Addressing the Challenge of Mental and Behavioral Health in The U.S. with Christiana DelloRusso, Partner at Providence Ventures
Welcome to the outcomes Rockit 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 want to welcome you to go to outcomesrockethealth/reviews to rate and review our podcast today because we have an amazing guest. Her name is Christiana DelloRusso. She's partner at Providence Ventures, Board Member of N-of-One, Board Observer at Omada health, has a really broad and deep appreciation and influence in the health digital space and I've just feel so lucky to be able to have her here on the podcast with us today. So what I want to do is welcome you Christiana to the podcast and then let you fill in the gaps of that introduction. Welcome.
: Thank you. Thank you. I'm really thrilled to be here. So thanks for having me. The only thing I'll call out is that Providence Ventures is a strategic venture fund in essentially the strategic venture arm of Providence St. Joseph Health which is a large, complex, integrated health system on the west coast and one thing I always like to draw people's attention to is that where a Catholic nonprofit. But if you think about the founding story of Providence St. Joseph hoealth. I joined in 2014 we were still Providence Health and Services. We've since merged with St. Joseph health, hence the new name, but the founding story is fascinating and so inspiring in that this now 23 billion dollar health system with what in seven states was actually started by five nuns.
: Who came out of the US from Montreal on horseback in the mid eighteen hundred.
: And they pacifically came out to this region to care for the poor and serve indigenous and pioneer communities that were settling out here. They had no money. They had very few resources and they just, they came. They answered a call and they persevered through these unimaginable challenges. If you think about it they were the ultimate scrappy startup and five women to boot
: I love it.
: And you know we're still here today. Over 160 years later so I love this story. I think it's so incredibly inspiring when we when we look at healthcare today we're like, oh gosh it's such a mess. There's overwhelming challenges that are so complex and you just think back to those women who you know again on horses with nothing like OK we're going to open a hospital. I love that story and I just I wanted to relay it and honor the bigger and broader organization that I work for.
: I'm so glad that you did Christiana because it is really an inspiring story and it just a testament to you gotta give a go giver, not a go getter. And these nuns did it and now they've led the way we're standing on their shoulders. What got you interested in health care, Christiana?
: So I mean my my past into being really inside of healthcare has been somewhat circuitous and pretty opportunistic and I actually started out as an academic research scientist who I was I was at the bench. I was working with the DNA, and cells and protein and animal models of disease like cancer and muscular dystrophy. And even though I was working on treatments for these diseases in the lab, a constant nag of myself was that my work was really far from the patient. And you know we always wrote at the end of every publication and everything you put into a journal at the very end that this research will contribute to a cure for this disease. And I was very impatient. I still am. I had a hard time believing it myself and I really just felt so far away from the patients who were actually suffering from that disease. At the same time in academic research you really have to focus on particular problem or one particular area to be successful because it takes complete and total attention and passion for that problem and while I really enjoy going deep in particular areas and learning as much as I can about an area I really at the same time liked learning about a lot of new things and kind of pulling my head up from the hole in the ground and looking around. Yeah, there's stuff over there and there's stuff over there. Little like a square where it's like oh, there's a new idea and there's a new idea. And so at the same time as I was feeling far away from the patient and continuing to learn new things and go into new areas of research I also felt like I couldn't really commit to that type of a career from my lifetime. And so I figured out how to kind of navigate out of academic research which isn't easy because you're not really taught how to do that when you're doing graduate work or postgraduate work. And so I navigate and I worked in a number of different companies in a number of different startups in biotech in Medtech, really supporting them on some grant program. I was essentially learning about the business side of science and that was really really fascinating. And what I also learned while I was doing that was I thought I was far away from the patient I really had no idea how long it takes to get something from the lab to something that's an actual treatment. So that was very, very eye opening for me. It also opened my eyes to the possibilities. There are so many possibilities out there in terms of different careers. And so I did that more and more and learned a lot. And when the opportunity came to get inside of a health care organization I figured you know this is probably one of the closest places I could get to being closer to the patients so I couldn't really refuse that opportunity.
: That's awesome. Thanks for sharing your story. The epiphanies that you had along the way and now going on four years here with Providence after all this time you know from the bench to the company to the provider what would you say today Christianna is a hot topic that every health leader needs to be focused on?
: Yeah I say you know there are so many and a lot of your guests have brought up so many. I would say one that I in particular have a specific interest in that I think is just it's a massive societal problem that we all should be thinking about as citizens of this country and this world is mental illness and behavioral health. It is a huge massive complex challenge and it really is different from the challenges of physical health. You know you break a leg. You go in and you get it fixed and you're out. Mental behavioral health issues - they're just much more challenging the reason why they're challenging. They're not easily solved whether it be not enough providers who can help these folks. Not enough providers who will take insurance who take cash payment. Fair enough. They're quite happy doing that. Their schedules are full. Why take reimbursement when it's a pain in the neck to lots of forms and everything to this that follows behavioral health that keeps people from getting help. To the fact that it's a disease that sometimes you don't even know what you're feeling and what you're believing is actually a disease or something that is biological versus something that you're causing. We just don't understand the brain frankly that well right now we're learning a lot every single day. But it's such such a complex problem. And I think you know we have an investment in Lira health which is a company in the Bay Area that's doing great things and really trying to serve up a ten times better employee assistance program. So that's a way for people to potentially get better behavior health and as an organization where we've launched the well-being trust which is a separate non-profit focused on community groups and organizations that really deliver a lot of these services out in the communities. And I think one thing health care leaders need to figure out and we're doing this as well as seniors who are the partners we need to engage with because hospitals are probably not the best place to deliver care for the mentally ill but who can and how do we better connect with them and how do we support each other moving forward I think some of the biggest challenges we're facing in society.
: Yeah Christiana I think you're bringing up a really great topic and one that I think is like you said oftentimes either avoided or just stigmatize and definitely a space that we need to be spending more time in I mean from your perspective what can be done. I mean what is the future if we do it right, look like in five to 10 years?
: Yeeah I think you know we'll try to figure out a think of the one of the biggest challenges specially for start up companies is really figuring out the business model of who's going to pay for this type of care and what are the right economics to make this work. It's just a really really vexing and challenging problem I think that we know. We also know a lot about good, evidence based care. It's just really hard to deliver with the right economics that makes sense for folks so I think again much like bigger, broader health care figuring out where the stakeholders should be aligned what's going to motivate people to provide better care and how do we support the families and the friends of people out in the community who are suffering because so much can be done by people that we know. But we need to support them as well not just the patient because it really is the community effort. So that's also an area focus. And it's not, I think we also have to accept that technology will definitely add so much and help a lot but it's not the magic bullet we really have to figure out how to leverage technology to empower the humans to help us solve this problem.
: That's such a great call out, Christiana. And you know when we look at this so many times entrepreneur wars or large companies will try to just throw technology on top of a broken process or on top of broken system and it just doesn't work. That's right.
: So what would you say right now you guys are doing that has improved outcomes. Maybe a company that you guys have partnered with or a project that you guys have started there at Providence Ventures.
: First I'll talk high level first about our approach, which I think is unique in healthcare venture. I mean we're not we're not new in healthcare venture that we're not the first. There's a lot of organizations out there that do this and there's different models for how it's done. And I would say you know our real goal as a venture is to invest in companies with whom we're going to be really close partners with. And the idea behind that is that we can invest the capital. But look if you look at there's a lot of capital out there which maybe isn't a good thing right now for the environment. There's there's an awful lot out there and you know we also have incredible scale. We have amazing assets to bring to bear as a just that massive health care organization that has footprint again across much of the Western United State. We have a ton of experts within our system and we really have a lot that we can add and to help a company be successful. So really what will try to do is both but we also need to drive returns to know that we don't want to forget that. So what we do is not we are a strategic venture fund but I would say that we are not a pure strategic fund and the three things that we do to try to check the box before we make an investment are: number one, we really try to look at the business as a stand alone entity and say you know if we are a financial investor would this be a smart bet. Can the company on its own show us that it's really a venture class business and it's something that we would invest in whether we have that resources or not. Second is what problem is that companies solving that helps us as a big health system is it one of our you know big hairy audacious problems that we have as a health system or is it kind of more in a smaller area or a nation and not that that's bad it's just something that you know with the scale that we have. We want to go solve the problems together.
: So we look specifically at what the company is doing and what it intends to do and how that's going to help us and what's the impact on us as a health system. And then third is what's the strategic value we can add to that company with the assets that we have which might be helping to risk a product in the earlier stages it might be testing out that platform and proving that there's real ROI behind it and it might be that you know if it's in one of our regions or one of our hospitals and we're really really excited and compelled by it how do we bring it to the rest of the system which is not is easy if you think that you might be in one hospital in a big system and it's just going to easily scale and deploy across the rest of the system and that is not true. So you know we really try to help those companies scale and so we're really looking for that win win win and the you know the theory is that if we're able to help the company the risk can get better and really make sure that its product is really fulfilling the needs of health care. You know we're not fully capacitated a system, we're a messy complex idea which is pretty reflective of the rest of healthcare across the country. And we also believe that most of health care is still delivered regionally so we want these companies to go out and sell the other houses straight. We don't want them we don't want to hold them close in our own. So we want to make sure they're scaling not just within Providence but across the rest of the healthcare ecosystem. So if we can line up those three things and it is not easy to do. But that's a lot of what we try to do during diligence so that when we do make an investment we are ready we say okay we've got our internal champions we got folks who you know said they were excited about this and compelled and they're actually going to put their heads and do some work on it. We figure that that's the right thing to do to make these investments work and actually return funds back to the system.
: Thank you so much for walking us through that process, Christiana. Can you share of a more recent company and one of the things that you guys are doing with them?
: Yeah I would say you know a couple of great examples one that we invest in a couple of years ago but that has been on the radar for a long time as Omada health. So they are a company and interestingly how they came to us was through our H.R. department. So they serve employers and health plans and they're really a digital therapeutic company that is all about prevention of chronic disease. And so they've digitized clinically proven programs that will hopefully prevent people from getting things like diabetes or obesity related chronic disease. And so they came to us in to our H.R. department that was really interested in finding something better for its employees. I mean health care employees actually largely are are sometimes in a worst case in terms of rates of for diabetes and obesity related chronic disease though actually piloted with Omada for about a year. And we as a venture team was it was early in our formation and we were able to kind of watch that relationship and watch the company get to know the management team and the timing was just great in that by the time we completed the pilot the HR team was really excited about finding a bigger deal and scaling it out to the rest of its employees and the company was raising it seriously. And so we made an investment. We came in alongside Norwest and some other strategics and you know overall it's the program's been delivered to almost 5000 of our employees who have collectively lost almost thirty five thousand pounds over three years and reduce their risk of diabetes by almost 40 percent. So they're doing great things. And you know sometimes we we always think about our patients but we don't want to forget about the people who are delivering care and their health and well-being is just as important as our patients because for them to be as healthy as they can and happy as they can in doing their work it's only going to make for a better health system overall.
Yeah, what a powerful example and actually Kristanna we had Lucía Savage from Omada on the podcast. She told us a lot about what they're up to and I think it's super cool to hear that you guys were involved with them early on.
: Yes. No they're great we really really enjoy working with them and they're doing really really important work. And I will tell you that you know nobody will ever say that prevention is easy. It is very very challenging. So they are tackling just a huge massive problem in society.
: Now that's for sure. Thank you for sharing that. And so you've been through a lot. Christianna folks Cristián is modest she's got her Ph.D. in Physiology. She's a brain in molecular and Cellular Biology. She's done a lot of really cool things you don't get there without hitting any roadblocks, Christiana so maybe I love to hear you could just share with the listeners a setback or failure that you had and what you learned from it?
: Yeah sure. So I go back actually to my graduate work and publishing your work is the most important thing in academic science. And so the culmination of my thesis work I was working on a gene therapy for Duchenne muscular dystrophy and this work was in my ear in mouse models and we had done some studies in older mice really trying to show that you could take older my suit already had muscle deterioration and go backwards and actually improve muscle function. So we did some studies. And you have a certain number of mice did a controlled environment and you know we did show some positive results and we got the papers accepted the DNA after the proceedings of the National Academies and it was all very exciting and the title of the paper was reversal of muscular dystrophy and MDX mice and as a graduate student you know you're ending you're getting close to actually earning that Ph.D. and then the article came out and the press got a hold of it which is not surprising. And I was working in the lab and the phone started ringing and the people who were calling me were parents of kids with muscular dystrophy.
: Oh my gosh.
: And I had no answers and I was kind of floored. And I thought wow wow. Like these people are holding out for anything and this is what really again kind of hit home and reminded me that what I'm doing is it's important. It's critically important what Donna's needs research labs but it's so far. And I have to tell them that. And so that is really incredibly eye opening and was hard because it happened at least five times that day. And so it reminded me I think you know it's just the huge learning is no matter what you're doing don't forget the patient from the other end. Right. I mean it's always always always have to think about that and be prepared for that because those are the people who really are in need and are going to be looking for answers.
: What a great story and a great message. Christiana how about the other side of the coin. You know that's one of the tough times. How about one of your proudest medical leadership experiences to date.
: Yeah you know I... in medical leadership. But again it goes back to just stuff that it is it's more simple but it has really, really long impact and especially when we talk about things like prevention. So you know one of the things in my bio is that I started and ran and sold a women's health business. And so what that actually was was a franchise business for new moms with their babies in strollers come into exercise class. And I did this while I was a postdoc at Children's Hospital in Boston and ran this side business and really this is out of necessity for my own sanity. I'd always been an athlete and I thought I had two very young girls and I thought how in the heck am I going to exercise. So this was a way for me to bring them with me. That's awesome. And so I ran these exercise classes for the new moms and they came together and one day we were outside and it was just a really neat day. And at the end of the class all the kids get out in there runs around and you see kids and they start doing push ups and sit up right next to Mom. And it just hit me that you know this is generational impact right? These are kids really looking up to their moms and saying hey we're in a group we have friends with us. You know we're doing something active. And this is important to mom, she needs this and it's fine right. And you know it just it really really hit me that I can be here and doing deals worth millions and millions of dollars. And that's important but you know I always go back to those moments of thinking I'm never going to be able to measure that in terms of our lives or dollars saved with those families down the road. I have to believe that that it really does have a lasting impact.
: Now that's another great example, Christiana. And I just kind of pictured those kids next to their moms and here you are you know in the middle of a Ph.D. program and meeting to find a way to just work out.
: So yeah, it's necessity.
: And I love that you did what you did because you know you not only did it for yourself but you identified that this is something that other women struggled with and you put something together. And I love the words that used generational impact with the kids doing push up next to their moms jumping jacks and what a great way to impact health.
: Yeah it was really really fun. I'll never forget that it was so different from what I would normally do and I have to call other franchis is called Stirling's tried sitting come up with the idea but it was a great opportunity because went into a franchise you know the marketing and everything is easy so the business side of it was actually fairly easy and running classes had been easy to me given my background coaching but it just, it really does have lasting lasting impact they think in and you know for women at a time when it's it can be very very isolating and really difficult. And so you know I would say that that group was not only working out and helping their health but they were getting advice from each other and supporting each other. And it was just an incredible resource for women in this place.
: I love it. And listeners you know take this example but don't just stop at Cristiána's example. Think beyond and the basic principle here is that just when you think you're alone with the challenge that you have at hand, look beyond and start a group, start a community because what'll happen is you'll find that there are a lot of people with the same challenge and you create an opportunity to form a community like Christiana did.
: Christiana tell us a little bit about an exciting project or focus that you're working on today.
: Yeah I say you know I come back to the work that Providence is doing in mental and behavioral health. There's a lot of effort internally focused on providing infrastructure for providers to share best practices to learn from each other because they think in a huge health system like ours it's probably no surprise that there's many many pockets of beryllium and to share those in scale those is really hard. You're talking about a population that's incredibly hard to reach and incredibly challenging to work with and see more positive outcomes. So being a part of this internal effort and really really trying to help folks figure out you know what are their biggest need. And then what are the technologies that will enable them to do a better job here. So I would say I'm watching this effort and I'm sitting right next to it and in it and I'm learning so much about this. And that's what I think I love about this job as well is that you know when you're making investments you'll often be calling folks and trying to do deals and figure out is Is it real is it really a problem but to be within the health system and just have this kind of access to the real challenges that people are trying to solve right now. It's incredible learning. And so to be able to be learning real time how people are trying to solve this problem and then to be proactively able to say, OK well if there's a technology or solution out there in the market that we can bring to bear that can actually help solve that problem then we can be a great partner to folks within the health system. So I'm just I'm really excited about the learning because it just never stop especially in this space where there are such big challenges.
: That's brilliant. Let's pretend a Christiana you and I are building a medical leadership course on what it takes to be successful in medicine. It's the 101 of Christiana DelloRusso. So we're going to build a syllabus with a four question lightning round followed by a book and a podcast that you recommend to the listeners. You ready?
: All right. What's the best way to improve health outcomes?
: Dig deeper with intention to address the cause not just the symptoms. I'd say it's another way of saying look for the social determinants of disease.
: Beautifully said. What is the biggest mistake or pitfall to avoid?
: Not listening.
: I love how short that was too.
: You said it was lightning.
: I love it. That was beautiful.
: Lightning round okay.
: How do you stay relevant as a health organization despite constant change?
: To getting outside of our box and continuously learning.
: What is one area of focus should drive everything in a health organization?
: Do excellent work.
: And what would you say. Christianna is your favorite book and a podcast that you recommend to the listeners.
: Let's see, favorite book. I would say I don't these days. I'm a morning person and so any attempt to read anything at night. I usually get two or three sentences so I can't say that I have read anything of depth any time recently but one that I continues to remind me of some of the most important stuff in life is Atul Gawande's Being mortal. I think everyone in health care should read it. Everyone side of health care should read it because if you talk about where we spend most of our healthcare dollars towards the end of life and the satisfaction of people at the end of life which is not very high I would say that is an outcome that individuals and families have the power to really change just by having some difficult conversation. Now I say that like it's easy right just by having..
: That's all you gotta do.
: But I think his book is so moving and personal it really helps to kind of kick off. What could those conversations be about. And it's just done. It's done so well and it's beautifully written and I still think about it all the time. So I think that people should definitely do that.
: A great recommendation. And how about the podcast.
: I really like Kara Swisher's podcast. What's the name of it. Recode is I think it's recode decode. I just love how she doesn't care. She just asks really hard, important questions.
: That's awesome.
: And so I think she does a fantastic job, she's super entertaining and she really just you know she she gets the truth out there which I think is important.
: And what does she focus on. What would you say the show is mainly focused on?
: Yeah I'd say a lot of you know big tech, high tech Silicon Valley but she's had a couple of really great influential female VCs who've talked about some of the issues facing the venture industry and the treatment of women. And so she's really gone deep with a few folks there that I have found to be very very helpful and inspiring and needed at this time.
: Beautiful. Listeners, take this syllabus learn from and practice it put it into action. You could find everything on outcomesrocket.health/Christiana and you'll be able to get all the show notes as well as links to the books and podcasts and everything else that she mentioned here on our podcast. So Christiana, before we conclude, I'd love if you could just share a closing thought as well as the best place where the listeners could get a hold of you or follow you.
: Yeah sure. So I would say my closing thought again I come back to this big massive complex messy health system that I work in and I'm so fortunate and grateful and humbled every day by the people in our system who delivered direct patient care. So they're out on the hospital floor as they're in the clinics. There are skilled nursing facilities and just they have so many amazing stories. And again this is what brings me closer to the patient and reminds me that everything that I diesel will hopefully, ultimately, positively impact those people and I think healthcare to a great extent. Technology has done in its interim form and we know it takes many many years but especially in healthcare technology has done a great disservice to these folks given its legacy infrastructure and its the lack of ability to change and upgrade and it's largely in some places taking the humanity out of health care. And what I'm hoping for is that we can really technology can be such a great enabler and if we can by investing in companies and helping them be successful if we can leverage technology and create this beautiful irony of putting the human back into health care and restoring the humanity to it. That's what I think is ultimately what we're trying to accomplish.
: Awesome. And what would you say the best place the listeners could get ahold of you is?
: You know our Web site is providenceventures.org We have our portfolio my contact info is on there but that helps give a little bit more background about the fund and what we're doing.
: Outstanding. Christiana, this has been awesome. Really appreciate all the words of wisdom and ideas that you've shared and also the amazing storytelling that you do so it always makes for a very dynamic episode. A big thanks to you and we look forward to staying in touch.
: Thank you, Saul. I really appreciate you having me on. And it's a great thing that you're doing so thanks for what you do.
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