Category: Patient Outcomes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

: This is exciting I'm ready.

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

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

: What is the biggest mistake or pitfall to avoid?

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

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

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

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

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

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

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

: Yes.

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

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

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

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

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

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

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

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

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

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

: Saul thank you so much.

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

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

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

: 4 Boys and one girl.

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

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

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

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

: Okay.

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

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

: Yes.

: Very cool.

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

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

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

: Yeah.

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

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

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

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

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

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

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

: Let's hear it.

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

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

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

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

: Okay.

: So we'll get after it then.

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

: Yes.

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

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

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

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

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

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

: Yes.

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

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

: Yup.

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

: Okay.

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

: Listen to patients.

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

: Not listening to patients.

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

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

: Love it.

: Optimization.

: Love it.

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

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

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

: Ooh. So this is a little crazy.

: Let's hear it.

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

: Okay. No.

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

: Literally?

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

: Wow.

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

: Jeez.

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

: Oh my God. That's amazing.

: So that's...

: The thing insane is the word.

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

: Oh my gosh.

: So for 30 days.

: Oh my gosh that's so crazy.

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

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

: Yes.

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

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

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

: Absolutely Saul for just chat again soon.

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

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

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

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

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

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

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

: That's a big shift.

: Yeah.

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

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

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

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

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

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

: Right.

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

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

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

: That's amazing.

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

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

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

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

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

: Yeah.

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

: That's really interesting.

: Yeah.

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

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

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

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

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

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

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

: Okay I'm ready.

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

: Lead your teams with relentless passion.

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

: Lead by a regulatory call to action.

: How do you stay relevant despite constant change?

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

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

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

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

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

: Oh that's a good book.

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

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

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

: That's amazing.

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

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

: All right thanks Saul. Appreciate it.

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

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

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

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

: And welcome back. It's a pleasure to have you all back on the podcast today. I have Jeremy Rassen. He's a Co-Founder, President and Chief Scientific Officer at Aetion. Jeremy is an Epidemiologist and Computer Scientist with 20 years of experience in the Science and Technology of Big Data. It's this awesome combination that helped them put together the resources and plan for the work that they do there. He was an Assistant Professor of Medicine at Harvard Medical School where he developed cutting edge methods for developing quality evidence using real world data. Prior to that Jeremy spent a decade in Silicon Valley. He was the fifth employee at Epiphany Incorporated where he was involved in the creation sale and deployment of data intensive applications for marketing and customer relationship management. There's no doubt that the shift that we're having in health care is going away from the typical Hey devices life sciences approach. It's all about what you could do with data to improve outcomes and so it's such a pleasure to have Jeremy on the podcast today to share his insights in this space. Welcome.

: Thank you.

: It's a pleasure to have you Jeremy. Anything that I left out in that intro that you want to share with the listeners?

: No I think that was pretty comprehensive.

: Awesome. Well listen there's no doubt that paths lead into health care and a lot of different reasons a lot of different ways. But what was the way that you got that into health care?

: You know I think in your intro you almost had it as you mentioned at the beginning of my career I spent about 10 years on Silicon Valley working on big data applications I was computer science undergrad went back to where I'm from which is a San Francisco area after school and got engaged in all the tech that was going on there in the mid to late 90's and really adored the technology, I really enjoyed the technology of using data sets to find these interesting associations to find even interesting causal facts. I wanted to apply that in a way that was different than what I was doing out there which was large as you said in marketing and customer relationship management. So transitioned to health care and my first step there was getting a doctorate in Epidemiology at the Harvard School of Public Health. And if you think about public health my parents I grew up in San Francisco they said their father is an internist in San Francisco. My mother ran a large social service organization. So if you average out the two you kind of get public health. So going to school, public health and getting degree in epidemiology felt like a return home in memories but also return home in the sense of being able to take the kind of questions you were asking of the data and apply them to a whole new field that is to say effectiveness safety and value of medications.

: I think it's so fascinating Jeremy and it's really interesting how you sort of dovetailed all that into the public health and and with your background in Computer Science. I think now is the time and everybody is talking about value-based care. What do you do? How do you do it? What does it mean? And so I love that you and your team are are working to quantify and really find a way to scale these things that are essential to our business and for our patients.

: You don't have to say that was one of the first things I've worked on in Boston and identifying named Sebastian. Sebastian had spent the prior 10, 15, 20 years thinking about how to use the data sets that came to be as part of the running of the health care system claims medical records and other data to really evaluate safety effectiveness and value in particular out of medications. And he'd been thinking about that in a very structured epidemiologic academic way. I've been thinking a lot about data and really from that from the first moment we put our hands together and said how can we take that really strong causal thinking that's developed in the field of epidemiology and put that to work at scale which is the big part of it. Put that to work at scale for answering these questions of value that we all have.

: Super interesting. So you're taking a look at this data and you're trying to figure out how to make the best impact and health care. What would you say today is the big hot topic that needs to be on all the health leaders agendas today and how are you guys at Aetion addressing it?

: It comes back to value for me. I think the inside the healthcare field at this point and talking to friends and colleagues who are outside the health care field gets pretty clear that the rising costs aren't good for patients they aren't good for the health care system and you know ultimately they have to be unsustainable. So thinking about how to spend money in a way that improves patient outcomes it also sustains the system. As a hot topic in our wrap up and call that call it value.

: It's really important to look at this and some curious how are you guys looking at value and how are you helping health systems look and measure value. I think this is a thing that a lot of people struggle with.

: Yeah we really look at values starting with decision. There's a thousand decisions made. You know every moment in health care as a scientist I have to be careful with numbers but a lot of decisions being made. Every moment in health care and those can be small decisions at a clinical and for one patient large decisions happening at payers or for pharma companies or other places affecting many many patients and I think the vast majority of the decisions are being made today or done either with intuition rather than evidence or with evidence that isn't really pertinent to the patients and that decision will affect. And so I think a lot of what we do is intuitive. We have the data and now, we have the information now to do this based on evidence to make these decisions based on evidence and not just any evidence. I think there's a lot of evidence out there. Our's a randomized trial year. That's a very high quality but doesn't necessarily describe the patients that we're treating at any given moment. It could be that the trial was done in a particular part of the country or in particular patients subsegment with a particular set of comorbidities. We need evidence that supports decision making for all patients and for patients in particular who were treating in any given moment.

: So Jeremy that's really interesting and I think it's important that we start looking at that I mean I think of let's keep it simple right like cable. If your cable company doesn't deliver what you believe is a good internet speed. Guess what you're going to cut them out in the same way as kind of happening here in health care. You know rising health care premiums have got rising co pays. So now you go to your grocery store and you've got this like Smart MRI place. Now they're actually giving you options. You're going to pay less for it. Value is something that we need to deliver. Can you give the listeners an example of how your company has helped organizations create results through this value perspective?

: You know absolutely and you know I'm thinking about the MRI exam.

: Yeah.

: That might be incredibly important for the treatment. One group of patients but much less important and perhaps even an important to remain powerful for another group of patients. There is certainly a cost of a certain kind of cost for patients with her procedure that he or she doesn't need. So that's in some ways the context that I think about value in. And so you know one example that we've engaged with here at Aetion is working with a pair here in the Northeast where they had a pretty general question and that question was, helped us better care for our diabetes population. Diabetes population at this pair large and growing and growing in terms of the disease itself the diabetes itself but also all that comorbidities that go along with diabetes and all the utilization and cost that ensue from the diabetes and comorbidities. And so those were the pretty big question. Now help us better manage her diabetes population and for us managing rather answering a question like that starts with really understanding who the patients are. Who is this population? And so to do that you want to break down the population using the data for the pair because that's representing ultimately the patients that they're caring for not national data not a randomized trial that 70 Ram payers data and really digging into those data to understand who the patients are? What kind of treatments they're currently experiencing? What kind of outcomes occur and how we could possibly change those outcomes or some or all patients? So with this particular payer we help them break down their diabetes population and show that it really wasn't monolithic in any way. They certainly knew that but described the ways in which it wasn't monolithic and in particular there was about 10% of the diabetes patients who were particularly severe particularly high risk and high risk both of a progression of diabetes but also these comorbidities type which I mentioned before. So as I said that's 10%. That's a relatively small number. But those 10% were being treated to guidelines and the way the other 90% work. And the guidelines say you start with the first line therapy that doesn't work. You move on to kind of something in the middle between first and second continue with second line therapy. And what we showed was having identified these 10% of patients if they're treated directly with the second line therapies which are more expensive they cost more but that cost is over the ensuing months represented much better outcomes for the patient and much fewer E.R. visits and hospitalizations, another kind of high cost services for the payer. So that's not everybody, that's one in ten. But if you think about how to treat the one in ten differently than the nine in ten, you end up with amazing results both for the patient and for the system itself.

: So yeah that's really neat Jeremy. And the interesting part. You know a lot like it's sort of a microcosm of the health care environment that we're in. Most of the spend goes the 5% of the issues that are out there. And the nice thing that your company is providing sounds like you're giving these people not a representation of the U.S. but a true analysis of their population.

: Absolutely. Every entity within health care has a certain group patients for whom they were responsible. A payer population, health systems, patients that they're treating. In this as you can get closer and closer to really looking at how to improve outcomes within that specific population under treatment, I think we can do better and better.

: Yeah and a lot of times we think of value-based care. Your mind and you know through conversations you typically go to like. All right. What value are you providing patients? And I think another way we should be thinking about it Jeremy and appreciate you for taking this up is what value are you providing to providers and helping them identify the best treatment for patients. As a payer for instance you're collaborating with the other stakeholders in health care. Value-based care is all about collaboration between all the stakeholders.

: Absolutely. And we see that as a very core part of what we do which is to help bring these stakeholders together on a shared and transparent and well understood evidence base that's pertinent to the patients being treated pertinent to the population is being cared for and to do that we need. Good data.

: And you know over the last 20 years I would say there's been a huge advance in a methodological basis for real world data analysis to real world evidence and say in 20 years that we are looking at randomized trials as not just a gold standard perhaps the only way of really getting at these important questions of just drug A work better for drug B among patients with very severe diabetes and substantial comorbidities. A randomized trial 20 years ago may have been seen as the only way to answer a question like that. Today we have the epidemiologic basis and scientists are sorry for going into the...

: That's all good.

: In methodologic basis for really doing that either with a randomized trial or with the data that's already generated as part of the health care system the real world data and I think that's the extraordinary evolution over the last 20 years that really gives us the opportunity to measure value and deliver value in real time. And for the patients who were being treated as I mentioned and I think that's extraordinary evolution of the last 20 years in our company Aetion in the software that we create as a platform for taking all of those developments over the last 20 years and putting them into software that can be deployed quickly and at the right points in the health care system to make these really important decisions that everybody through the system needs to make to make those decisions fully evidence-based at the highest level of quality.

: Love that love that sounds like it's a phenomenal tool. Folks if you haven't had a chance check out Jeremy's team and all the things that they're doing at aetion.com. You'll find all the software solutions they offer there as well as the team of outstanding contributors that they work with there. So things don't always work out Jeremy sometimes we hit brick walls especially in entrepreneurship and health care. So we learn more from those moments. So I want to ask you. Give us an example of a time when you had a setback and what you learned from that setback?

: Yeah I mean so we founded the company, Sebastian Schneeweiss, and I about five years ago and that's give us ample opportunity to as we go along. I'll say that there are a lot of things that that you know really came together over those first years and one of the first things that Sebastian did was to go and find just top top top down tech team to build out this software platform and we need to be able to do this fast and be able to do this scale. We need to do this on time. These are all things that you really need a top tech team to create. I think at the beginning of the outset, at the beginning we thought that our customers would have all the questions available and ready to go. And just you know we're needing software to input all those questions into you get the answers and what we learned over the ensuing years was that sometimes in fact even a lot of the time those questions were available but sometimes the questions were broader like I'm launching a new drug and I want to get ahead of any potential concerns that FDA might have about safety. How do I develop an evidentiary base around the safety of my medication or even something that was even a little broader like helped me understand my diabetes population. And so I think one of the things we've learned over the years is that the software and our interactions with our customers have to really start with all levels of questions and that we can really as an organization engage in these issues. And at any place in our customers thinking and that is something that we really learned over the last couple of years.

: And you know it's interesting because you often think like "hey you know we dive into some of these challenges that our customers have. And you imagine that the questions are already there but oftentimes as somebody coming in from the outside that's where we could offer the most value." Right. Just like seeing it from the outside and helping them formulate those questions.

: Yeah that's really interesting. You know I think coming from the outside or even coming from you know kind of just from the outside just outside right.

: Yeah.

: You can see a little bit how a pattern of thinking can lead to a series of specific questions and that's something that we can really help our customers with and something that we do you know at this point.

: I think that's so cool. You know one of the things that happens a lot with me Jeremy is kind of like a long long lines what you just discussed is you know I interview a lot of awesome folks like yourself doing outstanding things in health care. Now reach out to me and just say hey you know what are you saying and just kind of being off on that not even I outside like let's just call it sidelines right. You're still very involved. You could really help clients have that unique perspective that they need to make those breakthroughs.

: Yeah I mean the answering these millions have problems in health care. You know how do we find optimal value for patients in the system? How do we you know really get these underlying questions involves first with exactly that stating the right question. And you know I was reading a book by Judea Pearl which I highly recommended called The Book of Why, where Dr. Pearl is a one of the true pioneers in causal thinking.

: Okay.

: Helping to break down the problem and express it in a way that is truly causal. Meaning not just if I switch a drug A versus B which is going to be better for patient BUT really identifying which patients you're talking about and what that switch will mean and really can what the alternative would be to treating with standard of care and that kind of causal thinking is really needed because at the end of it if you're talking about a decision that's going to change health care or change health outcomes or improve outcomes for patients, you need to be thinking causally. You need to be thinking about "What can I change that's really going to make an impact on the patient or on the system?" So framing questions in a causal way is something that I as epidemiologist think about as a really important first step in this book by Pearl, I think talks very nicely about how to think about questions of framed causally.

: Love that. What a great recommendation there one that I'll definitely add to the list Jeremy thank you for that. Let's look at the other side of this this question right. You took us to sort of a set back and what you learned from that which is super valuable. How about one of your proudest medical leadership experiences that you've had to date?

: Well you know just as five years has given us quite a bit of time to experience the first part of that we've also had I would say a number of really proud experiences our company has as mentioned is five years old started with three people in a little office here in New York City. And we've grown now to mull over 100 where you're in York City up in Boston on the west coast and all over the country.

: Amazing. Congratulations.

: Thank you. And really the company has grown and as the company has grown the needs of the company have changed quite a bit. So one of my personal proudest moments was working to recruit Carolyn Magill, she's our CEO. She joined us a little more than a year ago and she had just this phenomenal experience growing startups and working in the payer sector and really just a deep deep understanding over her years experience of how the health care system works and the dynamics of the system. And that really complemented an important way how we've been thinking about decision making and causality and the science and the software to support all of those questions and decisions. And so you know thinking about promised the leadership experiences. I think bringing Carolyn to our organization and being part of that is something that I'm deeply proud of and has been you know incredibly successful push for our organization as well.

: That's awesome. Well Carolyn shout out to you and Jeremy nice work on recruiting her. It's tough to get the right team put together. I'm a firm believer of hire quickly but fire slow. Well it's actually the other way around right. Fire quickly hire slowly because it's hard to find the right people.

: It really is. And one of the things I really enjoy my organization is how deeply engaged in the thought that's required to really bring powerful solutions to the health care field and that's something that at all levels from literally all levels of their organization leadership there should be really thoughtfully engaging at all times and Carolyn and the leadership team that she's assembled as and she joined a little more than a year ago. I think really represents at where we are for it.

: That's awesome. Congratulations. So Jeremy tell me about an exciting project or focus that you're working on today.

: Well we talked a little bit about randomized controlled trials, RCT's and talked a little bit about real-world data. And so the sister concept abroad evidence that the DNRWE to use the lingo. For me one of the most exciting projects working on is looking at how the methodological developments over the last 20 years that I mentioned, real data in real-wprld evidence have gained ability to really support causal decision making whereas in randomized trials were kind of the big game in town perhaps the only game 20 years back. I think one of the most exciting projects we're working on is looking at how real-world data can support a regulatory decision-making. So we were selected by FDA working in conjunction with Brigham and Women's Hospital and Harvard Medical School in Boston to kind of replay history a little bit to take 30 trials that the FDA had used for decision making said 23 leading to a positive decision and seven into a negative decision and to replay history and to see if we can use real-world data. The data, it's part of the health care system data that's available at the same time that those trials were being run with real world data analysis have led to the same decision that the randomized trial ultimately led to randomized trials. As I mentioned a gold standard in causal thinking and also very expensive limited to small patients, limited to very likely among representative group of patients, older patients, patients with extensive comorbidities, lastly under represented broadly speaking in randomized trials. Could we come to the same conclusion using old data. So that's a project that's on going...

: Fascinating.

: With FDA and we're also working with regulators around the world on some more kinds of projects. And to me this lets us get to the place of really applying real-world data and all the instances where we can apply it and I want to be clear that's not every instance not every question answered by a randomized trial could potentially be answered with real-world data but in those instances where we could make that switch, let's have the evidentiary base for making that switch and let's do it because that lets us get at really key really important answers all that much faster at much lower cost. Again sort of this idea of value and the health care system and really lets us affect positive outcomes for patients as quickly as we can.

: I love your conviction Jeremy and it sounds like there's some really great groundwork happening here. It's even, take a look at causal versus randomized controls methods to do things within our space. I think that's a very important work that you guys are up to.

: And as a scientist I'll say it's thrilling work. I, it's truly thrilling work as well which is awesome.

: Fantastic. And the cool part about it all is that on the back end of it this thrilling work actually impacts patient lives and there's nothing more thrilling than that.

: Undoubtedly so and being able to do that at scale I mean being able to put it into stuff that really leads to that quality decision making and health care system access to place it's really really thinking very carefully about high quality patient outcomes and value.

: That's awesome. I totally agree with you. And we're getting close to the end here Jeremy this is the final part of the podcast. You and I are going to build a medical leadership course and what it takes to be successful in the business of health care. It's a one to one of Dr. Jeremy Rassen. And so we're going to write out a syllabus. I've got four questions lightning round now for you followed by a book that you recommend to the listeners. You ready?

: I am ready.

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

: So for me this course is about data-driven decision making and health care and for need and the best way to improve health care outcomes is to start by really really carefully measuring and understand health care outcomes. I think only by measuring and understanding health care outcomes can we really improve them and really prove that we have improved them.

: And is that second part that I feel like is often missed. It's like sure measure them but understand them. I love that you just throw in the understands there because it really takes it to that next level that you really need to improve outcomes.

: And you know somewhere in the you know later later courses here , the later lectures of our course. I think you get a lecture on applying what you learn and really looking to take what you learned and turn it back into that next cycle.

: Love that. So what's the biggest mistake or pitfall to avoid?

: So I think through our conversation we talk a lot about causality. For me the biggest mistake to avoid is to confuse an association that we see in health care with something that's causal something that if you made a change it would truly affect that patient. You see it over and over and over again. And to me that's the biggest mistake and also perhaps the most probable mistake.

: How do you stay relevant despite constant change?

: As an organization, you know ultimately we're answering questions alongside our customers that improve health for patients and so you know relevance in that case is making sure that we're thinking about the questions and have methodologies ready to answer the questions that most relevant for patients. As time goes from today to tomorrow to many many years from now.

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

: It's the seriousness of our mission. I think every single one of my colleagues here understands that the insights that we're unlocking are ultimately about patient health and that requires real seriousness of mission and of purpose. And I think I tried everything to do.

: Beautiful. And what would you recommend as part of the syllabus Jeremy?

: Well I guess part of the syllabus I've to say The Book of Why by Judea Pearl, which we talked...

: Talked about it earlier. Yup.

: If you ask me what book in general would I recommended maybe it's hard to look...

: Let's hear the extracurricular read listeners.

: The extracurricular read let's say I've just been really really enjoying the Trevor Noah audiobook, Born A Crime. I know this is in podcasts circles because I shouldn't say that this was one of my first audio book spoken word iPhone.

: Hey you took the jump though and that's what matters.

: It's linked the spoken word experiences. And I just thoroughly enjoyed it. His perspective is fascinating just the way he tells the story as he reads his own story. It's just phenomenal. "I couldn't recommend it more.

: Outstanding. There you have it listeners, check out all the things that we discuss. The transcript, links to those books, links to Aetion, just go to outcomesrocket.health/aetion and the website for Aetion is aetion.com. So make sure you check that out. Everything is right there for you easy to access. Jeremy this has been fun. I really have enjoyed our conversation.

: Likewise.

: Before we conclude I love if you could just share a closing thought. And then the best place where the listeners could get in touch with or follow you.

: Well the best place for listeners to follow us is a Linkedin or Twitter or pretty much either. Closing thought, it goes back to the beginning. Ultimately as a field, we need to be thinking very deeply about value. And as we think deeply about value we you make really important decisions for the patients were entrusted, to care for. And so for me those decisions need based on quality evidence, that's pertinent, that's there, that's timely, and that's how we best serve.

: Outstanding Jeremy. Now for sure you guys are leading the way in a very important way. So keep up the awesome work one of the things that I think about Jeremy when I just kind of think about the lessons that you've shared is that we tend to overestimate what we could do in one year but severely underestimate what we could do in two or three decades. And I think the impact of that it's going to be huge. It's going to be huge. I love what you guys are doing so keep up your amazing work. Thanks for carving out time for us today.

: Thank you so much for the opportunity. We're, we appreciate it.

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

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How Anthropology Can Help Improve Health Outcomes with Abner Mason, Founder and CEO at ConsejoSano

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How Anthropology Can Help Improve Health Outcomes with Abner Mason, Founder and CEO at ConsejoSano

: Welcome back to the show. And today I have an outstanding guest. His name is Abner Mason. He's the Founder and CEO at ConsejoSano, the only patient engagement and care navigation solution designed to help clients activate their multicultural patient populations to better engage with the health care system. As you all know this population health care approach is so important especially as the demographics of our country change. ConsejoSano's clients are typically health plans and provider groups serving Medicaid and Medicare Advantage members and patient populations. So the work that Abner's doing is fascinating. Currently he's the CEO there but previously he served as Founder and CEO of the Workplace Wellness Council of Mexico. They provide members companies with access to cutting edge workplace wellness programs and a form of best practices. He's done a lot. He was appointed by US President George Bush to the Presidential Advisory Council on HIV and AIDS. He's done a lot of things with other states as well. So it's a pleasure to welcome Abner to the podcast to hear his story and the work that they do at ConsejoSano. Abner, welcome.

: Thanks, thanks I'm glad to be here.

: It's a pleasure to have you my friend. So did I miss anything in your bio that you want to share with the listeners?

: Not only that I did do a stint in state government so I have had the experience of working on the government side which has its own unique challenges. So I always like to remind people that I have done my duty on the government side.

: Hey man that's important right. Because a big part of the payer is government.

: Yep yep yep. Chief policy adviser for two governors of Massachusetts and also worked in a couple of agencies in state government so I know I've got a feel for the cadence of state government and government in general and state governors in particular and the cadence is slow so I'm having I'm on the other side and I'm trying to frequently work with governments experiencing it. Realize just how slow government business one of the things we need change.

: Love it man I love it. Totally agree with that. So what would you say is the reason you got into the medical sector? What got you in man?

: I was a bit of an accident. I was a Chief Policy Adviser for the governor of Massachusetts and my background had really been in transportation. I had been deputy secretary of transportation from Massachusetts and deputy A.G. for the transit authority in Massachusetts so I had a lot of experience on the transit side and then I started to work on the highway side as well. But then the governor asked me to come to the governor's office to be Chief Policy Adviser. And in that role I had to learn about other parts of government beyond transportation including education the environment. All the other sectors of government at around that time I was asked to join the Advisory Council on HIV and AIDS. And that's really what got me into health care because when I joined the advisory council in HIV and AIDS I realize the challenges that HIV posed both domestically and internationally. They were good enough to appoint me chairman of the International subcommittee. So I was responsible for helping develop recommendations for the president, the secretary of state, and secure health and what the U.S. should do with respect to AIDS globally. And that just opened my eyes to the importance of health care but also to the importance of tackling big challenges and health care. And I learned a lot and then experience so that led me down the path of doing more and more in health care.

: Man what a winding path. But you know what. It's oftentimes when you get thrown into these situations that you're forced to grow and then you all of a sudden like when you least expect it you just sort of find your love for health care and I think it's so cool that you happen upon it like this.

: Yeah it was not you know a plan that's for sure a winding road here. But once I sort of dug into health care it's a fascinating area as you know it's got amazing challenges but you can really at the end of the day know that if you are effective you're really improving people's lives. So that's a great incentive.

: I agree completely so improving people's lives is key and I think a reason why a lot of people stay despite the challenges in health care. What would you say Abner is a hot topic that needs to be on every medical leaders agenda and how are you and your team at ConsejoSano addressing this?

: Obviously I'm preface this by saying I'm biased. What I think is a hot topic and certainly what we focus on here is trying to make sure that we can find ways to connect health care to what is becoming the majority of Americans so let me take a step back and explain and share my thinking on that. The country has changed demographically quite dramatically over the last few decades and we're on our way to becoming a majorit, minority country according to the U.S. Census will reach that status as a country in 2050. Majority minority.

: So how do you define that? What is that? What does that mean?

: So that means that basically if you add up the groups that are non-traditional white American yes you add up the populations of those groups they constitute the majority.

: Okay got it.

: Take Hispanics and African-Americans and Asians and Arabics folks and add them of all of those. What we would traditionally call minority groups broadly speaking if you add them up they will constitute a majority. That's a dramatic demographic change that has occurred and is occurring over the last you know three four decades. So according to the census the whole country will be majority minority by 2050. Some states you know like where I am in California we are already a majority minority state. If you take Hispanics who are 40% of the population here and add to that Chinese and African Americans and the other minority groups those groups compose a majority in California today the same thing is true in Texas today. Texas is the majority minority state. So this is a huge demographic change.

: Yeah.

: And it is a change that let's face it it's not easy. If you look at rest of our national politics today a lot of what you hear and see and read in our national politics reflects the struggle to accept this demographic change it's hard and it has created a lot of stresses in certain sectors of the economy and of society. I think that when health care for those of us who are in health care we have to accept that this change has happened. This is the America that we have become and it's the America that we are continuing to become. The idea that we can reverse this, it's just not possible.

: Right.

: So people in health care have to accept that we are a very multicultural country and becoming more so. That's the first thing we have to accept. And then the second thing is that health care in America has not kept up at all with that demographic change. Our health care system is just not equipped to serve the America that we have become and that needs to change. Like in California I'll give you. Credit is the Caligula's 40 % Hispanic right...

: Yup

: Only 5% of doctors speak Spanish speaking Spanish is not even go here because what really is important is not just speaking the language but it's understanding the culture so that we can engage with these patients. So just to answer your question the big challenge here is how do we begin to make the changes so that our health care system can engage with. Because if you don't engage with people you're not going to get good health outcomes if you can't get people to trust you, to come in for appointments, to tell you the truth when they come in, you've got to get you've got to reach out to them, you've got to get them to come in, and you got to get them to tell you the truth, you've got to get them to engage in a dialogue with you as a healthcare provider of health care system you know writ large. We've got to engage with people and we don't really get terrible outcomes and that's what's happening now. And I think it will get worse if we don't begin to figure out ways to engage with the people that the health care system has to serve and that engagement is not about language it's about culture is about connecting with people is, who they are, understanding who they are, and building trust, and hopefully over time that trust leads to a level of engagements that people say "Okay I'm going to listen to you. I'm going to come in. I'm going to have a relationship with a primary for example a primary care provider. I'm going to listen to my primary care provider. I'm going to start to think about my health in a more holistic way". So all of these things are important for us going forward and I think that if we don't start to get some of that right a lot of the other good things we're doing in health care are not going to bear fruit because we won't have the engagement that we need. That's some of the fundamental requirement.

: Abner, I think this is very insightful and I like what you've done here. Typically we find ourselves stuck not necessarily stuck but reflecting on things that matter in health care. But you've taken a step back and you've forced us like the listeners me to not just think about health care but reflect on the population of the U.S. and take a look at it and how that affects health care. So looking from the outside in folks it's so important that we don't get stuck in the trenches like we do. I mean we do that we were guilty of it. Nothing wrong with it but let's step back and start looking at the changes of the demographics that are happening in this country and that's why today with the discussion we're having with Abner this will be great way to sort of get you to start thinking about what you're going to do differently to best adapt to these changes seek a better serve your communities. You could better serve your patients so give us an example Abner of how you and your organization have created results by doing things differently.

: Sure. So one of the things we realized pretty early is that to get engagement we were going to have to do things differently to get engagement with these multicultural populations who aren't engaged. So we look to see what what's happening now and it's not as though health care providers across the country stakeholders you know plans and provider groups. It's not as though they don't know that these demographic change is happening. And so many of them have taken a step to start to address that. And what we call it is of multicultural patient engagement 1.0. Right. So and what that is is it's translation. Basically health care providers across the country if you wherever you go. Basically what they do is they take content that was designed and written for a more traditional sort of English speaking American who grew up in the English speaking environment. They take content written for that person and they translate it into other languages. And that 1.0 version doesn't work for a couple reasons one to engage people you've got to connect with them, you've got to figure out a way to build a bridge to them to connect with them, and when you send content that was written for a person A whose life experience who's in who's understanding of health care who has experience with health care who's experience with you know life in America is completely different, completely different from person B. But you send a message intended for person to person B you just sort of translate it sometimes poorly using like a you know some sort of google translate. You get really bad results and you don't get engagement...

: And you gain the last connection right?

: Exactly.

: Arguably.

: You really raise a good point. So even though it's well intended sometimes because plans are you know in provider groups and they're trying to reach out sometimes it's not that well intended. They're just checking the box it's just a regulatory requirement alerting a lot of places of America in order to comply with the law. You have to offer your services in these languages. So to check the box they just hard translate checking the box so really there isn't a real intent to connect with these people. They're just checking a regulatory box. But even sometimes there is a good intent, they're trying. But here's what happens if you've ever been a member of a minority group and you've been treated equally or you have been made to feel invisible or you've been made to feel like who you are really doesn't matter. And sometimes you've just been outright discriminated against. It's ever been in that it's in a person who belongs to a group and experience that what happens over time is you develop a very clean awareness of when people are being sincere and reaching out to you because they really want to know who you are. They really want to connect with you and they really value you as a person versus checking the box. It's like this antenna that these folks have and even if it's well intended if you send a check the box message that's really a content written for someone else that you're just checking the box. It can have a negative effect. It's actually worse than doing nothing because what it says to the person receiving it is you really don't care who I am. You really don't care to learn about me. You're making no effort whatsoever to connect with me and what that does is it builds distrust. It can also make people not like you very much but if you treat people that way like they don't matter who they are is not important. It's no wonder they don't want that kind of engage with you. So I think we've got to get away from that 1.0 version of engagement. And so what we are suggesting a consensus on what we're doing is what we call 2.0 we're saying we've got to take it to the next level and that is we don't think translation works. You have to start instead with culture. We have to figure out who these people are and what they care about, what they believe, what they hope for, what they fear, where they live, where they come from, what their experiences are in daily life. Trying to get a better feel for the whole person who they are. And we call that culture to...

: Yes

: And that encapsulates all of it which I don't understand who people are culturally so we start there then we design content based on the culture. So we don't design content you know we don't send a message to an Arabic speaker a young Arabic mom. She may be low made Medicaid. We don't send the message to her that the same message we would send to English speaking mom of the same age who has wound up in the U.S. culture. Not only is the language different but the content itself is different because of the way that Arabic understands life in America or what she experiences the way she understands healthcare the way her culture has weaved in and understanding of health care with the American experience it's even unique it's not even as though it's the same as if she lived in her home country. There's a wonderful I think kind of thing that happens when these cultures hit American culture and the third new thing gets created. So we're trying to connect with people on that level. So it's first of that culture then we design the content then we layer in the language so see language from and our view is language is a tool. It's not. It doesn't tell you anything about what you should communicate. It's a tool to communicate. Yes though language is actually the third thing it's not even the most important thing. Its first culture then content then language. And then the fourth thing that's really important is mode of communication. Health care in America is still stuck in the 30 years ago today and guarantee it's true for human beings.

: So you mean you should have faxed these people?

: Exactly. I mean it's craving that is. When they 18 right and you can't send a text message to the everybody communicates via text message. Everyone in America this is the way we communicate now. And yet in health care we can't do that. I was at a conference two weeks ago yeah. Held in San Diego it was a conference of Regional Health Plans. There were 27 plans across the country. These are pretty large health plans, regional plans across the country twenty seven. I was giving a talk I said "how many of you primarily communicate via text message with your family and your friends?" Everyone raised their hands. "How many of you communicate with your members who are in population health management or chronic disease management or just general engagement?" Not one hand went up.

: Yeah.

: Not one. This is 2018. It's as though...

: Not even one?

: Not one you know I jokingly say you guys may as well be using morse code numbers because snail mail and e-mail and I mean they're stuck in these old modalities engagement. That's not the way people communicate today. So I'll stop there. But it gives you a sense of how we are trying to change the way we approach engagement and what we're getting is incredible result because it turns out when you respect people enough to connect with them it's who they are and treat them like they actually have value as a person. They belong they are someone they they come from somewhere they have a history and you know they have hopes and dreams you treat it you treat them that way and you are willing to communicate with them in a way that they want to communicate as opposed to the way we want to communicate. You know the mode you can get the results.

: Love it. I think it's great. Definitely want to dive into these results that you're discussing Abner. When I was in college one of my favorite classes was anthropology. I just loved anthropology is one of my favorite classes. Maybe my instructor was cool but you know it was just so intriguing to hear about different cultures and to learn the different theories. And I just think about what you and what your team does. You guys are like the health care anthropologists.

: That's really cool. I like it.

: And you could help people understand and communicate and in fact get the outcomes that we're looking for so the health care anthropologist right here on the line with Abner my friends.

: I love that. That's great.

: Hey Abner so definitely want to understand more about the types of results you guys are getting. But before we talk about that I like to learn a little bit more about setbacks. Like Can you share one of the setbacks that you had whether it be with ConsejoSano or something else in your career that gave you a pearl that because of it you never do things any different because of that. So can you highlight a setback and what you learn from it.

: Sure. So when I first had the idea to create ConsejoSano which means help the advice in Spanish it came from, I was doing work in Mexico as you know my previous company was a corporate wellness company in Mexico and so I saw that there were a lot of amazing things happening in Mexico and health care particularly using digital and the mobile phone. Mexico is emerging a growth economy. You had a growing middle class looking for solutions that were affordable and convenient and confidential and obviously high quality but cost effective and telemedicine was growing in Mexico faster even than in the U.S. at that point because they didn't have a lot of the legacy issues that restrain telemedicine growth in the U.S. you the U.S. we have this practice of medicine regulations each state you couldn't have a national solution you could not have for a while a national player in telemedicine because it made it very different because of the state practice of medicine regulations where a doctor had to be licensed in the state when the patient was. So some of that's changing now in the U.S. and so telemedicine I think is a big part of the future in the U.S. right. But this was like five years ago eight years ago I saw in Mexico that it was going really fast and there they didn't have those legacy issues you could have one license of the whole country. And you have a growing middle class looking for solutions and they didn't have a lot of infrastructure either. So you know their health care system wasn't as advanced. So in a sense they were able to leapfrog to something new because they didn't have some of the older legacy stuff in the way. So I saw that and I thought this is amazing you've got a middle class middle upper middle class Mexicans using telemedicine for health care. And I thought if we could and I met one of the largest telemedicine companies in Mexico I got to know them. They have an incredible service. And I had this idea in the U.S. you have very few doctors and providers who speak Spanish right. So if I could connect with the mobile phone, Hispanics in the U.S. with this call center, the telemedicine company in Mexico they had a huge call center in Mexico City that was serving the whole country incredible quality, fantastic operation, McKinsey and Company of a study called them a world class telemedicine solutions are really high quality. So here's my idea I said I'm going to connect Spanish speakers in the U.S. low income Spanish speakers in the U.S. with these doctors in Mexico by mobile phone you could tap your phone anywhere in the U.S. and you'd be connected in 10 seconds to a doctor in Mexico who is actually in Mexico treating upper middle or upper middle and upper middle class consumers. So it was a great way to provide a beautiful service to low income Hispanics in the U.S. who prefer to talk to Spanish speakers. Great idea right.

: Yeah.

: I thought it was and I thought it was a great idea but I ran into the buzz saw of you know the regulatory requirements U.S. it's very difficult. The part of the population that I wanted to serve in the U.S. was low income Hispanics most of them on Medicaid. That's a state federal government program. And they have very strict requirements about using actual resources. The bottom line here is despite the fact that we have a huge supply and demand problem in the U.S. there's no supply for the growing population of Spanish speakers in the US who just want to talk to a doctor in a telemedicine type visit even though the huge demand in the U.S. but no supply, huge supply just across the border of Mexico that we could tap into as the requirements around regulations wouldn't allow it. And so that idea might fail. Great idea but the lesson I drew from it was that great ideas are frequently all about timing. I still believe that at some point in the future we're going to realize that it's crazy not to allow Spanish speakers in the US to be able to talk to doctors who they want to talk to who they are comfortable with by tapping their phones. And that's just across the border. The only thing separating us is as you know as the border that signals don't recognize it. You can call it either. At some point in the future my idea I think will become somebody to make it work. Well it wasn't me, I was too early. So it failed that idea but it taught me a lot about timing is everything. Almost everything.

: That's fascinating.

: At a wrong time, still won't work.

: I love it. What a great story and a great lesson and also a very fine one that you tell it humorously and I'm sure its painful in your point.

: It's alright. Yeah.

: But I think it's great. I mean I love that you kind of left that open ended there because you know it is timing. Maybe one day it will work if we form some sort of form or group that I have to be accredited to be a part of and very well defined guidelines. I think there could be a way.

: Well you know just as an example just like we can't now use actual resources four or five years ago it was hard for companies in the U.S. to count television companies in different states across the country because of the state grants the medicine regulations that really you know made it hard for a doctor whose license in one state to serve other Americans in other states who want to talk to their doctor because he's not licensed in their state. And so that's good and slowly but surely no the law is changing. That's a legacy issue from the way health care and medicine developed in the U.S. but slowly but surely technology is worsening the laws and the regulations that change. So you're right Saul, eventually. First we'll have to make it so that be easy to do telemedicine across the U.S. and maybe we'll be okay with that they will be part of a new NAFTA right. we'll be a little like getting paid or maybe renegotiate NAFTA some years.

: Yes that's that's the way I think it should happen. I love that man. Yeah it's interesting right. I mean a big part of what we do with the podcast Abner and listeners as you well now is just we connect silos and even like at the state level is just so siloed. Sharing best practices, talking about what could happen, is the way that things do happen. I think it's great. So tell us back to the results right so you guys bring forth your cultural paradigm that you help your clients understand how to message, when to message, and then you do the translation which is kind of on the back end what are the results. Tell us about those results and maybe one are your most proud leadership experiences from those results.

: Sure. So the key for what I described and how we work culture first, then content, then language, then the mode of communication. Anyone who hears that the first time since "sheez man that's hard" and on a certain level it is right. And so what we know is that we can't do that at scale without technology that the only way to do that at scale is so that we're serving not a thousand people but more like 10 million people to build the technology that allows us that is small so our clients are typically man is Medicaid plans are provided with serving Medicaid populations are for profit but we do have a social mission very focused on trying to make sure that people at the low end of the income ladder get access to high quality health care. And so as we are building the technology that allows us to classroom and technology allows us to learn as we go. So what we give we get a client we start to do a deep dive into who that membership is whether it's a group of patients or members of a plan. We micro segment we use publicly available data we use data from the clients health plan data. We put all that together and we develop what we call a community detailing. We implement community detailing process and we microsegment all of those members are patients into different groups based on some algorithms that we've developed and then we start to develop content messages for them based on what we've learned about where they come from, who they are, what they believe. We do a lot of AB testing initially to make sure we were getting it right and then we start to communicate with them. We have a lot of success with text messaging so the mobile environment is very powerful but it's not text messaging as you think of it just affects. We can send the text message with a link to a PDF or a text message with a link to an audio file. We can do health risk assessments and other kinds of surveys via text message so the mobile environment is very powerful and every communication that we make is two way and it's recorded and through machine learning and natural language processing we're figuring out every time we interact with with a patient or member more about them so that we can then tailor the next method so that it is designed to connect with them even more. We're trialing in effect use technology to create an experience for them a communication an exchange, a conversation that sounds like it's a human being, and so doing that and we're building you know early stage. You know we don't have all the answers. We're still building but we are finding that we get incredibly a good result. So for instance one of the big areas our clients care a lot about is pellicle quality measures like this in the Medicaid space. Under these measures, some example is babies from the time they're born to the time they're two years old maybe 10 vaccinations I guess required by Medicaid and we can't give all the vaccinations at once, it takes a couple of visits. And so getting these multicultural populations these moms or dads who are responsible for the baby to understand they need to come in for these vaccinations and bring the baby up and get them to come in. It's hard. And so that ends are required to get a certain percentage of these folks to come in and the plan doesn't the Medicaid plan. They're paralyzed and so they come to us and they say look help us reach out to these folks and so we use our platform and our understanding to reach out and we're getting some cases with what we call never seen. We're getting 60, 70% of people who are responding to us who....

: Huge.

: Through all the other efforts by the plan previously they wouldn't respond. So not only are we getting them to you know there's a process here because these are low income people right there Medicaid. They struggle with life and so if you're struggling to pay the rent keep a roof over your head a vaccination or immunization may not be your priority. And so we've got to figure out a way to convince that person. It's important and then help lower the barriers to get them to come in. So we do everything in addition to explaining to them that they should come and build a trusted relationship so they'll listen to us. So we sometimes we schedule the appointment. We do the appointment reminder. We actually just signed the deal with lift so that we're going to be starting working with. So that is one of the barriers is transportation. We can incorporate that into our offerings so that we can get that person to the clinic. So our goal is to reduce the friction and to lower the barriers so that as we build a trusting relationship we can navigate that person and took care.

: Love that. I think it's great and kudos to you and your team for those results. It's important. It's a fragile population and hey for the plans they get to meet those objectives so why not partner with somebody that knows how to do it. And somebody from a plan listening to this or even a provider take into consideration the things that we're talking about and ConsejoSano's is a fantastic partner to consider. So with podcast notes you'll be able to find everything there including a link. And best way to contact Abner just go to outcomesrocket.health/abner and you'll find all that there. Getting close to the end here Abner, tell us about an exciting project that you're focused on today.

: Sure I'd say one is the lift partnership. We just announced that two weeks ago...

: Yeah congrats on it.

: It's a great opportunity for us to demonstrate that a On-Demand, non-emergency transportation benefit incorporated into new Medicaid or Medicare Advantage offering can really drive better results. And so I'm really excited about that in part because I think a lot of people forget who are in leadership positions in health care. If you take a day off or you need to go to the doctor take a hit of the doctor not to get paid for hourly workers going in for preventive visit like a vaccination or well child is that you don't get paid because you're hourly and if you're living paycheck to paycheck if you don't have transportation for example and it takes two buses and that's about an hour and have two hours to get there then you're at the doctor an hour and then two hours to get back. You're talking five hours. That person that mama, that dad, that grandmother whoever's responsible for the child, it's not that they don't care about the child. They're just trying to balance. If I take five hours off, number one I might get fired. Number two you know get fired. I can't make the rent I can't buy food. If we could make that five hour visit more like two hours because the lift on demand transportation benefit we can get that mom to the doctor in 30 minutes or less appointments an hour and get her back two hours. She then makes a calculation that we will all make a financial thing I can afford to take two hours off where I'm allowed I'm going to get fired but I can't take five or six years. So what it does is it drives this is that it's good for the clinic because the clinics labs you don't like no shows and of her maybe she had a ride and fell through or whatever. If we can have it in the moment. Well I mean this is what got. Using new technology these new offerings like Lift's which has an on demand service it can be there in five minutes. Not the old transportation benefit where you had the do you have scheduled weekend as they entered and they came around you and five other people. That's not what people want.

: What do they want?

: So I'm really excited. I'm grateful to lift. I think they are thinking really smartly about you know how they can use their amazing company they built the service, they built to improve health outcomes for low income people. So I'm excited about that part.

: That's awesome. Congratulations. I know Lift is working really hard to up their health care efforts and thanks to partners like you who are in the thick of it and be able to make it easier for people that actually need it. So congratulations on that.

: Yeah. Thank you. We're excited about it.

: Abner so this part of the podcast is right before we conclude we build leadership course. What it takes to be successful in the business of medicine, the one on one of Abner. And so I've got four questions lightning round style for you followed by a book that you recommend to the listeners. You ready?

: Sure.

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

: To make sure that solutions are designed to meet the needs of all patients not just some.

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

: I think that technology alone will solve problems in health care. There always has to be a human component there. And if you forget that it's a mistake.

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

: I think you really have to have a pulse on innovation in your space. It's not enough just to be doing good today because disruption comes fast and furious. And so you need to be you know using current things well but you've got to have your thumb on what's happening in your space in terms of innovation, who's innovating, who's got new ideas, and you should be testing them all with trying new things.

: Love it. What's one area of focus that drives everything in a health organization or at least your organization?

: I think outcomes I think we've got to have to get away from the idea that efforts are important. The truth is in health care what really matters are outcomes and we sometimes confuse efforts with results. Maybe I should a policeman. We should not confuse efforts with results. We need to focus on results which means health care outcomes and no matter what the efforts are if they are producing the results of the outcomes we want. We've got to switch it up.

: Amen and what book would you recommend Abner?

: It's an old book but it was important to me by a philosopher Karl Popper. He was a philosopher of science. The guy is called Conjectures and Refutations and it's a great book that teaches a lot about humility in science and I think that's a good thing to learn about.

: Outstanding what a great book recommendation and how about any favorite podcasts if not...

: Yours

: Thank you. I appreciate that. But any other ones that stick out or just stick with the book.

: I'll stick with the book and your podcast.

: You're too kind, you're too kind. Appreciate that. Folks for links to all the things that Abner has shared with us including a link to ConsejoSano. All the things that they offer their solutions the latest events that they've got going on. Go to outcomesrocket.health/abner and you're going to find that along with the full transcript of our conversation today. So Abner this has been a ton of fun. I love if you could just share a closing thought. And then the best place for the listeners could get in touch with you.

: Sure here is my e-mail. It's abner.mason@consejosano.com and Im sure you can put it up on your...

: Notes.

: And closing remark is just thank you, Saul for allowing people like me to share our thoughts. I think you're right that we can learn a lot from each other. We take the time and we now have news like podcasts that allow us to supplement and listen to other people's stories about people's experiences and we can learn from them. So this is a lot of fun. I think it's important work too Saul, thank you for doing it.

: Hey it's a pleasure Abner and appreciate all that you and your team are doing to make health care better and improve access. Keep up the awesome work.

: Great. Thanks a lot.

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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

: 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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Doing Digital Marketing Right in Healthcare with Reed Smith, Founder at Social Health Institute

: Welcome back once again to the Outcomes rocket podcast for we chat with today's most successful and inspiring health leaders. Today I have Reed Smith on the podcast. He's the founder and President of the Social Health Institute and THA digital marketing. In addition, Reed also serves as Chief Social Strategist for Gray Digital Group as well as founding advisory board for both the Mayo Clinic social media network. We had Lee Ase a couple months ago here on the podcast as health tracker at the South by Southwest Interactive Festival. This gentleman is a consulting strategist, thought leader and it's a pleasure to have him on the podcast. Welcome Reed.

: Hey thanks for having me.

: Absolutely Reed. Now is there anything that I missed in that intro that you want to share with listeners?

: Oh gosh. No probably not. You know I've got four or five different jobs I think at this point. But people can easily track me down online. So yeah that's where I spend most days and hours and I've gotten into podcasting over the last couple years. And so yeah yeah. Going on a lot. It seems like these days.

: That's where we have to be if we're gonna make a presence and I know within healthcare it tends to be a little slower on the uptake but I think people are starting to figure it out. And so that's why it's going to be cool to dive into some of the things that you have to share with the listeners. Just curious though what got you into the medical sector to begin with?

: Yeah so I'll. You know I've got a marketing background and was spending time strangely enough down in Pensacola Florida. We were living down there my wife was working for a healthcare consulting company and the guy that founded and ran that company for a lot of years of getting quit Studer that has a lot to do with the patient experience realm got me interested and through that I ended up taking a job as director of marketing at a hospital back in Texas and that started that started down the course of kind of what I'm doing now. Gosh probably 15 years ago or so.

: Time flies doesn't it.

: It does. It does.

: So hospital marking and marketing at a hospital to social media. You've done a lot. And so within the space of communications and digital media what would you say Reed is a hot topic that needs to be on the leaders minds today that are listening to the podcast?

: Yeah for sure so I think this is probably something that fits regardless of what role you may play whether that be at a hospital or a health system or physician practice or on what side of the coin you're on. But is consumerism and that's you know that's changed quite a bit since I got into this and started doing this. And so I think you know when we, when I first started as a hospital marketing director it was very much really was a hospital advertising director and that was really all we did. You know we told people about what we were doing there was really not a two way conversation certainly not on line 15 years ago. And we've seen a lot of that evolve with consumerism and choice. And it's you know it's less about not less about. But it's not just about the patient the person getting treatment but it's about consumers that you know people who are making choices every day.

: Yeah this topic of health care consumerism continues to rise to the top and we've had a lot of different guests on the podcast talk to this point. Had Marcus from Walmart. He's V.P. of Wal-Mart and health care really kind of spent entire time talking about that and there's a lot of different angles to this topic of consumerism. So as it relates to the marketing efforts of say providers. But also let's loop in Life Sciences med device anybody playing in this space. What did they need to be thinking about?

: I think it's just like anything else here we have the internet we have access to an awful lot of information at our fingertips or in our pocket even walking around and so just like we have choice and are able to look at you know what kind of coffee maker we may want to buy or whatever it is and getting that feedback that's made its way you know far past restaurants and everything else and into healthcare. And so I think online reputation management and some things like that where people are actually measuring and looking at and making decisions about their care where to take their care care givers. So we've got folks that are taking care of parents or kids or whoever it may be they may not actually be the patient. I think that's one of the biggest things is that people are able to give feedback and be heard at any given time. It's like you can with anything else in your daily life. And so there's an expectation now not only you know can I research and find and make choices based on what I find online. But I want to be able to execute on those choices. So making appointments finding information paying my bill all the things that we're used to doing in our daily life we won't be able to do that with the health care system or with providers. And you know and I think from a provider standpoint just patient to patient or peer to peer conversations are you know clipping us in very different ways than just simply googling around in landing or whenever search result comes to the top. So those pure...

: I think it's a great call out. This parallel between the day to day doing your banking, shopping online. All these things are really kind of starting to be available and consumers are sort of demanding it from our health care systems. And it's interesting that a lot of systems are struggling to get to this point. I think it's presenting an opportunity for entrepreneurs that could be agile and partnering with our system to get there. Would you agree?

: Yeah I think so and I think we see some of these new technologies starting to make their way into like AI or Artificial Intelligence and machine-learning type pieces that yeah we can get really good at understanding why people are visiting the hospital website and what they're looking for and where they came from and where they hear before and some of those types of things and you know people you know especially probably our age and younger are used to dealing with are not wanting to deal with people you know say they will be able to get on find the information they want and take care of that. I mean I just you know pretty much book all my travel or hotel rooms and things like that through apps are very seldom talk to anybody til our rub on side and so that expectation just like the hotel. We've got to be able to deliver on that in health care and that's hard. That's hard from an interoperability standpoint for sure.

: It really is. It really is difficult. So inter. Great point right there's some things that we don't even think about that we do without speaking to somebody or or just things that like you'd go to Amazon and it populates seven things that you probably want to buy and yet not buying five of them you know we don't I don't think of these things they just happen they're so natural. And now we're having to adopt these things in health care. These adoptions come with tough roads. You've been around the block a couple of times Reed, maybe you could share with us a time when you had a set back and what you learned from that setback and trying to adapt is these new ways.

: Yeah you know I think we deal with it every day. I mean with technology that that inherently is going to come with setbacks in a lot of cases. And so I think the interoperability part is the hardest part. And so whether we're building consumer facing pieces like physician finders or appointments setting tools or those types of things you know sometimes that doesn't always jive with the systems that are in place and it makes it hard to move information back and forth. And so you know we've had to try to find alternate ways in different entrepreneurs and vendors that you know were working and doing some really interesting things and then you know we have found that we become a pretty good conduit for understanding. Okay well how does all this stuff fit together and what's appropriate what people need, where do things go in really understood that you know what we don't have to be the folks that build it all and do it all, we can just be the folks that understand how it all fits together and try to help guide people down the right path. So yeah I think we've kind of shape that vision over the last several years of your not needing to be everything to everybody in a lot of cases.

: So at one point you tried to be the innovator and realized hey there's no need if we understand how these things fit together. We could be guides.

: Yeah I mean I think if you look at it from like you know like a project manager type role or even in the clinical space you know we have care coordination and some things like that that happen. And so I think because of our background of what we do and what we continue to do and who were involved with on a daily basis we see what we're so we see what doesn't work. We see how other people are doing it where best practices may exist and things like that. So we don't have to you know in the olden days, the olden days whatever that means but we would build everything because realistically what you were talking about was a website and some campaign landing pages maybe some media buying and things like that and we still do all that and that's cool and we can definitely deliver on those types of things. But when you start talking about artificial intelligence and chatbots and some of those types of things you know what we don't have to own all those pieces. And sometimes people just need a trusted voice that can help and guide down a path that that brings you know the best of everything together in one place and understand how they can get somewhere quicker than have to sort it out on their own.

: Yeah nice school and you know so let's let's park on chatbots if that's cool with you. Yeah because we did a meeting on Tuesday the Health Care thank a fan was awesome. One of the members of the audience was start talking about a chatbot that they're offering that's backed up with an and the table that I was sitting at her body is looking around like what the world is a chatbot and was. You know so I think it's the worst parking and some of these things rather than assuming let's talk about it. What is it? How does it work? How can it help flow? How can it help customer engagement? Maybe we get about that for a little bit I think would be beneficial.

: Yeah so I think you know we've all dealt with them in our lives probably at least to some degree even if it was rudimentary several years ago. But you see these things on like car dealerships websites and maybe in hotels earlier years in different places like that. But the little pop up allows you to converse with you you probably don't assume it's a real person but it kind of feels that way. You can ask a question it gives you the early days it would give you links to like here's where you can find this information. You know some of that kind of stuff so instead of navigating a website via the traditional navigation channels, you're having a chat with in most cases a robot. So that's where the machine learning and artificial intelligence side of the equation comes in. But sometimes it does hand you off especially when like a tech support standpoint we'll hand you off to a lot of person when it needs to. So we're starting to see this make its way into especially hospitals. And we work with some different folks that develop this technology but what it allows for is you to land on a hospital website. It knows how you got it or did you show up the you know paid campaign. So maybe it knows that you know you're already coming from this part of town because this is your IP address and you came here via these ads and so we know you're etched in pediatrics or whatever it may be. And so it can use some intelligence there to narrow down what it thinks she may be looking for. But it allows you to have a conversation and say you know to pay my bill I need to make an appointment to get a physical because a lot of cases going back to the consumerism piece we don't necessarily, you know on the hospital side of the equation. Make it super easy for folks. You know we make you search for physicians based on their board certified specialty. Well that's fine. But I just know that I have this disease or this symptom or whatever it may be I don't know who treats that and know what type of physician and so these types of things can kind of bridge that gap because of machine learning they get smarter over time. So once they start answering questions and going through this understanding what people are asking for the bot if you will get smarter and smarter and then when it needs to you know if you have a call center or people in place they can hand off to a live person. That's kind of what we're seeing. I think it's a great opportunity to allow people that you know to get to the information a little bit quicker and a little more personalized than they would maybe just searching from your home page.

: Now thanks for the summary there Reed. I think it's good. It's important to understand the options that are available now that Reid took us down this explanation. I'm sure you could think of several experiences that you've had with chatbots. So they're definitely a great tool in helping to simplify is the key for consumerism and just kind of goes down this trend that Reed has been talking to us about. Reed what about an exciting project or focus that you're working out today. Anything you want to talk to us about?

: Yeah you know we've done a few things in the last couple of you know maybe 18 to 24 months that are pretty interesting. We've launched some podcasts which of course a lot of fun content...

: Let's give people the name

: Yeah.

: So they get well. So tell us about the pod cast.

: Yeah.

: Folks here already with a pen and paper do that just pause later.

: Well so you visit touchpoint.health and that's that's the website that houses I think we've got oh we're closing in on about 10 different shows and some of those are on digital marketing and patient experience which is one that I co-host, we've got one this co-hosted by former hospital CIO and health I.T. we have one that hosted by a physician that's more physician and technology based etc.. So storytelling content storytelling. So we've got a few there and so there's been a lot of fun and just you know enjoyable to do.

: And Reed I just want to say folks I listen to Reed's podcast so it's the reason why I asked them to share because he does develop some really great content. Put a touchpoint.health and you're going to find some really cool shows. And they span marketing. He's got one with a physician. It's just such a great great media platform that Reed and his team have established so check that out. touchpoint.health.

: Yeah appreciate that. Appreciate that. I think past that though we've sort of looking at and realizing especially in hospitals marketing apartments. There's not a lot of benchmarking data there. So how many how many FTE's they have in the marketing department. Well the budget's going up or down in past staffing and budget. How are we spending our money on campaigns and agencies and vendors and things like that and so we're trying to go in and start doing some surveying and benchmarking some of that data even to the point of understanding reputation management. So the primary consumer platforms of Google, Yelp, Facebook for example where consumers can rate review hospitals. Where do you fall? You've got four out of five stars on a particular platform is that good? Is that about average? You know et cetera and so I spent some time trying to kind of benchmark looking at markets and region state level things like that. So that's that's been kind of fun kind of interesting and has allowed us to go around and share some insights with different groups around the country. So...

: That's awesome. Reed you guys are always up to something cool. And folks here's the other thing so you guys all know I started a little platform to help you build your podcast right. Reed also has a cool little section of his website, touchpoint.health where he talks about gear and this is a question that comes up all the time like man this expensive and what microphone should I get or what program what software do I need. Reed and his team do a really nice job of highlighting gear that you need. So if you are somebody in marketing or you want somebody on your marketing team to get rolling with this awesome platform of I podcasting, they also have really nice resources gear focused posts there as well.

: Yeah. Thanks man. That shows a lot of fun to do business partner Amaan and I co-hosts that and course he's he's the guy with all the gadgets and so really I'm just asking him questions most of the time so it's fun. It's fun. As a good one.

: Yeah. very informative. So again folks Reed Smith here. Getting close to the end, let's pretend Reed you and I are building a leadership course and just digital on health care and what it takes to be successful we're going to write out a syllabus for the listeners with this lightning round. You read?

: All right.

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

: Be able to measure better. So I think he had to have something on analytics and measurement goal setting KPI and things like that.

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

Oh gosh shiny object syndrome. Maybe so you don't need to necessarily do something just because it's new.

I guess now that how do you stay relevant despite constant change.

: Oh gosh I think that's kind of back to the measurement piece. So I think doing things that are measurable and you can show success you know allows you to stay top of mind internally certainly but also allows obviously to have some sort of indication of how you're doing with the outside audience.

: What is one area of focus that should drive everything in a health organization as it relates to digital media?

: As it relates to digital media? I think persona or segmentation target development things like that. I think that's really what should drive. Well certainly after you know aligned with organizational goals but then actual site meditation and targeting I think should then drive everything else whether the media spend or creative etc.

: Love that. What would you say your favorite book for the listeners is?

: I'm looking here my bookshelf the one that I think is interesting and I think it is still relevant is a book called Change by Design written by a guy named Tim Brown from IDEO. So he's an innovation guy design guy. It breaks this idea down that that really innovation just shows up from really smart folks that just have brilliant ideas and talks more about that you know that the ideas come from more rigorous discipline and things like that. And so we like Change by Design. It's the bottom line is how design thinking transforms organizations and inspires innovation.

: love that. Great, great tidbit there. This has been awesome read. I've enjoyed our talk. We kind of talked about some some core concepts like chat bot gotten through some of your thought processes on digital health. How organizations get implemented? I had so much fun. I love if we could just hear your closing thoughts before we conclude. And then the best place for the listeners can get in touch with you.

: Yeah I think again you know it's a great time to be in health care. Health care marketing, digital marketing, I think there's a lot of really interesting and cool opportunities coming our way is to encourage people to you know continue to look at how you can stay relevant and how you continue to show value within the organization. Yeah I would love to connect with folks online of course who mentioned mentioned the website health earlier. But it's just Reed Smith on Twitter. Pretty easy to check down on LinkedIn as well and enjoy visiting with folks.

: Awesome Reed. Hey just want to say a big thanks on behalf of all of us and looking forward to stay in touch.

: Thanks man appreciate it.

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