Category: Patient Outcomes

Understanding the Power of Coordinated Care Organizations with Dr Jim Rickards, Senior Medical Director for Population Health and Delivery System Collaboration at Moda Health

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

: Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I thank you again for tuning in and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because I have an amazing guest and a great contributor to healthcare. His name is Dr. Jim Rickards. Dr. Jim Rickards has a wealth of experience in the healthcare sphere. Currently he serves as Senior Medical Director for Population Health and Delivery System Collaboration and he's also an author and thought leader in the space over in the great state of Oregon. He's doing some really interesting things to reshape the way healthcare policy is and really focused on strong strategic direction in what the state of Oregon is doing and so what I wanted to do is open up the microphone to Dr. Rickards to fill in any of the gaps of that introduction and give you a warm welcome to the show. Welcome, Jim.

: Yes thanks, it's great to be here. Appreciate the nice introduction. I selected just kind of highlight the fact that here in Oregon we're doing a lot in terms of healthcare reform especially in the Medicaid space and we've been pretty successful over the last five to six years in changing how we pay for Medicaid with our coordinated care model of care hope to touch on that throughout the program.

: Absolutely Jim and we definitely want to hear a little bit more about that you guys are ahead of the curve as it relates to that and what is it that got you into the medical sector to begin with?

: Well from a physician a radiologist by training so it's a physician who interprets medical imaging studies like CTs and MRIs and I was always just kind of interested in science and biology and what attracted me to radiology was just the fact that it really allowed you to kind of apply your core knowledge of anatomy and physiology and pathology without having to deal with a lot of the kind of more burdensome aspects of medicine like administrative complexities pre-authorizations which is kind of funny now because that's kind of the space I operate in now working for a health insurance plan. About seven years ago actually I kind of started moving out of the so-called dark room of radiology and into the healthcare payer space largely because I was becoming a little bit frustrated with my practice of medicine. It wasn't for the usual reasons you hear of declining reimbursements or increasing administrative burden. But I was getting frustrated because those feeling I was getting to know my patients a little bit too well. And I would say that most people are kind of taken aback and say oh you're a physician you're supposed to know your patients well and they say yeah if you're a family practice doc or an OBGyn and caring for a pregnant woman then by all means you should know everything there is to know about your patients. But as a radiologist the way I practice medicine is with high cost imaging exams which actually expose people to radiation. And so I was frustrated because we had so many so-called frequent flyers in my small town in Oregon. And I was questioning whether or not I was really delivering value to these individuals by reading you know multiple repetitive C.T. scans or MRI scans. Week after week on the same people and so I needed a way to to try to help these folks but it wasn't medical care they need. They needed help with their health. But what I started to learn was that so much of our health is determined by things other than the medical care we receive. Term by things like our behaviors or our peer group or level of education. All these so-called determinants of health. But as a physician, I didn't really have a way to impact these other areas. And so that's why I was excited in Oregon when we started to think about how we were going to change the way we paid for Medicaid and develop what was called the coordinate care model and basically it was way start looking at how can we pay for and govern all those other elements that impact an individual's health that aren't medical in nature. But think about behavioral health aspects, the dental aspects, the educational aspects. And so learning about that model what kind of attract the a healthcare administration and eventually moving on to make firm position as a medical doctor without insurance company.

: That's pretty interesting Jim and listeners if you haven't heard about it Jim wrote a book it's called Our health plan :community governed health care that works. In it, he takes you through this topic that he's just discussed with us. The coordinated care organization the CCOs. Jim, maybe we could dive into that a little bit. Widespread are the CCOs and what's that looking like ten years from now?

: Yes. So usually when I start talking about the CCOs I'd like to take a step back and just remind folks that in the U.S. basically there's three ways we pay for health care. There are all types of health insurance but in general there's three types of health insurance one there's commercial health insurance which individuals receivers employee benefit through there from their employer or they may purchase it on the exchange as an individual plan. So that's one type. The second type health insurance is Medicare that's health insurance available to individuals 65 years of age and over just by virtue factor 65, the cost associate of Medicare paid for by the federal government gets a little bit complicated and that there's parts ABCD of Medicare but I don't think we need to get into that. Then the third main type of health insurance is Medicaid and that's health insurance for economically disadvantaged individuals. If you're in one of the so-called expansion states and you earn up to 138 percent of the federal poverty level which is around 13 to 14000 that are here for an individual and you qualify for Medicaid benefits and the delivery of Medicaid benefits is largely up to the states. Now the federal government helped pay a significant amount of the costs associated with Medicaid but the states are in large part responsible for administering the benefits. Well in Oregon back in 2009 - 2010 we were having some challenges with our Medicaid program. We were facing about a 2 billion dollar budget deficit, the state budget deficit largely driven by cost associate with Medicaid the quality outcomes associate with our Medicaid program we're now what we wanted and Medicaid members were having difficulty finding access to care. So we knew we needed to change the way we delivered Medicaid benefits. We've had some managed care entities delivering benefits across the state but the system was pretty fragmented. There was really no coordination of various benefit providers from medical to be here to help the dental and a large number of the recipients also receive benefits directly from the state and the so-called fee for service system. And so while there were payments being made for Medicaid services again the payments weren't coordinated. There wasn't one single mission and vision for what it meant to have a healthy community of Medicaid members. There were no common. There was no common set of metrics to see how we were doing in delivering benefits. There was no one global budget for a community to try to manage to try to control spending around Medicaid benefits and there was certainly no way for Medicaid members or providers to give input or to have governance over Medicaid benefits. So the system was very fragmented care was siloed and it was really kind of inefficient. And so we decided and Oregon was that we were going to revamp the way we deliver Medicaid benefits and the state passed some legislation. We work with CMS to get an Olympic team waiver and we created what was called the coordinated care model and basically the foundation of the coordinated care model was the development of a new type of organization called coordinated care organization or CCO seashells or similar to organizations that probably most folks are familiar with hold ACOs or accountable care organizations. Now they're different in the fact that they go further in that they don't just pay for and deliver medical benefits but also behavioral health and dental benefits under one global budget. And they're also governed by the local communities that they serve. And so my story was I helped start one of these CCOs and the community I lived and being an actively practicing physician and seeing the need and the benefits of such an organization.

: Jim, supercool that you did that above and beyond your call of duty but it's something that you took on as a mission and that's what the leaders listening to this podcast do. And just like our guest just like Jim here and in our previous guest right you do more than your calling to create those solutions for the folks that need it most. And you had some success in creating that. And what would you say today has been some of the benefits that have been derived from the community through this CCO?

: Well so now across Oregon about 90 percent of all Medicaid members receive their benefits through with the CCO. So we have 50...

: Wow.

: Across the state care. Yeah. So it's huge like the model has really transformed the way that we pay for and deliver Medicaid benefits that are arguably the most challenging population there is. And so some of the big benefits have been for one the CCOs was our community governed. So now there's much more active participation in the development and delivery of Medicaid benefits than ever before. So each CCO has a governing board the governing board composition is actually laid out in state legislation. It has to have individuals on the board such as local elected officials local hospital administrators and actively practicing behavioral health provider and actively practicing primary care physician. So these organizations really have true broad based community input which again it's a little bit different than an ACO in charge or mainly governed by health care systems and medically focused is the CCO model goes much further by including those other individuals from the various parts of the health care system that aren't necessarily medical in nature. So I think one key success is very foundational in how these organizations are governed and organized and the fact that we've been able to stand up 15 of these organizations you know looking at some numbers or some more kind of quantitative or objective measures of their success. I think a big one is this number of 3.4 percent and basically that means that for every year these CCOs have been in existence they've been able to keep their annual trend rate increase at 3.4% or less so in other words the health care spending increases for the Medicaid population annually it's only been three point four percent for the five years the CCOs have been in existence which is really tremendous. I mean if you think about it. Yeah that the most challenging arguably most expensive members of our population we're able to control the health care cost increases associated these numbers by simply delivering care in a different fashion through the CCO. And I know that the ability to maintain that the cost increases has not come at the expense of quality but it's actually come about as a result of increasing quality. And one of the main reasons or ways we've increased quality is to dramatically increase the number of Medicaid members who are enrolled in medical homes. So in Oregon we have a really robust medical home recognition program called the PCPCH or patient centered primary care home program. Essentially the Oregon Health Authority which is a division of state government recognizes primary care clinics for being medical homes. We now have more than 90% of all Medicaid members enrolled in a medical home where they receive their primary care. So that's really been key to helping control costs while increasing the quality of care delivered for our Medicaid members. You know before the CCOs were around we had very few medical members that could even get access to a primary care physician. And now we think about it more than 90% are enrolled with a high functioning recognized medical home has resulted in better outcomes in lower costs.

: That's outstanding. And kudos to you and your team Jim for having put this together. I mean healthcare is tough enough but you went even further you knew impacted policy and implemented what you guys set out to do and just want to offer you and the team that you work with. A big congratulations.

: Yeah thanks. It's really been the effort of course of hundreds of people across the state all over different communities and you know really what the CCR model did was it finally gave so many of our communities and so many of our health care leaders and our providers permission to work together in a different way. You know before the CCL model was around as I was saying before payment for health care services was siloed and fragmented. But now with the Speciosa we currently have 15 of these CEOs and essentially each CCO receives a global budget for the number of members it serve or in other words it receives a Per per month payment for each individual responsible for covering. And then the CCO takes this global budget really PM PM from the state. And then it uses those dollars and as I risk for those dollars possible managing those dollars and providing medical behavioral health and dental care services. But before the CCO model before those dollars flowed the community before we had this board structure that was inclusive of all members of the health care system there wasn't that framework, there wasn't that permission for communities to do things like we've been able to do here in Oregon. So I think that's really been crucial in allowing us to be successful.

: That's outstanding and an inspirational story. Now it wasn't always easy, it wasn't always a success. Jim maybe you could walk us through a setback but you had that maybe other people trying to influence health policy can learn from.

: Yes so when we started the CCO model a lot of the different parts of the delivery system that were being pushed to work together really had had never worked together so public health departments it never really worked closely with primary care physicians radiologists such as myself and never really worked closely together with dental delivery providers. And so with that it was challenging to learn how to develop relationships. But part of structure of the CCO really supports the development of relationships among these various types of health care providers that didn't really work together previous to the CCO model and one of the ways we're one of the parts of the CCO structure that allow that to happen was development of what was called the Clinical advisory panel or CAP so most CCOs have a clinical advisory panel that's a governing arm made up of the various providers in the community and in the CCO that I was involved with the anthill CCO when we started the CAP or the clinical if as you panel one of the first things we did was we asked our providers you know what were some of the challenges they had and in terms of delivering care to the Medicaid members and rural Yamhill County where I was practicing we had challenges with access to specialty care we just didn't have a lot of various specialists in the county. One type of specialty in particular we were limited with was dermatology. So physicians who deal with skin issues we only had one dermatologist in the county and who was nearing retirement and didn't see a lot of Medicaid members and our primary care physicians told us you know we need to have more specialty dermatology care. And so one option would be Welkin the CCO work to recruit a dermatologist. Well there's not a lot of dermatologists out there fewer than 400 come out of training every year. So that's you know almost one for every million Americans. The ability to recruit run to rural Yamhill County was not very likely. Typically dermatologists like to go to more.

: Urban city.

: Affluent areas and where they can do various cosmetic services if needed. And so we had this challenge. Well we really need a dermatologist. We probably weren't going to attract them here. They are very expensive also to hire. So what we did was we decided we would leverage technology to get access for our Medicaid member to Dermatology. This kind of came about as a result of my familiarity with the way medicine be practiced. You know I've been practicing teleradiology essentially my whole career. Really what that means is I'm able to sit at a computer anywhere any time and look at an image. It might be a CT or MRI and I can apply my knowledge and skills as a physician and interpret that image to come up with a diagnosis and treatment. While I knew that the practice of Dermatology was very similar to radiology and that most dermatologists about 90 to 95% of the time to make a diagnosis just on visual inspection or by looking at a lesion and they don't really need to do a history of physical. And with that they could even just look at a picture on a computer. So the idea was how can we imply employ a Teledermatology solution to help our Medicaid members. And so we look for a national teledermatology provider we are able to find one we contracted with them and we had a some grant money and we were able to buy refurbished iPad Minis and we placed those iPad's in 15 of our primary care clinics. And so now if a Medicaid member has a skin problem and the primary care physician needs dermatology counsel they can just simply pick up the iPad or have someone in their office pick it up take a picture log into the teledermatology company secure Website send their picture to them and then within 24 hours get a diagnosis and treatment back. So literally within six months we were able to go from no dermatology access to having essentially 15 dermatologists with these eye pads and our primary care clinics. But this all came about.

: That's awesome.

: The challenge of not having specialty care in a rural environment but then you know using the community's voice to identify that problem and then get their help in implementing a solution.

: What a great story Jim and kudos to you and your team for that. I mean listeners you either have solutions or you have excuses and you can't have both. And you know a doctor records here and his team are able to do was think outside the box and they found a great solution with some iPad Mini's and an organization that could do it virtually. What a great story. And now the community that you guys serve has access to dermatology because you are creative and thoughtful in your approach. Can you share with us an example of maybe a project that's exciting right now for you.

: So since helping start the anthill CCO I've moved on and I now work from Voda Health which is a large regional health insurer in Oregon. And most of my work is focused on a value based care. So value based care is this notion we want to pay for quality and outcomes and not just the volume of services delivered so a lot of my work is geared at helping the provider community or provider networks understand what we're looking for. Help them understand various new payment methodologies we're developing. So we're currently in the process of this monumental shift in health care payment moving from fee for service to the value based care. There's a lot of different types of ways we can pay for value. Several of the key ways in which we pay for value have value based your models in place. One we use so-called performance based payments so we have a number of quality metrics that we build in the contracts in the providers are able to meet certain targets associated with quality metrics they can receive bonus payments. Most of these quality metrics are becoming more standardized. One of the things I typically hear from providers is they're just faced with meeting the needs of so many different payers and have so many different metrics in place. In Oregon we had some legislation passed Senate bill 440 which is working on developing a standard set of quality metrics in the state. We've really tried to align our quality metrics around existing metrics and with that you know a lot of our purchasers now build into the contracts they have with us certain quality metrics so our purchasers want to see colorectal cancer screening or immunization at certain percentages so we then take those targets and those metrics and build them into our contract with our providers. And then if they're able to meet the targets and pay them you know another way we pay for value as we use so-called care management fees. So we realize that there's a lot of work performed especially in primary care clinics that it doesn't necessarily come with the CPT code a lot of chronic disease management, care management behavioral health services. And so what we do is we build in the contract so-called care management fees. We give clinics the cash flow they need to hire staff such as behavioral health therapists or panel managers or social workers to help deliver increased value and disease management and care management capabilities to their members knowing that they can't necessarily build for a lot of those services. So my work is in going out to the providers and helping them understand those models helping them understand what their needs are and then making sure that they were meeting their needs.

: Jim outstanding. You're always a couple of steps ahead of what's going on in health care. And it's super cool to hear that you're now tackling the value based care initiative. I know with the mind like yours and your previous success. I'm pretty sure you guys are going to do a great job over there.

: Thanks. Yeah and it's a long road. It's funny a lot of this value based care work. It's very easy to see and conceptualize the solution or where we want to go. But being able to implement that across a population of hundreds and thousands of people and thousands of providers trying to get everyone to understand what we're trying to do is take a lot of time.

: It does. But you know what you did it before and I know you'll do it again. So it'll be exciting to maybe chat with you a year from now to see the progress that you guys have made.

: Yeah.

: So Jim getting close to the end here. Let's pretend you and I are building our medical leadership course on what it takes to be successful in medicine. The 101 of Dr. Jim Rickards. And so these four questions that I'm going to ask you are more lightning round style so I'll ask them give me some quick answers and then we finish up with a book that you recommend to the listeners.

: Okay.

: Ready?

: Yeah.

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

: The best way to improve healthcare outcomes is really to monitor and track them. You know I think one thing I experienced in my practice of radiology is you know I would literally dictate thousands of just x-rays every year but very few times throughout the course of a year what I actually receive feedback from referring providers are in other ways to see no was my diagnosis and just a heart failure correct or was the right call to say there was pneumonia there as opposed to like this. And so I think having a way to track outcomes and getting feedback to the providers is key and that's something that's still largely missing in our healthcare system. But you know back to our value based care work in trying to track delivery and performance of our delivery system with metrics and targets is one where we're doing that.

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

: That's a good question. I think thinking that you can do it all. I mean healthcare really is a team sport especially as a radiologist for so long I felt like a lot of the burden of delivering and doing all types of aspects of care delivery fell on my shoulders. But with healthcare becoming increasingly complex and with our knowledge of medicine and science growing we really have to acknowledge that it's a team sport and so not being willing to work closely with other folks in delivery of healthcare is a pitfall. So you really have to learn how to be part of the team.

: How do you stay relevant as a healthcare organization despite all the change?

: Well I think you have to be the organization coming up with the ideas and you have to be willing to fail. You know in general healthcare it's very conservative. You know there is some people say it takes 17 years or something from the time it's discovered to actually be implemented so that maybe a new therapy or medication. But I think you have to be willing to come up with the ideas and implement them and realize that they're not all going to work but you have to hopefully fail in a way that will make you more successful in the future. So learn from those lessons and keep willing to be creative.

: I love that gem fail forward guys and what's one area of focus that should drive everything in a health organization?

: We all going back to my current work of pay for value or fee for service system was not really set up to pay for value it was set up to help manage transactions and facilitate billing of procedural codes. But I think we really need to focus on value and realize that we're still in the infancy of value based care and it's going to be a long road until we completely move away from fee for service if that ever happened.

: That's awesome Jim. Now what book and what podcast would you recommend to the listeners as part of the syllabus.

: As far as podcasts I like conversations on healthcare forgetting right now who the folks are that do that but conversations on healthcare is a great one. And then in terms of a book probably recommended Porter's Redefining Health Care from Harvard Business Review. It's a pretty lengthy book but I think it gets into talking about value based care and it has really been the foundation for a lot of my ideas and thinking around healthcare transformation.

: Outstanding. listeners don't worry about writing any of that stuff down. Just go to outcomesrocket.health/rickards. That's Jim's last name, R.I.C.K.A.R.D.S. and you're going to be able to find all the show notes, the transcript, links to his work, links to his book, our health plan as well as all the details that we discussed here on the podcast. Jim this has been a ton of fun. We're here to the end and I'd love if you could just share a closing thought and the best place where the listeners can get a hold of you.

: Closing thought is I think now in health care there's more opportunity than ever. This was largely driven by the Affordable Care Act. I think things have kind of been in flux now with the new presidential administration. But I think we're well on the road to developing value based care initiatives and ensuring that as many Americans as possible will have access to high quality, affordable health care. So we just say folks involved in this space just keep up your good work it's going to be a long road and there's going to be plenty of work ahead. And then in terms of getting a hold of me I have my own Website. jimrickardsmd.com. You can log on to that or Google that and you can find me and that has links to contact me.

: Outstanding listeners again we'll provide that to you in the show notes. And Jim just want to take an extra minute to say thank you so much for carving out the time to be with us today. And we're excited to stay in touch with you.

: Great. Thanks a lot.

Thanks for tuning into the outcomes rocket podcast. If you want the show notes, inspiration, transcripts and everything that we talked about on this episode, just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book:

Redefining Health Care

Best Way to Contact Jim:

Jim Rickards

Mentioned Links:

Our Health Plan: Community Governed Healthcare That Works

http://www.jimrickardsmd.com/

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Why Continuity of Care Became a Core Focus for This Leader and How She’s Improving Outcomes with Anne Weiler, CEO and Co-founder at Wellpepper

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Why Continuity of Care Became a Core Focus for This Leader and How She's Improving Outcomes with Anne Weiler, CEO and Co-founder at Wellpepper

: Welcome back once again to the outcomes rocket podcast where we chat with the day's most successful and inspiring health leaders. I really thank you for tuning in and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have an outstanding guest and an amazing contributor to healthcare. Her name is Anna Weiler. She's the CEO and co-founder at Wellpepper a clinically validated patient engagement platform. She's really focused on this space and has been for quite some time. She's also a health care blogger. Her site healthworkscollective.com is really a site that you all have to check out because she dives deep and wide into all the topics in healthcare that matter and it's very well organized. Just as her and her business are doing for other practitioners they're very well organized in helping them improve patient adherence and outcomes for patient care plans. So without further ado I just want to extend a warm welcome to Anne. Welcome to the podcast.

: Hi. Thanks for having me, Saul.

: It's a pleasure. And anything that I missed in your intro that maybe you want to highlight?

: No, it think was a great intro. We will have our focus on interactive care plan for patients and we've taken the approach to say that if you help patients understand what they need to do and you break it down into actionable and engaging experiences they will actually do it. And so you know I think I'm not the one to claim that but the patient is definitely an underused reserve in the whole health care path and that's really our focus and then we help to scale that clinicians with technologies so starting to observe what's happening with patients and learning the care team that they need help as opposed to saying care team here is a bunch of people you have to manage and more work that you need to do and my backup background as you might tell is in technology. So I spent 10 years at Microsoft before founding this company and including three years running a business group in Microsoft Russia.

: That's pretty interesting. So you start off with Microsoft went over to Russia and loop back around. So now you're in healthcare so tell us a little bit about that what was the spark that got you into the medical sector?

: Well you know like a lot of people and I think a lot of people who came from technology into healthcare. It was a personal experience. My mom contracted a rare autoimmune disease and she spent six months in the hospital. The disease that caused temporary paralysis. And she is in the hospital. So she she had great care and she mostly recovered and she has some permanent nerve damage. But she mother covered. And that problem was she was discharged that she went from having round the clock care and physical therapy and occupational therapy and physician check and all week to a month before she could come back into the same facility for her outpatient. And so during that time we didn't know what to do. We had to hire some private care for her and we couldn't even explain to them what had happened which is basically that she was sent home with no instruction in over a month before she would come back in again. And that lack of continuity of care made me think you know we're in constant contact the rest of our lives with these mobile devices. Why is there this lack of continuity care and health care. And that's where it all started. And we were very fortunate my co-founder and I hear about someone who was at Microsoft. The two of us actually met at a startup in Canada that Microsoft acquired in 2001. But we were very fortunate very early to meet Dr. Terry Alliss, a Ph.D. researcher and professor at Boston University and she what we had prototypes basically and really felt like there was an opportunity to partner. So I was really sort of our first positive nod on the journey with finding a really great research partner who had been completed one randomized controlled trial and one other trial that was sort of quality controlled trial to show that the software works and that it has efficacy and that you can actually engage patients outside the clinic.

: I think it's super great. And thanks for sharing that story. Super glad to hear that your mom's doing better and sort of the spark that got you into this. The road has meandered and you guys have been in it for five years which is a long time for a startup in healthcare.

Well someone said this is about startups in general that half the battle is not dying but I would say I would say in health care also half the diving that's definitely half the battle in that you know we met organizations very early on who thought that we were doing something quite interesting. And then when we were still around two years later then they're like oh you're still here. Great. Now I can work with you. So you know health care and there's a good reason why but they are fairly risk averse. So a number of factors had to come together together to the point that we're at now. And certainly when we first started there then we got questions around. What are you doing? Doesn't really seem like a thing and now we're getting: how are you different from all the other patient engagement experiences? So number of things have happened in that focus in the method put on outcomes and certainly patient reported outcome has been a real a real benefit for us. Certainly Bundall where you need to think about overall cost of care. And then we also see lot of interests where there's an access to care problem and whether that's a specialist who have a very long waiting list. And is there a way to get people on board and engage them before they come in or and certainly in organizations that have a large catchment area with rural I mean even even our researchers at Boston University think of Boston University as being very urban. But they work with specialized patient population who have Parkinson's disease and the people may be coming for three or four hours to come in to the few specialist from the clinic and if they don't have to come back. That makes a huge difference for them.

: For sure. It sounds like you guys are definitely making an impact and without a doubt the hot topic here folks is patient engagement. What do you do when your patient leaves? What do you do when your loved one leaves? And how do you make sure that they get the care that they need that continuity? Ann and her team are definitely focused deep into this and can you give the listeners an example of how you guys have created results, improved outcomes or profitability?

: Definitely. So I think I'll start with some of the research the research studies and the results that our research partners have found. But we also continually are analyzing the patient interactions and the patient experiences within the software to find results and outcomes as well. And that's both on the patient outcomes side and on the effort and cost side from the healthcare innovation. So on the studies we partnered with two different PIs. One with Dr. Terry Alice, she's the director of Boston University's Center for neuro-rehab and they completed a randomized controlled trial with an exercise intervention exercise strength and conditioning intervention. Over 12 months for people with Parkinson's disease. The usual care condition which was a control piece was that you would come in and you would have a couple in person visit and assessment and then you would go home and then they might see them again in 12 months or they might never see them again. And then the visual intervention was a personalized application that had personalized video of the patients in it and the ability to be monitored remotely by a clinician and message with that clinician over the 12 months. So the difference between basically the usual care condition and the group that had the mobile health intervention was a striking physical outcome. So the people with the usual care condition are 12 percent decline in their mobility over a year. And the people in the mobile health interventions found 11 percent improvement and that's 12 percent decline

: It's huge.

: I now and that's what happens each year from the first year you're diagnosed with Parkinson's. So if you can stop that. You keep people self-sufficient you keep them. Sometimes in the work place you certainly keep them out of long term care facility. Now that study we then went and that we put them in additional of an additional research on a couple of things in there because that was not particular like it was. It was not looking at cost that was looking at efficacy. But then of course the next question became well how much did the clinician have to engage with the patient outside the clinic and what were some of those engagements and what was the cost of that really not hard cost because we got wasn't designed into the intervention up front but a couple of things. One was that in working with these people remotely the clinician was able to noticing either the patient message and said something about you know I didn't really like it or I find this one really does exercise that you want me to do really hard or they would also look at them as they were recording their outcomes themselves and seeing whether they were progressing and the clinician was actually able to change the program remotely so she could add in...

: Nice.

: Yeah she could make it harder, she could make it, sometimes she said she just took things off of their programmers. They really didn't like it because her goal was to keep them doing something. So I think I was really key. But then we wanted to also look at sort of the effort of messaging because when you talk to clinicians as soon as you open up the channels for messaging with patients that outside the clinic there's a fear that they're going to become overwhelmed with new work really because patients aren't messaging before we think some of that is actually replacement of messaging can be replaced in a phone call. And then also that messaging can tell you about things that and alert you to think before they would follow adverse about them. So that's why when we were constantly looking at evaluating the efficacy of our product as well as how people are using it. So we went back and we did some analysis on the messaging in this scenario. Again you know we combat the identified the data and did this analysis and applied machine learning to it. When we classified the messages that were sent back and forth during this year. We found that 70 percent of them did not require a response. And then we found that 3 percent of them are urgent. So what's interesting here is that the 70 percent who don't require response were things of patients journalling they were using this to talk about their experiences. And for the ones that were urgent things like you know I had a fall or you know I went to the Ed those other things that you want to reach out to the patient and find out more about. And the other interesting thing was that there was actually no correlation between messages sent by the provider and adherence which actually meant that thinking back to the 70 percent of messages don't need to respond that the fact that they're with someone on the other end that they knew they could get in touch with with this person and that the person was watching their progress whether or not to keep them adherent. It didn't really matter how much that provider reached out a message. So we had a couple. Most of the time the messages were equal. So the patient comes when the provider sends one but we had this one patient who is like them outliers somebody who's been 150 messages that someone and 600 messages and that provider did not match those messages. And those people stayed adherent.

: Interesting, that's the basic feeling that somebody is on the other side ready to support you.

: Yes. That was the key driver now because that study didn't specifically look at cause we actually entered into another study and the Boston University folks were part of that study but it was led by Dr. Jonathan Bean who's an M.D. and a professor at Harvard University. And that study was called a quasi experimental design. And what that meant was that they had done the study as an in person intervention already. So they did a one year study. They had an intervention and they the intervention was to prevent people who were at risk of falls from having a hip fracture so that they knew their intervention works. But it was also very people and in person intensive so people had to come in and again that was part of the conduct in Boston. People had to come in to do the intervention and so well it worked. It was hard for people they often had to find rides, there were a lot of a lot of snow.

: Scalability becomes an issue right?

: And scalability is an issue. So they did the same study the same intervention but then did it with a digital experience so it was very similar to the Parkinson's disease study which is why how we ended up in this and that one they have not published yet so I can't share the details but they did have better than expected. And clinically meaningful outcome though patient outcome patient had improvement during the course of the study. Now the other piece of that study is that there are researchers at Brandeis School of Public Health who are analyzing the cause. We're really excited to see that when it comes out because hip fracture is basically for seniors. You know that's the really the beginning of the end of their quality of life. Once you have a hip fracture your quality of life really declines and risk of increased mortality and also increasing expenses. So if you can keep people from having a hip fracture you know it's going to be good for everyone. So look at comparing the cost of doing the program and helping people at the clinic to the cost of the have fracture. I think we're probably going to see some pretty positive results especially since the cos it was designed as a digital intervention. So the costs should be pretty low.

: Anne, super interesting and no doubt you know once you get that hip fracture it becomes the kiss of death oftentimes. So it's interesting that you guys are focusing there. Definitely a key area. And thanks for sharing that right. I mean you guys are diving deep into the clinical validation truly shows your commitment. Take us through a time when you had a setback or had made a mistake. What happened, what did you learn from that?

: As a technology company. You know I think there's there's always time that you're constantly trying to improve the software constantly trying to improve the patient experience. I think it's not so much around setbacks, sense of making sure that you're continuing to learn as you go along and you're continuing to challeng your assumptions. So you know we have I think that software is both an art and a science especially when you get to be experienced because you think about things that you think intuitively. But I think it should be. But then you also need to continue to test them so very early on we were trying to think about what what is the optimal number of things that you should ask them and to do if you want them to be an adherent. And before we had enough data to to really test our assumption was about three things a day and we are clinicians and they had no idea. And the clinicians sending people home with a list of 20 things to do. And then when we did the thing we found that it was actually five to eight things. I paid half in your care plan is the right number to keep you adherent. So it wasn't so much a setback versus wow. Our assumptions were incorrect. And another place I think it's sometimes again with technology can become very enamored of the technology that you're building and you always have to remember to think about the end user and ask the end user. And so an example there. I'm not sure if you saw that last fall we won me Alexa Diabetes Challenge and..

: Congratulations

: Thank you. And a component of our solution there was a voice-powered scale and Gail scanner that looks for early signs of diabetic and when we first conceived of that you know we were just so excited because we thought wow this is really cool. You know advanced technology and then we were talking to one of the coaches in the program who's a behavioral health expert and she said what are you going to do to make sure people aren't afraid of having something to take pictures in their bathroom? And we we were just we all looked at each other and thought how did we not think of those? Those beautiful stories where people go go all the way to market with something and then they have a thought about that. But we got it before we really even tried our first prototype with patient but we were thinking what the value of this is so great that it's going to find these early is going to prevent amputations, of going to prevent hospitalization that we kind of forgot that maybe somebody didn't want them they taking pictures in their bathroom.

: Yup, that's amazing right and a great story to share and for the folks listening if you're working on solutions don't get too enamored with them get the feedback from people. Put it in their hands. Put it on their feet.

: And be willing to have people tell you that your baby is ugly.

: Totally. I love it. What a great share and truly appreciate that. What would you say one of your proudest leadership experiences in health care now that you're in this business have been?

: Well I probably to date would be our announcement that we need at HIMMS that we will have Mayo clinic care plans. So there are best practices for interactive care plans will be available on the Wellpepper platform.

: Congratulations.

: Yeah that when we started as you know we were as I said we were so fortunate to meet Boston University very early on but I don't know that we as non health care people would have said that our goal was we were going to have Mayo on our platform. So I think that's pretty big and it's something that we've been working on for a long time. So we always took the approach to say that health of them probably would want to you certainly best practices or their own interactive care plan. So we've built a platform is very flexible where you can create any type of care plan from the individual building block and so that this ability for healthsystem to license Mayo clinic care plan is something that's been in our roadmap for a long time that we needed to get to the right moment of having obviously know that the care plans from the leading research hospital in the country as well as health system really understanding what it means to engage patients outside of the clinic so that they will be ready to use the care plan. And you know what I think the great thing about this proudest moment is I'm positive they're going to be even more will be able to build on this and deliver even more innovation.

: That's awesome and congratulations on that. And in our health care economy it's not only important for us to develop cool things that are going to help improve outcomes. It's also important to get impact and his partnership with the Mayo will be an incredible way for you guys to increase the impact that you make in healthcare and super exciting. We had Lee Aase. He's the director of social media at Mayo and he told a story about the Mayo brothers and the things that they did to improve their impact. They traveled the world and they brought people from all over the world to Mayo and talked about what they were doing or learn from what they were doing. And I think you guys are sort of following in that tradition getting into that place where you could just teach other people how this software can help them improve healthcare and it's super exciting. So really really congratulations.

: Yeah you're absolutely right. It is about scaling this best practices and then it's also about learning from the patient interactions with healthcare plans and that's something that you know we couldn't do before. So we had in watching what people do and analyzing their results. It helps improve all of the care plans that help improve how people interact with patients outside the clinic. But we can also really improve care. So you know I talked a little bit about the outcomes that we've seen from research but we also have seen outcomes just in collecting this data that we've been able to identify patients who are at risk of readmission from their reported side effects from surgery which is not usually the thing that when you get your surgical instructions are really about symptoms and certainly the symptoms. Do you have shortness of breath or chest pain. That's the thing you want to look at first because you really should be calling 911 but what we found was that people who were having symptoms that were having side effects through surgery like not nausea or constipation actually had a three time greater risk of readmitting within 30 days. And that wasn't in ambulatory surgery scenario. Now you wouldn't know that unless you are actually collecting data with data from patients in real time. So that's the kind of stuff that that we really are excited about being able to do is finding those outcomes. We also had an interesting situation where one of our customers initially just report deployed patient reported outcomes surveys. So you know the ones that the and other insurers are starting to require to show efficacy of the program and for the first year they only had those surveys and then the second year they added a complete pre and post surgical care plan. And there was a 26 percentage point difference in the people who just were doing outcomes surveys to the ones who had the complete care plan. So again this is helping people outside the clinic will improve outcomes and patients want to do what they're supposed to do that today a lot of the ways they're receiving these materials make it really hard for them to follow the directions.

: Anne, supercool no doubt that your mom would be proud. And you know that experience that you guys went through. Now you're going to help others not have to go through and that's super exciting. Anne, let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine. It's the 101 of Anne Weiler. And so we're going to write out a syllabus here united together four questions, lightning round style followed by a book and a podcast that you recommend to the listeners.

: Ok. OK.

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

: Empowering the patient and understanding the patients goal. Often the patients goals are very different than the clinicians goal and I think the most important thing is knowing that you're actually meeting the patient goal. So we enable patients to set their own goals and track progress against those goals and that I think is both the biggest motivator but it's also the most important outcome.

: That's a great call out. What would you say the biggest mistake or pitfall to avoid is?

: I think from my perspective as a technologist and I actually think for health systems as well. The biggest mistake is pilotitis. I think that we're at a point now there's clinical research that shows that these solutions work. We know that people want them, we know that they can save money and when you do too many pilot if you don't have the right metrics and you don't it really doesn't signal the right commitment. And so I think jumping in and really deploying something and continuing to improve and tweak it is probably a better approach than a number of small pilot. We're not entirely sure what happened.

Love that an avoid pilotitis people, get committed. How do you stay relevant as an organization despite constant change?

: I think that our technology background really helps we're in that we're constantly looking at new ways to interact with patients. The work that we did with voice came out of that you know and voice is not widely deployed in healthcare yet but I think it has a huge benefit in that the experience is so natural in healthcare you're used to talking to someone you used to being interviewed by someone and so I think the technologies are going to be a really great way to improve. So I think with technology there's always something new and so staying on top of that and then evaluating the impact that it can have on your solution or your patients. That's really what we do. Voice and machine learning I think are the two things that we're really excited about going forward that we'll have a great impact.

: Love that. What's one area of focus that should drive everything in a healthy company?

: The patient.

: Amen.

: Yeah.

: I love that. So true. And thanks for walking us through that. What book and what podcast would you recommend to the listeners as part of the syllabus?

: I think everyone should read an American sickness by Elizabeth Rosenthal. It's tough to read because she breaks down everything that is not working in our health care system as well as how we got there. And so there are points when you're reading the first Top of the bank. I don't know if I can go on that very hard to read. But then on the second half of it she provides very actionable things that we can all do. But I also think it's really important just to understand how we got here because you want to undo where we are and you want to approve it. You have to understand the part about my hands down recommendation for healthcare books right now. I know that every year something new about that. That's great. I think that's one that everyone should read and it is now in paperback. And then I think on a podcast I really like a Healthy dose which is from Oxeon and Bessemer so to venture capital guys who are they interview people in the industry. And I really like how they are really teasing out like what are the macro trends like where are we going and also optimistically to. They've had Jonathan Bush on and he was really great. It was one of my favorite podcast because it was just after the thing that happened where they had that agitating shareholder and you know I think he had really taken some of that to heart and those like he could tell how much he cares about the mission that he's on but also like not satisfied with statusquo.

: Love that, some great recommendations and listeners I know we recommend a lot of books here. All healthcare leaders have amazing ideas and has recommended another great one. What we do is I recommend that you go to outcomesrocket.health/audio and you'll get access to blinkist which is a software that helps you reduce the time that it takes to vet out books. I know that the one that Anne recommended is going to be amazing you'll probably buy it but check it out. Anne this has been super helpful. I know that the things that you're doing are truly going to make a difference at Wellpepper. Why don't you close off the session with some closing thoughts and then the best place where the listeners can get a hold of you?

: Well I think closing thoughts. I think we're just really at the beginning of the journey and I think some of the insights that we're going to see from patient experiences and patient generated data out of the clinic are really going to drive improvements in care both in. I think the way that people are able to protect themselves but also clinical insight. So we're very excited about that and about the intra inpatient experience in patient generated data. And you can find us at wellpepper.com. And as you mentioned the beginning we have a blog. We try and talk about topical issues, conferences but we've been to, and if you wanted to get in touch directly you can use info@wellpepper.com and promote a follow up with you immediately.

: Amazing. And this has been a ton of fun. I really just want to say thank you for sharing the amazing work that you guys are doing over there and listeners encourage you to check out the show notes and the transcript will provide links to Anne's blog as well as links to Wellpeper and all the amazing things that they're up to so and just want to say a final thank you and looking forward to staying in touch.

: Thank you, so fun to talk to you today and I very much appreciate anyone who is so focused on outcomes.r

Thanks for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book and Podcast:

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

Healthy Dose

Best Way to Contact Anne:

info@wellpepper.com

Mentioned Links:

https://www.healthworkscollective.com/

https://www.wellpepper.com/

Episode Sponsor:

How Remote Patient Research is Improving Outcomes and Simplifying Clinical Trials with John Reites, Chief Product Officer at THREAD research

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How Remote Patient Research is Improving Outcomes and Simplifying Clinical Trials with John Reites, Chief Product Officer @ THREAD research

: Welcome back once again to the Outcomes Rocket podcasts where we chat with today's most successful and inspiring health leaders. I really want to thank you for tuning in today again and I welcome you to go to outcomesrocket.health/reviews so you could rate and review today's leader because he is an amazing contributor to Healthcare. His name is John Reites. He's a Chief Product Officer at THREAD where they help Pharma, CROs and researchers to conduct remote patient research. Their focus is definitely in digital health and fixing the way that these things are done in a more efficient way for patients as well as for the people conducting the research platform. And so he's had 15 years of healthcare experience among his other duties. He's the adviser at Blue Door health as well as you know he's been a guest lecturer at Duke University and in his previous life was a Head of Digital Health Acceleration at Quintiles. So really want to welcome you to the podcast John, excited to get the conversation started.

: Thanks Saul, thanks for having me. I really appreciate you doing the podcast. I love listening and I appreciate the work you're doing. So excited about the conversation that's going to be fun.

: Thanks John. So did I miss anything in that intro that you want to share with the listeners about yourself?

: Yes. You know I also have a life. And...

: What's that?

: You know... no. In this world we live in right there's so much to be done in health care. There's so much work we have to do. But at the same time it's super important. And I was reminded of this week that's just important for us to support help as it is for us to focus on our health. And I'm saying that because I have to go to the gym tonight so I'm motivating myself before we go.

: There you go. There you go. Get those juices flowing because you're going to be at the gym tonight baby.

: There you go.

: I love it. No it's good. You know that's such a good point, John. It's worth it's worth parking there for a second. Like we spend so much time trying to get other people healthy, trying to make our health care system work that, are we taking care of ourselves?

: Yeah. And it's funny I just found it today. You know, the business that threads in the work I do every day is helping customers to do remote and virtual research. So you know we're trying to help connect people to contribute to research in their home. But at the same time one of my customers said, Yeah and our patients are on the go because they were collecting data on an Apple watch and one of our apps living their lives and I said oh my gosh I haven't been out of my house in three days with my watch. And that's why my results are so terrible so it's just a good reminder that as we worked inpactthis road you're right we have to make sure we do it for ourselves too. And I know too many busy entrepreneurs that are doing amazing work in this space that we just have to keep reminding ourselves to stop for a minute and take care of what matters which is our health and our families also. It's a great point.

: Now it's a great reminder John so appreciate you bringing that up. What would you say got you into health care to begin with?

: Yes so I'll make a funny long story short as possible. I just fell into it. I didn't go to school to get into health care. I didn't get a degree in anything related to life sciences. My degree was actually in communications and PR and marketing. And frankly I was going to do communications or I was going to be in a in our rep for touring bands and apparently what I learned in college was that if you don't know people and have those connections coming out you're not going to be able to get that job out of school. And so through a series of events I ended up interviewing at Quintiles which is a global CRO and I interviewed because my wife knewan executive there and she got me an interview and I didn't really know if I'd get the job. But great thing was that night I got the job. Funny story as I learned about everything I need to know about Klinker research three days before the interview apparently must've done a good job talking my way through that position to get it and learned everything that I really know about the sector by doing it in a job. And I was chief paper pusher when I started like that my first job was I pushed files around and so I did every piece of small work that I could do to really understand the business from its highest points just sort of its the low things that everybody has to do to really move things forward. So it was good character building exercise but I really fell into it. I didn't sort of make this conscious decision coming out that I wanted to impact healthcare on day one.

: I think that's so cool that you fell into it but you've stuck with it. It's obviously something that has resonated with you and has moved you to continue doing it.

: Yeah it's because you know I think we have this advantage that sometimes we forget about in our industry. There's a lot of people who do a lot of amazing things to contribute to society. But one of the ways that we do we can actually see tangible benefits is contributing to research and development of drugs and medicine and products and devices and being able to see that firsthand and see people because of your work result you know having positive results. I think it's really powerful and we have this advantage that we live in this world we can impact people in a short period of time with something really monumental. So I think that I'm glad I fell into it because it's what I'm passionate about and it's what gets me excited. And you know amongst a lot of things we could all do as you know a lot of people in life sciences are really smart individuals there's a lot they can do. But having a passion for people and having a passion to care for people through this clinical research or health care in general I think there's a great mission that we need a lot of people to have in their lives.

: I love it John. I totally agree and you know I think their strength in communication is is a strength that is very much needed in healthcare and in any other area. And the other thing you mentioned is the importance of knowing people and just the little tidbit that I want to offer to the listeners is that get out there and meet the people come stand behind your LinkedIn or your Twitter or even e-mail for that matter like go to a conference or go to a local meetup and press the flesh and then you'll be amazed how much farther that will take your mission rather than just hiding behind your accounts which is not bad right. We could do that. But it's also important to do like John said just get out there and meet the people. So John what would you say a hot topic that needs to be an every medical leaders agenda today and how are you guys addressing it?

: Yeah. So the hottest topic for me is how you do virtual research. Right. So how do we take clinical research because that's what we specialize in. That's what thread does. How do we take clinical research and start to virtualize elements of it to make it either more conducive to a person's lifestyle or to collect more data continuously in between clinic visits or frankly to new types of data in the real world that we haven't really been able to collect when they come into a controlled environment. So I think that every healthcare leader today sees that the technology landscape is helping us to move healthcare to more remote and virtual models. And so I think that I would tell you just because I see it everyday and I see the positive impacts. But I'm also learning a lot of the lessons of actually doing this work day in and day out that. It used to be on our radar but at the same time to it there's this mentality that I'd say that I think we really need to take which is is that this is all a journey, it's not a destination that we drive to tomorrow in other words there's a really defined sort of crawl-walk-run that I think we can all take as an industry to start to virtualize components of clinical research. And some people are not ready to do that, right. Some people are just saying Hey I just want to give my patients apps. I want to be able to collect e pro or remind them of things or hook a sensor or a medical device to something. I just want to do something kind of simple to start because I'm not really ready to go all in and virtualize every one of my clinic visits. And I think we need to understand that not everybody is there and that there's a lot of different sort of tolerances in those models. And so what I would say is in doing these things differently I think it's really important that we understand there's a crawl-walk-run into this that it doesn't all have to happen overnight but it's something that we need to start doing today because it is happening. It is working and the lessons learned that you will learn from doing it are much more positive than me telling you what I learned over the last several years. So that's what I'd say is really the hot topic but also the area of focus that I think every medical leader really needs to have in their tool bag today or really be thinking about how to start implementing this type of work.

: That's really fascinating, John and anything that comes to mind as you walk us through your expertise here is the clientele that you serve. Are you working with providers and also pharma companies like what are your customers look like?

: Yes good question. So first off the people that we can help the people that we unable to do remote are virtual research is anybody that wants to do remote or virtual research. Our customer base has come really out of that focus that we have and so we are supporting pharma - large to small, CROs from large to small, nonprofits, providers, academic researchers and sort of a number of different customer types in between those. So again if somebody is trying to do remote or virtual research the way the technology works the way the engagement can work actually has a lot more similarities and differences. And you really see that when you win when you look at some of the work we've done in clinical research and then some more like late stage clinical research that actually has some care modeling in it or digital care plan so more clinical to commercial integration. And so irrespective of sort of where someone's at in the type of research they're doing and we're trying to service all of those customers with a standard way of doing this type of remote research with people.

: Fascinating. So let's take it a step deeper. Can you give us an example of how you and your team have improved outcomes maybe a case scenario?

: Yeah. So I'll be careful because a lot of that even though we have a lot of public work there's actually a lot of work that we have to wait for that to be made public. But some of the things that I really like are lately with some of our customers more in the Foremans and side. We've been able to take like a study protocol that has say 12 visits in it. And as you know once you do clinical research study with 12 and clinic visits that study starts to get personally really expensive. Right. So once you add 300 patients and you got to direct them there and then do these visits again the price and sort of the time and the commitment a patient has to have. That research really goes up and we've been able to work with some customers to keep meeting their endpoints to continue to meet their primary secondary exploritoriants. Exploritoriants points but do it in a way that they took those 12 visits and made it 8. And so they made eight clinic visits and they took four and made them virtual in this one example study example and to give you. So in doing that they were able to reduce cost and say hey now patient in my study you only get to come in eight times not 12 to 60. And if you have some issue we can actually do this work via telehealth with you when you're at your home. And so what we did is the outcomes that we produced is helping for the same, the same research outcomes to being that but also reduce the burden for the researcher and the providers, the sites and also reduce the burden for the patients to participate. And frankly gave them a tool so they have their own app that has some other engagement, content and some support services in it so they can be supported throughout the study and be frankly constantly reminded that they're are part of something bigger and so being able to sort of add value to those stakeholders while also helping them to meet the endpoints they have in their study really brought a lot of different outcomes very positively to a number of those takeovers, so hopefully that makes sense. But that's one example.

: Yeah you know and one of the things that I've seen with digital companies like thread that are successful is that they take an antiquated process, they remove steps, simplify it, and make it cheaper. And it sounds like that's exactly what you guys are doing.

: That is. And I want to say too that we're doing it and learning right like nobody's. Anybody who says I've built the perfect model to do engagement of stakeholders is a liar and you should run. And I'm not saying that because it's true. Yeah because we're all learning and just like we contribute to research we're all researchers ourselves. And we're making what I call successful mistakes all the time and they're not detrimental things we're just going to people don't respond well to that. Yeah maybe this thing has four clicks and it should have two. And that's the kind of learning that that we have to be very transparent of and are especially in our industry to say hey these are small sort of failures or things that need to be tweaked to be done better but we're going to optimize them. We're fixing it in real time. And frankly that's no different than the same experience that our stakeholders like patients and providers and sites. They all do that in their daily lives with every other branded entity they engage with from Amazon to Disney to ESPN. Right. These guys are learning and changing and modeling and I think that there's a lesson to be learned for our industry from consumer products in that we have to try things and then optimize when they work and optimize when they don't work as well as we want them to. And I think that for me that's the other piece is that as you're doing this work where you have to constantly be learning and constantly be listening. Like you mentioned earlier it because people will tell you what they like and what they don't like it doesn't mean that your products bad it doesn't mean that that that's maybe a change you need to make at a high level. But what it does mean is that when you're listening you're making sure that you're not in love with the how you run your business and you're not in love with your product; you're in love with the fact that it can actually change the industry you're in love with the fact that it actually improve outcomes for people. And I think that's the piece that we have to truly swallow when we're trying to be entrepreneurial in this type of work.

: That's really great John and I love that you highlight this importance of listening to the market. There's book hug your haters. I don't know if you ever heard.

: It's on my reading list. Did you like it?

: It was great man. It was great. And it basically boils down to what you just said John is that we've got to be open to that critical feedback especially from our current customers like if they speak up it probably means that other people are feeling or seeing the things that they're saying but they just want to speak up. So listen to them and take it to heart.

: Actually agree. Yeah and that feedback priceless like an old mentor of mine told me once that two statements that I like here one is if you don't have people that absolute love you and people that absolutely hate you in whatever you're doing you're probably not doing the right thing. Nice. The second thing though they said was this person said if you get on with a customer and you show them how you do your business and they just smile non say thank you. You failed because they don't care about your thing. He said if they get really passion about what your product doesn't have or what you're not doing it means that they see how your what you do solve the problem and they want to contribute to it with their voice. And so I think that from my perspective I totally agree. So I mean you hit the nail on the head that that feedback is not a bad thing. Feedback's actually a great thing and when people are giving it to you it probably means you're doing the right thing. And I think we have to take that to heart too to not be offended by that but the taking. OK let's look at how we can apply it and that's a learning system. And we always talk about the learning healthcare system I think we as an industry can really move that forward by listening and reacting.

: I think it's so great. Thanks for sharing those those nuggets of wisdom that your mentor shared with you. Now you're sharing with us. Obviously it's working. You're doing very well with this company. Talk to us about a setback or a failure John and what you learned from that particular moment.

: How long is this show? Yeah. Ok so that's one of the things that was really impactful for me personally and I know a couple of our team at it too was I just remember we're building this app and Web platform off our platform for patients to come in and essentially do a really large registry. In the registry we had gotten some insights from patients from people that would be enrolled to sort of figure out what engagement content and maybe what features or functionality would help support them to not just be supported by the study but to also continue to use this app in this case and in the list of features there was this one feature and I was like yeah that's fine. No one cares about that. That's not that big a deal is not put a big emphasis on it and people thought me on and said I think we should and we kind of did like a really MVP version of it real minimum viable product version. And funny enough all the patients ended up using that feature the most and basically kept saying when are you going to improve this when you going to make this better. And so again kind of going like that listening concept sometimes. I've made a lot of mistakes by assuming that I know people and again getting better that you know now that we actually meet with patients and sites and so many people have seen our platform now you know there's a lot that you work out and that you feel if you get a good handle on but I just think it's like we talking about that feedback loop. I think I've in the past made that mistake of not just not sending putting something out there or listening to feedback or not or making an assumption that maybe I thought I had because I knew it all. I should do. And so that was just one of the examples that I always kind of hits me and makes me grounded make sure that I remember that feedback is important.

: That's awesome John. Thanks for sharing that story. And it's just one of those things right. Don't assume. Make sure you dive deeper and question those those assumptions that you're making. And you know what though the good thing Jan is that you included it you included it you didn't exclude it.

: That's true.

: You could have kept it out all together.

: That's true. Yeah. And that's because like our team is awesome and they're much smarter and aggressive than me and good for them. They pushed it. So yeah it's a great point but I think we'll get it. I think that's the one I think about these lessons. I think so many of them have been because either I just didn't have my ears open or I wasn't - like you said I wasn't asking the right questions, coming to a result. I was making an assumption first and I think that's something that I'm learning and trying to build that part of character for me. You know for the long term.

: Yeah John and the other thing too is it's a testament to the culture that you've built there with your team right. If you've got a team that feels comfortable pushing back that's the type of innovative culture that will succeed. You know people that are not afraid to get out of their comfort zone and make suggestions and hold their ground.

: Yeah and I've got to say like I I've been really fortunate to work with so many teams over my history that have had that mentality or people that I could come into I was one of the puzzle pieces of a good team or a great team. I mean even today like you know our team at Thread this is the cultural mindset they have right. And it's really cool to see. I see like Kevin and Cho and Todd and Sean like people that will jump in and say hey I don't think that's a good idea. We learned this. It should probably look like that. So people are really jump in because they want to make something better because of what they listen to because of the experience and they can make better. And frankly to you I think the second piece is is that you're never satisfied with making something better. Right. We don't build something and stop like no no no. How do we continue to measure this. How do we get data to make this better. How do we continue to listen those customers to make you know not just moving a button but making sure that this is easy for them to use. This solves a problem for them and no, so I totally agree and I'm really fortunate that that's the kind of people I get to work with everyday. They're great.

: That's awesome John and yeah you know my my mind goes back to that example that you gave us about you're sitting in front of a customer and you're telling them about the problems you can solve the solutions and they're not passionately tell you. Yeah this is great. Or actually change this. The same thing goes, leaders, listening to this. If your team is just sitting quiet on that call or if they're just sitting quiet after that meeting are you missing something? Are you missing something? Or can you somehow figure out a way to get feedback from them? Give them a little bit more ownership because I think this could go just as much externally as John illustrated as well as internally.

: Yeah that's a good point. And like I just think Olga on our team she's our heads up our quality group and I think too, you know so many people sort of come to meetings and they think oh will these individuals will be allowed in these individual be quiet but being able to empower our entire team of Olgas super the most detail oriented person I know. And so she would come in and look at certain components of what we're doing and say this is not passing, this needs to be fixed. And so I think to enable and like you said the entire team regardless of their role to be able to be empowered to jump in and make those statements ultimately gets you where you want to go faster. But also in more detail.

: Love it. What would you say one of your proudest medical leadership experiences to date is, John?

: There was this one time that when my son was really young just a couple years old and he was...

: How old is he?

: So now he's 10. So he's been a while and I just remember he was having he was having breathing problems I think it was at preschool or something running around having breathing problems. And we went in to see the pediatrician and I went with my wife to the appointment because I was I just remember being a little bit young parent as my first child, I'm freaked out. Let's be honest right. And I think like the world's going to crash down.

: I'm right there, John. My son is one, so.

: There you go you learn that you're living it.

: Yeah, I'm living it so I know what you know.

: And it's that's raw math and I just remember just being panicked and our who was amazing. You know came in and said hey it's going to be fine. Here's what you know we did these tests and this what we found. And there's this great new treatment that just hit the market and it's this dissolvable pill for children that does X and I literally looked at the label and I went, Oh my gosh I ran those clinical trials.

: No kidding.

: And I couldn't for NDAs other things I couldn't say and I couldn't say it in a room but I got so excited I was like, me. Like I did, I was a part of that. And so I guess for me yeah you know there's there's just a few instances over my career work where you kind of saw like your research you do work that will result in something potentially positive but maybe a drug gets killed but you contribute something it may not be in the market for 5 to 10 years. And so to see something completely go to the cycle and prescribe your own son was really impactful for me right like I went, awesome that's what I'm I'm a part of something and look at what it just did for my family. So lots of those kind of aha moments. That's one that I'll never forget because it it made me felt like I was doing the right thing. I was a part of the...

: Full Circle.

: Yeah.

: And your son. He's doing much better now.

: Oh yeah. No he's totally good. Unstoppable so no we're we're good work. You were filming were you were taping this right during March Madness right. Right. Steadily tournament. And if you didn't guess from my profile were big Duke fans. So this is our this is our moment right here. So will either be very happy or crying furiously in the few days depending on the results of games.

: I got my fingers crossed for you rather man. That's great man. So thank you for sharing that very personal story. And just amazing write John, I mean don't underestimate the ripple effect of the actions you take in this in this field.

: Yeah that's right. No. And again like we're doing something impactful right. And I think that sometimes we were just we get in the paperwork we get in the red tape we get in the mix of the business that if we're not careful we don't step back little bit we'll actually miss the best part about our careers is that where we're impacting people's health. We're helping people to live longer to have more enjoyable and prosperous lives. Like I just can't say that enough said I have to remind myself of that too because I'm completely guilty of getting in my hole sitting in my chair and banging away on things. But we had this really amazing opportunity and frankly the reason I teach and the reason I'm trying to invest in other people is that there's this this next generation we have coming up that they're trying to find what they want to do is there especially as some of these younger individuals are really focused on social causes and they want to impact people more directly. What a great place to do that then in healthcare you just have to understand that it's part business right and it's part of this being able to impact people right and those two things go hand in hand and you have to use the system to both have its advantages and so I'm I'm excited about who's coming up but also know that it's our all of our jobs leaders who listen to your podcasts it's a really invest in the next generation and our own employees to make sure that they're getting the opportunities they have out there understanding what they're contributing to overall. I you know I feel like I didn't really realize that just a couple of years into my career when somebody sat me down and said, Do you realize the kind of impact you can have in the world by being in this in healthcare? So anyways for what it's worth it's just an encouraging piece. I think we all need the reminded of that.

: Yeah it's a great message John and it's definitely helped those that are coming behind us have successful careers and show them the way just like those that helped us as we were coming up showed us what a today is an exciting project. Obviously Thread is exciting but within thread an exciting project that you're working on?

: There's a lot of them. Some of the projects I guess if I had to pinpoint two specifically there's one I like where we're we're taking clinical trials and making them virtual. So we're using sort of all the different features and functionality that you have available in digital health and putting them all into one package on our platform so that you can actually conduct the virtual visits, remote data capture, engage people, make the sites experience better. So again kind of going after how do we change the whole research study model by introducing all these different technological advancements and so that that gets me excited. It doesn't mean that it's perfect. It means that they're still learning that has to happen but not to seeing one of these seeing lots of these gets me excited because it shows a shift really happening in our perception of this type of work but also in understanding that our constituents right the stakeholders are trying to survey sites providers patients are asking for this and they're willing to do it. We're the ones typically in the way to making it happen.

: For sure.

: So that's one of the projects. The other ones that I'm really excited about are some of these more longitudinal programs that typically happen in like later phase studies or commercial programs where we're able to connect you know medical devices the prothese can sense different solutions all together in one nice package for a patient so that they can really simply get into a study and contribute to it for a long period of time. Some of the first studies we really started supporting in this model you know are now in three you know three years out. So you start to see longitudinal benefit launch outcomes from from really these mobile enables studies really starting to come to fruition like data start to come out and be present at conferences. And for us you know that that research side gets us excited. So I think those two types of study models are really exciting and nothing gets me excited more frankly than people coming to us to ask about how to do them and knowing that they don't have to have all the answers but being willing to do them I think has been a big change the last five years in our industry specifically.

: That's super super exciting John and listeners if you want to check them out go to threadresearch.com you'll find all of just the things that they're doing and also will include a link to their company and are show notes so that you could just check out the show notes and pick it up there. So John, getting close to the end here. Let's pretend you and I are building a leadership course on what it takes to be successful in healthcare business today. It's the 101 of John Reites and so I've got four questions lightning round style for you followed by a book and a podcast that you recommend to the listeners. You ready?

: Do it.

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

: To measure them.

: Hey man, this is a lightning round. Keep it simple. And we do have the measure to measure.

: I think we talk about the big ticket outcomes all the time but we aren't measuring all the things all the context around the outcomes. All the pieces that you know all the steps in the process to contribute an outcome like a result. So if you can't measure the context and everything is happening around that secure outcome I think we really come up short on being able to describe why we got the outcome we did not just that we did get it.

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

: Again I think it's the biggest pitfall is probably probably thinking that you're the only one doing something. And the reason is I find a lot of folks come and say I know I'm the only one that's ever done this and I'm like No you're not sensitive doing this very similar. And so why don't you learn from their lessons. I think understanding that this community we have is helpful and that you're not a lot of times you're not the first one to do it. You might have your own unique flavor to it which is good but a lot of times there's other people to partner help you get there.

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

: Yeah. So status quo has a big X for us on the white board in the office. It really comes down to as we're doing this work staying ahead means actually doing it. In other words one of the things that we do is we work and we do the studies and we learn from them so that our lessons learned are actual lessons learned are not things that we think and I think we have to be really careful with that. The way to stay relevant is actually to do and learn and apply.

: What's an area of focus should drive everything in a health organization?

: Oh man. I think that high discussion that we talked about throughout this interview about how are we doing this right. That's sort of what's the big why behind all this the why is that we're all trying to make sure that our our lives and our kids and our grandkids lives are impacted by positive changes and updates health care. And so I think that if any company has a focus on that and they have a very specific big mission to contribute to that I think that's where it starts and I think a lot of times we get super tactical really fast and we miss out on the overall mission. Why am I actually waking up every day to make this change. And then how do we help contribute to that mission. I get to have both pieces.

: It's a great message. And finally John what book and what podcasts would you recommend to the listeners.

: Yeah. So there's a lot that I read there's two books in particular in the last few years that I would highly recommend everybody in our industry read. One is a book called Fascinate by Sally Hogshead.

: Ah okay, I've taken the Fascinate test.

: Yeah, it's awesome.

: I didn't hear about the book.

: Yes, fascinate.? Yeah it's it's a great book of the audio book on Audible is great too because Sally actually does it. I'm a big fan of hers. And it was really fun. And then the second book is Leaders Eat Last by Simon Sinek. And Simon Sinek is amazing speaker, consultant, sort of business mind but a really practical and I these are not books for clinical research or healthcare but they're books that I learned so much from that I could sort of apply to this work and so those are two that really stick out for me. When it comes to a podcast, the podcast I'm really really liking it's on the top of my list right now. It's called Masters of scale with Reid Hoffman and shout out to my buddy Chris who's actually one of the producers of the show. But Masters of scale is really a big podcast and it just talks about all these like really successful people and how not just how it started the business how they scaled it like how they work through changing an industry they were a part of and for us in the work we do a thread. It's really timely and so I really enjoy it. I highly recommend it.

: I think that's such a great recommendation. The books and the podcast and listeners you've got the syllabus as well as a transcript of what John Reites and I have just talked about. Just go to outcomesrocket.health /thread T H R E A D. You're going to be able to find all that there along with links to the books the podcasts the company and all the things that John just talked about. So this has been so much fun, John. I love if you could just share a closing thought and then the best place where the listeners could get in touch with you.

: Yeah it's great. So I really appreciate having me on today. It's been a blast and I like to come stations with people who are moving the needle and you're doing that and I really appreciate it. The closing thought I'd give is, is that as we look to where healthcare is going there is a movement that's happening and being able to work with people remotely and virtually all of our benefits. And so the closing thought I would say is that it doesn't mean that you have to wait for what you think the future is going to be. There is tactics and processes happening today that will help us start learning and implementing needs today. And as an industry to really keep up we have to take the baby steps right so you can crawl walk run into this work. So I think curves people to think about how they can crawl and what their risk tolerance and innovation tolerance is in that organization and just start doing something because that's where you're excited that's what you'll learn. That's what you'll put your personal stamp and fingerprints on things. The way that people get a hold of me personally, the best spot is probably LinkedIn. So it's just https://www.linkedin.com/in/johnreites/ and my email address is just john@threadresearch.com. But you want to message me on LinkedIn or connect I'd be great. I'd be happy to connect and just to get to know a fellow leader in the industry we're serving.

: John thanks again. We'll definitely include your contact information in the show notes as well and so on behalf of me and the listeners brother, really appreciate the time you took to walk us through your words of wisdom.

: Hey, Saul, thanks again man. I really appreciate it thanks for your time.

Automatically convert audio to text with Sonix

Recommended Book and Podcast:

Fascinate: Your 7 Triggers to Persuasion and Captivation

Leaders Eat Last: Why Some Teams Pull Together and Others Don't

Best Way to Contact John:

Linkedin - John

john@threadresearch.com.

Mentioned Link:

http://www.threadresearch.com/

Episode Sponsor:

The Best Way to Improve Medication Adherence with Lori McLean, Vice President, Meducation at First Databank

The Best Way to Improve Medication Adherance with Lori McLean, Vice President, Meducation at First Databank

: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I want to thank you and I welcome you to go to outcomesrocket.health/reviews to rate and review today's podcastbecause she is an outstanding contributor to health. My distinguished guests today, her name is Lori McLean. She's Vice President of Meducation with First Data Bank. For the last 20 years Lori has been building businesses internationally across high tech healthcare and cloud solutions. Her proven track record of driving growth and peak performance spans startup and mature environments. Most recently as CEO, Lori led healthcare software startup polyglots from an investment roadshow through to exit providing significant shareholder return with the acquisition of polyglot by First Data Bank where she is now. She continues to provide leadership in developing and delivering solutions to improve medication adherents and health outcomes. Prior to that Lori built the technology and sales alliance of IBM that spanned 92 countries led a Nortel Canada team to grow sixfold in three years and define and drove the business plan for a successful telecoms joint venture in France. There's no doubt ladies and gentlemen that she is a mover and shaker in health care and without further Do I want to welcome you to the podcast, Lori.

: Thank you so much, Saul. Thank you very much for inviting me.

: Absolutely. So is there anything you want to fill in there that I may have missed from your bio?

: No I think you covered it. Thank you.

: Awesome. Good good. So one of the things that I love hearing from our guests is the why you know why did you decide to get into healthcare care to begin with.

: No kidding. What my role leading polyglot on meducation was was actually my first foray into healthcare. Prior to that before 2009 I was always in technology and cloud applications and things like that. But I actually reached a point where I thought I decided, I decided I wanted what I did to be more meaningful to others. So it kind of poking around and I met the most amazing team on this in this company called polyglots with this really amazing meducation solution that all described later there was just no turning back. There was no looking back. There was no turning away. And honestly since then no working in the healthcare industry where everyone is focused on helping people when they most need help is just an energizing on a constant daily basis and fantastic.

: That's wonderful, Lori and there's no doubt you can definitely get that which you search for is just giving and helping those in need. So you dove into this new company. Your first foray into health care and time just zipped right by. What do you think a hot topic should be on every medical leaders agenda today is and how are you guys addressing it?

: As far as I'm concerned the topic that should be number one number two and number three on everybody's agenda is improving medication adherence. Let me let me quickly explain why. An amazing number of patients failed to adhere to the medication instructions and were just talking about medication instructions not to like medical instructions generally. So medication instructions alone.

: Yes.

: It's estimated that about 80 percent of patients make an error taking medications.

: Staggering.

: Up to 60 percent stop using the medication before they should. And overall this is huge. About half of half of all patients in the U.S. are non adhering to the medication instructions and the consequences are staggering really as medication nonappearance is the single biggest contributor to avoidable health care costs. It's estimated that almost 300 me we've heard some of that 300 billion with a b dollars in avoidable health care spent every year and medication adherence has been associated or is associated with one hundred twenty five thousand deaths per year. Ten percent of hospitalized patients and almost 23 percent of nursing home conditions. So you just think about some of those numbers think about the cost and our health care system on a per capita basis is not exactly leading the world. And these are the kind of things that just this one single issue that is the biggest contributor to avoidable healthcare costs. And one of the you know the biggest contributors to patients being is here and their medications is just being able to understand their instructions. If you think about the instructions you get when you pick up a prescription at the pharmacy if you've had the pleasure of being in a hospital recently and you think of that pack of paper that you're given when you leave these instructions are not useful. They're almost always in English. They're usually written in some Cluj of medical jargon and legally used.

: Yes.

: And they have more to do with you know covering some legal liability than actually helping a patient understand what they must do when they get home. And so what we've done and it's not just me it's an amazing team that I work with but we've developed a software application that produces patient specific medication and instructions and calendars at fifth grade reading level. More than 20 languages but designed to reduce medication errors and improve inherent. These aren't statically plus things like that. This is your calendar of your medications. You know what you're supposed to do. Morning noon evening bedtime a little simple grid. This is your instructions. You know you're taking your by X and for this reason twice a day and your kid is taking it now once today for another reason, another form. These are very very patients specifics so we integrate this application with your pharmacy or hospital or clinic I.T. system and then use the data from the patient's record to automatically create these instructions and they can be in Swahili, they can be in English, they can be in Russian. Regardless of the language they'll always be simplified to the fifth grade reading level. You can raise the font for your you know elderly patients that kind of thing. And they're all created from with in a by a health care provider from within their clinical workflow. So without interrupting what they have to do and the point is is that you know the solution called education has proven to increase medication here and improve health outcomes and reduce hospital admission rates. And so we're very excited about it. A lot of people using it now and it's our contribution to trying to address what I think is what I think is the most important issue in healthcare today.

: Wow. That's great. And there's no doubt that you're all in on this project. And listeners. I had a chance to meet with Lori and she showed me how her form looks when the form is given to the patient. It is just a very simple thing to read and to understand. I recently picked up my grandfather from the hospital he was getting a pacemaker. And the nurse walk me through the instructions and I'll tell you what my head was spinning Lori.

: I know. I know. I mean my mom came out of the hospital and I made her a little you know calendar like this of her meducation calendar for her. She laminated it left right size around around her home. But anyhow she she I mean she at the end of the day she had ended up in a nursing home because she hadn't taken her meds properly. So it's not just a language issue. They are sick they may have diminished cognitive function. They're not you know when we when we speak about our ability to understand these instructions, it's dynamic. You and I have really great health literacy. The term we use health literacy but you know when you're sick and you're half drugged out coming up you know coming out of the hospital you're concerned you're worrying about getting home. You don't have great comprehension you don't remember all the things that the doctors tell doctors and nurses about. And so yeah you know I don't think it's just for just for people with poor reading and in your poor English skills. I think it's us for everybody for all of us.

: It's a must and providers. You're listening to this. What are you doing today to improve your medication adherents? Have you taken a look at all the options that are out there, if you haven't, I strongly suggest you take a look at what Lori and her team are up to at the end of the podcast here will will provide a link for you to have a place to access and get information about the way the system works and what it can do for you and your patients. Lori maybe you could walk us through some of the ways maybe some of the numbers and stories of how you have improved outcomes with the system.

: So I'll actually speak about some other things that our clients have done. I haven't actually funded any studies on my own. I've just let my clients sort of build up various you know build the studies and and and various pilots. So university scientists in Philly they did a study where they showed that patients were twice as likely to actually read medication versus standard medication instructions. Ok so lots of not really good enough but it's Step 1 twice as likely to read. In the same study, they also showed that they had a much better understanding of when to take medication how many times a day that kind of thing. OK. And so improved medication and understanding. But the most important part of this study was that patients were half as likely to miss a dose. So patients that were referring to medication instructions were half as likely to miss a dose of the medication than if they were using the standard stuff that we provide them at the pharmacy in the hospital. So you know real impact on medication adherence and the correlation between medication adherence and health outcomes is irrefutable. There was another study done at the Durham V.A. Medical Center. I'm actually in Durham North Carolina so this is kind of up the street. It is a six month study of that with cardiovascular disease and at three months. So just a single piece of paper just a calendar of their meds was automatically created from there from their patient records in the clinic EHR at three months. There was a 77 percent reduction in these that reporting that they forgot to take their heart med.

: Huge.

: It's huge. And at six months they were a clinical trend showing decreases in patients blood pressure and body weight. You know but that just is just the P.I. on that study actually is wrapping up a three year study of medication where we'll actually have it. You have have study results that take us all the way to health outcomes. But we know that relation between how it comes and then between medication adherence and and how come.

: That's pretty amazing, Lori. You know just thinking through aspect of behavior management you know it's just so hard to do that and it and you know you guys have kept it so simple with hate. Keep this reading level between fifth and eighth grade make it simple and you'll see the results. And it sounds like you guys are definitely seeing them.

: Yes that's right. I'll tell you. I have to always have to jump in with this one because it might be my one of my proudest moments ever was San Francisco General Hospital. This is a pilot's disability pilot of education. And they divided a bunch of high risk patients into a control group and a study group. Yes the control group received the standard medication instructions and discharge counseling and then the study group or counseled the pharmacy led study counselors pharmacists using education. So this is really warms my little heart here. 26 percent of the patients that receive the standard instructions were readmitted less than 30 days after they left the hospital 26 percent over a quarter. That's way too high a number of patients back in the hospital for the same reason they came in for. Okay, so they left the hospital they got sick again less than a month later. Only 8 percent of patients receiving education were readmitted within 30 days. That's a 70 percent difference in readmission rates. So we know we know we can keep people out of the hospital. We know we can keep them healthy. We know we can have an impact because then it is not just the fact that they were readmitted and you know there's probably penalties for that. But they stayed out of the healthcare system they stayed at home they took their meds properly they stayed healthy. And that's that's our core fundamental overarching objective all the time.

: That's amazing and just the difference that it made. I mean 8 percent versus 26 percent. That's huge.

: Imagine if we could propagate that to every health care institution across the country and that that's what we're working on.

: Amazing. I love it. And you know as the results keep coming Lori, I have no doubt that you guys will definitely get a foothold of the entire hospital system in the United States. And so when you guys you know it really helped see the way that it's laid out would you be able to share a snippet of that for the listeners so we could include in the show notes?

: Oh yes absolutely. Absolutely.

: Awesome. Will Make sure to do that. And so you took us down one of your proudest moments. Lori, I feel like oftentimes we learn more from our setbacks and failures can you take us through a time when you had a set back and what you learned from it?

: You know I always think my biggest mistake was not living with was more personal and professional. I was something my biggest mistake was not moving into health care sooner. What the jump don't fall spell and to help there there. But to your question rather than dodging your question you are completely underestimated the effort and well actually the imperative of integrating with charts. I knew it was going to be important that education be accessible from by you know by healthcare providers, clinicians, nurses, pharmacists from within their workflow that you know we just needed to look like we were part of the epic or the stirner or the paragon or the sunrise or whatever Cerner McKesson you know system. And so I just didn't recognize you know maybe how important that was and how much work it would be. And now we're there that probably cost a year probably cost me a year in speed to market but I don't know how much I've probably got to save myself a year if I buy recognized and addressed it more quickly. But the marketplace has also changed a lot. All those names I mentioned are now you know many of them are opening up and making it a lot easier for third party applications like like meducation to integrate. Now you know we're integrated with Cerner really nice when they're epic paragon. We used to be the Kesten paragon of scrypt sunrise, clinical works, Athena. And you know we have and others tha's now just basically looks almost like a feature from within those good organizations I.T. systems which is really makes all the difference in the world to people who are wanting to use it. And you know counting clicks things like that you get to what you click. You've won the game.

: That's awesome. And listeners just a note to take here from Lori's story. Lori, thank you for sharing that. She could have saved a year and now the market is changing so it's a testament to how fast things can move. But also how slow they can move and how planning ahead can help you really save time and get to market faster. You shared an amazing story there, Lori. Tell us about an exciting project that you're working on today.

: Oh gosh. Well we're you know told you that some of the outcomes that had attempted a general hospital. Right now most of what we do with meducation relies on a health care provider to generate the materials and make them education instructions. Part of that discharge instruction package or make it make medication. The piece of paper that you're given when medication is dispensed from the pharmacy or whatever. So we're building out now patients facing application don't think about a medication reminder app there's dozens of them out there. But we're talking because we because of our success integrating with Epic's, Cerner, McKesson, scripts, you know Athena, etc. We have the ability to pay for a patient's medication or agent information the medication information and other information from their health care record. So you know it's traditionally been very difficult to get your own healthcare data out of your healthcare providers I.T. system you know they hide behind the hipper requirements and all the rest of that stuff there's lots of good reasons why it's difficult there's a lot of lousy reasons was difficult and now we have the ability because of our relationship having overcome my my little stumble there with the relationship we have with these folks. Then there's we can now pull a patient's information out of their health care record and provide it to them so that they can will present it to them in the form of a very patient friendly application where they can see their med list either instructions massage it share their healthcare data, their healthcare habits with their other providers with their family caregivers. But we're going to what I'm most excited about is getting control of that data into the hands of patients and that I think is the next phase of what we're going to be doing health care industry is frankly evolving so fast.

: That's really cool, Lori. And as we as we dive into the next phase of interoperability we've got some deadlines coming up looks like 2019. They push that by year to make these things open. So it's pretty exciting that you guys are already working on it and just that so think about the power of being able to share that information. You're on vacation and you need to see the doctor. I'll just pull out your app and you're able to show exactly what you're doing.

: Exactly exactly. Incredibly powerful and you know they have to be can be so much more social ability to share it with parents to share it with their kids, their family caregivers, for parents to you know well seem to be dealing with aging parents right now. And so we want to be able to share those things and not have this onerous permission system that you know really share my data with my husband I think it took me a rewind to me it took me a lot of time and effort to be able to share data just between husband-wife. I mean you know they were all becoming so much more social. Now the other aspect.

: Wow yeah that's really interesting. Glad you guys are working on that. You guys know how to stay ahead of the curve. So let's pretend you and I are building a medical leadership course, Lori and what it takes to be successful in medicine today. It's the 1 0 1 or the ABCs of Lori McLean. And so I've got four questions lightning round style and then followed by a book and a podcast that you recommend to the listeners. You ready.

: OK good.

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

: I've said it before improved medication inherence. It is the single biggest contributor to avoidable health care costs in this country which means this is where we have the greatest opportunity to improve our patients health.

: What is the biggest mistake or a pitfall to avoid?

: Avoid assuming that patients are like you or us. We and our friends are college educated. We read English very well so we're extremely healthcare literate okay but 44 million adults in this country read below the 8th grade reading level. Another 22 million adults are limited English proficient and we have a growing elderly population with vision challenges and sometimes diminished cognitive function. It's just one in three Americans and people in the U.S. has called low health literacy and it's so it's much too easy for us to forget that a vast portion of our country and our patients are not as fortunate as us. They're not as educated as us. They're not health literate as us.

: That's powerful.

: That's what we need to avoid.

: It's powerful. How do we stay relevant in healthcare despite constant change?

: Listen to customers. I think it is not just is not enough specific to healthcare customers are the very very best means to prioritize your development, choices or opportunities. They're the best means to prioritize everything you do.

: What's one area of focus should drive everything in health?

: Improving healthcare through understanding everything we do here at meducation is about overcoming low health literacy to try to improve medication adherence and then I won't repeat all the follow on. We know the staggering consequences that could be staggering negative right now and could be staggeringly positive if we fix this issue.

: That's awesome. And Laurie what would you say a book and a podcast that you recommend to the listeners?

: The toughest question you ask. Probably the most influential nonfiction book that I've read in the last was probably Thinking fast, thinking slow by David Kahneman and really just rereading that frequently and it is the most enjoyable fiction recently I was in the last year or two is probably up late. We cannot see the empty meter.

: Very cool. Very cool I love it. So listeners you'll be able to find these resources at outcomesrocket.health/meducation. Lori, did you have a podcast that you want to recommend?

: I don't. I read a lot of audio books but I'm not a podcast person.

: And you go well it's all good. It's one of the reasons we ask the question and just want to spread the podcast love Lori so at least outcomes rocket...

: Recommend one for me.

: I just published an article about the eight most amazing podcasts in healthcare.

: Really?

: Yeah yeah. So I will go ahead and send you that Laurie and also included in the show notes which I think you'll enjoy very much.

: Thank you so much. That's great.

: Absolutely. Lory, this has been a ton of fun. I wish we could keep talking but we've got the 30 minute mark there so I love if you could just conclude by sharing a closing thought and then the best place where the listeners can get in touch with you or follow you.

: Well I really, you share my interest in improving health care and by improving medication adherence and will probably put these Mashona well but I can be reached at lmclean@sdbhealth.com or 9 1 9 6 5 3 4 3 8 7. And this is the. There's no silver bullet out there. This is an ecosystem and the multifactorial way please. We all work together to achieve this.

: Lori, it's been awesome. Listeners. She shared her best way to contact her. Here's a willing leader in health that wants to contribute to improve Haitian adherents with the use of take are up on it and see what happens. So and solaria just want to say thank you again for making time to be with us and looking forward to staying in touch.

: Thank you so much for having me, Saul.

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Recommended Book:

Thinking, Fast and Slow

Best Way to Contact Lori:

lmclean@fdbhealth.com

9 1 9 - 6 5 3 - 4 3 8 7

Mentioned Links:

https://www.fdbhealth.com/

https://outcomesrocket.health/best-healthcare-podcasts/

Episode Sponsor:

How You Can Save Time and Money By Getting Your Contacts Perscription Online with Joel Wishkovsky, Founder at Simple Contacts

: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I want to welcome you again to the podcast. Thank you for tuning in. And I also welcome you to go to outcomesrocket.health/reviews where you could rate and review our podcast because today we have an amazing guest. His name is Joel Wishkovsky. He's the founder at Simple Contacts. Joel is an innovative entrepreneur, investor and startup advisor. He's a leading voice in digital health and telemedicine. And he's obsessed with the democratizing access to health care, making it more convenient and accessible with technology. At Simple Contacts, they're refill service for contact lenses that allows patients to avoid unnecessary visits to the optometrist office. Let's face it. It could take long and arduous time to be there. And so he's come up with a great solution for it. Previously he founded Sols Systems, a pioneer in 3-D printing of medical devices and he was instrumental in launching Smart Vision Labs, a smartphone based medical device. This gentleman is an amazing contributor to Health and I'm so excited to welcome Joel to the podcast. Joel, thank you for joining us.

: Thank you. That was a wonderful introduction.

: Hey my pleasure. So what did I miss? Is there anything else that you want to tell the listeners about you?

: You know I think you know what gets glossed over a little bit in the introduction is that in addition to being a founder of companies if you want to make a difference in healthcare you've got to get involved across a variety of different parts of the ecosystem. So not just starting companies but also investing in them with their personal capital or in behalf of other syndicates advising new companies and mentoring people who are thinking about getting into healthcare because you can't do everything alone.

: I totally agree. Joel and that's a great call out, right. Putting your money where your mouth is and you're definitely doing just that. What got you into health care to begin with?

: Yeah I actually got sick and I got diagnosed with the disease called ileocolitis it's actually very similar to Crohns it you're familiar with that, it's auto-immune disease. And I was healthy you know late 20s I was active and had my first real health scare and was just completely blown away by how bad the system was. I started thinking really that what kind of technologies can we create with brain to make the system better. How can we make it faster. How can we get cheaper. How do I know how to go to the doctor's office. And that question how do I not have the doctor's officer sent me down the path of looking at remote technologies like sols where we did orthopedics remotely and simple contacts were doing vision exams online. Anything you can do to sort of take out all the infrastructure costs of delivering care in a doctors office getting to patients who can do it remotely and were healthy enough for it and doing it that way it's more cost effective use more convenient. And because we're going direct to the patient and we're a sort of a new company, new system, new technologies and an opportunity to redesign process and experience for patients rather than for a payer or a hospital system.

: That's fascinating. Thank you for sharing that. By the way the frustration of your own care led to just this opportunity to say you know what I could do something about this. And listeners. It's the courage to create. It's that just the ability to say I don't have to deal with this that distinguishes the guests on this show. And it's also the listeners of this show. You too are doing a great part to improve health. Just like Joel has and so Joel in your current venture with simple contacts are you guys is this a consumer product. Who is your customer?

: Yeah we're a consumer product. And investors are putting money into the company and it's how we talk about consumerization of healthcare. I would create a platform where patients come online take their exam get prescriptions from doctors fees or platform as well and then combine conferences and everything we do everything we think about. How do you make excretion patients exceptional, it choose us. Patients can choose to go optometrist office know LensCrafters known as ophthalmologist. She's also in her care. We make a difference is that patients know about us and choose us. And that means that we can put the patients first. They have to choose us as a consumer.

: Yes. Very good. And is this something that they could use their insurance on or out of pocket.

: Yes the exam cost $24 out of pocket for most patients. And the cost for an exam even if you have insurance. So the vision of space has a number of complexes. One of them is contact lenses and eyeglasses exam are not the same results are different. So you don't have insurance. okay for glasses exam it does not include a fitting for contacts which can be anywhere $150-200 dollars and that part of exams like $200.

: So the patient would actually still have to pay 150 bucks.

: If go to the doctor's office?

: Yeah. Well that's big. And they could do it from the comfort of their own home.

: Yeah they can do from anywhere, from office, from their living room, bathroom, they can do it in a hotel room, do it on trains, to the parking lot was like the break room of their work, factory floors.

: That's amazing.

: Actually. If you think about it it's fascinating it's like the realization of telemedicine, it's medicine and checkups feeding into patient's lives.

: That is super cool. And Joel this is super fascinating and amazing that you're able to put together a platform like this. It takes too much time to spend at an optometrist office and it's pretty cool that you put this together what would you say is a big thing that you guys are doing to improve outcomes?

: I think the one thing that's really important about platforms like ours is when you increase access and you make it more affordable. Patients can choose to do instead of trying to go around the system. So the largest issue for people who are contacts is over wear. People tend to where the last pair of contacts for way too long because they don't have time to see a doctor in their office. We have a lot of evidence that you use our system are taking exams more often are buying freshlense s more often and are using the recommended where schedule versus doing things that are incremental to their health in order to save money time.

: That's pretty cool. It's the side benefits of it that I think would be of interest also to payers because if you have over wear you can imagine some of the complications like hey you know somebody ends up getting some sort of eye infection or eye disease and so I think that's really neat. So Joel, let's jump into how you guys are doing things differently. I mean is anybody else doing this out there?

: Not really. And we're really the only one stop shop that has an exam built into the experience. If you think about where we are is we are very much like a traditional optometry clinic. We have doctors who work with us. We have exams like done for patients and we also happen to sell contacts so patients come to us and they will know optometric clinic. The difference is that we don't have any of the overhead costs of the retail clinics, we don't have any of the electricity bills and it's not taking hours for your exam and visit the doctor is taking you on average less than five minutes. So that's...

: Amazing.

: Mentally unique and it fits into this in concept patients have been how they get their care. They don't want to go one place to go and examine another place contacts or glasses and I think that's sort of a model that is actually very applicable to a lot of verticals like people want be able to go see the doctor and get their medications or get their sort of prescriptions without having you know many steps.

: Yeah. That's awesome. Simplifying the process and listeners. The thing that I want you to take away from the amazing things that Joel and his team are doing at his company is that when you come up with an idea to improve health it doesn't necessarily have to be a product it could be a process improvement. And he's doing just that through his company now. Joel, can you walk us through a time when you made a mistake or you failed and what you learned from that.

: Yes. So interesting things that sort of happened is there's been a group of small group and vocal group of retail clinics who are running optometry clinics and glasses and stores those stores. Sort of like, hey that technology is very disruptive to us we don't want to exist. And in 2016 actually a couple of states pass laws that banned us.

: Really?

: And in Georgia for instance I was basically saying you get obese online you can get birth control, abortion using drugs online but not contacts and not glasses. I can prescribe online and have very specific rules against it. I didn't really see that coming. We didn't know there was a blowback and we certainly you know we are now Paul, clinical guy not regulatory guy. And we just saw them. Oh my goodness like these guys are going to try to legislate us out of business. There are clinics and it's really definitely that mistake we should have realized earlier that what's happening is that they also engage. I think what we did learn was like hey, we can win these battles. We can go do education campaigns, talk to legislators, talks to the regulators. We can make sure that when they're debating this the State House is not just a retailer's perspective not business person's perspective. It's a patient's perspective and they consume technology and meet us and so very engaged. It's 2016. And actually in late last year we had state level battles with seven states seven...

: Wow.

: Hated the idea of banning our technology and we won every single state.

: Seriously?

: Seriously. So some.

: Amazing.

: We found that eyeglass, and we've learned how to engage the regulators, representatives each state educate them and show them where technology is starting rumors and mistakes and beliefs.

: And Joe what do you think has led to your victory is that different litigations.

: At the end of the day what we're doing is the future. Depending on the representative right, different representatives have different platforms.

: Yes.

: Some are. You know people care about things like free market better access for patients. So are you with that is hey this technology is just one competitor in many patients to choose. We're not forcing patients into online, patients choose us.

: Yes.

: And they want more comprehensive exams they go to see a doctor saying we're not doing that. And then the second arguments is like other people who care more about like access in rural communities. The cost of care. So your own music listen tell them this. They are already on this and in many states are passing laws comprehensive reform to enable telemedicine to use the fares that the carry medicare medicaid. Think about how to incorporate telemedicine. So we are sort of say hey this is not a consequence and glasses issue. This is a telemedicine issue and the technology we use contacts has happened. We just happened to sell contacts, like we could just as easily have a simple birth control or simple hair loss and been selling those products. All right positions for those products because really the technology is the same. What we do is not really today's contacts, we're specific to be we're doing online, get prescription and get a refill without all the steps that normally involve process. And so that our evolution goes a long way with this patients representatives that care about things like rural access and low cost access here.

: I love it Joel. This is so awesome and you guys are adding so much value to people out there by removing all these steps in a convoluted, complicated and time intensive process. And listeners the takeaway that you should take from what Joel just shared I mean he did not get into the business of policy but because he had his strong vision for the business and helping patients. He had to and he didn't let that get into his face and he didn't feel like he failed. He actually prevailed and it goes. Joe, you're a good example of that quote that says failure does not define you, it refines you and Joel.

: Absolutely. Before we recorded this you mentioned that when you're entrepreneur at heart and this story of entrepreneurship is not what you hear in the Mark Zuckerberg of the world. You know like that's Bill Gates, it's like very very rare normal store of entrepreneurship is about struggle and coming up with creative interesting solutions in spite of all the offset you. It was easy to to sell contacts online to remote telemedicine, someone have already done. I would have even have an option. There would be no opportunity. And so you know you get if you want to be an entrepreneur. You're gonna be a founder of a company especially in healthcare where there's so many different stakeholders. When big, powerful stakeholders you have to adapt and use points where you have friction as a sort of catalyst create new and interesting solutions.

: Yeah what a great share and thank you so much for sharing that with us. And you know behind me in the back of my mind I kept thinking like Uber and the things that they're doing and the fights that they had to have. And when you push the system to that edge of discomfort that's when you know you're doing something impactful and you're doing that, Joel.

: Yeah a lot of people were interested in our company advisers to work here. Part of our customer service teak and fast company a lot of them look at this from over half of the legislative side and see the animosity was really small retailers say oh my god if someone is upset about what you're doing, you're clearly on to something. Would be upset.

: Yes.

: They wouldn't be spending so many million dollars a year stop you if they didn't think it was a mortal threat.

: That is so great. I appreciate you sharing that listeners I hope you get a little bit of inspiration here from Joel and what him and his team and this group is doing. Tell us a little bit more about the other side of the coin. Joel an experience that you're super proud of in your medical leadership career.

: Honestly I'm proud every single day. I'm proud of that part who feel incredible. I'm proud of that team of forty something employees now and it works best consumer companies in the world. Making sure technology companies and we have this channel where men are slack when everytime writes a review every time they write an them. Yes. You know survey result. Any feedback. Talk to a customer service rep or you know the email goes in his channel and you know you get like dozens, hundreds of these things a day. And they are all so positive. And yes we're 88. Health care is just like stupid right now dollars and is down five star reviews on android and reviews were crazy. I mean I would support a battery like a first when I wake up with the letter and look at that feedback channel I'm like wow like Imagine for a second that you are an entrepreneur and you get that idea that affects you. You know I'm kind of. And you're like wow this response really is things I could fix that. But you like it when you make a little MVP product and it kind of works. Kind of like it. And then you know fast forward you know a year or raise some money like that Isoke really starting to see it all scales of business and you get dozens hundreds of vice or abuse a day that is so validating it's like.

: Super validating.

: Like how proud I had this idea of I into a company a a service. And people love it. Like that's just amazing. Original one from 730 AM.

: Today.

: Yes 730 AM's just two at that time actually the first one. Five stars IOS review. I'm never going anywhere else if you don't believe in a five star. I'm sorry you feel that way. It's called simple contacts for a reason. It's cheap to get lenses it's dazzling and helpful to make sure it stay atop your prescription. They go above and beyond the US as a customer and I'm so glad. Try it out. I would never go anywhere else. My contacts for 18 years now and I wish this company has been around for that long because it makes getting new contacts so easy and accurate your prescription. Thank you so much simple contacts.

: Wow. Why does a raving fan right their.

: Totally.

: nd awesome Joel.

: The next one is actually read only piece of it you know a five star review in IOS like a few minutes after that one is titled wearing contacts from a subway.

: From the subway. I love it.

: I was on my last pair for the month. I'm ashamed to admit it. As silly as it sounds or Conatser an app really has been a game changer for me how easy and fantastic.

: That is so cool man.

: Ordered a new set of contacts from the subway question mark. Why yes I think I will add a hash tag. I'm even writing this review from the subway.

: That is awesome.

: And amazing. It's someone's life on the way to the office. They provide other prescription. I don't have to call the doctor and make appointment. I'm so proud of that.

: That's so awesome. I'm glad you opened up your phone and shared some of the reviews because it is validating when you hear people like even when when I hear folks post reviews on my podcast. Hey keep it up like amazing interviews great. I mean this is just an example the market speaking to which you're creating an acceptance and encouragement to keep going. That's awesome, Joel. I love that you shared that with us. So let's dive into this. Things are going well there. What's an exciting project that you're working at Simple Contact right now.

: Yeah I think one of the things that we've learned is that patients want things that are super easy and were sort of constantly working on making that task easier and more convenient. One of the things that we learned a while ago is that the task we have was pretty easy to do. Still these people say oh is this thing legitimate. Yeah you ask a question as to whether the larger search results how far to organic search results is simple contact's legit. We've been working in front of the last two months to recreate example in a way that feels more like a doctor visit. So said having books right now you're going to see a treasured instruments and it goes a lot of good process. It is self directed. The new version actually looks like a FaceTime interface now and so close out there's a doctor's I can get you a doctor or I'll give you all explanation. And he also will walk you through the process take you step by step. And it's a real doctor doing it so he feels a little more like the official doctor. That same amount of time is not more time to do it this way but it just feels more interactive and more personalized that's what we've been working on.

: That's pretty cool. And so this is just a testament Joel to you and your team's ability to take what the market says. Because listen there is the market speaks and if you listen you're going to get the feedback that you need to make your products and services that much better. And useful and Joel and his team saw that one of the organic searches in Google was is this real. So what led you to go with that feel of the doctor. You could have done a lot of things right. You know you could have done an education campaign but like what got you guys focused on doing it this way.

: So our team is everyone in our company comes from a massively successful consumer direct consumer consumer technology company things like SoundCloud Sikhi and you know Casper like those kinds. We have a lot of experience building things for consumers. And with that experience a heavy reliance on data. Yeah well Dick's looking at our flow understanding we're dropping off and people start to drop off Zamel during the first test. They don't really understand if it's real.

: Yep.

: 2000 reviews, you know people are organics off the charts with a lot of referrals. You just hear about some podcast like this or maybe their friend they don't really trust Helden about it like they get it started dropping off. So yeah a lot of what we're doing is focused around that zone where you are extrinsic test first time. It's always for that.

: That's pretty cool and all and congrats. I'm sure it won't affect the flow. I'm sure it sounds like it's still the same amount of time and you guys are still continuing to do it. Hey from the subway and listeners if you're listening and you wear contacts by all means. Joel will share how you could get this done. In fact why don't we just do it now. JOEL How did they get in touch. Do they download the app? Can you give us the onboarding here?

: Yeah I mean look simplecontacts.com there's a lot of experience. I can also download the app for iOS and also for Android. Just search for simple contacts. So we actually have a code for all your listeners. It's code: outcomesrocket all lowercase, all one word. The $3 off code so they can use that don't be out I guess Android or find us on the web. simplecontacts.com.

: Amazing Joel. Thank you so much. Listeners take advantage of that. Go to simplecontacts.com when you check out use outcomesrocket you get 30 dollars off. That's amazing. Joel thank you for that.

: No problem.

: So Joel this has been fun. Let's get into the section of the podcast where we build a medical leadership course on what it takes to be successful. The 101 course with Joel Wishkovsky and so we're going to write out a syllabus. I got four questions for you. Lightning round style followed by a book and a podcast that you recommend to the listeners. You ready.

: Yeah I guess didn't we have to name it first.

: Which one.

: Do we have to name of course. I was told I was told I need to come up with a name the course.

: Let's hear the course.

: You had written the 101 course ABCs of and I had empathy. It is empathy.

: I love it. The ABC of empathy listeners and Joel you were the first to come up with the official name for the course. I love it.

: Amazing.

: So the ABCs of empathy. Let's hear it Joel. What's the best way to improve health outcomes?

: I think a lot of times we talk to patients and the the key is to listen to what they want into what we do. Look at how they use our app. They know if they want to gain their trust. Once you gain their trust you know they'll work with you to take your recommendations and be healthier.

: I love it. What's the biggest mistake or pitfall to avoid?

: Treating patients and caring for them by giving them. Here's your issue. Go take this drug. I'm an investor advisor or lover of a company called Parsee health which is a direct consumer holistic medicine practice and it's a take that to heart. They said okay if you have a headache I'm not going to give you Advil. I'm going to figure out what's happening here why are you sleeping. Well you have stressed to marital issues like what is going on that could be religious. We can try to help solve before we start giving you some occasional. Caring patient, not just treating them.

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

: A lot of values it just happens and I will never compromise on and use as type principle you make a decision so no matter what the role looks like you have values it for us transparency is openness and caring and sort of focus on patient experience. And I think that's the most important thing.

: That's awesome. What is one area of focus should drive everything in a health organization?

: This is the one thing that no one ever does understand why it's putting patients first. There are so many stakeholders in our health ecosystem a payers the suppliers. The hospital systems or the doctors that it seems like for so many organizations especially the recumbency, payers to treat first providers to treat it. Second doctors third in patients last and that really needs to be footpads had patients first.

: Patients first. I love it. What book and what podcasts would you recommend?

: These are not about health but there's a book called The third Chimpanzee by Jared Diamond an evolutionary biologist talks about human beings and our relations with other animals how we evolved and specifically looking at similarities and other animals and I think for any person who thinks probably about the world as a really good option to how closely we are with animals and the things we learn about ourselves from their anatomy and their structures.

: I love it. And what podcast would you recommend, Joel?

: My favorite is Tim Ferriss.

: That's a good one.

: Yeah they just Tim doesn't always talk about healthcare very often the third of his podcasts are about throwing out personal conditioning and treating your own biology. But overall his approach to life and thinking about individuals in your own development is great.

: Outstanding recommendations listeners don't worry about writing any of this down. Just go to outcomesrocke.health/simplecontacts and you'll be able to find it. Joel's profile, our question and answer session, as well as links to the resources he provided and a copy of that link that you could click on and type in outcomesrocket for your 30 dollars off. Before we conclude Joel would love to just hear your closing thought. And then the best place where the listeners get in touch with you.

: I think just put patients first. Care about the user experience the patient experience bring all the things we know about consumer design and customer service to healthcare. We can do got some major improvements. When you care about the patient first you put them first. I think everything else falls in place like sort of the right alignment you can find me personally @joelwish on Twitter and also Instagram over joelwish And you can find our apps simplecontact.com or @simplecontacts on Twitter

: Fantastic. Hey is my pleasure Dolle. So glad you made the time to be on.

: Take care. Have a good day.

: You too.

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Recommended Book and Podcast:

The Third Chimpanzee

The Tim Ferriss Show

Best Way to Contact Joel:

Twitter - @joelwish

Instagram - joelwish

Mentioned Link:

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Accessing The Highest Quality Care at the Intersection of Music, Technology and Neuroscience with Brian Harris, Co-Founder & CEO at MedRhythms, Inc.

: Welcome back once again to the outcomes rocket podcast, where we chat with today's most successful and inspiring health leaders. I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have an amazing collaborator in health. His name is Brian Harris. He's a co-founder and CEO at Medrhythms Incorporated. He's a passionate motivated leader and entrepreneur who strives to make the world a better place by helping others. He's demonstrated that these amazing qualities by building world class digital medicine companies and developing the arts and neuroscience group at the American Congress of Rehabilitation Medicine. His company Medrhythms focuses on digital medicine that uses sensors, music and artificial intelligence to build evidence based neurologic interventions to measure and improve walking. That's a mouthful right there but that's because Brian does a lot. And so what I want to do is open up the mic to him to fill in any of the gaps of the intro and we could kick off this podcast. Brian, welcome to the show.

: Well thanks for having me. It's certainly exciting for me and honor for me to be here so I appreciate that very much.

: Absolutely. So tell me Brian you've got a lot of interests. You've done a lot of really interesting things. Why did you decide to get into the medical sector?

: Yeah it's been a really exciting journey thus far. You know getting into health care and growing Medrhythms and it actually started you know when I was growing up I was a musician. Music was a passion of mine. Played a lot of bands a lot of different scenarios that way and I knew that music needed to be a part of my life long term more than just a hobby. But I knew that music education wasn't going to be for me. It just did. I didn't have a calling to it in the performance world I didn't have a calling to have either. And I learned about the idea of music therapy of using music to help people when I was in high school and I said you know this makes a lot of sense to me. But when I was in college I took an online class in music therapy I'm from the state of Maine took this class at the University of Maine and I had this opportunity one summer to intern with at the time the only private practicing music therapist in the state of Maine.

: How did you find them?

: So luckily he actually was the one that had been contracted to teach us on my class that I had taken and so I reached out to him and you know I had this opportunity and during that summer he was working with severely developmentally delayed children and adults and I had the opportunity the very first session that I ever observed of music therapy of an actual board certified music therapist who would work with an 18 year old boy who was functioning cognitively and physically at about a 1 year old level. So a very very low functioning boy and this music therapist began doing music with him and within the first 10 minutes in the presence of this music therapy session this boy was cognitively functioning at a higher level than what anybody had ever in his life. Wow. So I distinctly remember his family the people that work with him in his day program who came into the room and were literally in tear because they couldn't believe how this boy was functioning. And it was at that moment that I said A. that this is my calling in life and I need to you know devote my life to this and B. was while this was a magical and beautiful thing to witness this boy that there was a reason why he was having this response neurologically. Something was happening in his brain and that if we could answer that question of why that it then we could really harness that power of music and replicate it to help a lot of people. And so that's what got me focused in on music therapy and what was actually called neurologic music therapy so really explaining these things through purely neuroscience. So fast forward I became a board certified music therapist and with advanced training in the neuroscience of music and how that can be used to help people recover things like movement language and cognition following any sort of neuro disease or injury. And I actually started the program as a clinician as a hands on board certified music therapist operating much like a physical therapist or an occupational therapist a speech therapist would at Spaulding Rehab Hospital in Boston and what we were seeing particularly in gait training or improving walking after injury that people were getting better faster with greater results. And sometimes music was the only thing that worked. And we said to herself why doesn't everybody have access to this. And how do we bring this to more people. And at the same time the field of digital therapeutics and digital medicine was beginning and getting a lot of weirdness around that and it was really good timing and we became committed and said what digital medicine and digital therapeutics is the path forward to bring this intervention to everybody who needs it.

: Brian this is such a touching story and it definitely like when your passion hits you or your calling hits you, you know. And when you were in that room with that boy that 18 year old boy and that's when it grabbed you and you haven't looked back since. And it's really a really great story. Thank you for sharing that.

: Well yeah, thank you and I appreciate that. It is one of those moments. And you know I distinctly remember it happening and I you know honestly felt so fortunate to be sort of early on in a career and have one of these moments and I said this is really about something that's much bigger than you know right here in this room with this boy that the only way that we can go forward with this is figuring out how we bring this to more people. And to me that was always through something like neuroscience because that's what you know medicine appreciates that's really how we're going to move forward with this. And you know it has been one of those things where it's been very focused journey so far and we're trying to keep going without looking back into the future as well.

: That's awesome. And listeners, you know the power of music with healing. We had a guest, you guys probably listen but if you haven't. His name is Walter Warzoa. He's outcomesrocket.health/walter I don't know if you know Walter from Los Angeles from HealthTunes.

: I actually listen to the podcast I haven't met him before myself but I did listen to that.

: Oh you did. Cool I'll have to connect you guys because you guys are on the same wavelength.

: Yeah he's doing some very interesting stuff. I would love to be connected to him.

: Yeah. And so so you know no doubt listeners. Music is powerful and if we go back to the beginning ages just when humans first got on earth you know music moves people, music heals people and I love what you're doing Brian because it gets down to the science of it and it's just so powerful so. So tell me a little bit about Medrhythms and some specifics about how you guys are improving health outcomes.

: Yes, we have built a digital medicine platform that replicates one of our standardized interventions in neurologic music therapy that's called rhythmic auditory stimulation and essentially what that is is using rhythm to improve walking. So what the research actually shows is that from a neuroscience perspective at a high level is that when we listen to a rhythm in our environment that it activates the auditory system because it's inhibitory input but also because it's rhythmic that it automatically engages the motor system. Subconscious level and those things actually begin to fire at the same time. And that process of aligning the motor system and the auditory system is what we term entrainment your brain entrains to an external rhythm and that is something that happens in 97 percent of the human population regardless of age, culture, ability or disability. Everybody is brain neurologically responds the same to music in this way. And so what we see especially even in people that have damage to that motor system so something like Parkinson's disease or Huntington's disease or stroke that affects the way that they move we can actually use music or rhythm as an external cue to engage that damage motor system to help them move more appropriately. And what they've also shown is that when you exercise to music or when you move to music over time that it aids and that process of neuroplasticity of your brain's ability to heal or strengthen connections throughout your life. And so what we're doing is we are using a digital method platform we have sensors that connect to the shoe. They collect all of the data about walking so that symmetry strides like cadence x y the plane of your foot in real time. We feed that into our algorithm that's software based mobile phone and then we change music in real time guided by those neuroscience principles of how music can improve walking. And what we've been seeing it through the research that's been done on the intervention itself over the past couple of decades is that primarily in gait speed that we're able to improve gait speed by .3 to .4 meters per second. Over the course of therapy and what we know is that we look at other outcomes other than just for helping people to walk faster and safely. We also know that gait speed is also correlated to things like falls which is a huge burden to the healthcare system and also connected to things like annual medical costs. So while we are improving just you know mobility and helping people to be more independent through improving the way that they walk. We also see there's a really big value here and also potentially being able to prevent things like fall and decrease medical costs over time because we're keeping people healthier.

: Now that's super interesting. And Brian thank you for sharing that very fascinating way of getting to these improved outcomes and you've not always had a working solution. Can you share with the listeners a time when you had a setback or a failure and what you learned from it.

: Yeah you know that's a really great question and certainly you know in this journey of entrepreneurship there's often times where things don't go as planned and you know it's interesting. We actually started the company as a therapy company where we were hiring board certified music therapist to provide this care in person. What we quickly found and as we know as we started to grow it was primarily people paying out of pocket for this. But we quickly found that a scaling up services business takes a lot of capital takes a lot of time and there quite frankly aren't many people as you can imagine who are trained in this area.

: And there's a lot of variability too right.

: Oh certainly a lot of variability here as well even within the field of music therapy there's a lot of variability even in terms of how people are trained and where they practice and what their skill sets are. And we came to a turning point where it says what is the future of the company look like. Because this isn't accomplishing the objective that we've set out. And while we are helping a lot of people in the area we aren't making the impact that we wanted to make. And that's when we really had to make that decision that well the path forward is actually not necessarily just in services or in people providing this care but it's actually in technology and digital therapeutics to be able to do this and the field actually has advanced such and the technology that such a technology can do.

: That's interesting. And thank you for sharing that. And listeners, a thing that you'll notice other folks that we have on this podcast are the ones that have taken the courage to create and to build and it's not always easy and you always have to be managing two businesses. Number one the business that you're in. And number two the business that you're becoming. And Brian, thank you for sharing that because it's something that every entrepreneur goes through especially if you're going to be successful and so if you had to pull out a nugget from that learning what nugget would you share with the listeners?

: Well I would say you know one of the most important things about this process for me has really been be open to change. Being open to taking in the information that you have and being willing to make decisions and important decisions and commit to them. And so while we thought that we were going to be a services company going forward that's not who we are now and that's not who we're going to be into the future. And when you make a decision you really have to sort of go all in when you have to commit to it in order to be successful in that area.

: Very cool. Very cool. And part of what you guys are doing in this pivot Brian is is using artificial intelligence. Can you share with us how you're applying it?

: Yes. As you know by virtue we're still early early on in the development of our product. We're still working on building that out. But what we're looking at is all of the data that we're collecting about walking about gait and how people move we're getting real time data or real world data of how people are acting in this space. And so with that data what we're doing is we look at our ability to be able to A. make our algorithms better over time with the data that we're collecting and then B. potentially to be able to look at even prognosis or diagnostic capabilities to say well how is the disease progressing. And so looking at taking that data and saying well somebody who has Parkinson's disease that affects their movement we can actually see how the disease is progressing over time and using AI to unlock those features and also being able to potentially diagnose when somebody is at risk for fall racing and how their gait declining etc.. So we look at our AI to 1. make our algorithms better and 2. to potentially be able to unlock a predictive and diagnostic capability

: Super exciting man. I'm very curious on what's going to happen there man make sure that you reach out to me again when you get things going because I'd love to hear how things are improving outcomes with artificial intelligence.

: Yeah we certainly well you know we are as I said we're at the beginning stages of this. We've started to use this with potential clients and we've seen some really incredible outcomes so far that we get really excited about. So I look forward to seeing when we start to incorporate the AI going forward. You know how that even takes us to the next level.

: So Brian share with the listeners a time when you had an amazing success. One of the most proud leadership moments in medicine that you've experienced to date.

: That's a fantastic question. And you know I mean for me I'm a clinician by training and you know sort of a clinician turned entrepreneur and so the things that excite me about leadership in this space is really talking about how we are impacting the lives of those that we serve. And you know the reason that we exist as a company and the reason why obviously I think of most healthcare companies exist is because they want to help people improve. And there's one particular client that comes to mind that really was sort of the inspiration for Medrhythms and for metals as a company in terms of improving walking and also for us to build this device. It was a guy named George who had had three weeks of physical therapy. Five days a week at Spaulding and had been walking with a cane and he had just begun walking with a cane and was walking very slowly and he was unstable and we began doing this intervention called rhythmic auditory stimulation. It was me as a clinician and in one 45 minute session George was able to walk without a cane for the first time since his injury he walked twice the speed that he had walked at the beginning of the session and walks six times in the distance. Over one 45 minute session. Amazing. And for me that was the point where I said this is something that the world needs and the world deserves to have. And as we've been testing our device now to replicate that intervention that we were doing then actually just last week we were doing some product testing and we had a stroke survivor who came in who had her stroke 20 years ago. In 1997 she had a stroke and we actually did about 30 minute session with her every day Monday through Friday last week and she showed a 25 percent increase in her gait speed over one week from the beginning of Monday to the beginning of Friday. Her baseline speed had increased by 25 percent. And so these are landmark moments for me to say that A we can do that B it's working and C something to get excited about going in neutral.

: I love it. Brian there's no doubt that you keep the patient at the center of everything you do. And I think that is a very key part of your success to date and why you're going to continue to be very successful in this space moving forward.

: Well thank you. You know I think you as I said one of the things that we hope that all people in that are building companies is health care at the crux of it all is that it has to revolve about the patient it has to be about improving those outcomes. And while we need to certainly get the business right in order for us to be successful which is you know there's many challenges in and of itself that we focus on at the end of the day. People need to enjoy it. People need to use it and people need to show improvements. If we're going to be successful.

: Absolutely. So Brian this is the part of the podcast where we take a dive into a horse that we're going to build it's a syllabus for the listeners. It's the 101 course on how to be successful in medicine. The Brian Harris Crash Course. OK I got more questions for you lightning round style followed by a book and a podcast that you recommend to the listeners. You ready.

: All right.

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

: Best way to improve outcomes is to be collaborative with all the providers payers customers in health care. You're bringing people together. That's the only way that we're gonna improve outcomes in healthcare for working together.

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

: I would say in this area is trying to go it alone and being isolated and not you know taking feedback from other folks.

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

: Well I think we're number one as being true to who you are and listening to your customers and making sure that you're providing value to them. I will allow you to be sustainable over time.

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

: I think we've hit on this a few times today but I think that it really needs to be centered around the patients and their outcomes and what value you can provide to them.

: What book and what podcast. Brian would you add to this syllabus.

: That's a good question. One of my favorite go to books actually that's not necessarily related to healthcare but to business in general is a book called The go giver and it's something that we have all of our employees read as well. And it's really a book about it's a play on the word go getter but the go getter is actually seems self-serving for the giver. It's about how much can we give and add value to other people and therefore value will be added to our own life. And it's a book about sales but it's really life lessons on how to be a go giver. And so I suggest that book and a podcast. I apologize all about this but I have to say I really appreciate what you're doing here in sort of being on the leading edge of bringing people together. I'd say people should go back and listen to all of your previous podcasts as well because you really crossed the domain in this space and bringing a lot of different points of view here. So I would certainly suggest people do that.

: Thanks brother I appreciate the plug and man The go giver. I love that.

: It's a phenomenal book. And you know I've read it a number of times and every time I read it it gives me a new perspective on how to be an effective leader and you know how to really make a difference in the world. I would certainly suggest checking that book out.

: Man that you spoke to me right there Brian because so every every year I choose a theme for my business or my life. And so my theme this year I chose two words and those two words are faith and giving. And that title just it was delivered to me by the universe through you my friend.

: Well you know I think that those are two important points in life. You know faith and giving are two things to be focused on so I'm happy to hear that. And you sent me a mailing address and I'll send you the book.

: You're the man. Brother I appreciate that. I will definitely do that. All right. Major major gem's here major words of wisdom by Brian. Don't worry about writing it down. Just go to outcomesrocket.health/HARRIS That's Brian's last name and you're going to be able to find it there. So Brian before we conclude this has been a ton of fun. I love if you could just share a closing thought with the listeners and then the best place where they can get in touch with you.

: Great. Yeah. You know I think for anybody that's listening out there I think that now is a really exciting time to be in this field of health care and to be innovating in health care because I think we're going to see a lot of exciting things going into the future and I think the more that we learn about technology from my perspective the more that we learn about music and how music affects the human condition that it will change the landscape of healthcare as we know it. And so that's what I get excited about and I hope that you get excited about those types of things too. And being innovative and being open to change and open to make a difference in the lives of those that we serve. If you're looking forward to getting in touch with me I welcome people to reach out. You know I'm always open for collaboration and having conversations about how we can tackle this problem in health care together. You can check out our Website now at www.medrhythmstherapy.com which actually is focus a bit on our therapy practice. But you know my email is bharris@medrhythmtherapy.com and I do hope you'll reach out.

: Brian this has been a ton of fun and listeners. Again you want to get all the information the links, Brian's web address, as well as the things that we talked about the links to the go giver and the show notes. Just go to outcomesrocket.health/Harris harris and you're going to find everything there. So Brian just want to say thank you so much. Really appreciate you taking the time to share your passion and your words of wisdom with us today.

: Likewise. Thanks so much for having me. It was really an honor to be here.

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Recommended Book and Podcast:

The Go-Giver

Outcomes Rocket

Best Way to Contact Brian:

bharris@medrhythmstherapy.com

Mentioned Link:

http://medrhythmstherapy.com/

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How You Can Make a Difference in The World Just By Taking Your Medicine with Claus Moldrup, Founder/CEO at DrugStars

: Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I really want to welcome you to go to outcomesrocket.health/reviews to rate and review today's podcast because today we have an outstanding guest. His name is Claus Moldrup. He is a Ph.D. ex. professor that decided to get into the health business and is now the CEO and Founder at DrugStars. They're really doing an amazing job. It's a patient movement application on both iOS and Android and they're all about giving by taking. And so they want to just be part of this movement and also invite you the listener to learn a little bit more. And so Claus has a really great background and not only as a professor but he was also spent some time at AbbVie the as the commercial director and in the executive management team. So his experience in both academia as well as the commercial world of health will really provide some good insights here. And what they're doing in the company but also what we talk about today so Claus, I want to give you a warm welcome my friend.

: Thank you and thank you for having me.

: So maybe I missed something here in the introduction that you want to share with the listeners anything you want to share.

: Well I think you've covered it very well. I think it's been like 3 careers in my life. I started out as you said in academia pursuing becoming a professor. My goal was to become the youngest professor in Copenhagen, Denmark. I didn't succeed and that I was number two really but that's good enough. And then when I was like bored of doing that I was asked by AbbVie to actually to develop patient support program for Humira which is one of the biggest brocks in the war and that was fun and interesting learning. And then two years ago I quit that job to become the CEO of DrugStars. And the interesting thing is actually when you look at that is that combining stuff from being academia you know building up a research facility and then having the big pharma commercial card on top of that that is maybe the best education you can have to get into startups because then you get both the very professional stuff from the big pharma thing but you also get from the research part of it where you buy going from one failure to another. You get that under your skin as well which is like very important in startups. So I think that's the best education you can have at the start up.

: Man you have such a unique background, Claus and you know it's interesting too that you're you a big conglomerate academia as well and now you're touching the startup world. You definitely keep changing it up. What do you think is something that needs to be on every health leader's agenda today and how are you guys at Drugstars addressing that?

: Well I think that one of the things we we are actually missing and that's from a lot of stakeholders within healthcare is to get the most out of the technologies we already have. I mean we are extremely focusing on building new technologies new medical devices new getting you know new drugs on the market. It's like a technical fix for us. And I think basically we don't get the most out of what we have already. Let's say we're getting a new drug on the market and it's like let's say 10 percent better than the one that's already on the market and it's like first choice in treatment. Again what would that change if patients don't take the medicines anyway. What we see is there's a huge huge change when you have the clinical trials you see the effect is effectiveness and then when it's in the market people are not taking the right way and it's like elude it. So you can come up with a new fantastic drug which is a few percent is better than the existing one but in the end you might not even see any change in the treatment outcome. And I think that's one of the things that we should really be focusing on.

: I think that's a really great call out, Claus and it's true a lot of the things that we do in health are really incremental innovations when a lot of the exponential growth could come from process and adoption improvement.

: Yeah. Yeah. And of course there was the whole idea about DrugStars is how could we leverage on the fact that 40 percent of our medicines taken worldwide are not taking world wide as recommended by the doctors and pharmacists.

: 40% huh?

: 40 percent. That's a lot. Yeah I mean it's not 40 percent of the patients. I mean we all forget when we take medicine. So all of us. So it's an accurate level. 40 percent of all the medicines and basically across all diseases and therapies. So that's really something to improve here. The cost to society is huge. The cost for hospitalizations the cost of quality of life to the patients and in the end also of course the revenue loss in big pharma is enormous. So there's a lot to gain for everyone.

: Absolutely. So you know it just curiosity is high here, Claus. What is it that you made you decide to get in the medical field?

: Well it was very opportunistic ,to be honest. I was actually more interested in the history of arts and I would like to introduce theorems and look at other stuff. But then my parents told me while there's no jobs in that area and I said OK let's let's find that. Actually you look into you know the curriculums and say OK where can you when you're done with your know masters where could you get the most priority of different jobs. And then in Denmark it's a pharmacist is actually doing a lot both with the Indian public pharmacy both within authorities a lot within pharma of course. So I thought OK I don't have to decide what's which way to go. Now let's get that degree and see what happens.

: Nice. So it was it was more of a practical drive that.

: True.

: Lead to.. very nice. That's good. Yeah you know so my background my education was in classical humanities and my parents were the same. Like what are you going to do with the history. But I loved it. It was fun. And in the process I got into it just through health experiences that happened to me. But at the end of the day, we're here Claus and so now we take our diverse backgrounds and we and we do something with it, right.

: Exactly yeah.

: Give us an example of how DrugStars is already improving health outcomes.

: When people are improving on taking their medicines. That's of course is doing something. And when I was looking into this field there were like I think maybe a thousand different inheritance tools in app stores. So in that case if it's just a reminder tool to remind people to take medicine we are not unique in any way but that's basically just the pot of drugstores that is giving something to the individual patient. The thing with drug stores is that you earn stars by taking your wages and these stocks you can donate those to charities, those charities ofcourse and we will convert it to real money and already within one year we have donated more than 90,000 US dollars just based on patients being active on our behalf. Of course are not. They don't give any money themselves it's us out of our pockets and of course that is our unique proposition that we are not only a remembering tool to remember of medicine and hopefully get a bit of treatment by doing that. But on top of that we are also contributing to the patient organisations, the NGOs, the nonprofits, that they can actually improve with in different diseases as well.

: Got it. That's pretty cool right. So you're a patient and you're you're taking your medication not only are you helping yourself but you're helping others. I think a lot of people I think especially you find this out when you become a parent you willing to do more for others than yourself sometimes.

: True and of course we have drug stores is based on you know a lot of thinking about of course psychology but also on gamification and one of the most rewarding things to do is actually to give something to other.It is a lot more rewarding and is provoking a lot more things in your mind than having that say a free coupon to stop. I mean it's a lot more rewarding and people are getting back so are retentions stuff is better when you are actually giving something for charity. I remember one of the reviews on iTunes was a mom writing thank you for a fantastic app. I'm using it together with my daughter who's eight years old and we can have like a lot of discussions on which charities we should donate for every time just for the interest. How can we change something just by doing that. So that is creating something which is, there's a lot of energy in there.

: Now that's pretty cool. So I have to ask Claus, because I know that the listeners are wondering if you guys donate and so tell me about the financial model here and how this works.

: Basically we we can get sponsorships so we can have sponsorships from other foundations or from pharma companies, insurance companies, and they have no influence on where the money go. They can say OK we want to sponsor all diabetes patients and you're good then you can do that but you cannot just sponsor your own product. You need to sponsor the competitor's products as well so they put in let's say a hundred quid into our sponsorships and then they distribute it among those who are then getting stars within diabetes and then the diabetes patient can choose to either give it to like diabetes foundation or if they want to give it to like heart diseases or whatever. I mean then they can decide doing that and the and sponsor have no influence on where the money go. So in that way they are surely sponsors with the hands-off. Which is very important for us.

: That's really cool and very clear on how that's done. So would you consider your company a non-profit.

: We actually because we are based out of Denmark and here we are a profit company but we are actually now because we now entered the U.S. and the U.K. and we see ourselves being asked that question a lot and we are actually going into filing an application for 5O0 0 non-profit registration.

: Got it.

: For that part of the company.

: Very cool. So you'll be a final Nc3 you'll be doing these things that are very much in line with those types of organizations. And the nice thing here. It's pretty cool listeners. They have Classen his team has a really clear visual of what a patient does when they're on the drugstores app. If you go to drugstars.com you'll see the patient journey and it's pretty sweet. And you know the nice thing is that you get to choose do you get to choose where you put the money. So not only do you benefit yourself you benefit others and you get to decide where it goes.

: And right now when you used in the U.S. you will see that there is like generic patient organization so you can decide to donate to diabetes area or the health hot area. And that is because we are finalizing. We went with the patient organizations in the U.S.. Now it's free for the organizations to be a part of the app. The only thing they need to provide us with is a picture or a logo and some small piece of text that describe what they do. And then the straight agree to get money from us. So it's pretty straightforward. And when let's say fabulous it could be a try for another diabetes foundation is entering the app then they are taking over that more generic description in the app. So already now when you sponsor giving your stars to diabetes it will go to that patient organization who will finally sign up for that area.

: That's great. Now, Claus - what's your vision for this? You know at the end of the road what does this look like.

: Put the mission to become the biggest patient movement in the world. Not as a political movement we also across all kinds of diseases so we don't have any focus on a specific disease but we really like patients wars to be here and the development of the decisions within the development of new drugs. So let's say we in the future have like say 5 million users of growth. And these users are reviewing different drugs because you can review drugs in our app then that review will become a central part of payer's understanding of what should they actually pay for and where they should not go. It could be like it's basically like a trust pilot for medicines. If you are if you're a payer, first of all you look at the clinical trials. Yes and then if there is too competitive drugs which are equally as good and the price is the same. Let's say in the future they go to the DrugStar application and they see that one of them is actually having a much higher score than the other one among the users. The likelihood that these patients actually will take that drug better and more consistent is quite high compared to the one which has a low rating from the user and then they will probably go for the one which have the the people's voice behind them. That's the main idea of that.

: That makes a lot of sense. I love the vision and as you put together the platform these patient reviews visible to other patients or is it more back-end to payers and...

: It's back-end. I mean you know we don't want in that sense to like make a ranking of drugs. It's not that just because you have this particular whatever experience and attitude towards the specific drug that should not have a huge impact on another one. I mean we all are different we all react different to different drugs and we should take that into account as well. So it will never be like advice of drugs.

: Got it. It's more of of you get rewarded and you get to continue feeling good about what you're doing and at the back-end and there's the engine that would help fuel feedback for the drug companies.

: Exactly.

: Got it. It makes a lot of sense. Give us an example Claus where you have had a setback or a failure and what you learned from that failure.

: Oh there's been a lot of that.

: That's entrepreneur, right? The life of entrepreneur.

: Well, actually in this case I'd actually like to go a little back to the first study I did within health or mobile health. Yeah. I think it was back in 2005 or so at that time we didn't have any smartphones but we had text messaging and I thought that OK if we can increase adherence by doing text messaging that would be an awesome thing to do though it did run a clinical trial with a control group and of course an intervention group within asthmatic treatment. So they were reminded to take their medication. There are you know there prevention inhalators every morning and their result was very interesting. We actually showed that we increased adherence which was a good thing. And we also asked how often they went to the doctor and hospital and the intervention group which had a better adherence than the control group starting go more often to the doctors and hospital. So that was not really the outcome we expected.

: That's interesting.

: And it turned out that there were more regular on the medication. But at the same time they were more regulate on doing it the wrong way because the inhalation technique was bad. So increasing adherence is not always a positive outcome. And I think that was a very interesting learning because when you look into literature or whatever you're saying OK better adherence we get a better outcome but that's not always true adherence is more complicated than just timing. It's also how the quality around how you actually manage your medication.

: Yeah. Because as a binary character but it also has a qualitative character too.

: Exactly. Exactly. And a lot of cases people miss the quality and just looking at the numbers.

: That is super interesting listeners think about that and there might be some assumptions that we're making and Claus shared one of his has set back moments. To us what can we learn from this. You know and when you think you have something right dive a little bit deeper and think about the qualitative measures of what you're doing or what some of the results that you're looking for that's really great share, thank you Claus.

: Yeah.

: What would you say one of your proudest medical leadership moments to date is?

: Before us started drugstores authority was some of the publications I've done. And you know very very egocentric very focusing on my own merits. I think that the first time I went out you know with the first donations to one of these very small patient organization it was a incision for cystic fibrosis which is a horrible disease and it's luckily only a few patients people get it. I think in Denmark alone we have like 500 patients but they take a lot of meds and when I was standing there in front of one of those patients and with their you know the leadership from that organization and handing out quite substantial amount of money compared to our companies and that small organization, I really feel proud because this was not only money or something. This was based on other patients having activities around that disease generating some funds for their organization. And I really thought that was beautiful. So yeah that actually made me feel very proud.

: That's awesome man. That's fantastic. And what would you say today is one of your exciting project or focus areas within your company.

: From the very beginning we've had this questionnaire six questions in the app which is what we call medical experience and attitude index which is the one where you rate your medicine. And now we're starting to put that more into AI. So we can actually predict when people are dropping out of the treatment before they know themselves. And I think that's going to be game changer in a lot of ways because suddenly we can give feedback to patients saying that OK with these answers on these six questions we can actually tell you. And also based on your activities and the app and so on. We can actually tell you that you might be at risk of dropping out through treatment within the next let's say 30 days. If you're not aware of that, you should definitely start to think about it and maybe even have a discussion with your doctor on why is that happening. I think that is something which we upfront can because when people are just dropping out of that treatment you know suddenly they go to the doctor and the doctor asked: Did you take your medicine? Yeah, I did. And then they will have none of the medication because the outcome was not good on the first one. Then it's starting all over again and it's not really taking the aspect of why they actually fail on the first one. I think that would be important.

: Well super interesting that you're doing this Clouse and it sounds that you've definitely been passionate about the medication and here in space since very early and I'm excited to see how this thing takes off and just you know the new things that you guys do with the new AI engine for it.

: Yeah.

: So let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine. The 101 at the ABCs of Claus Moldrup. So everybody is going to have to take this course if they want to do well in medicine. We've got a syllabus here lightning round style so I got four questions for you that will just answer. Followed a book that you recommend to the listeners. You ready.

: Yeah.

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

: I think you should have smaller projects that can fail fast rather than big ones. Just failing as well but not fast.

: Love it. What is the biggest mistake or pitfall to avoid?

: Using the word project. Because when people love doing projects it's always something that is the word itself as long in some way. And I think in our company we're not allowed to use the word project because it's basically something that you can buy from doing a project because it takes too long.

: Don't use the word project. How do you stay relevant as an organization despite constant change?

: I think you should always listen. Every time someone is addressing something to your product or service or whatever it's important to take it into account that the rest in the future a way that you work around that area.

: What is one area of focus that should drive everything in a health organization.

: I think it should be the patients experience of your service.

: And what book would you recommend to the listeners?

: I'm actually not reading books to be honest.

: OK.

: And I actually also when I was a professor at the University or was bragging that I haven't read full paper, not even my own. I'm too impatient to do it.

: What about audio books?

: I listen to a lot of audiobooks and actually all the members of our company have a subscription to Blender's. Which is like a service where you get an abstract of a book in 15 minutes. So it's audio and they are reading are the main outcomes of what they think is the most important offer of a book. It's you know it's...

: What is it called, Claus?

: It's an app on the internet and I think it's a German.

: How do you spell it?

: B L I K I S T. I think something like that. Yeah I can give it to the show notes.

: Yeah that would be awesome. It sounds really good. Is it available in all languages.

: Yeah it is.

: Awesome. Sounds great. And the descriptions are audio too.

: Yeah it's only audio. You can read them as well but it's only 50 minutes and it's small blinks out of text then they you know walk through all the main parts of the group which is like frantastic because usually there is a lot of stuff you can skip.

: Totally.

: Not in novels and stuff like that but more and you know business books and so there's a whole section for startups as well.

: Beautiful listeners classes provided some really great things here and on this syllabus. Everything that we discussed as well is a blinkist and and all the things he's up to at drugstores. You could find those at outcomesrocket.health/claus. C L A US you'll find everything on there so don't worry about writing it down. Claus, we've gotten here to the end my friend. I love if you could just share a closing thought and then the best place where the listeners could get in touch with you or follow you.

: Yeah well you can always like go to our website and write to the info at DrugStars.com It's actually going direct into my email. I think that's one of the way that I listen to all of our users is that when people are contacting us, I'm the first one to get it so it's not just directed to someone in customer or whatever. It's actually going to. So that's the way I listen. I think one of the things that I've been focusing on a lot on the last few months is that when you are in this space where you gave me fine stuff we always the metrics that investors and stuff use for how successful we are is how long people are staying on our app and the retention rate and the engagement rates and all that kind of stuff. And when you're doing gamification it's all about grabbing people's attention and I actually think when you're looking at the app landscape across all kinds of categories everyone wants to have your attention. So it's an attention game for apps like ours and to be honest I really don't like that. I think attention is a very valuable thing for a person when you are looking into your screen you're not looking into the eyes of your family. So one of the things that are really looking into is that when you are asking for the attention of users, you should only ask only for the amount of time that is needed for people to do exactly what they should do in your app and nothing more than that and then they should close the phone and look at their family.

: That's a great insight. And so with that my friends, Claus always leaves us with some really great things to think about. Claus, I really want to express our gratitude for you to spending your time with us today especially at the wee hours of the night over there in Denmark, shows your dedication.

: Thank you thank you for having me.

: It's a pleasure my friend.

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Recommended Site for Audio Books:

https://www.blinkist.com/

Best Way to Contact Claus:

info@DrugStars.com

Mentioned Link:

https://www.drugstars.com/

Episode Sponsor:

How Dacadoo is Standardizing Personal Wellness with Your Own Personal Health Score with Matt Park, VP Sales, North America at Dacadoo

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 once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I welcome you to go to outcomesrocket.health/reviews where you could write and review today's podcast because he is an outstanding contributor to Health in the software space and in general. His name is Matt Park, Vice President of Sales North America at Dacadoo. Dacadoo is the health score company providing a mobile first digital health platform that helps people to live healthier more active lives. He's had a really great history really a veteran in software he was around even before there was windows. So this guy knows what he's up to and his experience has gone through the continuum of the provider side but also especially the employer benefit side through H.R. software that helps managed care of people and now at Dacadoo he's doing some pretty cool things and so including key measurement indicators to help you stay healthy. So I thought it'd be a great place to have a conversation about the things that they're doing there and couldn't be more excited to have you on the podcast Matt.

: Thanks, Saul pleasure to be here.

: Absolutely. So what is it that got you into the health space to begin with.

: Well that's a good question. I've always been really interested and more and more so over the last few years in things like nutrition and exercise I've always been very conscientious and really wondering you know when the sort of health care business was going to get more focused on how they get people thinking about and care of themselves. So it's always been on my mind I've done lots of research on it over the years and it was really just coincidental just as I was thinking about changing jobs few years ago that I was approached by Dacadoo and it's a Swiss company based in Zurich Switzerland. And to me that was already interesting because I've lived overseas in three different countries that I speak fluent German and that's always kind of a hobby of mine a slight interest. So that was interesting. And then the fact that they were doing a digital health platform and wanting to launch in North America that was super interesting to me because that's really what I do and have done best over the years is startups in the software business and I've started up companies for U.S. companies I've started up European operations in several different countries over there with different U.S. companies and then I've started up different companies and divisions of companies around the U.S. too. So having the chance to start up the operations for a Swiss company in the U.S. that was really exciting especially in the health sector.

: Yeah that's for sure and you obviously have a really amazing background in helping get companies off the ground here and abroad. Dacadoo is special. So you want to tell us a little bit more about what they do and why it's different.

: Yeah this is really an interesting company. So first of all we it's a digital health platform to engage people and healthy lifestyle and better nutrition exercise mindfulness things like that but more importantly they spent several years before rolling out their first product to create their core intellectual property which we call the health score and the health score is unique because it's a real time health score. Think about a credit score for your health for.

: Exactly what I was thinking about.

: And yeah I caught your batting batting average and health. So it's changing in real time and this is what makes it really unique it changes in real time. It's composed of over 100 different data points about human health that we track and those roll up into three subcategories of health that we call lifestyle body and mind. So we're looking at holistic health not just one aspect of health and not just one category but really all the different inputs that really do impact your overall health. So the lifestyle component represents things like movement nutrition stress and sleep body is age weight height gender blood pressure blood values so all of your biometric information and mind is emotional and mental well-being. So that's a core piece of the IP and then we have a full platform so now that you know your health score now that you know your credit score so to speak you've got to have a way to manage it right. You need a way to make it transparent to the user. What does it mean. How is it changing why is it changing how can I manage it and improve it. And that's what the rest of the platform does.

: That's super interesting and I think about this as sort of the consumer facing side of early warning scores not sure if you're familiar with early warning scores or not Matt.

: Early warning scores. I mean you mean at no risk scores if that's what you mean.

: Yeah exactly. So there are risk scores early warning scores for clinicians they take like mews is one of them. Mews right and take an aggregate score of several different parameters and it's a single number that alerts a clinician if something's going wrong way ahead of time before it actually happens. And so basically I'm looking at this is just like wow this is so cool. This is a way that you can use it outside of the four walls of the hospital before you end up there.

: Yeah no we could actually do that. I mean we could deliver that kind of information to clinicians as well because the health score itself is actually based on really serious science. And underneath the health score there's a complex set of risk models. So the original sort of concept of creating the whole score was to answer the question you know what are your chances of dying in the next X number of years. So that number can be any number that we plug in there 10 years 12 years whatever. And so in order to create the score the founder of the company Peter Artemus was able to enlist the help of an MIT professor. Professor Dr. Lawrence Jacobs who was a long time professor there in theoretical physics who also happens to be an M.D. and now works in cardiovascular research at the University of Zurich. But Peter was able to get Laurent's to help him to create the models that would create ultimately the health score. So the health today is based on 300 million person years of clinical and customer data and that's a lot that's a lot of person years.

: That's a ot person years.

: Very hard to duplicate. I mean just to have the access to this amount of information. So it really was several years of research and science by Dacadoo to create this.

: Pretty cool. What does Dacadoo mean.

: It actually is sort of a made up word according to her it is the sound of the rhythm of music I guess as they as they talk about it in Switzerland.

: Dacadoo OK alright, very nice

: Maybe you can think of Dinka do if you know you know Jimmy Durante.

: Oh yeah. Oh yeah

: OK. There you go.

: So man that's so cool. That's really interesting and your customers obviously being employers and listeners if you're an employer thinking about your rising health care costs let's face it next to labor and just supplies your healthcare bill is probably one of the largest and average is eight to ten percent increase costs here. What can you do. What things can you apply to help curb those costs that are really limiting your competitive abilities here. Because we're in a global economy. So you know something to think about. Can you highlight a little bit about who uses you guys and maybe a way that you've helped improve outcomes for companies.

: Yes absolutely. So our customers were really a technology company and a technology platform so our platform is really designed to enable entities to shape it to their own needs. So you know we enable customization very easily. Wait labeling branding as well as you know putting in their own content and managing that. So our customers tend to be higher level entities that we deal mostly with insurance companies so both health insurance and life insurance companies we deal also directly with large corporate wellness programs so directly with the corporations. And then lastly and very interesting and more recently we're getting a lot of customers in the pharma business who are focused basically on specific medications and impact the health of specific populations that have chronic illnesses. And if you think about it if you combine healthy lifestyle better nutrition and exercise with most of the major chronic illnesses you can have a significant impact and outcome on those people's health. I guess I should say for the fifth category that we work a lot with is health tech. So this is the sort of the greater healthcare ecosystem of technology companies that are designing products and applications apps portals et cetera to solve all of these problems and Dacadoo's core technologies and we have a number of component technologies can also be licensed to our open API and then incorporated integrated very easily into other platforms.

: Very cool very cool. And Matt can you share a story of how your technology has improved outcomes. Anything you have in mind.

: Yeah yeah absolutely. So in the last few years we had an analysis and assessment done of a large group of active users that were out of one specific country and that was over the course of about three years of their use of the technology. And so we were able to come up with some really good stats showing that the average user's key health measurement and I'll tell you what those are improved significantly. So following formation is useful so the variables that we were measuring were weight waist size systolic blood pressure diastolic blood pressure resting heart rate diabetes risk and hypertension risk and we slow increases for the percentage of Dacadoo users that got impacted ranged between you know 10 percent and 40 you know something percent depending on which of those categories you're talking about. And the the average decreased meaning benefit because if your heart rate lowers or your blood pressure lowers that's good so that's when the rate decrease. But the improvement I should say ranged from 3 percent at the low end to about 30 percent at the high end depending again on the variable that we're measuring and then we we do another measurement because of the the core risk engine that this is built on. We can measure some interesting things. So we produce another measurement that's called healthy years gained and 80 percent of the users had two and a half healthy years gained. Well I think that's a really good metric.

: That's awesome. Hey I'll take two and a half more years.

: Yeah exactly what you want them healthy right you are healthy.

: Oh healthy. Absolutely yes. Healthy years. Sign me up Dacadoo

: Yeah.

: That's pretty cool. Without a doubt. And. Think about all the things that employers can be doing for their employees or the payers could be doing for the lives that they cover. This is definitely something very interesting and why not. I mean we have dashboards for everything else. Why not have a dashboard for our own health.

: Yeah agreed. And I think this is one of the big things missing in wellness programs and in all entities of companies organizations the health care system that are trying to help people improve their health is the real time impact of programs doesn't exist. It's very hard to measure. And so in wellness programs I wrote a paper on this last year and part of it was about what I call the the measurement conundrum. And that's because we don't know how to measure the health impact of our wellness programs in a short term way. So what are companies doing. They're trying to find a way to figure out that claims are going down and all of the people in the in the health insurance business have told me that's a three to five year project. So you know eventually people realized that's not going to work. So they try to figure out that well we can measure absenteeism and presenteeism of employees that would surely show the data that we need to prove that it's you know our programs are working. But you know with most companies using a PTO system today you don't really know why people are even absent.

: Right.

: And by the way when they are sick they come to work because they don't want to lose their PTO days which they think are vacation days. So that's not that's that's so true. That's a statistic from the H.R. organization.

: That is fascinating. And so what you guys are doing now is through your IP you're helping people with an early indicator of their investment in wellness.

: Yeah it shows an early indicator because you can run a program let's say that you want it to run a challenge for the month of February and maybe it was something as simple as a walking challenge you know trying to get the population of our employees out walking more and promoting it and talking about it at the end of the month of February. Wouldn't it be nice to run a report and say Hey people congratulations we just ended our challenge. It was a great success. We were able to improve the health of the average participant by 12 points. And that to me is the kind of thing that people need to understand Hey what I did is working. I see health score going up every day and that's the feedback that people really lack in anything that they do exercise weight loss nutrition is that instant pat on the back. Hey this is working it's helping you be healthier.

: If there's anything that will help improve it is measurement and for sure sounds like this is a novel way of measuring the impact of these programs. I like how you guys sectioned things off into a lifestyle mindset and body. I think it's pretty cool that you guys have specific measurements that lead to the indicator and as pretty interesting how you guys have done it.

: Yep by the way it's not novel DaVinci came up with this idea. You remember his picture of the man. Yes. His arms out that was basically lifestyle body and mind what he considered holistic human right. So that's what we use.

: That's pretty cool that you mention that Matt because it's not new. However I've had a couple of guests on the podcast say something very insightful is that innovation and healthcare happens with implementation and so ideas and technologies exists but when you can actually implement them and apply them like you guys have that's when the innovation happens in healthcare. And you guys are definitely doing it.

: Absolutely. And because of innovation there's currently 300 and 18000 apps health apps and the App Store 318000 apps. Is that what it's up to now. Yes. Is whooping up like 200 in something every day. Ok so imagine the amount of data that's being created about people's health and imagine how different and disparate that data is.

: Oh my gosh.

: And imagine if you're a consumer and you're trying to measure all these different things and using different apps that none of this data would ever make sense if you put it all together. So I believe that there's a big problem and that is the normalization of health information so some kind of standard framework that the health tech world is going to have to start building apps in so that they come together and mean something to the consumer that they're trying to impact by the way they're all being built with really good intent and I believe that that really is true. And a lot of them can do great things and it's super what the innovation I see at these conferences it's science fiction almost. But we've got to come up with some standardization. So and one of the ideas and obviously I'm certainly heavily biased in this area but what are the ideas that helps to make this normal is a standardization of a score health score that everybody who is involved in healthcare knows oh well what's your health score. Well I'm a I'm a 750. That's great. Or I'm a 550. People know what that is.

: What brought you down. What happen.

: But imagine you know consumer financial business without a credit score today it would be.

: Yes it would be. Yeah that's a really interesting thought and would be interesting. I mean now with the you know what does it mean for use 5 and people getting access now. They're are going to be required next year to give access to patients, give data access to patients. And so I think we're getting closer and closer to that. I think you bring up a really great great point because if we don't do some sort of standardization things will continue to get pretty confusing.

: Yeah pretty messy.

: So Matt give us an example of a time where you had a setback and something that you took out of that a learning.

: From my perspective when I started two years ago with Dacadoo to launch into North America with this new app I basically was chasing everything that was you know I'm responsible for growing the market so I was chasing everybody who was interested. And I did spend a lot of time with health tech companies early on because they were finding out about us. We were exhibiting at shows and things like that. And there was tremendous interest and I thought this is going to be a great area of the market for us. And I still today think it's going to be but it still hasn't become because I think there's a lot of innovation there's a lot of new companies there's a you know a lot of innovators and many of them really wanted to have a health score in their application when they saw what we were doing because it made total sense as part of what they wanted to deliver to their customers. And I spent a lot of time on it. But what I didn't realize was that a lot of these companies barely had a product yet. No I wasn't really dealing with and no disrespect to those companies by the way. But.

: Yeah of course.

: I needed I needed to focus my time on companies that were you know more mature in what they were delivering. And so I think that now I know what companies to work with or what would it look what they should look like for me to spend my time with. So from a sales and marketing perspective I think that it's pretty unique. There's so much going on in the health tech space in this digital health world that you just have to be careful where you spend your time.

: I think that's a great call out and if you had to boil it down to just the qualification process how do you do it now.

: First of all.

: Stage of business sir is it is revenue. What do you do to to qualify.

: Yeah. One is just ask you have requirements. I find that you know sometimes. Now that's one of my first questions. But you know I found that a lot of companies say you know what we have is really cool and they wanted it but they didn't exactly have requirements to know what they were going to use it what they were going to how they were going to put a product together. And then certainly I think what stage they're in what size customer base they have if they don't have a customer base what they want to put our technology in it to hopefully you know when it rolls out and help attract customers I get it. But can they afford to do that. And most likely they can't.

: Now it's a great learning and and definitely it's easy to get excited about a product and lose time and before you know you spent a lot of time going after potential customer. And there it goes because they weren't qualified really great share. Matt thank you for sharing that.

: No my pleasure.

: So in this part of the podcast we're going to do a lightning round. We've got four questions here. It's the 101 on how to be successful in health care with Matt Park. And so we've got four questions lightning round style followed by a book and podcast that you recommend to the listeners. You ready.

: I'm ready.

: Awesome. What is the best way to improve health outcomes.

: Best way to improve health outcomes would be to clearly identify how you're going to measure them. How are you going to measure the outcome that you want to be able to report on until you understand the whole equation then you can create the way to prove it.

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

: I think kind of what I said before about this business is so big there's so many different aspects to a digital health and you think you know what it means but it means so many different things. So I think you need to narrow your focus if you want to be successful in the digital health space you need to narrow your focus on what area are you going to play and is it a defined space. Or am I helping to define it.

: Love it. How do you stay relevant as an organization. Despite all of this change.

: We spend an awful lot of time getting out in the market. I think last year at Dacadoo even though we're a small company we did 17 conferences in the U.S.. Wow. The guy presented at 13 or 14 of them and we did probably that many in Asia and that many in Europe as well. So we are like super active out in the market and that way we get to touch what's going on. And it is changing so fast it's incredible so you have to be there live to hear what companies are saying what the leaders of the companies are saying.

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

: The end user the patient. If it's a medical organization then the patient if it's a corporation it's the employee it's the constituent it's the end user and it is because technology for technology's sake just is waste. And you don't realize who's going to use it and how are they gonna feel about using it. And you see a lot of this quite frankly with 315000 apps out there. It's scary right. So you've got to focus on the end user.

: What book and what podcasts would you recommend to listeners Matt

: The book than the one that I'm reading right now is sales are the new cure by Robin Smith and Max Gomez.

: OK.

: That's really science fiction that's happening right now. It's incredible. Foreword by Sanjay Gupta. So very cool. And of course I mean I would recommend this here outcomes rocket podcast.

: Thank you. Thank you very much my friend. Listeners don't worry about writing any of this down. All the pearls that Matt has shared you could find those at outcomesrocket.health/park that's Matt's last name PARK you could find all the show notes, links to the books he recommended links to Dacadoo and all their on their one page. So Matt before we conclude our love if you could just share a closing thought what the listeners. And then the best place that they could get in touch with you.

: Sure. Closing thought is I think that there's a lot of good things happening in digital health. And as I mentioned before with a focus on the consumer on the patient on the end user I think that the people that are in digital health are in it for more reasons than to make a buck. They're in it for sincerely wanting to make and have an impact on people. And I think that it can happen. Digital Health will play a big role in that but we have to be extremely focused and aware on every time we bring something to market. How will that really impact in a positive way. Our consumer.

: A great message and what what what does the best place for the listeners to get in touch with you or follow you.

: Yeah sure. So I think you know just by my e-mail address is matt.park@dacadoo.com that's the easiest way.

: Awesome. So listeners you'll find that again at outcomesrocket.health/park and just want to thank you again Matt for spending time with us. Really looking forward to seeing how you guys revolutionize this space of just this one score for everybody's health. Thank you so much for spending the time.

: Thank you Saul, that was great. Thanks.

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

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Recommended Book and Podcast:

Cells Are the New Cure: The Cutting-Edge Medical Breakthroughs That Are Transforming Our Health

Outcomes Rocket podcast

Best Way to Contact Matt:

matt.park@dacadoo.com

Mentioned Link:

https://www.dacadoo.com/

Episode Sponsor:

How Two Health Leaders are Paving the Way in Diabetic Foot Problems with David Armstrong, Professor of Surgery and Director at Southwestern Academic Limb Salvage Alliance at Keck School of Medicine and Davide Vigano, Co-Founder & CEO at Sensoria Inc.

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

: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I welcome you to go to outcomesrocket.health/reviews where you can go rate and review today's podcast because we have an amazing treat for you today. We've got two outstanding collaborators and contributors to the health space. I'm gonna I introduce them to you and then we're going to dive into a topic of diabetes foot care and all the complications and opportunities within this space in medicine. We're going to talk about artificial intelligence and we're going to really have a great conversation. So without further ado I want to introduce my two amazing guests. First I've got Dr. David Armstrong. He's a professor of surgery and director at the South Western Academic Limb Salvage Alliance also known as salsa at the Keck School of Medicine at USC. He's an amazing contributor and has some great things to share with us today. And then we also have our other guest. His name is Davide Vigano. He's the co-founder and CEO at Sensoria incorporated where they work to deliver healthcare solutions for the smart aging patient. So what we want to do here guys is I want to open up the mic to both of you fill in any of the gaps in the introduction that you want and then we can move forward with the show so why don't we start with you. Dr. Armstrong.

: Well listen it's a pleasure to be here. Thanks a bunch. An absolute pleasure. I tell you what I just subscribed to your podcast app just given you 5 stars. After testing a Calera interview. Now let me tell you I'm just looking at all these circular talks. It's like an entire panoply of greatness here. Every single one. This being the least interesting and we can change that. It's a total pleasure to be with you. And by the way with my longtime friend Davide Vigano. Davide Vigano.

: Thank you Dr. Armstrong. It's a pleasure talking to you Saul I think we have a fantastic opportunity to share more about what's going on in the world of diabetes and the complications which is a problem of epidemic proportions right. So it's a pleasure to be with you this morning.

: Absolutely guys. And so I always like to kick off the podcast with understanding the story behind it all and I'd love to hear from each of you. What is it that got you into health care to begin with.

: I grew up with this. I'm a doctor pediatric surgeon by training. I grew up with a problem in my dad's office. My dad was a longtime. Podiatrist in Santa Maria California I grew up in the office. Mom and Dad as well. I saw how many problems folks had this massive unmet need in the area from a very very early age. So I guess you could say yeah I was born with a silver foot in my mouth. That just happened really bad. But you can edit that out if you like. The further we're in the area really has been and learning about people with diabetes. And you know we talk about the scope of the problem minute. The fascinating thing about taking care of many people with diabetes is they do not have the ability to feel pain. As we all do they make it pain when they get when they have it and they don't want it they don't have it when they need it. And that aspect of treating the absences is a fascinating thing that's really got me interested in medicine and surgery is the opposite.

: Yeah super fascinating and a great story there. Thank you for sharing that. Dr. Armstrong So what about you. Davide what got you into this business.

: I've always had a passion for health care. I'm a geek by background I'm pretty early not a medical doctor but you know my family has been impacted by multiple healthcare issues. My uncle lost him to diabete. Years ago I managed the health care solutions group at Microsoft for many years and actually contributed to starting that before it was actually sold to G two years ago. So yeah it's health care is very very very important to me and you know health care becomes very personal very Gretry right so it's not a passion. I think we all have the need to actually make it a priority because we all need to help solve some of the problems that health care system is facing. Selfishly right. So all we all need it at some point the chance that the consumer becomes a patient from time to time.

: This is true.

: You hear a guy like this like Davide. And by the way what a great pretty name. It's like David wasn't enough. You got to add a vowel. A good idea. Oh yeah.

: But the extra mile is nice. I like it

: The mellifluous isn't it. The point is you have a you have an engineer and you're a man like that today and mashing it up with with medicine and surgery on our hands and people talk about team science team medicine but it's one thing to talk about it's another to really live it. When you when you do that really great things can happen. And that's what we're talking about.

: Yes super interesting and actually I had a chance to interface with some of the things that you offered Davide the sensors in the socks. I was at Exponential medicine and you guys had a little booth there and it was very interesting to see the technology. And I'd like to ask both of you what is a hot topic that needs to be health leaders agenda today. And then how are you guys addressing it.

: Well let me let me get it right. Maybe I can give you the topic that you know we were there was at top of the agenda because it's at the bottom of everyone's agenda up until very recently. And that is the end of the body the foot in diabetes. I mean I can guarantee you there are a lot of podcasts getting recorded right now and I can gossip with you or to you that we are the only people talking about this and this is the definition of unmet need. Let me tell you why. So right now every 20 seconds someone is going up lose their foot or leg because of diabetes right now and every 20 seconds. That is tragic. There's a lot that we can do about.

: Every 20 seconds huh

: Every 20 seconds.

: In the U.S. or worldwide?

: Worldwide. But in the U.S. If you want to I mean we can take the data where you want. Let's talk about the problem in the U.S. U.S. alone now this problem is a problem now that. Let's compare it to something that we all care about. Let's compare it to cancer. I know it's not fair to compare one problem that's horrible to another but you know we all care about cancer. We all have family members who survived or succumb to cancer. But right now the diabetic foot and the lower extremity cost of diabetes in the United States are more expensive. And the five most expensive cancers in the United States. And like I said I'm sure there are plenty of people right now required podcast's or lecturer's or maybe even walkathons for breast cancer and colon cancer and lung cancer. And you know what they should be. But like I said we're the only people talking about this problem.

: Why do you think that is. Why do you think and maybe Davide you could chime in here as well. Why. Why do you guys think this issue is not in the limelight.

: I think that's the numbers that Dr. Armstrong are just walking us through are just unbelievable right. There are almost surreal and there are very embarrassing re on top of what you just said you know there was a 50 percent chance that the patient will have another antedated within two years and after an amputation. David correct me if I'm wrong but you know there is a five year life expectancy right so very similar to cancer. The reason why we're not talking about it is because these numbers are medieval. Right. We should be embarrassed by them right. I mean we're talking about amputations. Right. And between 80000 and 90000 amputations every year in the United States right. This should not happen. Unlike other issues with cancer where we don't have the final cure there are solutions to diabetic foot complications. But we need your help in building the awareness so people know what to do. Right. Most of these people don't feel their feet or will they suffer from a condition called peripheral property which means that their nerves are damaged. So we're asking these people to do things that they're not equipped to understand. Right when we tell a patient stay off your foot. It doesn't mean the same thing that he means to us. So we think that these patients are not discipling. We think that they don't care about their health which is not true. The problem is that their brain their system their nervous system is damaged so they need help both from a medical standpoint and they need help from the technology so we can replace some of these sensations and help them leave a healthier longer life.

: So yeah Saul, you hear this now you hear this from today. But it's one thing for us to talk about this and he did such a great job of talking about this. But listen this is something else. Just imagine if you couldn't feel something on your feet right. It happens so slowly. It's like watching paint dry or watching grass grow. Right and we except slower. And so it sneaks up on you. And that is the problem with diabetes in general. You know we have about 30 31 million people with diabetes in the U.S. now about 100 million people with diabetes or diabetes in the United States. So this is a big problem. But about half of those people are going to get this problem where they lose what we call protective sensation. And if you were an evil deity and you were trying to sock it to humanity. You know what. Not yet. You wouldn't pick all a high profile problems like heart attack or a stroke or even HIV these horrible problems that are scourges you would pick something that was silent and sinister right. It sneaks up on you. That's the problem here. This problem is covered by bedsheets in the hospital it's covered by shoes and socks. And imagine if you couldn't feel the problem until it just got away from it. So that's it. And now all of a sudden we have been working for a long time in this area are all of a sudden with a lot of the work that's happened over the last generation are starting to get a lot of interest now from industry not just from tech but from industry as well which is really exciting because they're all of a sudden starting see it has started to uncover this problem themselves and lift the bed sheets and see that this is a problem that's affecting millions of their patients. The giant health plans in the U.S. and health ministries around the world and it's also leading to massive opportunities and that is to really make a difference and that's what the Davide has been working on a great deal and it's frankly super exciting.

: For sure. And so let's double click on this guys and dive a little bit deeper. The problem is clear.

: Double click on this. That's great man. Great. So I'm click and let's double click

: Well I got them using my three fingers wipe.

: I love it. I love it. How do we fix it. Right. There's no doubt it's a problem. How do we fix it.

: So I think there are multiple answers to this and I will start from the technology standpoint. And of course there is a lot more and probably more importantly on the legal side and I will let David talk about that. But there are multiple ways that we can help diabetic patients regain that kind of sensation right. That helps him or her understand what's going on right. As David said these problems sneak up on you. Right. So a small scratch under a foot could become a diabetic poodle's or a diabetic foot ulcer needs to be treated right. So after treatment what the doctor tells the patient to do when sorry if I'm super talking about in a very very plain terms about this but the patient needs to stay off his foot. So the cornerstone of healing of the diabetic with ulcer after treatment is what doctors call mechanical offloading right. But how do we ensure that a patient stays off his foot after surgery after the treatment of a diabetic foot ulcer. If the patient doesn't understand what staying off his foot stabilizer doesn't feel the pressure under his foot nervously. Right. So we're working with the other companies because it's not enough and isn't sufficient to just talk that's in Syria. And you see here that there are multiple companies that have a vested interest in helping the patients recover from that police officer. One example is optimal monitoring either the right they create specific footwear that has been proved to have the same level of efficacy of it all combat cast and these days people don't want to be put in a total contact cast. Right. The goal of that type of footwear is to ensure that the patient is offloading the area of previous ulceration. Right. But how do we know that the patient is wearing that piece of software which is called moodle smart. How do we know the level of activity of the patient. So we inject our textile sensors into that piece of footwear we connect a device that we call Centaurea core which is basically a Fitbit for a diabetic patients raggy provides us with the right activity monitoring of the patient. It also provides alerts to the patient. But more importantly it provides us he would provide us with the ability to understand whether the patient is wearing the device is now wearing the device and the level of pressure that the patient is putting on the area previous.

: Fascinating . If the patient can't feel get some sensors to report out where the pressure is.

: What you can't feel can kill you. I mean that's really that's the if you want to know the message and maybe we can replace we can't substitute for that sensation in other ways. And there there's a lot of really clever ideas that are happening. And look I'll give you the clinical in this but in terms of the you know the geek stuff to you not just what you know I mowed lawns to buy my first friggin Timex Sinclair 1000 in the set at a popular place. And ever since then I've been geeking around in amateur hour with gadgets up on my own. But it's great to be with professionals like Davide to give me a little something to strive for. But this idea of monitoring our pressure and temperature and other things on the foot is not new. The we saw one of my mentors Professor Paul brand who is a fascinating guy. You have a whole podcast on him. He was raised in India and he came to the United States to work. No kidding. With people with leprosy and people with leprosy have similar problems to deal with diabetes believe we can even say sometimes that some of these people with diabetic complications are like modern day lepers. But he used to work in the 70s and late 60s. He developed technology that actually was like a little device that went into the shoe that was connected by a little wire that ran up a leg. About clunky into the ear was like little AM radio thing went to the ear and buzz in someone's ear when they were putting too much pressure on the bottom of their feet. You want to talk about a form factor that didn't yet exist and so what happened. Well most steps you take are not hurting the person so this thing just kept bothering people drive him crazy. So they took it out of their ear yeah let it go. We took up this mantle in the late 80s and early 90s. We try to develop something that was similar but just buzzed on a chest and he was a little tacker that would do that to give people a message saying Hey Mr. Garcia There's a little too much pressure on your foot. That was great. The people still pour that thing off. They had to work with technologies that are now called wearables. But back then these were Analog Devices that with time stamp activity says no. And then then came one of the early adopter companies like sport brain and other stuff that would actually timestep activity. That then allowed us to dose activity like we chose a drug and that is a game changer. Now what we're doing in healthcare today and I know that wearables now are sort of passe but it's exciting to see this technology now weave its way into what we're doing in healthcare on a daily basis. And now the tech from Davide from Sensoria is super exciting because. We can literally measure of variety of things we can out like almost a little intensive care unit in a fabric so it doesn't have to just be a sock form factor or a fabric form factor to be any kind of interface. So this sort of thing is a fundamental game changer for people like me and people like us on our hands clinically who are trying to prevent the problem.

: Super interesting and quick thing here is for the listeners you've probably heard about these problems maybe haven't appreciated the magnitude of the issues of diabetic foot issues. Maybe you have somebody in your life or in your community or patients that you're seeing. And so this discussion is very meaningful. 30 million people in the U.S. with diabetes. That's almost 10 percent. So definitely interested in hearing your thoughts. Feel free to ping us and let us know what you're thinking about this topic. Do it underneath the show notes in LinkedIn or Twitter feeds that we share. Because I think one of the key things that Davide and David want to do is spread the word and get the conversations going. Davide you're about to chime in there.

: Yeah I was actually going to comment on what Professor Armstrong just highlighted right. So in the world the problem is even even more acute. So according to the CDC. Well over half a billion people will suffer from diabetes by 2030. And some people believe correct me if I'm wrong. Some people say that we are already there and some people say that there are really a lot more than half a billion people right. Some people talk about 640 million people suffering from diabetes in the world. Clay percent of all of these people will suffer from some level of diabetic food complications. Right. So it's a huge huge number. Right. So it's not at all wearable technology it's about injecting technology into whatever these people use and wear every day. Because we all wake up in the morning. Some of us take a shower but most of us end up wearing something great footwear socks shoes and other garments. So it's all about really nailing those garments not adding an additional piece of plastic to the waist of these patients which will help right. So we talk about you and me. It's UTI. It's the internet of me is biometric sensing data that comes with the human body that clinicians and researchers can help make sense of and improve our health. Well that is I think the next wave of computing we've got a transparent computing referred to it as you need. These are the T. And I think there is a fantastic opportunity for all of us to collect traditional data accounting as an example. Collect also novel novel datasets like pressure level under an right. We're not claiming that it's not possible to collect the data with the traditional wearable technology that is in the market right now but we can right we can do that. The huge advantage that we have compared to a few years ago is that we all walk around with this mark and we all walk around with a smartwatch. Many people will walk around with additional computing devices that will allow us to surface some of these datasets turned into actionable information turned into what we call wisdom. It's nuggets of wisdom for the specific needs that we have right for you. I suffer from diabetes. I will need specific wisdom nuggets for that. So that's the huge advantage that we have. Right. So we can collect novel data sets and for the first time ever we can use haptic feedback or we can also use the devices that people have that they carry around all day long to help them stay healthier and manage their condition in a more efficient way.

: Isn't that the most important thing. Saul and Davide it's it's making this stuff transparent and easier. And you know you see adoption of various kinds of technology and you wonder why something took off and something different. It's usually when something just hits. It just works and it works in the background and you don't have to think about it and that's where we are evolving now and it's about designs. And this is really an exciting time because we're starting to see consumer electronics and medical devices bill better and the beneficiary is both obviously I think there's opportunities on both of them. But we're starting to see now that we're starting to see medical devices that used to be. And by the way still are. Friggin ugly clunky hard to use start to go by the wayside and start to married with a little bit of good quality elegant industrial design and really just human factors elegance and that is what you're starting to see with this is just the last five years not even the last certainly not even the last decade. But by the way if you will let's step back and you were asking about why people should care about this and we talked about that at the outset. But here's some more data that I think probably would suffuse every single episode that you have in the podcast. And it's it's this it's that in the last decade in fact 2009 specifically that was the first year in the history of humanity. That more folks died of non-infectious diseases so-called non-communicable diseases or in CDs than from all plagues in the world combined. Now there are still way too many people dying from Ebola and Marburg on the horrible end and then even on a much larger malaria and dengue. And all these other horrible problems chikungunya. Pick your virus and pick your plague or your best to pestis in the past. But in 2009 a switch was flipped and while in the Arka time you know we may have horrible plagues from time to time but it's likely to go back. Now we're dealing not with disease but as one of really great thinker Steve Jones is kind of a science pundit. The UK used to say going from disease to decay and what we're really dealing with with these non-communicable diseases heart disease cancer diabetes is we are. And arthritis all these other things we're dealing with delaying decay and if you want to talk about the big idea it's not about solving everything it's not it's not about disobeying the UK. It's not by just acquiescing if you will or I guess you would say just say Okay okay that's not right. Maybe we can be a little we can triangulate past you things and we can delay and tech from people are Gavitt and others in this field are revolutionizing that because now we can monitor things that usually put people to sleep which is these quiet things that just sneak up on you before they land you in the hospital or in the intensive care unit or you die from as in this case your feet really can be killing.

: Yeah. And so around this topic Dr. Armstrong and Diabaté I'd love if you guys could add a tip for the listener or the health provider the company looking to address this problem. What should they do. What do you recommend that they think about in a different way to help them tackle this issue.

: Well in my opinion there is a fantastic opportunity to join forces between the clinical world and that technology will work great for the first time. We have incredible powerful tools that can allow us to stay healthy or longer. Right. Think about something that has nothing to do with diabetes which is or you know has very very loose correlation with it which is false. Right. One third of people age 65 and bombs fall each year in this country. The number one cause of fatally non-fatal injuries. Right. It shouldn't happen right. We should understand more about why people fall these moderate and not just the characterful dispatching and dispatching as we should have data what happens before I fall and be able to a analytics and efficient Derrida's models that at least help us reduce the number of falls. I don't think there is enough work and concentration and partnerships between the research and clinical world and the technology engineering world to solve this problem. Every time I talk to someone the best thing they can do as an aging baby boomer right is we are dependent device. We turn the focus group what people refer to those pendants as they refer to them as the death button because as them. Armstrong was talking about those medical devices are seen as a stigma. People don't want to hear them right. It's just that they forget about them. They don't forget about them. They don't want to be seen wearing. So it is not just a clinical problem it is an engineering problem as well and we need to join forces with the clinical community. And I wish we were there right. We were just the beginning of a journey here but we need more help and we need more people that care about smart aging and living longer. But the quality of life is as important as good as living longer and longer in a painful way. So I think there's so much to do in terms of partnerships. That will be a human right before humans and we all hope that we can actually deal to start building this this alliance right. This will become Internet of me alliance because I think we need it. I care more about my own data and what it can do to help me age more gracefully and healthier than my thermostat. Right. I mean yes I think that selfishly that's what we should be focus of it.

: What a great point. Dr. Armstrong.

: Yeah. So I look there are you know so much of this stuff is easy to talk about and it's hard to implement. But that's why there's so much hope now as we marry no good quality public health with sort of the assistance kind of like a tech Sherpa in a way. And that's why I've never been more excited about this this area. You know I can't tell you how many conversations I have had over the last generation. Now as I get older and lose even more hair. I can tell you. And by the way I did ball for a free and long time. So I'm like not on board. Not only that but but. But if.

: You're handsome old man you're a handsome man, you're a handsome man.

: You have very low standards there. You're great at it. No I just I don't know if you swipe left or right. I don't wish to do that. Just yeah. Well no but the bottom line is the bottom line is that what's really exciting now. Is that there is a great deal of hope in this area. So I just left the operating room where I came in here to report that with a patient that had been walking on for a few days. Great guy and a really smart guy but he just didn't know. And it was not his fault. No one poll getting the word out about this problem. This problem is the biggest problem that you've never heard of. I know a lot of people are carrying a torch for various kinds of diseases and you know in my area they believe and I you know we work we tend to work in a lot of different areas in medicine and technology and engineering. This problem is huge and it is getting bigger. But We now have the ability to not only treat people when they have a problem we have the ability to get out in front of it. So as an example now. We can use technology like you heard from from Davide but we also know that a wound will heat up before it breaks down. Now we can use thermometers to identify hotspots and we can look for asymmetries and see there. We've been doing a lot of work with that a lot of federal and not for profit funding over the last generation looking giving people thermometers so they can dose their activity by checking their skin temperature just like they does their insulin checking their glucose. There are now companies that have come out that have been doing this in this field through smart socks as you've already heard with Davida siren care. Another company that has a smart platform that you can step on like part of metrics that can literally scan a foot and say Mr. Garcia your big toe is hotter than your other big toe. You're about to ulcerate. Why don't you take it easy. And we're going to get you to see Chuck Jones on this unscheduled visit on Friday because we have access to his medical records at problems. And that solution I should say is merging now and it's really really exciting because in the past prevention hasn't paid and it's been the bane of my existence both in the operating room now in the clinic but now for the first time you've heard people talking about going from volume to value. Well God bless it because I feel like prevention starting to pay and this problem is biggest problem you never heard about. At the end of the body hopefully going to be one of the beneficiaries. And we're going to hopefully try to eliminate unnecessary imputations over the next generation.

: No super super thoughtful input there and listeners. I hope you took away some really great tidbits here from Dr. Armstrong and David Day on the magnitude of the problem. Some solutions that you could think through and also hopefully you're leaving with some connections that you didn't make before about how foot ulcers or foot problems can lead to false. Right. Something that's high on your list of things to avoid. Let's make these associations and so really want to thank these two gentlemen for joining us today. And what I'd love to do is just give you both an opportunity to give a closing thought and then the best place where the listeners can get a hold of you.

: The best place to get a hold of us is at sensoriahealth.com. Anyone that has an interest or a passion for what we do as Dr. Armstrong was saying the foot is the foundation of the human body. And that is to say that they humans were these a masterpiece of engineering work or so. It works fantastic and it works. There are so many moving parts in the foot. From an engineering perspective that when something breaks down it becomes a really big problem very very quickly right. So that is where you can find us if you have a passion for I mean you've got a passion for keeping people healthier get in touch with us info@sensoriahealth.com.

: Awesome. Thank you Davide. And Dr. Armstrong.

: Yeah look all I have to tell you is want one little tip that you can take away as a patient. You're going you happen to have diabetes. I know someone has diabetes and they come to your regular doctor is it just tell them to knock their socks off literally just take your shoes and socks off. When are you going to see the doctor or the nurse practitioner or the nurse and the battle for some. No problem. Not that that have a look at your feet because there's often not as much of a reason to look at them and sometimes they can spot a problem where they ever start. That's one little tip. It's FREE for you but for those and for all kinds of data next generation technology from what we talked about today to wearable robots to spray on skin. What you can go to our blog which is diabetic foot online.com where you can. Find me on Twitter at G.G. Armstrong. Obviously you can google us and find us at USC that you at the University of Southern California look here's to making a difference here is helping people move through the world a little better are a little leery of keeping a few more legs on a few more bodies. I think that's what we all are. We have diabetes or not. And Saul, thanks a million for doing this. You're terrific.

: Hey guys. Breashears You both. This has been an educational session. So a big thank you goes to you Dr. Armstrong as well as you David A big thanks for me as well as the listeners. Guys have a great rest of the day.

Takes for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.

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Best Way to Contact Them:

Davide Vigano - info@sensoriahealth.com

David Armstrong

Websites:

sensoriahealth.com

https://keck.usc.edu/

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How Today’s Leaders Can Better Understand Today’s Millenial Mindset in Healthcare with Emma Goodman, Director of Key Accounts and Webinars at Becker’s Healthcare

How Today's Leaders Can Better Understand Today's Millenial Mindset in Healthcare with Emma Goodman, Director of Key Accounts and Webinars at Becker's Healthcare

: [00:00:01] 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

Saul Marquez: [00:00:18] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because our guest is an outstanding person as well as a contributor to Health Care. Her name is Emma Goodman. She's the director of key accounts and webinars at Beckers health. She oversees two divisions with a passion and drive to create results and add value to both providers and health companies working with them. She loved delivering phenomenal customer service to their top clients which in turn helps them reach more people and improve outcomes. I really want to just welcome you to the podcast today because you're an up and coming leader in health and I know you're going to offer tons of value. Just want to give you a warm welcome to the podcast.

Emma Goodman: [00:01:15] Well thank you so much, Saul. I am so excited to be chatting with you today.

Saul Marquez: [00:01:20] It's my pleasure and the pleasure of our listeners. For sure. And so anything that I missed on your intro that maybe you want to fill in.

Emma Goodman: [00:01:28] Yeah. You know just give you a little bit more background on on. So we are a multimedia healthcare company and really the number one go to source where executives can learn news and business information in their industry in healthcare. So we what we aim to provide pearls of information that the busy execs can then take back to their hospital the surgery centers to make more informed business decision.

Saul Marquez: [00:01:56] It's a really really neat business and you guys definitely provides major content. I mean I I have you guys on my RSS feed. I definitely get a lot of stuff from you guys so keep pumping out the amazing content.

Emma Goodman: [00:02:08] Awesome. We absolutely will.

Saul Marquez: [00:02:11] So Emma out of all things you could have done. You decided to get into a health organization. Why did you decide to get into the medical sector.

Emma Goodman: [00:02:19] Yeah well that a really great question. When I started my career I really didn't know too much about the business side of health care and I was just really eager to learn and jump in. So I'll tell you a little bit about what has really stuck with me and why I continue to be in this space. So with almost four years in this space I really realized what a fascinating and ever changing industry to be a part of. And that to me has been really exciting. So what I'm constantly fascinated by is Chipo resilience that industry is it needs to be with the constant change that surrounds it. So I think that's really why it's been so exciting for me to you know be in the health care industry is just with the change and the resiliency of it all.

Saul Marquez: [00:03:07] I totally agree with that point. Absolutely.

Emma Goodman: [00:03:09] Yeah. And for myself the fact what I live every day is being able to work with just some of the coolest and most innovative companies that are out there. And so I am just enjoying constantly learning from the health care companies and the solutions and services that they provide. And really you know our collective goal is just to deliver better experiences for patients and to deliver better patient care. And so when I think about it in kind of the grand scheme of things I just think wow what a really cool mission to be a part of.

Saul Marquez: [00:03:42] Yeah it really is mind you guys are definitely doing some interesting things to improve outcomes. You work with a lot of companies many of them innovative and successful. What would you say just based off of your experience should be a hot topic on every medical leaders agenda.

Emma Goodman: [00:04:00] Yeah that's a great question and there are just a ton of interesting and important things that are going on right now in this space. Are you a legally editorial Keyvan just has the best pulse of what healthcare execs should be thinking about. But you know I'm really excited in several factors. It's just the growth of health I.T. and really no one's surprise we are just finding that that is just such a booming area. There are a vast majority there are a ton of fantastic health care companies are just providing really unique solutions in this area as well. So we're really excited about that. We are launching a six event that focuses on health I.T. and clinical leadership issues and trends and solutions in the industry. And we have just seen just tremendous growth in terms of attendees and our partners for our health safety and revenue cycle comprende which is in its fourth year. So I think that health I.T. is one area that we are just really really excited to dig even deeper and to grow kind of our readership and not base as well.

Saul Marquez: [00:05:05] Now I love I love the meetings AMA and listeners if you haven't had a chance to check out one of the Beckers meetings they are definitely worthwhile. And of course our lovely city of Chicago. So it's convenient for those of you in the Midwest but if you're not in the Midwest definitely worth coming out because some of the attendees are just the amongst Healthcares most influential and they also make the meetings really exciting and fun. When I was there last time I got to meet President George Bush for instance and so they definitely know how to keep it very entertaining. What would you say some advice for young in this field but you've also had some success very early on. Maybe you could share some advice to people starting their careers in this space. The millennial representation in our industry is growing. You know what words of wisdom would you share with them.

Emma Goodman: [00:05:59] You're right it is a really really interesting time because millennials and I am proudly I'll probably consider myself. We are just now really the largest part of the workforce. So you know whether you're entering your career as a millennial or you're an executive trying to better understand this generation. There are a couple key things that you know I'd love to share with your listeners also. The first is that what I've noticed about my peers is that we really care about the opportunity to have a mentor or a coach really in order to move quickly up in an organization and that's something that I've noticed that really characterizes this generation is the importance of career advancement and having the opportunity to have a mentor or coach to help get them there. The second which I think is just so fascinating is the importance of a good work culture. When I had the opportunity to interview people who are who are interested in joining our team and I asked them what's the one thing that you were looking for you know in a career after graduation they always say to me I'm really looking for great work culture. So a company that cares about its employees and the community and will almost build a sense of family is crucial crucial to this generation and something that organizations that health care and even other industries actually need to pay attention to in the recruiting process if they want to hire the best and brightest people you know right out of school or any young leader. And then I have a few pieces of advice for you know young adults starting their career that I've picked up from my experience and just my fantastic team here beckers. So I say the first is have a good attitude and be flexible. It is really warming to know how are having a good attitude it can get you. And you know when I look for people to join my team I always look for someone who is positive and open minded to training projects and opportunities and really you know what they're saying when they have this attitude and outlook is I'm here to do great work for my company. I'm not just here to do great work for me.

Saul Marquez: [00:08:13] I think that's a good call out.

Emma Goodman: [00:08:15] Yeah. And yeah. And then this next point I think is really something that we look for for folks joining health beckers that is to say yes and then figure it out. We call that bio for figure it out here. And when will we. Yeah yeah. So wouldn't we. FIO Exactly. It is a known afternoon here at Beckers. So we all aims to follow every day that you know about it. If you have that one on your team who says yes I can tackle this and then figure that out. How valuable does that person become. And then I have two other quick things that I think are just really really important pieces of advice that I would share. The next is absolutely bad for that. Be back again. And then you have to listen to it and embrace that. So you know the question that I love to ask the people that my bosses and then for the people that I oversee is what you need from me and what is going rate that you like to see more of. And once you get those answers you've got to ask them again the next quarter the next time you sit down for a one on one meeting to constantly be evolving and then you have to make sure it's not something that you're checking off your to do list but you're listening and you're embracing it and you're making changes and then the last one is something that I've picked up with me as I've gone through the beginning stages of my career and it's really you cannot expect to be great if you're not willing to put in the extra hours. And it seems really simple buy if you believe that the work day and that I have you are just not going to be the most successful you that you can be. So I use prep time on Sundays so I can hit the ground running on Monday and it just makes a tremendous difference.

Saul Marquez: [00:10:01] Some really great words of advice and listeners take a note from Emma's words of wisdom here and kind of reminds me of the Kennedy ism where he said Ask not what you could do for your country. Ask not what your country can do for you. Ask you could do for your country. I think the same thing applies for careers and healthcare. That's not what you could do for your. I completely butchered it. But you guys know what I mean.

Emma Goodman: [00:10:28] Exactly. Exactly. You cannot expect for your company to be doing things for you. You have to be doing things for your company in order to be successful.

Saul Marquez: [00:10:37] Well said Emma you said it best.

Emma Goodman: [00:10:40] It's teamwork you set me up

Saul Marquez: [00:10:44] I love it.

Saul Marquez: [00:10:45] So Emma what would you say one of your proudest medical leadership experiences to date is.

Emma Goodman: [00:10:50] Yes. So when we talk about kind of what questions we'd be talking about today this one made me think a little bit. And I was really really excited when I came up with OK what was I going to talk to you about today. So I would have to say that my proudest moment here Becker's is just the growth of our web and our product line here every year. So our webinars are meant to be educational opportunities where healthcare leaders can log in and learn from other thought leaders in the industry about how they're solving certain issues and problems and you know what's going on and how are they going to tackle that. So I would say that you know being the success that our clients have seen in giving their thought leaders the opportunity to speak some of their clients the opportunities to present to their peers and really the most important topics and problems that we face through our beckers platform has just been so exciting to me. Last year we executed nearly 100 web in our campaign. When I think about. Yeah. You know it's been really really exciting busy but exciting awesome. And when I think about how that created such a great space for constant and further education within our industry I just feel really proud to lead that charge here at Bakkers and I think that here at Bakker's we are just excited to be a leader in the industry on this front. The education and constant learning from our peers.

Saul Marquez: [00:12:16] Yeah that's pretty amazing. A hundred webinars and 365 days you guys are cranking it over there.

Emma Goodman: [00:12:23] We are. And you know it's all thanks to and because I get to work with these wonderful folks each and every day. But it really is all thanks to our fantastic fantastic partners who really provided a thought leader to be able to speak to some of these issues and we just are so excited to be able to partner with them to provide the education opportunities.

Saul Marquez: [00:12:43] That is so cool. And kudos to you and your leadership there for making this happen. Tell us a little bit more about an exciting project or focus that you're working on today.

Emma Goodman: [00:12:53] Yeah absolutely so as I mentioned earlier we are very very excited to be launching our next conference and our newest event will take place this May in Chicago. Like you said I'm we're both a little bit biased that need the greatest city in the world yet picking that May in Chicago and it's focus on the intersection between health I.T. and political leadership. So as we look to develop this of that we really got an understanding from our readers and from the fantastic leadership of our publisher Scott Becker in the proposal that hey this is an area that a lot of potential to dive into and so our agenda is packed. We've had a hundred and 112 hospital health and speakers know presenting at the conference and some of the topics that will be discussed. Artificial Intelligence tele health data analytics clinician burnout World Population Health System really really important topics that we're going to be discussing at this art or new exhibition and not really overall we are just very excited about the growth of our conferences as well. So happy that you were able to come for the annual meeting last year and we really strive to provide destination advance for healthcare executives to learn and take back information to their ability to make great decisions. We want to provide a space where folks can network with their peers and others in the industry. And like you said we love to have a little bit of fun at our conferences too. So our vision and a part of our strategy in the year ahead is really has a world class franchise healthcare event and we are excited just to see that continue to grow with our success of that here.

Saul Marquez: [00:14:33] Well congratulations on the launch of that than just with experience having on the previous meetings that you guys hold and to the listeners I would also encourage you to also just hang out in the hallways and the coffee breaks and because some of the best conversations that I've had have been after one of the breakout sessions where you talked to another fellow leader in health and maybe make a synergy happen or a connection that could potentially help you improve outcomes in your organization. So Emma let's pretend you and I are building a medical leadership course on what it takes to be successful in the business of health today. It's Emma's 101 on health business success. So I'd like to write out the syllabus with you with getting some brief answers to this lightning round four questions followed by a book in a podcast that you recommend to our listeners are you ready.

Emma Goodman: [00:15:25] I'm ready.

Saul Marquez: [00:15:26] Awesome. What is the best way to improve outcomes for a growing team.

Emma Goodman: [00:15:31] I think the best way to improve outcomes for a growing team is by giving your team ownership of projects and half and then holding them accountable. Plus you have to provide constant feedback along the way.

Saul Marquez: [00:15:44] What is the biggest mistake or pitfall to avoid.

Emma Goodman: [00:15:47] This is a good one not asking enough questions to your key clients or partners that leads to making assumptions. You don't have a great understanding of their goals and their needs. And just can lead to a whole mess of things. So not asking a question.

Saul Marquez: [00:16:02] I love it. How do you stay relevant as an organization Emma. Despite constant change.

Emma Goodman: [00:16:08] We listen to our readers and we adapt. So we grow our business to affect the industry and we must stay nimble.

Saul Marquez: [00:16:17] Beautiful. What's one area of focus that drives all else in your health organization.

Emma Goodman: [00:16:22] So I think I may be a little bit biased. This is my everyday buy. I believe that it is outstanding client and customer service beautiful and Emma.

Saul Marquez: [00:16:32] What is your all time favorite book and podcasts you recommend to our listeners.

Emma Goodman: [00:16:37] Yes I will talk about a podcast that I'm loving which is how I built this podcast from NPR. For anyone who has an entrepreneurial spirit this is such a great podcast and is perfect for your work. They interview really really great leader and entrepreneur like Mark Cuban. My favorites were the founders of AirBnB and Ben and Jerry from Ben and Jerry's ice cream of course. But listen to their story how they built their brand and their wildly successful companies. It's just fascinating interesting and above all else just inspirational.

Saul Marquez: [00:17:16] Very cool. Definitely have to check that one out and what book would you recommend Emma.

Emma Goodman: [00:17:20] You know it's a great question. Right now I am reading super boxes and I've just started to get into it but I am just trying to open any book that I can get to help further develop my leadership skills. You're a backer so I'll have to keep you posted on this one so that it's turning out to be a great one.

Saul Marquez: [00:17:42] Awesome thank you for that. And listeners don't worry about writing any of this down. Just go to outcomesrocket.health/Emma E M M A. You're going to get all the show notes as well as the syllabus with the book and podcasts. She just recommended and you're going to be set for improving health outcomes. So before we conclude I just want to ask that you share a closing thought with the listeners and then the best place where they can get in touch with you.

Emma Goodman: [00:18:09] I will absolutely, Saul. Thank you so much for having me today on your podcast. I love sharing more information with you about Beckers. I think that my closing thought would be at the end of the day. We in health care are all here to really make the patient experience great. So in whatever area of healthcare you are in having that in mind just as a constant Reiber has helped keep me grounded and really really charge forward as we enter their future together. So again thank you so much you can reach me on linkedin. I'm a good man. Then or feel free to email me at egoodman@beckershealthcare.com outstanding.

Saul Marquez: [00:18:50] There listeners again. You could get all the contact info as well as links to Beckers and all the things that Emma shared with us. Just go to outcomesrocket.health/Emma. Just want to say thank you so much for being with us. It was fun and I'm looking forward to staying in touch.

Emma Goodman: [00:19:07] Yeah thank you so much.

: [00:19:12] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

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How I Built This

Best Way to Contact Emma:

egoodman@beckershealthcare.com

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