped me and my vision for what I bring to Heartbeat a lot because it showed me that you don't really need to climb a ladder in order to form a path. And sometimes making your own path with people that are interested in the things that you want to accomplish also is sometimes much more powerful than falling into the line that other people have in mind for you. And so as a company we've been you know so far it's still early but we've been very dedicated to an open atmosphere where it's a safe space of sharing ideas iterating on those ideas. And even if some of them don't work, out the learning process is definitely there and more valuable than any one thing that we may have tried in the past.

: Yeah that's a great call out you know and what could seem like a setback could oftentimes be what propels you forward and not getting that Chief Resident position really sort of catapulted you into trying to figure out how you can add value. And I think it's pretty cool that you envelope that into what you're doing at Heartbeat now. I'm excited to see how you guys really turn this into something that impacts populations in the way that they are taking care of themselves. So I know that you guys are pretty early on right now but what would you say one of your proudest moments to date has been with the group that you've formed?

: My proudest moment is probably the first day that I was in the office. But oh I'll get to something that's a little more tangible than the first I'll just describe the feeling that I got being in the same room as an engineer,a designer,business people, a data scientist, an educator myself, and a cardiologist just all sharing ideas and brainstorming on a whiteboard. It was honestly something that I had never experienced before and I really got to see the power of synergy in that room at that one time and that energy really is something that hasn't stopped. We all encourage each other. We all feedback on each other's ideas. We all have different opinions and biases and we all call each other out on that. In order to really achieve a common goal. And that's very powerful. And the example that I'll give to you is Heartbeat's program that I started which is still very early on called Heartbeat A Lead which really asks people in the community to nominate themselves, their friends, or family members with things that they're doing that they're proud of regarding their heart health. So so far we've had an awesome turnout of people putting in their names. People that grew up in underprivileged situations, eating very unhealthily in their childhood now teaching their whole families how to cook and how to exercise. We've had people who have gone all the way through extensive heart disease resulting in heart transplants and now going back to their own communities and talking about heart health. And that's what I like about what we're doing and that's why that's probably my proudest moment so far because even in the digital space which is how we deal with our Heartbeat A Lead applicants I'm really seeing what Heartbeat is doing is affecting communities. And even though it's early I'm sure that's going to turn into hard outcomes at some point because I can already see the excitement.

: That's pretty awesome man. Congratulations.

: Thank you.

: So we're getting close to the end here Mark. I know. It's amazing how fast these things fly. Let's pretend you and I are building a medical leadership course. And what it takes to be successful in medicine today. The one on one course of Dr. Mark Abrams here. So I've got four questions for you lightning round style followed by a book that you recommend to the listeners, you ready Mark?

: I'm ready.

: All right. Question number one what's the best way to improve health care outcomes?

: I think number one we have to give patients more engaged in their care and really make them feel part of their health care team.

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

: I think it's easy to do when we're trying to change health care systems but we really can't forget why we do what we do which is the patient's front and center.

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

: Great question and I think the answer is that you have to be the change and then you'll always be relevant.

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

: In one word I'd say it's innovation.

: Love that and what book would you recommend to the listeners, Mark?

: A great book that I read a while ago and recently reread. It's called The Spirit Catches You and You Fall Down by Anne Fadiman and it's a book about an immigrant family from a small tribe called the Hmong tribes who moved to California and they have a young child who's diagnosed with epilepsy or a seizure disorder. But their understanding of medical illness is something that we doctors refer to as health care literacy was very low and they really didn't understand what was going on with their child even though the doctors knew what was going on with their child and I think it points out something very important which is that we may have a lot of research that tells us about disease how to diagnose it how to treat it but if we're not bringing in patients into their own health care team in a way that they understand and buy into then we're really not accomplishing very much in terms of patient health and patient satisfaction I recommend reading that book and really really thinking about how it affects our health care system today.

: And it's such a great point that literacy piece you can know it all you could know how to treat it but if you can't explain it it really is not going to help you with things like medication and here and soon. And what happens when a patient leaves the hospital. I think a lot of things fall through the sieves so to speak. When you get to that point I mean it's a phenomenal recommendation by Mark here. And folks if you want to check out the transcript and all of the things that we discussed links to this book as well as the company go to outcomes rocket health slash heartbeat and you're going to find it there. Mark this is awesome. Really appreciate the time you spent with us if you can just leave us with your closing thought and then the best place where the listeners could get in touch with you.

: Absolutely so thanks so much for having me on your show. It's really been fun talking to you. The last thing that I'll leave everybody with is to really think about a personal experience that you've had with the health care system and think about what was wrong with that or what made you hesitate in reaching out to your doctor. I know we all want to do better with our lives in terms of our health because that's kind of that's an asset that we have that nobody would trade anything for. And I'd encourage you to join Heartbeat and our mission to not only prevent heart disease but also get involved in learning about your own health and reach out to us. So the best way to get in touch with us is to either go to our website heartbeathealth.com or you can e-mail me personally mark@heartbeathealth.com and I'll get right back to you.

: That's awesome. So there you have it folks. Take a note. Reach out and for you Mark we give you a big thanks for joining us today.

: Thank you.

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Empowering Women and Families to Take Care of Their Health with Paris Wallace, CEO at Ovia Health

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Empowering Women and Families to Take Care of Their Health with Paris Wallace, CEO at Ovia Health

: Welcome back and today I have an outstanding guest for you today. His name is Paris Wallace CEO and co-founder at Ovia Health, the leading women's health and technology company trusted and loved by millions. Ovia's Health fertility, pregnancy, and parenting programs empower women and families to take control of their health care and start families with confidence. Paris is also co-founder of Good Start Genetics. It's a genomics company focused on fertility and reproductive health. Good Start Genetics was acquired by Invitae and this is a stock market NVTA. Prior to Good Start Genetics, Paris spent his career starting companies and working with startups. He's a serial entrepreneur, a lover of health care and making things better in outcomes and so it's a pleasure to welcome you to the podcast, Paris.

: Yeah thank you so much for having me. I'm excited for our conversation today.

: Absolutely. Now is there anything in that intro that I left out that you want to let the listeners know about?

: No. I mean you do a nice job of summing up. You know I spent my last 10 years really trying to improve the health care system for women and families. I'm really really excited about that.

: Well it's an important mission to be focused on. There's definitely room for improvement and also a lot of good being done and so curious what made you decide to get in the medical sector and focus in this space?

: Absolutely. Yes so you know I decided pretty early on in life and my career that anything that I spend my time on professionally I wanted to be with a company, an organization that really had a tangible impact and a positive impact on the world. So early on, there while I was in business school I started looking at really closely studying kind of impact investing in organizations and really thinking about where I could get involved and actually ended up doing a fellowship at the Kennedy School at Harvard. I'm spent a year studying Social Entrepreneurship and saw so many different models of social change from nonprofits to for profits and really made the decision and the realization that I thought the way that I could make the most change and really have a positive impact in the world was to create a for profit company that ultimately was in a business that could change the world. No improvement for folks so started good start while I was in business school with the idea of helping parents see if they're at risk asking a genetic disorder to their children but really taking next generation DNA sequencing into the clinic were the first company to do that on a massive scale. Really pioneers in the genomic diagnostic space that has now become a huge industry. And then on the data side with Ovia Health now helped over 10 million women something I'm incredibly proud of my team is incredibly proud of you know to help them do the most important work that they do in their life of starting their family. And that's really been an amazing place to innovate but also really positively impact the world.

: Met outstanding. And so you definitely have found a great niche to make that impact on. Folk, Paris was actually named to the 40 Under 40 list in Boston in 2017. So the way you do this is by adding major value on scale. And he's doing just that. So Paris just diving into the health care system today. You know you guys are focused on women's health and so within that what would you say a hot topic that needs to be on every medical leaders agenda today and how are you guys approaching it?

: Yeah I think when I'm out looking and talk with folks across health or a spectrum I think something that there's not a big enough focus on and there certainly should be especially with the way that the trends the prevailing trends in health care just consumerism and health and thinking about the patient as the customer and how do you design solutions for those people as payers and also as patients. It's been a massive shift in who is paying for health care and whether dollars are coming from. Each year a larger and larger percent of those dollars but also frankly just a larger and larger percentage of the responsibility for one's health care is falling on that patient or back consumer. Yet the industry as a whole is still designing solutions for providers for payers and not necessarily for this end user who now more likely than ever and especially going into the future as is likely going to be paying for that service and likely going to be the one who's responsible for the follow up. So I really think how does the industry change how do we really embrace consumers, rethink the role that they're going to be playing in the ecosystem going forward, and start designing solutions but allow them to be more educated about their own health care and better navigate the system whether it be on the payment side or even the treatment side where these users are getting more most possibility.

: I think that's such a great highlight. Paris Sandy had a previous guest say that the user interface to health care is broken and it presents many opportunities for entrepreneurs. And so you're definitely highlighting that point as well. Can you give the listeners an example of how you at Ovia or at one of your other companies have improved that user interface?

: Yeah absolutely. You know one of the big problems in health care is data interoperability. Right. So there's all these amazing data analytics tools that exist but there's not a data set for them to be used against that can really forward science and understanding. So in Ovia we came up with this really simple idea which is we will create a great platform for users that's really delightful and we'll ask them to share their data and then we'll use that database to do core research on women's health really to get the outcomes. So you know we start, we launched us about five years ago. Fast forward we now have the largest data set that's ever been collected in women's health over 15 billion data points across and million women and we're using medical guidelines and machine learning to really understand the fundamental biology for women's health and how to promote outcomes in a way that's totally unprecedented. Right. And it really started from that design thinking of not saying hey how do we access information that's in EMR maybe across different platforms and then reformatting something that we can scale. You know we said hey you know we now about 40% of the pregnant population in the U.S. on our application we're using the data from those users to do real time analytics giving that information back to the users and they're changing their behavior based on that. So we really are able to practice kind of this population like medicine based upon putting the consumer at the middle and designing a solution around that user fundamentally and treating them as both the you know the payer the provider and the patient. And they've really been able to respond to that new way and we never do things to really unprecedented.

: What a great example. And you know so was this the vision from the beginning? Did it evolve? Maybe you could walk us through the journey because that to me is very interesting.

: Yeah. So we really started out with this vision of wanting to become the platform where women and family went to make their most important health and life decisions. We believe that to build a really meaningful engaging health care experience you need to go everything from what color do you paint your nursery and what are the hot baby names this year to is that symptom normal. And how do I avoid preamps here. Preterm birth and everything in between. So you know we started with a direct consumer applications became kind of the number one digital health brand for millennial moms. Build the database around it started using analytics to really understand what that data was telling us in a way that no one had ever been able to do before. Turn that into outcomes and results for our users which we then were able to take those outcomes and results and engagement and start working with payers and employers and provider organizations to help improve the outcomes for the users. But at the same time just have a completely delightful understandable experience for those users that they wanted to interact with everyday.

: It's a stressful time and there's a lot of questions and you guys made yourself the friendly place to go and the users responded so you know as folks as we as we approach this topic of health care consumerism it's more than just a topic it's the reality right. I mean we're used to going onto Amazon, click and a couple of buttons, getting some recommendations on what we find relevant and the speed at which it all happens. It's just critical that we align to that in the health care space. And I love Paris's message here. Him and his team are doing this so definitely a lot to be learned from Paris's words of wisdom here. Paris how about the other side of things. Tell us when you had a setback something that didn't work out the way you wanted it to. What you learn and what you do differently as a result of that?

: Yeah I mean a great example is from my first business could start genetics. You know we were really committed and really excited about how the next generation gene sequencing was going to change medicine. You know really revolutionized medicine this way when the first generation of gene even concerns were coming out right after the Human Genome had been sequenced for the first time and we were really scientifically incredibly motivated. And I think you know ultimately the mistake that we made was not going out and talked to enough doctors and realizing that although clinical accuracy was important and the technology was important there were other things that they wanted to do with their patients things around turnaround time things around out-of-pocket pay for patience insurance that were not going to be reimbursed for that direct to patient reporting on that we just missed. So we launch a test that was absolutely the gold standard in the market and continues to be today but didn't have some of these other features that folks came out and I think everyone would readmit this now that with a much lower quality test. But that had some of the features that really made as attractive in the market. And they were able to you know effectively compete with us whereas if we had both had the gold standard test as well as some of these features early on there would have been no way to compete with us. And that was a big lesson that I took on to Ovia and really thinking about you know making sure that we stayed cool really really close to our users really really close to the folks who are paying us. And you know it's not about what we want to sell them. It's about what they want to buy and really and making sure and what they want to use and really making sure that that we stay close to those folks and we're making the right decisions for them not just right decisions now based on the technology or based on other prevailing trends.

: Man that's such a great call, Paris and what comes to mind is that not sure if you ever read the Blue Ocean Strategy?

: I have not read that.

: You haven't? It's a great one and he lays out a really cool Buyer Utility Map. So it takes you from start to end the buyer experience and then the six areas of utility and then just kind of plotting yourself on a map and it's really kind of thinking through this paradigm. The lesson that you learn and it's easy to say from the outside versus when you're in the trenches right. And so it's so cool to hear about your story what you've learned and now how you're applying it and the structure for those listening that at Paris it's Blue Ocean Strategy it's the buyer utility map. Put a link to it on a show notes but it is a concept that's cost companies billions of dollars and it's all the help companies help billions of people and make billions of dollars. What a great great thing to share.

: Yes I mean I think absolutely resonates and that's still that's the next barrier with health care is for folks big health care companies to actually start designing things with the patient in mind not designing things that physicians will use for their patients not designing things that payers will use for their patients but actually designing things that patients want to use that also have utility for payers and providers. I think that's something that that's an approach that we've taken that shouldn't be novel. But isn't the health care system right now.

: Yeah. Now that's super interesting and yeah you know you got to keep all of the constituents in play folks and Paris and his team know how to do that. They have a sweet spot for this. What would you say one of your proudest leadership experiences in health care has been to date Paris?

: Yeah I mean I think I'm only a leader because I have a fantastic team behind me and I think the biggest milestone that we've celebrated so far and at the Ovia and something so huge pride in the accomplishment and also the team that it has allowed us to get there is to have over 10 million users. Right. So if you think about it there's 4 million births a year in the U.S.. We've been around for about six years. We have about two and a half years worth of all the births in the U.S. have used the Ovia platform to help them do the most important work that they do in their life that should start their family and to be able to have that big of an impact, to be able to help people during this time in their life really get better outcomes and make it easier. And how many lives were saved with our technology across those 10 million folks. It's just such a meaningful accomplishment for myself personally having started this with three other folks and you know been around a table to have that level of impact and have a team that's really dedicated to seeing that impact in the world. It's definitely my largest accomplishment as a leader.

: That's awesome man. Congratulations. And for the listeners Paris that are either pregnant or act with your service.

: Yes so you can you can go on to the App Store. We have three apps- Ovia Fertility, Ovia Pregnancy, Ovia Parenting. We also have solutions for providers, for payers, and for employers. So you know on the employers side we're really focused on improving the way that families are supported in the workforce. Well from the outcomes perspective as well as from the employee perspective when we love working with employers on it.

: Love that. And from a provider perspective, you also have a solution?

: We do. Yes so we're starting to work with provider organizations to really be a digital platform that providers are using to continually monitor their patients and to become relevant in their patients digital lives to improve outcomes and engagement with their provider.

: Outstanding. You know folks this is a great example of just mastering what you offer and just offering it to all in our health care system. There's a lot of stakeholders. So whether you be a provider payer or a patient family there's definitely a way for you to take advantage of the solution that Ovia as put out there so appreciate you highlighting that parents. Tell us a little bit about an exciting project or focus that working out today?

: Yeah I mean we're really really focused on building this employer and provider business right. The end goal is to obviously improve the way that families are supporting the workplace but at really surround our users with all of the resources they need whether it be their employer benefits their insurance benefits their providers where they can get access to all those resources inside of our application to really make a meaningful impact on their outcomes on their pinnacle outcomes as well. As you know making it as easy as possible to transition from employee to working parents successful working parent this is a transition that's incredibly hard in the U.S. for a variety of reasons. Hample from you know negative health outcomes because people are not getting guidance from care to workplaces that are well intentioned but don't necessarily have their benefits programs designed in a way that are easy to use or understand for the target population. So helping companies solve this and seeing what it means to our users when these things are solved is just absolutely tremendous the impact that we're able to have. And something are really really excited to continue. This is growing incredibly quickly will grow 200% this year because it's just you know I think obviously we have an amazing solution but a lot of it is just it's a huge issue out there and it's something that employers are realizing they can really do something meaningful in their employees lives during this incredibly high stress but really happy time. So they're seeing what we're doing and say I want to be part of it I want to be part of this movement.So

: it's been really heartening to see that that outstanding parents and employers today are one of the largest economic stakeholders in this. So if you're an employer looking for a way to support your employees not a solution to think about. Kudos to you and your team my friend this is truly exciting and talk about just finding that tipping point where you're offering that value to patients and then also even to the payers whether it be employers or insurance companies. You've taught us a lot. I love to just summarize it together with you today. Let's. And you and I are building a medical leadership course and what it takes to be successful in the business of medicine today. It's the one on one of Paris and some of their. Some of us with you. I've got four questions. Lightning round style 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?

: I think the best way and the lowest hanging fruit is just data right. Being able to actually deeply understand your users or your patients or your members or your employees in a data driven way that is replicable that is applicable across the entire population huge opportunity there that very very very few companies are actually taking advantage of.

: Love that. What's the biggest mistake or pitfall to avoid. Make sure you deeply understand the user of your product or service and that you deeply understand the buyer of your product and service they may be the same person. But in healthcare a lot of times there are two different people and you need to design for both of those folks with a deep understanding of them.

: Very wise. Folks listen because some good stuff. How do you stay relevant as an organization despite constant change?

: I think that it kind of sets a little bit too far with the last answer. I think it's really understanding the user right. If you want to know where the market's going if you want to know what people are going to want next year five years from now ask them if you have that relationship built in and you have this kind of virtuous cycle where you are continuously learning about those folks who are using your product and buying your product. You're going to be able to stay ahead of where those needs are and you're going to be able to continue to iterate the product in line with what their desires are. And you know I think that is absolutely key in ensuring that you are up to date and doing what you need to be doing?

: Love it.

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

: Yeah again I guess this is that refer.It's your users. As soon as you design something that you don't know the users are going to love you're gonna make a mistake and they got this great advice. When we when we first started doing digital product design someone said keep asking the question until you know what the answer is going to be because you've heard the same answer some times. I think if you if companies were going to go out and actually be able to do that you could avoid so many mistakes and so many billions that are wasted on products that no one wants or no one's ever going to use.

: Love that. You know what your user wants. And is your user the one that buys it. Great message here Paris what would you say your favorite book that we'd add to the syllabus listener.

: Yeah. So I'm going to be a little intriguing here and I'm actually going to talk about a podcast because this is a podcast so presumably you were both reading books. Podcasts are dancing to this how I built this which is an NPR podcast. Absolutely fantastic. They tell the stories of entrepreneurs who built huge companies like Patagonia or BMB and they talk about you know really a very I would argue simple customer understandings that these entrepreneurs came to that led to these gigantic companies. And I love it because it shows that you know this stuff doesn't have to be super complicated, it's folks just really digging in to customer, really understanding what their needs are, having some insights about the trends of where the world's going. You put those together and you're really able to build a huge company and I think you know being in health care and technology on this side there's so much we can learn from the pure tech folks on the other side and this is a great way to hear from some of the best entrepreneurs in the world and what they did to really build companies that we all use everyday.

: Love that. What a great recommendation. Paris and you know as a podcaster, I'm a huge consumer of podcasts as well and I love that you made this recommendation. It's been recommended to me before but I've never actually listened to it. So I am now going to listen to the first episode today. Thanks to you .

: Great.

: Thank you very much. And listeners take a look at that too because it sounds amazing. Before we conclude Paris, this has been fun. If you could just share a closing thought and then the best place for the listeners to get in touch with you.

: Yeah I mean in terms of closing thoughts I think this is the time to do it and health care there. You know it's the largest industry in the in the United States and things need to radically change over the next decade for it to be sustainable. It's that one thing that everyone in the country is going to use. At one point or another. And if you can figure something out we can really make a huge impact on people's lives in the way that you can. Any other industry and really together we can have a huge impact on the world and the way that people are living in it. So I really would encourage people I know it's really hard and it's slower and harder and sometimes it's like less and the other industries. But this is the place to be. And it's just getting started. We're just at the end of I think at the end of the first stage and that gets the really really exciting part. And health care and innovation therein. In terms of getting in touch with me, Paris Wallace you can find me on Twitter, Facebook, LinkedIn, I would love to answer any follow up questions. I'm sure more about what we're doing a lot of mentoring young entrepreneurs thinking about these these things or anyone who wants to talk about consumerism and health care. I would love to have that conversation with you.

: Outstanding Paris, you gave me goosebumps with that closing thought. So a word of encouragement to all of us listening to this Paris thank you for spending time with us and looking forward to seeing more you take this company and the next ones that you get involved with in the future. Thanks so much for all you do.

: So thanks so much for your time today I really appreciate it. Take care.

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Patient Safety Through Smart Community Building with Roni Zeiger, CEO Smart Patients and Patient Safety Group

: Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have the outstanding Dr. Ronnie Zeiger. He's the CEO at Smart Patients and Patient Safety Group. Dr. Zeiger is the former Chief Health Strategist at Google where he led efforts ranging from Google Trends to symptom search. In 2012, he and Gils Friedman founded Smart Patients, an online community where patients and caregivers learn from each other about treatments the latest science and how it all fits into the context of their experience. As we know the health system can be very opaque and solutions such as these are providing patients with what they need to have their own concierge and medicine understand where they're going. Ronnie serves as the CEO of Smart Patients and continues to see patients in the urgent care clinic at Santa Clara Valley Medical Center. So it's a true pleasure to have you on the podcast, Roni.

: Thanks for having me. I'm excited to be here.

: Absolutely. So I'm always curious you know people that are doing outstanding things in health care what the genesis of it all was. What made you get into health care to begin with?

: It was a little bit accidental. I was always into science and thought I would be a scientist. During college I spent a lot of time working in labs and while intellectually it was really interesting it was also a little bit isolating from a social perspective and I kind of wanted a way to combine science and people. I was very lucky to grow up bilingual. My family is originally from Chile. Oh yeah. And so I took a job as a volunteer a job as an interpreter in a clinic near where I went to school. And it was tons of fun to be involved in those conversations and I saw that as a really fun potential career path as well. So it wasn't too hard I had done a lot of the same classes that I needed to do for her premed so kinda actually last-minute changed from molecular biology to go to medical school.

: Wow. Outstanding. And yeah I mean it's close enough so that you didn't really have to make any drastic changes. Kind of parlayed really nicely huh.

: Yeah yeah it was, it was lucky an easy switch that worked out great for me.

: That's awesome. Now have you been to Chile lately?

: I have. I go every few years actually going this December.

: Oh you are?

: To spend some time with my 98 year old grandma.

: Oh my gosh 98 huh.

: Yeah.

: That's amazing. Good for you and good for her that she's taking care of herself. Hopefully she's doing well.

: She's doing amazingly well.

: That's awesome man. Yeah. Chile is one of those countries that is super progressive and in their sort of healthcare technology adoption. I covered Latin America for a while. My folks are actually from Mexico so I got a chance to experience Chile. And yeah I mean they're just forward thinking, moving in this space so fascinating. For those of you that don't consider these country is if you're looking to expand your technologies and your business, Chile is definitely one that you should keep on your radar.

: Thank you.

: Right. So what would you say Roni is that hot topic that needs to be on every medical leaders agenda today?

: So many ways to potentially answer that question. So this depends a little bit on on the space that you're in. Two things come to mind: One is learning from your end users you know that could be your patients or the patients using your system that could be the clinicians and other staff that are interacting the tools or services that you're bringing but have been supposedly practicing and definitely preaching concepts of user centered design for a long time. But I still kind of suck at following them myself because I regularly fall into the trap of thinking that the ideas that are making come up with or are the right ones because you know we're good at what we'll do usually. But you have to get reminded of the humility that the reality that you know we never get things right the first time iteration is required and there's no smarter people on the planet than those on the front lines of whatever it is that you're trying to search. So building feedback loops and spending time with folks who are using your tools are the folks at your serving. There's no substitute for that. So I try to ask the question like no what have we learned from our patients today or what have we learned from our users today or what have we learned from the leaders that we're supporting today. Because if it's something that we're only doing like once a quarter that's more than most of us. So it is one thing. The other is more about kind of at a philosophical level. And that is making sure that you and your team are really excited about the direction you're heading in. And that's a tough one because if you're not then your options are not necessarily easy. But I think for a long term successful for you as an individual and for the team that you're leading if you're not excited about what you're doing then you you don't need to sort of fine tune what you're doing or do something dramatically different.

: That's an interesting point, Roni and so as you dive into that I mean if you are not you know what are the risks and if you're not how can you pivot maybe you can dive deeper into that.

: Well it's interesting I hadn't thought about it before until right now but I think those two ideas are pretty related. One of the things that can get me really excited is spending more time with with the individuals actually sometimes spending more time with people and less time with software even though those are my kind of stuff building software. Visiting partners spending more time with clinical staff and with patients. I get to see patients but that's very part time and that's wearing a kind of a different hat so to me a lot of it stems from interpersonal relationships whether that's with a patient, a colleague, a partner, a customer because people are quite inspiring and in healthcare we have this ridiculous privilege where most people go into healthcare go into it because they're excited about helping others and so that kind of breeds a lot of that energy that we can tap into. So I think maybe when you're feeling a little lost or inspired or like "Gosh am I really doing what I'm supposed to be doing?" spending more and more time with the people that you're working you or that you're serving especially the ones that you don't get to interact with regularly is effective and inspire often inspiring way of kind of finding more energy which in turn will help you fine tuning out the direction that you're heading in.

: I think that's such a great great highlight and it's really interesting that you guys have decided to focus on this segment. You know the patient segment frankly the health care really the economic business models don't help companies focus on this space but you and your partner have really done a great job. And folks if you haven't checked out the site it's https://www.smartpatients.com/ one of the areas that I found most interesting Roni was the communities and all of the things that you guys focus on. I mean it is just so many things that I mean whatever your condition or area that you're in there's something there a community. And so I'd love if you could just share with the listeners how these communities have led to outcomes improvements or better care journey for her patients.

: Sure. So I think there's two very interestingly different chapters in the story from certainly from a business perspective. So building community in general and building communities for patients is incredibly satisfying and nurturing work and at least doing it the way that we want to do it is not a huge business today. There are not a lot of business models where we can charge significant sums for connecting patients to other patients. This is something that kind of is thought of as something well yes sure. That just happens. You know maybe in the neighborhood and we can facilitate it happening online. We're not an advertising platform or a clinical trial recruitment platform and those are two common business models. Nor are we doing kind of data mining and selling aggregate data. None of those things are necessarily bad. We're continuing to work hard to align the service that were building the fundamental value that we think we're building which is really the ability to learn from each other whether it's patients learning from each other or others which I'll get to a second. But this is still a very new idea in healthcare. One of my personal goals with all of this is to make peer support that the thoughtful and well managed connection of one patient to another family member to another it's a normal part of our health care system. So getting for example health systems to prescribe peer support is something that we're working hard on and we're making progress and it's super slow because it's a cultural change. So it's not the "Oh yeah we're going to have you know 500 million users in 18 months" story. So an interesting thing that's happened that's been just a huge stroke of luck because it wasn't it wasn't really planned. Is that as we've worked with health systems to help them provide their patients with a safe trusted and well managed option for peer support as opposed to the Wild West that is stereotypically East face. We started getting a really interesting question from them which is "Hey now that we understand how this works, it's good that this is an option for our patients - What about us? What about nurses who are also sometimes struggling with various issues?" Different from you know of course sometimes we all of us or sometimes patients. But you know we have very now we have a bunch of other issues that we deal with at work and peer support this is kind of an untapped resource for us too. So that's led to the more recent chapter of our work. We actually acquired a smaller company an even smaller company where she'd say called the Patient Safety group about a year ago. We'll be relaunching that actually before the end of this year. Haven't really formally announced it but it's also not a secret and there we're using a lot of the same social engineering tools and a lot of the same software tools to support clinical staff. And that includes not just here support but also doing more quantitative measurement of things like things related to safety and quality. So we kind of back to it or into another portion of our business which customers the same. It's the health care system. But now instead of having to invent a brand new category which is peer support invented from a business perspective and peer support is not a new thing it probably existed before organized medicine. Right. And the way normally support each other as humans. Now we're doing that for patients. We're starting to do that for our health system staff and we're doing it in a context that directly supports safety and quality both for patients and employees and using our social engineering and tools to do that in a way that's growing our business nicely and in a way that we're excited about.

: I think that's so cool Roni that just one of the quotes that I heard back in the day it was like 12, 14 years ago was like the best way to succeed in business is to be in business and you can't spend your time at the drawing board. You've got to get out there and and this is a great great example of that you guys went out with a solution providers started noting and the other thing too. I think it's really great. I mean so many people go to the Web and they search their condition and then they find all of these things that scare them or mislead them. I think it's great that health systems are looking to you guys for a more organized credible way to to inform patients. How do you guys monitor what's being put out there and that out. What is good versus bad or do you guys not do that?

: Yeah. It's a rich question. So we do very short answer and then I'll dig in a bit deeper. I think sometimes people kind of imagine that there's two possibilities one it is a totally kind of unmonitored system - whatever happens happens. Then the other is which of course has its pros and cons you know good things will happen and bad things will happen there. And then the other would be a system where basically there are only clinical experts answering questions kind of more of an official Q&A. And in healthcare, we traditionally have been very uncomfortable with the first one because who knows how people might hurt each other. Browning around knowing me and we're very comfortable with the "well let's just make sure that it's only valid qualified legitimate experts answering people's questions so that people get the right information and no one is hurt and no one gets blamed for someone getting hurt".

: Right.

: There's a really a spectrum between those two and we've landed probably somewhere in the middle. It's a little bit hard to to describe exactly where we are in that continuum. But first of all there is a belief we have a belief that peers are a very useful source of both emotional support and information. Doesn't mean that everyone is providing sort of accurate and it was going to provide accurate information. Quick sidebar academically at least I think that's a really interesting question to consider. What percentage of the information that we provide as clinicians is accurate? I struggle with that myself because I don't know what I don't know but that's a separate there's probably a whole separate podcast.

: It is.

: So that's more just a discussion point that there is no perfect gold standard story. There's this beautiful medium that you can find where a very small amount of consistent thoughtful gardening if you will can make a community very high quality. So for example maybe one out of a few hundred people are potentially going to screw up a community by being rude by having an agenda. It's really their own agenda not my agenda that serving anyone else in the community by posting misinformation. And it turns out with a pretty modest amount of consistent monitoring which we do both automatically and with what people. It's quite easy to ensure that those people don't disturb the community. It takes work but it's actually not that much work. So those for this kind of a step function where the free for all that we imagine is I agree not good enough but it's pretty modest and therefore pretty inexpensive amount of work to make it a really thoughtful well managed community and that does not mean that my team is kind of the owners of truth. We have a pretty complex social engineering process with some software tools that makes it so that consistently the community is the one that questions things that are questionable. So it's not you know me sitting there saying "hey guys there's a potential piece of incorrect information here" that we are watching and we do occasionally get involved. But really the vast majority of the time it's someone else in the community saying "Hey Joe welcome. And I'm concerned about what you said here and here's why can you say more about where you learned that?" And so that's built into the culture. So it's a little bit complex but it's probably easier than you would think. And it's really interesting that it's actually scalable.

: Fascinating. Very fascinating. Thank you for diving into that. I was just kind of want to know more or less how that was laid out and makes a lot of sense. It sounds like it started in a piece together quite nicely. People are getting a lot out of it. So can you give us maybe a story about how this is resonating with patients? Maybe a positive outcome that happened or just something that that came out of this has come out of it so far.

: Well gosh so many I'll answer with something that I just saw yesterday. I mean it's a tiny one I'm sure we could find many many others but we have a mechanism by which a member of a community can invite someone they know to join smart patients. Actually I'm going to give you too. So there is basically an invite to a friend or invite a loved one feature and one of the regular sources of joy for me is because I'm an admin, I see when someone invites someone else and they have the option of including a personal note along with the invitation to say like "hey here's one to check this out" or something like that.

: Oh, nice.

: And one of those that happened yesterday someone wrote a note to her daughter I think it was an adult daughter saying "hey a lot of the questions that you've been asking me about Dad I think that you'll find useful answers to them here. - Love, Mom".

: And that was a very you know the specific context it happens to be with that about a narrow degenerative disease, a disease similar to Alzheimer's. The specific kind of clinical context didn't matter to me quite as much as I.. like you know I can for personal reasons can very much resonate right now with struggling with illness of a parent and I have a bunch of advantages like my clinical background etc. But imagining that someone is able to help her daughter understand what's going on with the dad is just awesome. I don't really know what the outcome is so I don't know whether it turned out to be actually useful but just being able to offer that hopefully peace of mind to the mom is really cool.

: Yeah. Yeah. Being able to facilitate that.

: Yeah and of course it's not us doing that right. It's the community. It's the fact that there are other people sharing with each other gave the mom in this case the feeling that would be helpful to her daughter. And presumably it's being helpful to the mom because she's hanging out in the community too.

: Right.

: And then what should seem like maybe a totally different story is that I think that there's some exciting connections. So we do now with our work with health care staff through the Patient Safety Group or division or business. We do a lot of surveys of staff and some of them are required surveys like for joint commission accreditation a patient safety culture serving that needs to be done with the step or two years to measure your safety culture. And we recently did a quick experiment. We snuck in one extra question into the required survey and the question was "What is something that recently inspired you at work?".

: That's a nice question.

: Yeah I think so. I'm a little biased. In a couple days, we've got thousands of responses. This is a big health system where we posed this question and the range of answers is just awesome. First of all the motivation for asking the question is what is inspiring us to do our work in health services system and how can we make those inspiration's a more regular part of our day. Not that anything new. This is already happening. It's just about you know maybe how can we expose people more to those things that inspired them. And it ranged from the case it ranged from things like my sister is from a physical therapist who said you know my patient and tie her own shoes now.

: Nice.

: To a staff member who said who was just amazed at how much people volunteered to work extra during a snowstorm to make sure that both patients and staff were safe and had rides home and have food. So it's just a lot of those kind of small things that maybe you aren't necessarily headline worthy in the traditional sense.

: Yes.

: But I think both of those stories the mom who said "Hey daughter here's some stuff that hopefully will help answer some of the questions you have about what dad and we are going through" and then the staff members who are talking about what's inspiring them to me these are great examples. This isn't like you know none of these things are going to create patents or they're not like traditional biomedical technology but it's just low hanging fruit that I think and easily double or triple the value and quality of what we're doing if we tap into it.

: I think that's so cool and the inspiration that human connection is really a big part of what we can definitely use more of in the healthcare sphere a had about a year ago. Ronny I had Nick Nick Adkins you know the pink socks movement guy Yeah he's doing some great things more so I'm kind of like just giving hugs and handing the pink socks out reminding people to be present and show that they care. And you know this kind of gives me the same type of vibe except it's a little bit more data driven and community based. But it's great to have this focus and says as you and your partner have been working on these wonderful initiatives can you share a time during this process that maybe you had a setback and something that you learned from that setback that as a result you're doing things very differently.

: There's probably like a thousand answers to that question and I think of a of recent one

: one that strikes you the most.

: Yeah. So one that's top of mind these days perhaps because some of the things that are going on in the country. So we have a disproportionately white user base. OK. And that correlates with also it correlates pretty well with the demographics of people who are online in general but even a little bit even a little bit more so. So we were told slightly higher than average economic status of our user base and that's not necessarily a bad thing, that's not necessarily a good thing. So we did a couple of focus groups in the last year with some academic collaborators with African-American patients and family caregivers and to try to be very very open ended way to ask questions about their healthcare experiences - what kind of tools they use, they need. And while what I was expecting to get out of that was things like you know having a more diverse looking set of people on the home page and not only something as superficial as that but that's that's one of the things that I would have hypothesized was was going to come out of that ended up being a set of conversations about much deeper trust issues in the healthcare system and in our community in general. And I'm not answering your question quite the way I think you intended because.

: No but it's an interesting discussion though.

: Yeah. Because I don't know yet what we're going to do differently as a result. We're still chewing on it. But it was definitely a kind of a big learning and humbling experience that we're not even sure if we're asking the right questions to help us serve the broader population that we like to serve. It's sort of like you know we asked you know how would you like us to, how might we change our tools. And the response was I'm not sure if we would go to you for any tools.

: Yeah.

: Not that there's anything wrong with you Roni or you Smart patients in this case this is patients taking patients facing as opposed to their clinician and staff facing patient safety. That is one of those where we're I think some of our most fundamental assumptions need to be challenged and I think what we what we need to do is take a step back and even ask questions like What's the difference between online peer support and in personal peer support.

: That's where my mind was going. Yeah.

: Yeah.

: And community clinics and things like that. Yeah.

: And what happens in the neighborhood in the apartment building versus in the clinic versus in the church and who asks who and who's willing to ask him for example. You know one of the anecdotes from those that of discussions is that for the person answering she answered No. In my culture and she wasn't pretending to speak for all African-Americans or anything like that. But in my community we keep this stuff to ourselves. Now this is nobody else's business. So your premise of reaching out to someone who's been there is something that I'm not totally comfortable with. So just fascinating side of learning which which to me you put it certainly in a way is a setback because it means we're not very close to solving that one. But also it is really exciting because it means we have to get I think more thoughtful and creative about how we support people.

: Yeah that's really interesting you know and and maybe the angle is hey you don't have to share what you could consume and that's ok too long as you get what you need from this.

: That's a great point. That's a great point and that's a good I think not to the reality of most online communities. It's not quite as extreme in health as it is in non health communities but even in our communities the active participants who are posting far outnumber the active participants who are reading.

: In general or in health care or...

: So this is very true in general and it's still significantly true although not quite as extreme in healthcare.

: Interesting.

: And focused. So it still follows the same kind of thing that we often hurting in elementary school which is if you have a question please ask because there's probably five other people...

: There you have it. Yeah. Wow. So interesting and definitely an interesting challenge to tackle. And I think answers ahead. So I think thank you for sharing that and it's it's always interesting to sort of test these assumptions. One of my favorite anecdotes is- Assume you me there's a you and me and there's an ass at the beginning.

: Yeah.

: It can make an ass out of you and me and so it's always great to question those things and you guys are doing it so thoughtfully. So kudos to guys.

: We're getting there.

: For sure. What would you say one of your proudest moments to date has been wit- it could be with you know with this business or your time at Google whatever whatever strikes you.

: Two come to mind. One is a long time ago and one is really recently. So one a long time ago when I was at Google I got to work on some wonderful projects some of which didn't have the light of day and some of which didn't. Which is as it should be I think if you don't work on some things that aren't working you're probably not taking big enough rest. But the absolutely simplest thing I ever got to do at Google was also probably the most impactful thing maybe that I have maybe that I will have done in my whole career. We got a message from Will user actually pretty hard to sound like a customer support message to Google. But if you're persistent you can figure it out and follow this message across my desk with said "Hey Google this morning my daughter swallowed something poisonous and I went straight it was piped in poison control phone number and I couldn't find the number. And you guys get better." Fortunately her daughter was OK.

: That's good.

: And it's true that it was hard to find that kind of number quickly. So we did a bunch of thinking about you know how do we do this at scale and for different situations and different regions and languages. But we agreed that that in the meantime while we figure out how to do it sort of the Google way really really well and in a way we would do a little bit of a hack which said you know hey if someone types in poison control or a variant of that and they're in the US just put the red phone icon at half of the page and say in the case of poisoning an emergency call this number and probably in the end but just you know just a couple of weeks of work and in the first week of that being launched and still live you know that touched more people than by a couple orders of magnitude that I will see in my whole clinical career.

: Wow.

: So just from a scale perspective that was awesome and it wasn't you know that's obviously has much to do with the reach of Google that has to do with me being.

: Right.

: It was nice to help make that happen and then much more recently. This is a patient safety group work. I've been talking to senior executives to help them analyze the comments that were there from the anonymous comment that the front frontline staff share when they do their annual Culture Survey. And traditionally well stereotypically and I think quite commonly this kind of data especially the messy anecdotal data that's not this time draftable gets overlooked because you know. Well you tell us if there's something egregious that we need to be aware of. What maybe suggest a liability. I've had a lot of fun in the last several months having conversations with healthcare system leaders to help them see what comments from their frontline staff as the raw materials for their next best innovations and things ranging from sophisticated pipeline for tracking for quality improvement all the way to super mundane things like "Hey let's make it safe for patients and employees to cross the street from the parking lot to the hospital." And it's sometimes the really simple things that we don't take the time to think about because we're thinking about you know "CEO level" quote unquote "CEO level solutions". So kind of connecting healthcare leadership to the raw materials that it's it's actually not that hard to get from from frontline staff has been probably the most recent from.

: That's awesome. Now it sounds like you're getting some key insights and these little wins you know folks and think about all the things that you're focused on. Ultimately it's got to resonate with the people that you're working to inspire the people that you're working to help feel better. So great. Great point here Roni. So tell us a little bit about an exciting project. I know you're working on over there but if you had to come up with one that you want to highlight here maybe it's highlighting it again and going a little bit deeper. Or maybe it's something that we haven't talked about yet.

: So one that I think we've touched on super briefly but I'm really excited about it and it is still a still pretty new for us is adapting the peer support model that we've developed over that we've been sort of refining over six years for patients and adapting it to clinical and at first glance that looks like perhaps unexpected thing to do because when we talk about peer support in healthcare we think about someone who's got a diagnosis or a loved one has a new diagnosis or is about to undergo a stere procedure. But it's actually pretty generalizable to different kinds of health related stresses and opportunities for support. And as we've started prototyping and designing with a lot of our health system partners with several of our health system partners we're building our initial version of peer support systems for staff or nurses physicians and others. And it's exciting for a couple of reasons one is it's hard. It's different than your support for patients and families. It's also remarkably similar. So while in one case the context might be the diagnosis of cancer. And in another context on the other side the context might be I lost a patient today or I am so stressed and tired because I spent my whole day caring for patients and then I go home and I have to care for my aging parent or my sick kid.

: Yeah.

: And you know I'm only getting paid for one full time job but I have at least two and I don't know how long I can do it. These are really different situations. But a lot of them magic I think we can tap into is the same. Because it's about asking around in a thoughtful way and saying to people hey are you going through some stuff that where you think it might be helpful to talk to someone else in a safe private way and then asking other people or even some of the same people Hey we're going through this and do you feel like you'd be available to talk to someone who's going through it now and that second part is actually probably maybe the most important secret sauce to community in general I think and that is that I think we're wired to feel really good when we're able to help others. And so I think you can define building community as simply making it easy for people to help others. So we almost want to do that. We don't spend a lot of time doing it because we're busy and because it's not easy. Like a lot of us probably have conversations like oh I want to like volunteer for x y z sometime soon when I make time for it. If someone handed that opportunity on a silver platter to us those of us who are relatively well-off and have our basic needs be met Oh yeah I'd love to do that. So that's kind of what I feel like this work is about. And in this particular case designing tools and workflows to make it easy for health staff to support each other is super exciting and I suspect if we do it right it will allow us to make those staff better off and therefore also make their patients better off. I know from my own experience that you know when I'm having lousy stuff going on in my personal life I'm probably doing less a good job with the patients I see.

: For sure. It's really great. Yeah I think this is definitely exciting. And the amount of people you can touch through touching clinicians just expands exponentially. Know for every one clinician that takes care of say a thousand patients a year you're helping millions of people.

: Ideally yes that would be awesome.

: I love it. Well Roni you guys are definitely up to some great things getting close to the end of our time together here. Well maybe we'll have to do a part two to this one. Let's pretend you and I are building a medical leadership course on what it takes to be impactful in medicine today. It's the one on one of Dr. Roni Zeiger. So we're going to write a syllabus for questions lightning round style followed by a book that you recommend to the listeners. You ready?

: Sure.

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

: I have no idea. Quite a massive question. No I have, I do have an answer. Pick one outcome to focus on at a time.

: Love it, what's the biggest mistake or pitfall to avoid?

: One that I'm really worried about is falling in love with a number because we can measure it without being sure that it's measuring something that really matters.

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

: Stay really close to your users.

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

: I mean so my daughter was at our office the other day and she wrote on our white board - build meaningful connections. That's something that she's thinking she she just started high school and that's something she's thinking about. And that's what she thinks what we're doing. So it's a hard one to measure but it certainly what drives us.

: Love that man. And that's that's a big part of what we're doing here at the outcomes rocket and that truly resonates and makes an impact. What would you say your favorite book is?

: So a book that I've been recommending a lot in the last couple of years related to many of the things that we've been talking about. It's called Reinventing Discovery. It's by really smart scientists journalist type named Michael Nielsen and reinventing Discovery is mostly about the ways that human networks are changing the way we do science. I just think it's a little bit about kind of crowdsourcing meets science in a super interesting and challenging way. It certainly has an influence the way I see the untapped power of people and getting things done when we get smarter about connecting with those people.

: What a great recommendation Roni. And folks if you want a link to this book, transcript and the show notes for everything that we've been discussing just go to outcomesrocket.health/zeiger as in Dr. Zeiger and you'll be able to find everything there. Roni before we conclude I'd love if you could just share a closing thought and then the best place for the listeners could interact with you or your company.

: Closing thought. No pressure. I would say at the end of each day and this is advice for me as much as anyone else but at the end of each day let's think about something that inspired us so that we don't lose the opportunity to feel good and reflect on that and then also some things that challenge us in particular - from a user of product or service that we're focusing on getting in touch with me is pretty easy. I'm on Twitter a fair amount and also happy to receive email via roni@smartpatients.com

: Outstanding. There you have it listeners. Roni Zeiger with Smart Patients. It's been such a pleasure to dive into the efforts that you guys are going through and really excited to see where you guys take things here with the newest innovations. So Roni a big thank you to you for spending time with us today.

: Thanks for having me.

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Solving The Medication Adherence Problem with Omri Shor, Founder and CEO, Medisafe

: Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have the outstanding Omri Shor. He is the Founder and CEO at Medisafe. Medisafe is an M health platform that solves medication not adherents. A huge billion dollar problem that we have in health care by addressing all the major underlying causes of this complex program including forgetfulness, fear of side effects costs, and lack of motivation and support. Today the app has 2.7 million registered users. So Omri, thanks so much. It's a pleasure to have you on the podcast.

: Thank you very much for the opportunity. And I'm looking forward to chatting today.

: Absolutely. Now Omri, tell me the one thing that I want to, that I always ask my guests is what got you into the medical sector to begin with.

: Sure. So our story begins in about six a bit more than six years ago. My father is diabetic and hypertensive and we're backing Israel, and on that beautiful day he came to me and he asked me a quick question which was "Have you seen me inject my medications today?" And I gave him a pretty quick answer that was low. I mean at that point no I haven't seen him. However I unfortunately understood that there's no you haven't injected your medications. He went back into the house and injected a second dose of insulin, in a room and that was completely mistaken. And we've started thinking about how people manage their medications as a result of that. What tools does patients have and what functionalities and so on and so forth? And Impalen, we've also started thinking about what does a health care grant ecosystem, actually does for patients in terms of medication management. So we clearly notice that these providers, payers, pharma companies, pharmacy, nurse coming any of his clinicians none of them had a solution that they could have provided my father that point in time. And at the same time, he carried an iPhone. So we thought that we can create the new medium for patients so medication management using solutions that are coming to the market.

: Well thank you for sharing that story Omri and hopefully, your dad is okay and he is just kind of a little misstep that led to solution being born.

: Absolutely my my is doing very well, he's actually Medisafe user number one.

: Is he really? Awesome.

: He keeps on notifying us whenever there is any issues or or any bogs or anything like that. We have one user who's notify us right away.

: That's amazing. And it's good to have that feedback loop with technologies like these and no doubt the hot topic here is medication adherents as it relates to this. Omri, what would you say health care leaders need to be thinking about?

: Yes. So medication here is part of a bigger problem which is medication mismanagement. And patients are lacking tools to actually help them better manage their medications. And that leads to a lot of burden on the health care system. It's a critical issue. And let me give you some of the numbers that when I found out about those numbers kept me awake for a few days. It starts with 700,000 people a year suffer in emergency because of medication management issues and of those 700,000 people, hundred and twenty five thousand people a year will die. And you translate that statistically, it's every four and a half minutes an American dies. For me, it was very troublesome. That according to the U.S. Congressional Budget Office leads to about 300 billion dollars of excessive expenditure. And that is because of additional admissions in additional emergencies and so on and so forth. Just imagine what the health care ecosystem could have done with additional 300 billion dollars a year. Right.

: Absolutely.

: Of course it does. It could have been billed. So it seemed to us like this is a huge issue. It's an unseen problem and something that should be brought to the attention of the grand health care ecosystem.

: You know like I like the way you framed it Omri, it's a part of the medication management problem that is medication adherents and so folks the best in any industry truly have the ability to make distinctions about whatever it be that they that they work on and Omri obviously is giving us a distinction here. Medication Management versus medication adherents. I think it's really really important to take in mind as we work to tackle this problem. Omri can you give us an example of how your organization and technology has created results. I mean, aside from 2.7 million users which is very impressive, what are some things that have happened to improve outcomes?

: Sure absolutely. So one minor correction today we have 4.5 million registered users.

: That's a major correction. Congratulations 4.5 million that's outstanding.

: Yes indeed that's a big population of patients and many people that we're helping. So this is exciting for us. I would like to say that when you look at a different constituents across the health care ecosystem many say for various outcomes for various stages. So I think that health care should be more focused on patients. So I'll start there. Medisafe helps hundreds of thousands of people each and every day to manage their medications correctly and what do I mean by manage medications correctly, that is starting from the basic reminders. She's a very important piece of the puzzle. However when you move further it's about educating the patients to for. There are two to factor that patients over time and so on and so forth. We're really looking to help keep continue for that patient from the moment that they're prescribe till the moment that they take their medication from health care. It's about looking at potential drug to drug interactions of that patient. And regarding that feature, Medisafe was able today to prevent tens of thousands of drug to drug interactions. We have received many e-mails from patients about how Medisafe literally saved their lives by identifying those interactions. So I think that we should start with the patient then when we move further into the health care ecosystem, our primary partners are in many cases pharma companies who are interested in proving patient experience for their patients. Of course that all translates into better outcomes, right. So imagine that we can improve adherents by 10% right. That we can move 21% of the nonadherent patients to become adherents. What are the implications for patients that are now healthier that do not need to suffer from any complications? And what are the implications to the health care ecosystem when you look at for diabetes patients for instance. There has been a study that showed that by improving adherents by about 20%, you save many hundreds of dollars a year as a result of that. I want to take it to one level higher because clearly it's important to improve outcomes for each and every patient. But Medisafe collects that level of data. So we have today over 1 billion medication doses that we're taking using Medisafe and about 6 million data points as to how patients take their medications right. Early health care stakeholders have claims data which is patients were taking their medications as pointing time. And that comes every 30 to 90 days. And then there's a lag. By using the Medisafe data, we move from a once a month to once every three months data sample to once to 2 to 3 times a day data sample. And we can understand patient behaviors in ways that were never available to us as the health care ecosystem todate and really get unparalleled insights into patients behavior, patient challenges, and how to solve them.

: Yeah that's fascinating Omri. And like you said right there's the individual patient impact. But then it's the broader population health. How can we manage the overall behaviors of populations whether it be community or whether it be a subset of a chronic illness? Fascinating work that you're doing and I think it's making a big difference. Can you share a time with the listeners when you had a setback and something that you learned from that setback that as a result you always do things a certain way.

: Sure absolutely. Let me start with one very important because I keep on getting to the patient right. Yes. So apparently although health care thinks that way, every patient is different. Because every patient is different, their challenges with medication management are different. Medisafe started the beginning we had a big vision but we started with features and functionalities that were one size fits all. However over time we've learned a lot about how to personalize experiences for users and one of them for instance is it's a very simple one. What is the call to action to go and reminds all to go and take his medications. And here is some very interesting insight for you. There are various ways to talk to patients and if I will go to a 50 year old patient and I will tell them hey "take your medications not only because it's healthier for you but because it matters for your family because you want to go and see your children or get married and support them over time. So it's not only for you it's for the family." We will see about 20% higher engagement from that. However, if I will go to a 20 to 30 year old millennial and do exactly the same talk about family values, we will get about 5% lower engagements. It's going to talk. So it took a lot of time to really start to see how do we think about personalization and that took about gazillion failures over where we kept on having many many challenges in bumping to walls until we have understood with our older values there. And remember I always thought of myself as a bit to see and to be company. So inside the health are ecosystem, there were many changes over the years. How do you prove. How do you prove veterans here. Right. And one of the things that we've found out is that the transparency of the data is not yet there. The access to data is not yet there and it only took us about five years until we had enough data so we could do a good enough data matching and be able to prove that value to the health care ecosystem.

: That's a really great lesson learned Omri and a great share for the listeners to think about. Let's take a look at the other side of that. What's your proudest leadership experience in health care today?

: So fortunately we are in place that we are working a lot with patients and we get patients sending us e-mails every day about how they can't imagine going through their patient journeys and their challenges without having Medisafe by their sides. There was one patient's specificically that told us "If I had on my phone just 3 apps, my calling app my texting app, and Medisafe, then my phone would fulfill what i seek.

: That's great.

: One in other beautiful example is a story of a gentleman called Richard and he used Medisafe to manage his wife's medication. However his stepfather used to take maintenance medications and at some point in time he was prescribed with an additional med. And then what happened is that he was prescribed with that med however, the pharmacists made a mistake and gave him a different med that the one that was prescribed. Richard then had Medisafe on his phone, so he went into interaction center to learn that if his father will take this mistaken med at the same time of the maintenance medication that he's taking, he's taking a severe risk of literally dying. So they then went to the doctor and the doctor indeed confirmed that there was a mistake there. So being at that point that you can help so many people be healthier and live their lives without the challenges of medication marriage is really an exciting place to be at.

: Now that's really exciting and an amazing stories that you've shared I'm sure many more. But some great ones that you highlighted for us and I'm just curious. So before this whole journey started Omri, what were you doing before Medisafe?

: So I always knew that my calling in life is to be entrepreneur and I worked for a startup in a completely different place. No firm management software. I was employee number one and it was in Israel where i startup. I was in charge of the entire business side. Initially it was reading the marketing messaging and after that working on how the product flows and then managing some of the sales activities it was a great time where I learned a lot of my intrapreneurs skills.

: Very cool. It's fascinating and so from that experience, were you able to bring over some knowledge and skills that have helped with Medisafe?

: I absolutely have. Human interactions human interaction when...

: Yes.

: You need to change the behavior of the secretary so she manages better. At is in some part is, it's similar to doing those things on patients. However, I think that business is business and you need to think about a business that you're building. Think about how you implement business models. How you help create value? How you quantify that value? And so on and so forth.

: It all goes back to value and one of the neat things that I think can happen is as we tend to get tunnel vision and healthcare and it helps to look beyond health care and see what other industries like legal for example are doing to solve problems. And it's amazing the parallels that you could find to apply it within health care. Sounds like you did a little bit of that on the legal versus Medisafe side. Appreciate you sharing that. And how about on Medisafe an exciting project that you're working on today.

: So in Medisafe for the last few years we've clearly been in touch with the big technology companies in our space. And about a few months back, Apple announced that they're allowing patients now to hold their health records information into their Apple device. And when we heard about that we thought that it is very exciting, it's reaaly breaking the barriers inside the health care system creating a true interoperability on the patients as opposed to the industry's side. And then we thought that the ideal thing to do is when the patient actually has their medical records and clearly medications are part of that to be able to pull that into their Medisafe account and create really frictionless and accurate medication loading into Medisafe. So on June of this year, Apple announced that they will open health records API...

: Nice.

: On their press release, there were a number of beautiful screen shots those screen shots were Medisafe.

: Oh where they really? Nice.

: To be the first company to actually take the medication data from the health records and hold that into their patients Medisafe's account. So were hardly on no final datas of this thing in intending to launch the future officially this fall.

: Outstanding. Congratulations on that.

: Thank you. And that's on the patient side right. And as I said, the biggest challenge is to run those two companies at the same time, in the business side in the consumer side. So on the business side we are in the process of really implementing Medisafe together with more and more pharma companies in creating value for them by managing patients medications for action.

: Outstanding and you've provided such a great example Omri of being able to create a DTC company add value there while at the same time creating a B2B model that works hand in hand with your B2C model. And I think it's a great example one that entrepreneurs out there looking to make an impact in health care should study. So folks check out Medisafe, medisafe.com and the things that they're doing just an outstanding group. So let's talk about this syllabus so we're going to do a quick lightning round Omri. We're going to build a leadership syllabus on health care. The business of healthcare the one on one on business with Omri. And so I've got four questions for you lightning round style followed by a book that you recommend to the listeners. You ready?

: Yes.

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

: I think that you should make sure that you're taking a strategic approach to how do you validate the value. And do clinical great studies and validate your solutions.

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

: I think it's very important to keep on focused to identify where you are going and understand the market and the market dynamics and just keep focused on what you're trying to achieve.

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

: Always identify your target population and your consumers, your customers understand what they're looking for in an ever changing world. Continue on interviewing them and adopt the solution very quickly. Figure it quickly. Listen to the market and bridge those gaps constantly.

: Great advice. What's one area of focus that drives everything in your organization?

: Patients. Patient reviews each and every day. If you lose sight of the patient and what you were and how and what's the value that you generate to them you lose grape of the business and data is key. So we keep on looking at the data and looking at what our patients need and keep on training.

: Love it. Love it Omri and what book would you recommend to the listeners on this syllabus?

: So there is a great book called the Blue Ocean Strategy. Strategy book that essentially tells you stories of companies that were able to substract values from their products and add various other values instead and my dad created the Blue Ocean is supposed to read the ocean where everyone else is competing. So essentially it's how you differentiate yourself from your competitors based on the value that you can bring to the world.

: What a great recommendation Omri. I picked that book up probably about 6 years ago but this is a good reminder to pick it back up again. Listeners if you haven't read that, it's such a refreshing way to approach you creation and look I mean Omri's doing an outstanding job. Him and his organization. This one popped up on his syllabus here for you, so you better read it. So Omri, thank you so much here to the end, I really appreciate your insights. Before we conclude though I love if you could just share a closing thought and then the best place where the listeners could interact with you and your company.

: Yes. So first of all thank you very much for your opportunity to talk to you today. I think that it's important to understand that better health care and for us are medication management has a ripple effect across the industry. By focusing on the ones who matter most the source of this problem which is improving medications for patients, I think we can improve health outcomes across health care continue. I would be happy to stay in touch you can find me on re short LinkedIn and you can reach out through the Medisafe website and click Contact Us and those e-mails go to my inbox as well.

: Outstanding. Omri, thank you so much. Keep up the outstanding work on this medication management medication and here in space you guys are doing outstanding things and leading the way. And thanks again for spending time with us. It's been a pleasure.

: Thank you Saul, enjoying the opportunity to talk to you today. And I'm looking forward to staying in touch.

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Finding Affordable Quality Healthcare with Kevin Krauth, Co-Founder and CEO at Orderly Health

: Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have the amazing Kevin Krauth. He's the co-founder and CEO at Orderly Health. Kevin left his role as the Senior Product Manager for Electronic Arts. That's EA as many of you are aware digital platform team to help found Orderly. Prior to EA, Kevin was working as a Product Manager at a mobile analytics startup called Upsight in San Francisco. His clients included Blue Mobile, Tender, Jack Threads, and Kaiser Permanente. Obviously the organizations you all have heard about. Kevin can trace the roots of his interest in health care back to early childhood memories making rounds with his dad at the time a physician in Denver. Originally enrolled in the premed program at Duke. Kevin shifted his focus to the business of healthcare choosing instead to study health care policy as a public policy economics major. When he's not in the office, you could find Kevin's skiing, rock climbing, or running, usually while listening to podcasts like this one...

: That's right.

: On health care and technology in the mountains of Colorado. So Kevin it's a pleasure to have you on the podcast. Glad you could join us.

: Thanks so much for having me. I'm excited to chat with you Saul.

: Hey me too. Now did I leave anything out in that intro that you want to share with listeners?

: One part of my story that I do always like to share is it mentions that I started off in a premed program at Duke. But what really ultimately sealed my fate in terms of not going into health care as a clinician or a physician was a conversation that I had with my dad. It was 2001 and my dad had been a practicing physician for about 30 years and ultimately one of the things that we talked about was how much the health care industry had changed and how many physicians really didn't love their jobs anymore. You know they got into health care in order to practice medicine and it was so bogged down by bureaucracy and politics that they ultimately ended up either leaving or telling their kids to not go into the profession which is a really common trend. So I am one of those health care defectors and I guess by happenstance that I make my way back into the health care industry.

: Well it's in your genes my friend even though you're not practicing as a physician you're still impacting health so excited to dive into some of those things and yeah you know this physician, physician burnout is a real thing. Lack of satisfaction is a real thing. So looking for ways to improve those elements are great business idea for those of you looking for ideas to get into health care. But diving into some of the experiences that you've had, what would you say is a hot topic that needs to be on every medical leaders agenda and how are you guys approaching at Orderly Health?

: Yeah and I have to apologize upfront because I think that I am just about to drop a bunch of buzz words but I know it's a little cliche. I do think that there's a lot going on in the health care space around the things that we've been hearing about for years things like big data, machine learning, artificial intelligence. All of these things in my opinion, there was a lot of promise for the last 20 years or so and we're now starting to see that promise come to fruition and what I mean by that is you know with big data technology we're starting to see more and more analysis of claims and outcomes and how that can improve the number experience with machine learning. A good example there is how computers are effectively being taught how to spot and recognize imaging radiology images, x rays, and stuff like that and are doing a better job of analyzing breaks and maybe cancer cells or something like that before a trained physician can. And then the last part with artificial intelligence, humans are prone to bias and there's a lot of different ways that they can get stuck in their ways and not be able to be quite as agile or capable as these algorithms that we're teaching computers how to recognize. So I think in a number of ways the confluence of these three trends is coming together. And what we do is I actually think is pretty lightweight compared to some of the heavy hitters on the clinical side things that I mentioned related to spotting cancer cells or analyzing claims and outcomes. We're leveraging existing technologies in the AI space specifically using natural language processing technologies to create a platform that allows people to interact with the health care space as though they're interacting with a human when they're actually interacting with the software. So I can't take credit for a lot of developments that have been made in this space where as they say we're standing on the shoulders of giants at Orderly Health. But I do think that being able to spot these trends and leverage them has really been a foundation for our success and we hope as a foundation for future success as well as we're making it easier for individuals to navigate the health care space.

: Yeah I think those are some great insights. So maybe you want to tell the listeners a little bit about Louie and what your service does?

: Yeah sure. So in a nutshell what Orderly he has done is we've created a chatpad that helps people, individuals navigate the health care space. And you know I'll talk a little bit about Louie which is the name of our chatpad but also about where we're going because I do think it ends up I think diminishing the value of our platform if we just chalk it up to just yet another chatpad. Effectively what we found when we were trying to start this company was individuals wanted an advocate there and a lot of companies out there that do specific things very well. For example if you want to find a doctor covered under your plan there's a number of different companies that are out there that will help you. Not to mention your individual insurance company but you could use better doctor or health grades or Zak Doc or a number of others that will help you try to find a doctor and even schedule for you a somewhat plan year on what we're doing is enabling a platform that brings multiple of these different single source or single use case providers and bring them all together into the form of a chatpad so you can ask a question like, "What's the best pediatrician covered under my plan?" And we can answer that using our API partners and data and service providers. But we can also help you navigate to at home care using a partner of ours called Dispatch Health or let you know that you can order your medications online instead of going to your local Walgreens receive yes using our online pharmacy partner and the big innovation that we're bringing to the table is that by bringing all of these different solutions into a single platform. When you chat with our chatpad Louie, you're actually chatting with effectively 20 different apps that you would download onto your phone and through a heavily compliant back and were able to share some demographic and contextual information with these different service providers so that the handoff tends to be very seamless. It ends up being making for a much better use case and then we sell that to insurance companies so that you no longer have to deal with the dreaded portal or wait on hold for your insurance company for hours on end to answer a simple question about your benefits or finding a telemedicine provider or something like that. So we're just getting started but we have a few enterprise customers and we're really excited about the progress that Louie has made in the last year or so.

: Well I think that's really interesting Kevin how you guys are sort of aggregating all of the different apps and giving consumers access to them. So are you guys working from the space of business to consumer or are you going to be working through payers and employers to offer this?

: Yeah I mean we actually take a hybrid approach. I think that for most people who are developing in the health care space the idea of B2B2C business to business to consumer is fairly common because consumers as we all know it's a trend that is starting to change. But for the most part consumers are not the ones at the core of their care and we're really trying to change that we're trying to make consumers decisions more seamless and more informed with the data they need when they're making those decisions. So we are focused on selling to insurance companies, payers, third party administrators also known as TPA's, and other players in the healthcare space that provide their services to the individual patient or member. We like to think that as a user because we're trying to get away from the nomenclature of thinking of people always being sick and when you have it when you put everybody uses patient effectively you're already assuming that the person is sick. So we're trying to change that a little bit but we do have a consumer facing side. And what's great about that is we can go directly to our consumers with Louie. So our platform is actually white labeled many times a user of Orderly may not know that they're using Orderly the way that it works as an insurance company will offer Orderly to their members but they might rebrand it as their own chatpad. So you know...

: Got it.

: Cross blue shield we'll call it something different but if you go to the Orderly Health website you use to be able to actually sign up directly. And this is where we run experiments and try to improve the member engagement and experiment with different functional use cases that individuals can try and that's actually how we improve our member experience for these insurance companies.

: Well I think that's pretty cool and sounds like you're tackling a little bit of both sides. The consumer as well as the business side of it. So as you think through some of the more recent use cases can you think about an example that you've improved outcomes or or improve the overall health care process. Can you maybe share an example that for us?

: Sure yeah. I mean I think that the things that we do best and this is something that we figured out from our consumer facing application and people signing up just on the web and testing out Louie is we help people find doctors that are helped them manage their medications and then we help them with answering questions about their benefits. So the statistics that we always bring up is that we have about 70% onboarding process or 70 percent conversion rate when it comes to people on boarding which is incredibly high in the healthcare space. But more importantly we're seeing 20% month over month retention on Louie. So people sign up interact with Louie and then they'll come back to one in five of them will come back the next month. And that's really important. That 20% number is really important because the standard in the healthcare space is somewhere around 1%. Often you're seeing much lower. The reason being that most people don't want to consume health care. But if we're able to make it engaging and fun then we'll actually see we can get away from what I was talking about earlier. The idea of health care being sick care right it's the idea of naming all of your users patients and assuming there's something that they need. Well with that 20 percent we're seeing people come back and ask questions about when they can schedule an appointment and whether they're covered for an annual physical. And we're still early but we really are bullish on the idea that by getting that engagement up we're going to be able to see a lot more users being proactive in managing their care so that it's not secure that it actually is health care. They're ordering medications when they need they're making doctor's appointments when they need they're getting the care that they need to be preventative rather than reactive. And I think that that's really important.

: Think that's a really great call out. And Kevin what would you say at a time or an example where you had a setback and what did you learn from that setback?

: Yes sure. Well what is the quote. I think it's I don't know if it is or it might be. What is the word I'm looking for that it's misappropriated to Obama. But that success is not a linear path. So Fred Wilson said the job of the CEO is to do three things well it's articulate the long term vision of the product. Make sure you have enough money to keep the lights on and hire and inspire a talented team to execute on that vision. One of the things that I've really tried to do is have my series of failures be learning experiences but to avoid that major failure that's going to sink the company. And we've done okay without so far. But what I will say is that the hardest to take failure as a CEO is when you make the wrong hire. We actually got on board and early we never. It was kind of our tech leader early on and that was a tough decision for us because we're always shooting for that unicorn engineer tech person who's going to solve all your problems but ultimately you as a young startup you really have to get a little bit lucky and inspire people at the right moment. And I think that what we found is that the longer you keep on people who are a bad fit the more dangerous it becomes the company. So you asked what the failure was I mean we've made a couple failures when it comes to hiring. I think that what I've really learned from that is and for anybody who's thinking about starting a company out there I can't stress this enough. Whatever your fears are in terms of the worst possible outcome imaginable it's not as bad as you think it is in your head. You think the reason that we hung on to employ is a little long is I was always afraid that by making this decision to let somebody go or moving on with another decision that we were going to somehow sink the company and that it was going to be the end of orderly. And I think that what you realize is once you've made a decision you remove that burden from your mind space and it just allows you to be much more clear and move ahead. So it's it's like leaving off an anchor even if you have no tech talent or you make a decision to go into a different business unit and you have no experience in that business unit, there is a clarity that comes from making that decision that allows you to move ahead so much more quickly and in a lot of ways it's very liberating. So I think that that's been the greatest experience that I've had from failure is just how freeing it can be to not continue to worry about the failure. Make it. Accept it. Move on.

: I had such a great message and yeah hiring is tough. I'm a firm believer that you just have to hire slow and if you need to, fire fast. I had an open role recently and I wanted to fill it quick but it took me eight months. Kevin it took me eight months but I've got the guy for the job and he is just going to do amazing had some great candidates overall. But yeah I mean it just it's worth waiting.

: Absolutely. And during that eight months I can only imagine the level of doubt and fear that creeps in. We've had that same experience you just want it to be over. But in the end it's worth it. I agree with you.

: Yeah that's awesome man. So what would you say one of your proudest leadership experiences in health care has been to date?

: Kevin this might seem kind of minor. Again we're still pretty early. We've been around for about three years but we actually have made a couple pivots that has slowed our product development at times. But I'll never forget this. We were demoing at some angel investor pitch event. An investor who is also a physician came up and started to talk to us and he was asking about our application and whatnot. And he was looking for a doctor and he was testing it and he was comparing our product side by side with his insurance company's data and it turns out that he found a doctor that was covered under his plan on our system that his insurance company didn't have. So what was so interesting about that is that little window for us turned into a contract not as an investor but with another company because we had a company that found out about us through the fact that our data was better than theirs and it started a conversation. Well how are you doing this. What's powering this on the back end. And we explained to them that we use all these different data partners and kind of mashed together that data. So in a lot of ways we can have more than one angle for where that data comes from. And they were only able to use their own internal Provider data set. So it ended up being just this it was a long process. But what started off is this really minor when in a moment of pride for me turned into a contract for one of our first enterprise customers.

: Kevin so you know what? What a great example and what you're saying is just so true. You know today the direction that our industry is heading it's going to be the companies and the people that can actually make insights with data and better control manage and clean data so that it's useful that are going to be the most successful. Look at companies like Amazon for instance right. They're doing a phenomenal job of managing this data. And to your point you were able to do it in a way that was better and got this contract out of it.

: It was super exciting. It is such a thrilling moment as one thing I will say is when you're starting a company and people don't talk about it enough I know that there's plenty of material out there about how hard it is but it is also just a string of setbacks and failures that you just have to push through. And all those moments of just little reward that that makes you beam like a proud parents and ultimately they keep coming back.

: Yeah that's so cool that Kevin did you have an insight here where you're like man maybe the actual value we could provide is different than we thought at the beginning?

: What a great question because I was hoping a Davidge to talk about this anyway but this is something that we're working on and this is really an extension of that contract that I was telling you about. So again we have a system that does some interesting things and it brings together all these different sources of data. But on the backend we've been working on trying to figure out a way to make that data more valuable so that it's not just a pass through and this was in some ways a bit of a eureka moment but it also took a lot of work because we knew we needed to dig in and find the skill set necessary to really pursue a product out of that one little insight. So what ended up happening was we spent nearly two years recruiting a head of data science and we ended up finding an incredible candidate and now we're really investing sort of doubling down on that one insight where we're now taking multiple different sources of data and rather than just saying okay what we can do is you ask a question we connect you with the best data source and pass that data source through unchanged. All we're doing is developing software on the back end that can take multiple different sources of data and then compare specifically around provider networks. So we can compare what data is available for each physician or clinician or whatever it is on the web. So I kind of joke like it's a little bit like the analogy in Jurassic Park when there's gaps in the DNA they fill it in with a frog's DNA. Well I'm sure you know many listeners know many times network data is patchy and incomplete or incorrect altogether. Yeah Rick you can take multiple different sources of data for the same doctor or clinician or dentist or whoever it is. And even though it's not entirely consistent what we're working on is actually mashing all that together to give one unified look at this information so that it's accurate and predictable based on what source it's coming from and other contextual factors like location specialty that sort of thing so this tiny insight let us down this road of developing something a lot more sophisticated and we're super excited about the progress that we're making on that tool.

: That's awesome. Kevin congrats on that. And yeah like you said it's those little insights that turn into the real aha moments and even lead you to a product that actually is desired and needed by the market.

: Yeah absolutely. And it's something that you constantly have to. Again we're kind of we're rehashing a number of cliches in the startup space but you do have to constantly have an open mind listen to the market. There's the concept that the market always wins. You really don't know what you're building until you put it out into the wild and you see how people react to it. There's just countless stories right. RMBMB started off as an aha moment during a conference in San Francisco. Instagram started off as a check in app right people what the best entrepreneurs do is they take something they get it into the market early and then they see how people respond to it and they really chase down the opportunities for where their success and what they've built.

: Yeah I think that's a great message and you're doing just that Kevin. So kudos to you and your team and and keep up the great work man.

: Well thank you very much. I always say don't confuse activity for achievement but we're well on our way. We're trying hard.

: That's awesome. Now let's pretend you and I are building a medical leadership course and what it takes to be successful in the business of healthcare. It's the one on one of Kevin and so I've got four questions for you lightning round style followed by a book that you recommend to the listeners. You ready?

: Yup.

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

: I think listen to the patient. You have to put the consumer the individual at the center of health care. Otherwise it's never going to work.

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

: Don't think that you know the answers I think you really need to kind of like what we were just saying take your failures in stride learn from your mistakes and really listen to the market so that you understand what the market is demanding.

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

: I feel like I'm being a little bit of an old broken record here but I just think you have to keep an open mind and never assume that you're right. Otherwise you get into thinking that you get into a closed minded attitude and you narrow your viewpoint and it never works.

: Love it. What would you say the number one area of focus that drives your company is?

: I think it's all about the consumer. We're trying to make the consumer at the center of health care. So anything that we can do to improve the consumer user experience and it really starts with us even using our own products right. Understanding what we would want out of our system helps us understand what other people would want as well.

: What book would you recommend to the listeners?

: My favorite startup book is A Hard Thing About Hard Things. I think it just has such a good job of capturing the startup experience. But if you're talking specifically about health care there's a great book called The Healing of America by T.R. Reid. And I think every American should read it because we have this weird American exceptionalism that says that nothing that works in other countries can work in America and that's just simply not true.

: Love that. So Kevin this discussion has been great. We've talked about changing the direction of your company. We've discussed consumer versus business to business. I mean we're covering a lot of great things. What will be the one thing that you like to leave our listeners with as a going away point? A closing remark.

: Yeah I mean I just think that in all of the mainstream media you hear so much about health care costs going up and how health care is such a political football. I want to leave with a message of optimism. I think that people often think that health care is 20, 30 years behind and it's so complicated that you can't change it. But if there's one thing that I've learned from my experience thus far trying to create Orderly it is hard but there are a lot of really smart people out there doing incredibly cool things in the health care space. And I just want to encourage anybody out there who's even on the fence about joining health care because maybe like me they were a little worried about the bureaucracy or just how hard it is. You can't do hard things unless you try. And I think we need more smart people in this space. Any innovation or any industry that's a little behind means that it's rife with opportunity. So I take it are really optimistic viewpoint of the future and I'm excited to be living in a time when we have so much change all the time and technology and I'm just really excited about the next 15, 20 years and where that can go in the health care space.

: Great voice of optimism there Kevin. And what would you say the best place that the listeners can get ahold of you or follow you would be?

: Well I am on Twitter. My Twitter handle is at kevinkrauth. You can also follow us our thoughts and musings on health care at Orderly Health, we have an Instagram and Twitter but I'm pretty available so if you ever want to just reach out to me directly in my email address is just kevin@orderlyhealth.com. I'd love to hear from you. Love to hear your thoughts and inspiring stories in health care space.

: Outstanding. Hey Kevin this has been a true pleasure. You've left us with a lot of great things to think about and consider. And I really appreciate you jumping on the show.

: Thanks so much Saul. And thanks all the listeners who are listening out there.

Automatically convert audio to text with Sonix

Recmmended Books:

The Hard Thing About Hard Things

The Healing of America

Best Way to Contact Kevin:

Twitter- @kevinkrauth
Email: kevin@orderlyhealth.com

Company Website:

https://www.orderlyhealth.com/

Check out this Link:

https://outcomesrocket.health/podcast

Reimbursement in Digital Medicine Explained with Swatee Surve, Founder and CEO at Litesprite

: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have the outstanding Swatee Surve. She's the founder and CEO at Litesprite. A Women 2.0 Seattle Female Founder to Watch, Swatee is currently leading Litesprite, a firm that combines games, machine learning, and big data to improve health outcomes for a variety of chronic health conditions. Litesprite is the first video game to win a U.S. Surgeon General Award and the only one recommended by clinics today. The firm has also received financial awards by the U.S. Army, Robert Wood Johnson Foundation, SXSW, Livestrong Foundation, and Singularity University. All organizations with which you all are are all familiar with being that your health care leaders. So throughout her career she's had major results and she's been identified as knowing how to set up best practices. She's been identified as a creative results driven leader so with a true pleasure that I bring Swatee to the podcast and now give me a warm welcome. Swatee welcome.

: Welcome, Im really excited to be here today. Thanks for the opportunity.

: Absolutely. Now Swatee, did I leave anything out in that intro that maybe you want to chat with us about.

: Sure. I think one of the interesting things about my focus in health care has been Ive been working in this space of what's now called digital health before. There was actual term for it so I'll go and date myself. But back in the late 90s early 2000s I was working with wearable technologies back then and my interest. I'm a biomedical engineer by training and really my interest back then was the applications of technology but at the patient's side. Because what I was seeing is a lot of applications in the enterprise internally are big diagnostic systems. I started my career at Eastman Kodak and at the time there were a big provider of radiology imaging. So I worked in the research labs there and we were on the task. The group was an innovation center and were tasked to look at and identify what's considered Greenfield or white space opportunity. So I was looking at the space this will literally looking at how are these really interesting technologies at the time, the web or even somewhat kind of remote monitoring devices are being applied in a home care setting or in a consumer setting. So I'd start looking at this emerging field of wearables back then. There were some efforts around remote patient monitoring in the home. So I was looking at digital health applications well before anyone was really even thinking about them and that kind of continued throughout my career. I was the first person Nike had hired to do wearable tech in 2001 my patents were there first. Yeah very cool a first for the company actually and then that kind of continued when I went to Microsoft in about eight years ago I was looking at the applications of artificial intelligence machine learning health care data sets. And that was in 2011 as I now. So 70 years ago. So I'm not a I'm not a stranger to health care and I'm certainly not a stranger to a lot of the technologies that people are talking about today.

: I think it's neat that you've sort of gone along this winding road with different consumer goods companies and now you're on your new venture with Litesprite. What would you say Swatee is a hot topic that needs to be on every medical leaders agenda today? And how are you guys addressing it?

: Sure. Quite often because of the work that we do we find ourselves in a position where it's a consult where either getting consulted or we find ourselves in a position where we're unintentionally where we end up being thought leaders. Hope we find out well gee no one's been doing it yeah. Which is kind of interesting. It's not us saying it it's people who come to us whether we get a call from a payer or a provider saying we've never seen anything like what you're doing...

: Which is pretty cool right.

: It's a double edged sword. Yeah it's cool if you like that you have to be comfortable with it. But no I think it's cool. And one of the things that we're seeing in the conversations that we're having with providers, payers and understandably Saul particularly with the interventions that we have is talking about any intervention that gets integrated into a patient care plan or in the hospital or a clinic or is gonna be part of outcomes based plan. Capitated model and a payer is China or a payer's try to meet a capitated plan by the state government. Well what are the things they need to understand with your podcast talks about is outcomes. So we get asked about outcomes all the time and it's been interesting and my clinician, Dr. David Cooper one of his previous roles was working and the Department of Defense on mobile health apps for the military. And so he's very very familiar with evidence because he's also looked at evidence and what's appropriate and what's not what's considered reasonable at this stage of the industry of digital health because it's still fairly nascent relative to others so we find ourselves getting asked what we think about a lot is appropriate levels of evidence because clearly if anything is invasive you know the more invasive it is the higher levels of evidence that are going to be acquired and understandably so to mitigate patient harm. I think one of the things that trips up people with digital health especially and I see this a lot with providers that may be tasked with go get innovation and bring it into my system right or a pair that's looking for new solutions because the previous ones haven't been able to demonstrate outcomes are there. No they're not getting engagement. Maybe a patient engagement solution. They're not getting engagement so they're looking for new stuff and so we see a lot of people struggling with that question, "how do I know this is going to work how do I know this isn't going to hurt someone. And then quite often what they'll do is they'll retract to the most conservative position which is not wrong but at times it can be in direct conflict with innovation because innovation is inherently unknown. It is exploring and it is. And in fact a long time ago. When I say long time ago around 2011 or so but I think it's still the same. The NSF and the NIH was very prescient actually they had this daylong discussion about the fact that even perhaps the clinical trial model may not be appropriate for accelerating digital health innovations because the reality of it is as digital health changes rapidly. I mean look at how does your cellphone from three years ago, probably cannot do the things that the new cellphone the latest models you...

: Oh it's dated.

: Yeah that if you had it if someone gave you a cellphone from three years ago now you'd be like I don't want it.

: Please don't. I don't want it.

: Yes. The functionality and capability that I used to, right. And some innovation cycles and capabilities change so much and as a result different game people have different expectations they have different usage patterns and then their usage of technology and reliance the technology changes. So what's appropriate level of evidence that you can maintain and ensure patient safety and risk is not being compromised. But at the same time you're able to keep up with the innovation cycles and take advantage of the innovations in these rapid cycles that the technology does allow you to do. I think that's that's an inherent kind of conflict. And I think each organization needs to kind of figure out where they want to be on that continuum.

: Yeah I think that's really really insightful Swatee and as manufacturers and industry starts looking at and digital technologies I mean number one this is where the puck is going. If you're not currently working on a project that's integrating technology and data insights you're going to get left behind. If you're not then you're going to get left behind period. So those of you that are, the insights that Swatee's talking about is actually very very interesting right because if you're a traditional med device manufacturer for example or a pharma company that you have these long cycle approval ways it's not going to be the same or necessarily the right way to do a digital health application. Really insightful Swatee and so what are the things that you have found on your journey through some of the things that you've done. For example for this this mental health platform that you're currently working on.

: What have we done relative to evidence or just general took qubit out?

: Evidence and then also outcomes that have come as a result of the platform.

: Yeah. So it's an opportunity but it's also you know as long without opportunity they are risks right. There's always that case. So as we talked about one of the opportunities and your health is it allows you to accelerate and get products and impact patients a lot quicker and improve patients lives and get outcomes out there. It also allows you to test very quickly what doesn't work. And they talk about that in a lot of the other industries about failing fast. And there is consequences are failing faster in health care. So you have to I think be measured about it. But one of the things we did because it allowed us as we tested our product every we have for the listeners who aren't familiar with Litesprite, we have a mental health videogame called Sinasprite what it does is it teaches a combination of evidence based treatment methods to players and it's through a protagonist Socks the Fox who wants to become a zen master. So it's a it's a rather unusual construct right. It's fun. It's a little irreverent maybe childish for some who are very used to allopathic method and are very very direct method of delivering health care but more often than not one of the things we've discovered. So you're coming off of the premise that it's a game. Any I've talked to some of my advisers and board members for a lot of people in health care game means it's not serious and it's somewhat dismissive and that's okay. But here's the thing. And it's been shown time and time again. A gaming construct is a place where and Jane McGonigal has written about this and it's been talked about by gaming experts. It's a comfortable place where people can learn and fail. Right. And another other aspect of construct of games that people come up in conjures is this teenage boy in the basement playing these hyper violent games. And that's not really gaming today. Gaming today is the average gamer is a 40 year old woman. And yeah I had no idea the advent of mobile games in fact I think a year or two ago it was the first time that they you know a down forecast for consoles. So just even understanding what a game and a construct is. But the reality of it is we didn't know if this would work right even though we would have all this data. Is someone going to resonate with this? Is it going to resonate? We had our eye hypotheses. So you have to do the traditional product testing and we did it in a lean methodology meaning that once we had enough of a product out there that we could start to get feedback from player feedback. We would continue to build and grow on it. But one of the things we started to do along with that and it's kind of tricky to do but we started collecting clinical evidence. So that's one of the unique things that we did was we didn't wait for the product to get built to its 100% level. We said we're going to start building it out. But it impacted our product development in the sense it slowed that down because we couldn't necessarily change may implement changes that would radically alter the experience. That's another thing you have to kind of worry about with innovation if you can change the things quickly and some, if you can change things quickly and you're running a test then how much do you change before you're really actually altering impact rate and some digital hub companies have said, "you know what we're not doing clinical testing at all. We're not going to go down the outcomes path we're just going for commercial data."So some digital hub companies have decided that others have taken the other route which is no we're going to go. Do we completely full randomized clinical controlled trial? We're going to wait eight years for our results to come out. Right. And there's going to be a continuum that I think you're going to continue to see. So what we did was we said okay well we'll have a good enough baseline product we're going to go out there and test it and we're going to do minimal increments things that we know probably won't impact the overall usage or engagement. And then look at the clinical measures. So that was one of the things that we did differently and that resulted in a publication earlier this year that Ohio State's College of Pharmacy. So we enlisted the help of college pharmacy from mental health video game to look at improvements and impact. And that was published in JMIR under general Internet medical research just earlier this year.

: Very cool. Yeah it's interesting right. There's a spectrum that you can take and it's really there's no one size fits all strategy really kind of have to figure out where you're going to come up with your approval pathway.

: Yeah. And it will be different because that's another really cool thing about digital health. There are all kinds of approaches you can take you know to solve the problem because you have so many tools that allow you to scale something but depending on what you end up choosing to do your level of evidence will be different and how you test it will be different. So it may not require testing at all. I mean if it's not in a pejorative sense but if it's a scheduling app, do you really need to show that you're improving our life by X Y Z or is it just a patient satisfaction Net Promoter Score? Or is it workflow efficiency? Right? And those are maybe three totally different metrics and it's going to be up to the organization what are they optimizing for your metrics and why you're asking for sure optimize to year end objective.

: Yup that's a really great call out.

: So I mean maybe none of those may just be hey look at so it's a competitive advantage.

: Right.

: Because none of our competitors locally are offering this. So we don't need evidence we need to just get it out there and make sure that our patients are aware of it and create stickiness that it can go all over the map with this stuff.

: And yeah it's such workflow it's clinical practice is that at home is it at the hospital. All these things come into consideration and so Swatee what cwould you say a time that you had set back, a big learning that you got out of that setback. You want to share with us?

: Well you know it's a really interesting question and I think it's an important one to raise especially for us in health care because we're not typically allowed to fail or even discuss failure. Usually as big risk implications. Right.

: Yeah big ones.

: It's big ones right. So it's great. But you know I was it was just actually last week I was particularly frustrated about wait where things were with our company and I was tired. Have you ever done a start up? It's exhausting.

: Yeah.

: It was one of those moments. It was late at night and it was eleven o'clock. I was exhausted from the day and I was talking to my friend at Nike. He actually it's kind of interesting he started brand Jordan for the company. So he's like...

: That's pretty cool.

: Yeah he's a veteran who's been around for a long time and so he was like Swatee like you know when we were starting Jordan Yeah I was asking a lot of players in the NBA. What's the deal like about Michael. And there was a player. I grew up in Chicago so I know all the players so he's like there's this player BJ Armstrong and I remember B.J..

: Did you grow up in Chicago?

: I did. Yeah.

: You know that's where I'm based right?

: No I didn't.

: I knew I liked you for a reason. I knew I like you for a reason.

: Fast sensibility comes out in real life. It's probably very conversational it just kind of weird for a lot of people out of the West Coast.

: That's funny. So he is asking these players right?

: Yeah and he's asking BJ and BJ said you know here's the thing about Michael. He either wins or he learned something he doesn't lose. Yeah. So losing and with failure is when you had. I think this is really true for innovation. It's, a failure is when you haven't taken a time to get a lesson or learn something and you should inherently that's what it should inheritly be. Is your learning if you're not if you're an innovation role and you're not learning you're not innovating because you should either be winning or learning. And if your leadership isn't encouraging that then you really have to ask yourself "Do they really want innovation?" Because the other thing about health care is people say they want innovation and then you give it to them and then they just turn around and run the other way. So if you're in a situation like that then you really act and ask yourself. Are you innovating and you really want to innovate? And it's okay to say "hey we don't want innovation" it's okay to say that because we're a variety of factors your business model may not support it, your culture may not support it and trust me I've been in rooms and I've been in presentations and I've given it and I've seen my fair share of hostility. I've seen my fair share of discomfort. It's just you just don't have people in the room that are temperamentally suited for innovation. It's all okay but you just have to be very very self-aware on where you are but if you really are innovating your journey. So I think for us if you want to put it in that frame our biggest learning opportunity. Right. One of the biggest and it's not really even a failure because in fact we're actually I think we're leading the way because we get asked a lot and I'm happy to talk to them, is around here reimbursed. And that's one is another area I don't think people yet have gotten an appreciation for. This is one that's coming up because rules are even changing. Regulatory is coming up now where it's encouraging the adoption now and right now in fact there is a call by CMS to comment on upcoming they have got an upcoming telehealth changes to telehealth coding for 2019 and are encouraging comments. I was just talking to the CMS folks just last week. And they said "please comment on this because we're not experts and we read you from the innovators, So we may not know about new technology applications and interventions so please comment." So one of the areas of learning for us even as we're going through this is for example we didn't we never thought our solution could be reimbursable well through the partners that we were working with. We started coding and billing certain call are like "oh wait a minute you can build against this you can build in there like?" Yeah. So we started working then with our current provide clinic partners that we're working with. We started talking to billing experts, restarted engaging with other payers will working with to come up with a schedule of codes and we started talking to people at CMS saying "hey can you help us understand some of the coding here." So that's actually a learning for us that we're now we get asked by digital companies when we tell providers hey we're reimbursable we're like you're remembering your reimbursable or payers. They get really excited. And they're like okay you're speaking our language you actually understand the world that we're part of. Now are we going to be right on this? No? maybe not. It may not be applicable frankly to some people some providers or payers will be like because they're in a very restrictive. What they don't. It may not and we told them we said look we don't, you have to talk to your provider you have to talk to your health agents or your state agencies. Here we work with some some parents that have had gone to their own respective Medicaid governments and said hey we want to use this program will it be a reimbursable and they've gotten the reimbursement right or the approval to use the program and care. So we'll work with providers and payers hand in hand. And we're taking active efforts now to see if there there's even ways that we can help reduce that friction. So we talk like payers that I can see the discomfort that comes in right because this is so unknown it's the discomfort of the unknown. And we all know that they're going to reimburse. We want the solution but then it's more work because we have to go back to the insurance company it's going to be a pain blah blah blah blah blah. Right. But we tell the press here's a schedule of codes depending on your care setting that you can use and please check with your provider it may or may not be applicable but here's a path forward.

: It's interesting. And for the folks listening that have digital therapeutics or mobile technologies you're going to want to know some more about how to get in touch with Swatee and their work that are team up to because you're more than likely are like oh my gosh I want these codes so we'll give you a way to get in touch with them here at the end of that podcast. What would you say one of your proudest medical leadership experiences is to date Swatee?

: You know and I know it's going to be really cliche but I would tell you you know when we first started I started the company in 2013 and at the time nobody was really thinking about gaming applications and health care and like I said nobody even knew what was going to work. I'd always get. How is this going to work? And you really think people are going to use this and then even our own team had internally assumptions of who it was going to work for. And I think the most proudest moment was getting that initial player feedback. We were working with the clinic out in Arizona. It was Arizona's first integrated Behavioral Health Clinic and they gave it to their patients. And these are patients with relatively high utilizations. There are some of the more complex cases and we got the feedback we started using the app within three and within three weeks we got feedback which is you know back to that as I mentioned before we were testing looking at qualitative feedback the clinical and the qualitative feedback that came back was just astounding that we received and these were what was interesting is that it just blew out any expectation assumptions that we had. It was a wide age range of people men and women in their mid 40s to early 50s to early 20s then and what was even more interesting was the patient population that were impacting. These were people with PTSD, severe depression as well as bipolar substance abuse. And within three weeks of using the app they were saying things like it's life changing it's their inspiration every morning everyone should get it. And now is the first set you know as a scientist or. OK. And even though it is a group of the like. And we started to learn that gee it's going to impact people beyond just the mild to moderate. This actually has impact on the people that have more complex cases and thus the higher costs. But in the back of my head I'm still thinking okay well imposter syndrome sets in is like well maybe it's not real or it's just a one off. Yeah. And yet over the years it's consistent. Well that's what's been the striking thing. The feedback that we get and I hear this and I've just I just heard it a few months ago from people about some of the most difficult to reach cases is where we've been able to make some pretty amazing head inroads into along with helping the general population so...

: Is that where your award from the U.S. Army came in with the PTSD?

: Yeah we were working with the army. Yes. They were our first deployment ever. It was our first deployment ever. We had a public beat. But our first real clinical deployment was in a military complex. It's really interesting. Yeah they were really big supporters of ours. So it was the army. This is on base. So it's not even veterans this is active military...

: Active duty.

: Active duty and their dependents. And what's kind of interesting about Maddigan is people don't realize this. It's a young population and their active duty and they mirror the U.S. population. So it is a great site. What what's the other thing is that it's families lots of families there so the like young families that are getting treatment at Maddigan is that it's not what you think of if you think about army. That's not what you think of immediately now. That's who we were dealing with. So it's again putting aside preconceived notions when you hear something. But that was our first deployment and we were working in the clinical results of that study. Got us the Surgeon General Award.

: That's awesome. So how did that whole thing even happen? How did you get hooked up with the army to do this?

: So this is an example of where networks and innovation networks are really important. We knew another start up in Seattle were West Coast based so we knew a startup in the health care community and we were somewhat known and she met a colonel there Colonel David McKuen that's an oncologist and I think they're on a panel together or she heard him speak that. A science life sciences industry event here locally. And when she found out what he was trying to do which is promote innovation in the military complex she said "hey you should talk to this company locally." And that's how we got connected.

: Amazing.

: Yeah.

: That's cool. And that's the beauty of it. And thanks for sharing that Swatee congrats on that. The difference that you and your team are making is outstanding and the award decide the lives that you guys are impacting our super super amazing. And then also just the message behind the message being that you have to connect the silos folks. And part of what we do here on the Outcomes Rocket is put people together to share their story so that we could have these conversations to make a difference. And much like the story that Swatee just shared the local startup that met the colonel that then made an intro. This is what we all should be doing to move the needle forward and Swatee, this is awesome that you guys were able to actually take that introduction and put some good work forward to help the lives of these young young folks not just men it's women that are going through this stuff.

: Thank you. And you know if anyone's interested in what we're doing you're wanting to learn more or if you have a population that has behavioral health needs. Give us a ring. Because I think we've been able to help a lot of people and we want to help a lot more and we're not going to be able to do it alone.

: That's awesome. Now Swatee if they do, what's the best place for them to get in touch with you?

: They can email me directly. So I'm at swatee@litesprite.com.

: And so folks will also leave that e-mail address as well as links to Swatee's company. Just go to our otcomesrocket.health/litesprite and you'll be able to find it there. Getting close to the end here Swatee let's pretend you and I are building a medical leadership course. And what it takes to be successful in the business of health care. The one on one of Swatee Survey and so I've got four questions for you lightning round style followed by a book that you recommend the listeners. You ready?

: Yeah.

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

: Build technology that truly empowers patients on what they really need.

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

: Unintentionally applying old frameworks and expectations to new scenarios.

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

: You have to constantly learn and you have to learn from all different types of sources.

: Of that, what's one area of focus that drives everything in your organization?

: What do our end users, patients, or clinicians really want in need.

: What book would you recommend to the listeners Swatee?

: So is this going to be probably a out of left field...

: Let's hear it.

: I would actually recommend there are two books of poetry that I would actually recommend. One is by Pat Ingoldsby, Half a hug. It was he has a bunch of AMI's as Irish poet. That's one. And then more contemporary version is by Rupi Kaur. And it is called The Sun and Her Flowers. It's her second collection of poetry. She's Canadian based so I think that's actually very both of those are interesting because you talk about one of the things that poetry does is it describes something in a way with words that's unexpected. It's about changing your mind, changing your frame.

: Yeah.

: So poetry is a really easy accessible way. I think that you can start changing your mind because they start describing events, experiences in an evocative way not a direct way. And I think that helps you with innovation you need to be able to see things from different perspectives, different angles, different lenses. That means you need to be able to change your mindset and your frame.

: Super. I love that that's definitely left field but awesome. And I think a really interesting way to do that. I'll definitely be picking up one of these Swatee so thank you for that.

: You'll have to let me know if I a poem short.

: So good. So if I choose one of them which one should I choose the two that you've discussed?

: I don't know. it was a Pat's was the first book I ever did pick up and I still haven't even actually finished it. But I just like literally what I'll do is I'll just open the book up and read one of the poems that's how I don't even read it and...

: Kind of desk reference right.

: Yeah.

: Yeah I kind of like what's the word of the day kind of thing.

: Yeah.

: I haven't finished Rupi's right. This is a new book of hers I put it up. And so I haven't actually gone through with it that's more she's Asian American, Asian immigrant, like I am so. As more personal I mean by an interpreter like really helping me enjoy the evocativeness of words, it was Pat Ingoldsby so...

: Okay, very cool. And we'll be picking one of those up. Definitely will connect with me on that and listeners do do the same. Keep your mind open, reframe. This is the way that we are going to change outcomes in health care. Before we conclude Swatee I'd love if you could just share a closing thought with the listeners and then the best place that they could get in touch with you.

: I think it's, innovation is hard no matter what, where you're sitting on the spectrum whether you're a health care leader internally making decisions to someone who's been tasked to identify solutions to whether you're the innovator in this space creating the solution and then you might be all of that right. So I think it's just really important to, I would say it and not a pejorative so just check yourself and see where are you at on that innovation spectrum. Are you asking for things that are reasonable or appropriate? Or are your expectations reasonable or appropriate at that stage? And if not then what can you do or if you need that if you need that type of information. What can you actually do to help further that? What can you do to roll up your sleeve and become an active participant rather than a sideline critic?

: Love that, Swatee. And you've provided your e-mail to us so appreciate that, we'll include that in the notes you've left us with a lot to think about. So we appreciate that. And thank you for making time to spend with us today and looking forward to staying in touch.

: Thank you.

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Why Video is the Best Resource for Medical Education with Roman Giverts, CEO at VuMedi, 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 where we chat with today's most successful and inspiring health leaders. Today I have the amazing Roman Giverts. He's the CEO at VuMedi, the leading healthcare video network for doctors. Over 200,000 doctors use VuMedi to improve patient care and grow their practice. They provide a large targeted marketing opportunity for healthcare companies using a native advertising model. Roman founded the company from his college apartment as an undergrad engineer at UC Berkeley. He's a huge believer and bootstrapping from nothing, loves helping entrepreneurs get their companies off the ground. Before starting his company, he worked that techcrunch at the original Office in Mike Arrington's home. Additionally Roman was the first intern in NBC Universal's Antipiracy Group where he was exposed to pioneering companies in the online video space. So it's a pleasure to extend a warm welcome to you, Roman I really appreciate you making the time for us.

: Thanks Saul. Really excited for this conversation.

: Absolutely sir. Roman you could have gone out a lot of directions. Obviously video is is a fundamental tool for marketing and communicating in any vertical. But why did you decide to choose health care?

: Right. Good question. So video is getting really hot as YouTube was launching and I was taking this internship and I really had no background in medicine so a little bit accidental that I stumbled into it but I just happened to be dating a girl, who thankfully is my wife or this would be an awkward story told over and over again. My girlfriend at the time in college her dad is actually an orthopedic surgeon

: Nice.

: So, one day I was just kind of walking around their house and I just stumbled on him watching a surgical video. And this was about maybe 10 or 11 years ago and before Netflix if you remember we had these like racks of DVDs you know.

: Yeah.

: So yeah something like that but it was surgical videos and he kind of explained to me that he uses those videos to learn. And of course I said there isn't a website where all of you physicians can go and look these kind of videos up and you know there wasn't and that was kind of how I stumbled into it. He said "you should go create it." And I had three or four other ideas and the other ideas I had zero users and I thought I had one here. OK well I think this is my best idea and I guess we're kind of maybe where I got a little more invested in the industry was when I really two things you know one a lot of the other you know my friends in college you know everyone to start a company or build an app you know their ability kind of cute consumer applications, the Apple app store had just launched. So people do a little cute picture apps. I just thought this concept are a lot more meaning behind it. Helping physicians treat patients and improve patient care just kind of inspired me more. And then you know when I learned about the size of the market I just couldn't believe healthcare is number one vertical in our GDP. So it all together had meaning from a big financial opportunity and I kind of thought this was a great space to be. And so I was actually supposed to go to law school and I had gone in and had to tell my parents I wasn't going to a top 10 law school. That's something...

: How was that? How did that go?

: Well I started telling you about the product and I didn't tell them about until we had like I think a thousand users but it went pretty well.

: Very cool. Hey if you sold that to your parents those investors were a cinch.

: Parents want you to go to grad school. All they've got to do is go to grad school like you know and to throw all my test scores out. And in fact, I'm not even getting a job, I'm going to work for free and live at home instead.

: Got to love that man. Well fast forward to today. You guys have definitely picked up some good traction and you're doing some great things. What would you say Roman is a hot topic that needs to be on every medical leaders agenda today and how are you and your team at VuMedi tackling that?

: Yeah I think what we see probably the most exciting inspiring trend is just the rapid innovation in some of the specialties particularly oncology and Rheumatology you know having called you're changing humanity right so probably the biggest one is going toggery now is the approval of karty cell therapy. So kids who are under 25 and none of the available treatments could save them and get a curtsies so Transperth piece of therapy and really saving lives is pretty pretty incredible. You know people call us from oncology every week there's a new FDA approval. So it has all of that has enormous impact to just about every field right whether you're a clinician right. Your ability to save lives. The economics are very controversial so these therapies are very, very, very expensive. The FDA pathways have been modified now because again you're saving lives and think there's no rapid approvals. Things like that. And then you go from a point of view it's a significant change in practice to actually apply these therapies. And so when you see headlines like 400 percent increase in survival in bladder cancer. And that's something that as an oncologist you want to take advantage of. That's not like 10 percent minor impact in some type of quality of life measurements of lives being saved. And so they have to get educated and they have to keep up and they have to learn and so from VuMedi point of view that's really where we fit in is trying to help these oncologists as well as many other specialists. There's rapid innovation, rapid change and of this are trying to keep up and treat patients that are trying to help them.

: That's awesome. Super important too right. That rack of DVDs is a day of yesterday and we're in the streaming age. So no doubt it's important for clinicians to have a point where they can actually go visit get what they need and move on. Can you share with the listeners how you've applied some of these technologies to help leverage and scale the new solutions that are available?

: Yes sure. I mean I think that the educational pathway is complex. I think that we take for granted how hard it is to actually know just to stick with the oncology example and actually change your practice and use one of these therapies let alone change how you do a surgery which is even more complex where even how you treat a patient with diabetes and a few comorbidities very very complex educational pathway. I think a lot of what's traditionally been out there from the days before the internet it was textbooks all the way to today. There's a lot of news websites you know that cover in a paragraph or a short video about pathway is complex it's hours of education. And so that's where technology comes in. In VuMedi we have 50,000 videos just on one topic we might have 30, 50 or 100 videos. You just can't do that with the DVD rack. We started talking about, you can't do that with basic search right. We have very advanced taxonomies very advanced understanding of like basic, intermediate, advanced content understanding of related content. And then we're also you know investing a lot to understand what are users where they are in that pathway. And the only way to do that is with technology and I think that's what technologies enabled the physician to be able to not only to get access to so much more content right with 15000 videos compared to 20 but also to enable the platform like the VuMedi. So then recommend that actually help make decisions and help guide them to the right place.

: That's a great call out. And folks if you're curious the website for vumedi.com, check them out over there see what they're up to. Really cool stuff. Making education simpler. It doesn't have to be complex. And with all the changes it's super important that we have a tool to make it that way. So Roman talk to me about a time when something didn't work out. A setback that you guys had. What did you learn from that setback? Take us to that moment.

: Sure if I could spend the whole podcast on those probably I think the top of the list. I think there's a tendency to prioritize and do things that sound good over doing things that have the greatest economic value and output. I'll give you just one example that we've made that mistake many times but I'll give you just kind of the one biggest example you know our goal is to get as many doctors on the platform as we could and we chased big round numbers of 50,000, 1000,000, 2000,000 so we would open up specialties that had very large numbers of doctors on pediatrics, radiology and so forth with over 50000 physicians. What we learned though is that that's not necessarily the greatest economic opportunity for human right so what sounded good. Getting to a hundred thousand doctors wasn't actually the optimal way to grow the business. And you know today you know we've learned that it's actually the greatest opportunity for us for specialties like oncology or rheumatology which are significantly less physicians but physicians spend a lot more money. Those products cost a lot more. So every one of those physicians is much much more valuable to the platform and to the potential advertisers. And so I think that if you're a product guy like me and you know you want to solve a problem for physicians which we did you don't always put your kind of businessman hat on and actually think about how do I build the biggest business the fastest way possible and I think we've learned from mistakes like that. And I think now in everything we do on a day to day basis from every single product decision, every single expansion decision, every investment we make we think about what is what is the economic output of that investment. And by doing that you grow a lot faster.

: Yeah that's a great call out Roman and one that we're working and the innovation of a product your company needs to keep this in mind just because it sounds good doesn't mean it is good. Good ideas aren't necessarily good business plans and so it's a great message from Roman that he's shared with us today so let's keep that pressure test those things. Hold yourself accountable. Don't just go with something that sounds good. Well how about one of your proudest moments Roman what's been something that you guys have achieved today that you're like man this is awesome.

: Yeah. Just give you the achievement and then maybe give you a little backstory for why it was so important to us which is you know also learning in Q4 of last last December's lots of months ago we had our first 100 percent renewable quarter in Q4 as our biggest quarter were more large percentage of our sales comes in. And so that's a nice you know a nice metric but is really a journey of about a year and a half. Previously we've had a bit of a transition at the Meddie sales which previously did not report it to me in reporting it to me which is a whole new area for me to learn about. And we really transition that the company from celebrating sales to celebrating customer success. And I think there's a tendency to get really excited by when you close a new deal. Right. And we still celebrate that by all means. But I think what I've learned is that growth comes from the success at the conclusion of the delivery of what you sold. In other words in the renewals right. And so one of our company values that we created about two years ago was customer success right and everything was not about the sale. It was about delivering success. And so you know we want to our customers are on an annual cycle. So you know that January is when we began a lot of these investments in their success. So you know we didn't know whether they would you know we invested a lot and then you kind of wait wait wait and then you get to the end of the contract you're up for renewal. So we saw that all of that, all the investment that we made in the success of others translating was a renewal and the reason which have been important for the company was that it showed us that the methodology that we were undertaking the principles of philosophies that they were working in I mean you know not only did we beat our forecast and it was a great financial year show that like we as a company knew what we were doing and we really were delivering to our customers. And it inspired us for the future growth that we made if we could continue to do that so it was sort of an exciting last day of the year there. But a long road getting there.

: That's awesome. Congratulations on that Roman to you and your team and you know it's those little shifts that can make a huge difference. Roman, your last name as Giver. You are a giver my friend. You're a go giver not a go getter.

: I never heard that but I'm going to use it, thank you. I'll share with you we have we have a joke internally we call it if anyone remembers a song from the early 90s called OPP or yeah I remember that it is other people's problems and so one of our core values is you know we care about other people's problems. We want to solve other people's problems and that's sort of a funny use of customer success.

: Love that. What a great story there. Roman and I love that you guys have those little playful ways to engage culture there at your organization you're doing a really nice job there man.

: Thanks, Saul. I appreciate it.

: Absolutely. Now tell us a little bit about an exciting project or focus that you guys are working on at VuMedi today.

: Absolutely. You know I mentioned sort of oncology as a theme. You know that's by far the fastest specialty we've ever launch which took us three or four years and other specialties we drew just in a year of over 6000 oncologists using the platform hundreds of videos and partnerships. It's a great space to be in. But you know I think what we're learning also then is the targeting and how important the targeting target technology is in that field particularly in that a typical oncologist treating 20 different cancers that's changing every like you said every week there's a new FDA approval. Furthermore you don't see these cancers are really rare for specialties like blood cancers. You're seeing one or two patients a year. Right. So you're not you know you're trying to stay up to date. So you know we're really working on is targeting the physicians when they actually need it, when they actually have that problem. Right. So you get a lot of news letters I get a ton of them. Well reality is I'm dealing you know 20 types of cancers right now. My problem is the breast that you're sending me something along that's not going to do it for me right. And so knowing the users really well as well as having the content and actually having the technology in the taxonomy that underpins a lot of that knowledge to be able to recommend the right content at the right time. I think that's really exciting and I think that all of us shop on Amazon have seen that type of thing in action that's what we're trying to bring to medicine and I think it has a huge opportunity to really change workflows of physicians and how they acquire information and and as a result how they change their practice and treat patients.

: That's pretty cool. Yeah I mean as a consumer you definitely value companies that could say hey Roman I know that you've kind of interested in this so why don't you check this out. Oh my gosh thank you. I think it's amazing when you have a technology that helps you do that and it's not easy right. I mean you sound like you guys are putting in the technology, the algorithms, machine learning, whatever you guys are doing to actually make the platform smarter so that it makes smart recommendations. I get into my car in the morning and it says it's ten minutes to your son's daycare. And then when I get back in it's like all right it's 15 minutes back home. Those are the kinds of insights that people want. Right.

: As you said it's really complex. I mean the quantity of data is just extraordinary and the scale of it our engineers are just talking this morning. They were up to 1 am upgrading our database last week. You know the amount of data points you know imagine every opened up an e-mail, every impression, every page view, every tiny thing that a user does tells you whether they're interest in something or as importantly that they're not interested in something and then you know trying to take all those data points and add hundreds of thousands of users to come to a conclusion. It's very complex and the credits are just the quality of our really advanced engineering team sort of the backbone of humanity.

: That's awesome Roman. And yeah I mean you know half the battle like you said is like separating the signal from the noise. If they don't open it that's just as important as if they did. So you know that you should be focusing on something versus not. And folks when you're thinking about how you use data within your organization take some of these thoughts that Roman has left us with an understanding you've got to separate the signal from the noise. If you're going to make those true insights to improve outcomes and and build better business models. Roman, getting close to the end here let's pretend you and I are building a medical leadership course on what it takes to be successful in the business of medicine - the 101 of Roman Giverts. We're going to write a syllabus for questions lightning round style followed by a book that you recommended to listeners you ready?

: Yep.

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

: Study just measuring everything so that the data exists and then making it transparent so that at the very least you have access to even multiple organizations can have access to analyze it and innovate around it.

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

: Not having a fully completed interdisciplinary team health tack or digital health. It's an interdisciplinary field. You know it's healthcare technology as well as often other other fields. And what I see most often is a company started by technologists or actually started by a physician or clinician that doesn't have all of the pieces together. And I think it's required if you don't have one of those pieces. So much struggles to succeed.

: How do you stay relevant despite constant change?

: Yeah I mean it's important. VuMedi has been around for 10 years so that's a good one for us to talk about. It's really all about growth. We grow much faster the last 3 years than our first three years. The faster you're growing the more relevant you are and that growth is all about creating results.

: Absolutely. And finally what is one area of focus that drives everything in your organization?

: What I just said results were all about creating results.

: Love that and you're all about the OPP right?

: Results and OPP. I was wondering how my mid 90s love for rap would intersect my professional career and finally.

: I love it man. What's your favorite book you want to recommend to the listeners?

: Yeah the book I've read is at least ten times is Crossing the Chasm. It's very well known in technology marketing if it's known as a medical book. But it is by far the most important book that helped me succeed. I probably read it five to ten times just in the first year. Every time I was stuck I'd go back and read. Crossing the chasm explains to you when you start your company your first year you're going to have customers or users or whoever stakeholder is trying to acquire that say no you and that don't use your product or don't buy your product. And that book explains to you why they're not buying it. And that allows you to understand sort of where you are and your trajectory and where you need to be going. And we talk about that book at VuMedi on a regular the concepts in that book of crossing the chasm and early adopters of fragment pragmatic buyers product solutions on a daily and weekly basis to this day and following their niche marketing strategy is literally what we're allowed to succeed because we started real real small as a site for shoulder surgery and in just a few decades. Now as you mentioned we have over 200000 physicians in over 50 specialties by now. It all started with a really targeted niche marketing strategy that I got from crossing the chasm.

: Gotta love it. Great recommendation Roman. Folks if you want to get a hold of this book as well as the transcript from our conversation today just go to outcomesrocket.health/vumedi. You're going to see all the links there and you could get your learning on. So Rumman, this has been a blast. I love if you could just leave us with a closing thought. And then the best place for the listeners to get in touch with you or follow you.

: Yes sure. My closing thought is just to take you Saul for organizing this podcast I think Healthcare, health tech, digital health education is necessary and there's so many podcasts online. Technology is really great. More exposure for our field and view giving a platform to people like myself to come on and share share thoughts and beliefs and ideas on this skills. Also thank you for doing it. Thank you for having me on and I really appreciate it.

: Absolutely Roman. It's a pleasure. And if anybody out there listening to this sort of what you said struck a chord with them. What would be the best way for them to reach out or follow you?

: Yeah. The best thing to do is I always gave out my e-mail and I'm going to do it. But you can just e-mail me directly at roman@vumedi.com and if I don't reply just just send it again. We get a lot more inbound than we used to but I tried to make myself look for many people as I can.

: Folks if you write an e-mail to Roman just type in Outcomes Rocket in the subject and the likelihood of him answering will go up.

: So myself by the way for other people I've listened to so that's a good call.

: Absolutely. So folks there you have it. Roman Giverts with Vumedi. Roman, this has been a blast. Really appreciate you sharing your insights and looking forward to catching up with you soon.

: Thank you.

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Recommended Book:

Crossing the Chasm: Marketing and Selling High-Tech Products to Mainstream Customers

Best Way to Contact Roman:

roman@vumedi.com

Mentioned Link:

vumedi.com

Check out this Link:

https://outcomesrocket.health/podcast