Reducing Misdiagnosis in Radiology and Beyond
Episode 491

Ron Vianu, Founder and CEO at Covera Health

Reducing Misdiagnosis in Radiology and Beyond

Pioneering analytics-based programs to reduce medical misdiagnosis

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Reducing Misdiagnosis in Radiology and Beyond

Episode 491

Recommended Book:

Zen and the Art of Motorcycle Maintenance

Best Way to Contact Ron:

LinkedIn

Company Website:

Covera Health

Reducing Misdiagnosis in Radiology and Beyond with Ron Vianu, Founder and CEO at Covera Health transcript powered by Sonix—the best automated transcription service in 2020. Easily convert your audio to text with Sonix.

Reducing Misdiagnosis in Radiology and Beyond with Ron Vianu, Founder and CEO at Covera Health was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text. Our automated transcription algorithms works with many of the popular audio file formats.

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

Saul Marquez:
Welcome back to the podcast. Today, I have the privilege of hosting Ron Vianu. He’s a serial entrepreneur and problem solver by nature. Currently, he’s the CEO of Covera Health, a leading clinical analytics company, pioneering quality based solutions for payors and providers that enable the measurement and delivery of high quality care. The company builds programs for employers, health plans and strategic partners to reduce missed diagnoses, improve patient outcomes and reduce medical costs. Covera Health’s first solution is its innovative Radiology Centers of Excellence program, and it operates in all 50 states. This problem of of misdiagnosis is this huge and accounts for for the waste that much of our health care dollars really go down the drain for us. So it’s a privilege to host Ron, hear his thoughts on what they’re doing to make things better, to improve outcomes and reduce waste and dive into some of his thoughts and health care and entrepreneurship. So, Ron, so grateful that you’re able to join us today.

Ron Vianu:
Glad to be here. Thank you for having me.

Saul Marquez:
Yes, sir. So tell us a little bit about what inspires your work in health care.

Ron Vianu:
So my background really goes back to when I was in college, I was a pre-med student at NYU with visions of being a pediatric neurologist. And what I ultimately discovered in my studies in college is that I was really looking to solve problems more than anything else. And I didn’t feel that that’s something I would be doing as a clinician, although that turned out to be an incorrect belief at the time. But that really led me down a path of becoming an entrepreneur, building businesses, selling businesses and really trying to solve problems around those businesses. Ultimately, through those efforts, I found myself fixing problems in health care. Initially, those problems were more focused on transactional efficiency issues, on price transparency concerns. Eventually that all led me to really thinking about quality and to what we’re doing and what the market generally is doing about understanding quality and healthcare, which I think is one of the most important things that one can tackle within the healthcare ecosystem. And so for me, being able to be in an environment where which is where we are today, where we’re tackling in our estimation, one of the most important problems in healthcare, which is understanding physician quality and how that impacts patient outcomes. From my perspective, being able to work on that day in and day out is incredibly rewarding.

Saul Marquez:
Well, you zoomed in in a way that really helped you tackle that that impact that you were looking for on a larger scale. So kudos to you for gravitating toward that. And quality is key. So I think this is a great opportunity for you to share with the listeners what exactly Covera Health does and in particular, how you’re adding value to the health care ecosystem.

Saul Marquez:
Sure. And it might be worthwhile to mention that there are tons of folks working on quality and health care in a variety of different ways. There are folks that are thinking about hospital ratings. There are folks that are thinking about orthopedic surgeons and what are their revision rates and to what extent is that in for a quality about that surgeons. So on and so forth. And so it’s important for us when we think about quality in the market that we’re in to be able to define that very clearly. And so for us, as we think about quality and tackling in the market, we very much think about whether or not a physician is arriving at the right diagnosis for a patient. Because if a patient receives the wrong diagnosis or a misdiagnosis, if you will, then all care subsequent to that often is misguided, ineffective, certainly not cost effective, can harm the patient and most importantly, ultimately may leave that patient down a path where they don’t experience a good outcome. And so where we see ourselves within the healthcare ecosystem today is starting within the world of radiology, which many of your listeners may not know is not a commodity. And by that I mean there are lots of folks who look at radiology and feel wherever you get your MRI or C.T. or whatever the study may be, mammogram, chest x ray. It doesn’t differ from a output perspective. Which center on which provider at that center you’re visiting? Well, years of research has shown us that the variability within radiology is not dissimilar, if not greater, to the variability that exists within other medical disciplines. The difference is that within radiology, it has to be understood as a supporting specialty for all other medical specialties. And so if you think about a patient in their care journey being misdiagnosed at this very pivotal early juncture, when they’re getting this diagnostic procedure, it’s potentially going to impact them months, years or the rest of their lives as it relates to the potential for them receiving a good outcome. And so the way ultimately we’re looking to impact that system is by both enabling patients to understand which providers will be best for them as it relates to achieving the right diagnosis and ultimately achieving the right care as a result of that, providing benefit to the provider community to enable them to understand or have visibility into the quality of care that they’re delivering so that they can use that information to improve that quality of care. And finally, and you mentioned this in the in the introduction to the payer community, and that can be large self-insured employers plans and others where they’re struggling with and tackling how to build a benefit design systems and networks and all the sorts of things that are necessary to keep their employees healthy, providing them this foundational tool of fundamentally helps them improve outcomes and reduce costs.

Saul Marquez:
Brilliant. And you’re tackling something really critical for really the patient, the provider and the payer. You’re touching each one of these. And you’re right. I mean, you know, it is a supporting specialty. If that initial diagnosis fails, then everything else fails and the waste happens and bad outcomes. So what would you say makes what you guys do different in this space? I mean, I know there’s been others that have tried maybe not as successfully as you guys have. What makes you guys do better?

Ron Vianu:
I would answer that question by almost rephrasing it to times. That’s really what is the biggest challenge we’re facing. And to the extent that that we’re solving that challenge, that’s really how we’re doing things differently. And I think very often you see within the healthcare ecosystem, companies that are hyper focused on serving one particular stakeholder. So they’re creating products for the payer community as an example or they’re creating products for the provider community or they’re working directly with patients to inform them and empower them with information for them to make better health care decisions. One of the challenges that we face every single day is how do we serve all those communities equally and an additive way. And so the thing that we believe we’re doing differently and better is that we’re trying to both benefit the provider community such that they can improve the care that they’re providing to their patients, but do that in a way that is seen as acceptable to the payer community. And quite frankly, the way we tackle that comes down to the science that we leverage to solve these problems and that we are provide great visibility into the science that we leverage to solve those problems. And by that I mean the solutions that we have our PHDs working on day in and day out. And these are folks who are working in data science and machine learning and artificial intelligence. All of that infrastructure, if you will, we display to all of our participants and ask for their feedback. So we engage them with a solution in order to get their buy in. With respect to the activities that we’re engaged in.

Saul Marquez:
So you’re you’re involving the stakeholders in this particular instance that the provider in the process you’re showing, you’re lifting the hood and you’re saying this is how we do it. How do you provide guidance around here that would help you provide better care and then you make the tweaks accordingly?

Ron Vianu:
And that’s that’s a constant back and forth and without their input. Ultimately, they would look at our solution as a siloed solution that’s perhaps helping the payer community, but doesn’t really drive any meaningful benefit to them.

Saul Marquez:
Now, I think that’s a really smart way of doing it. And one of the one of the key reasons a lot of companies fail is because they don’t do that. So kudos to you for being able to take that information and implement it really quickly as you think about the different cases and different employers that you guys have been engaged with. I know Wal-Mart was sort of a big headliner for you guys. You started collaborating with them and beyond other other companies. What do you think is a story of outcomes you’ve improved or business processes you’ve improved that you’d like to share?

Ron Vianu:
Sure. I mean, we’ve been quite surprised even from the early days of our research to the extent and the degree of impact improving radiology has on the total outcomes of a particular patient population. And you know, if you think about it intuitively, it makes sense of the patients misdiagnosed very early on their care. What is the likelihood of them actually getting better? So from an at least an intuitive, instinctual perspective, that makes sense. But what we’ve seen is that by modifying or improving the degree of accuracy of their diagnosis early on within the radiological stage of care or stated differently, reducing the number of high impact misdiagnoses these patients are experiencing, the employers and the plans that are serving those communities can save a significant amount of money from a downstream perspective, and those patients do significantly better. And so to quantify that a little bit, depending on the market and depending on the particular nuances of the population, there have been employers who have been able to experience anywhere from 8 to 15 percent a total cost savings for those patients who have been impacted by this program, which is fairly significant given that radiology in and of itself represents only anywhere from seven to 10 percent of their total cost as they think about their medical spends. And so we we see those results again and again, which are intuitive. But if someone is misdiagnosed with cancer as an extreme example, they don’t have cancer or the reverse where they have cancer and they’re provided a diagnosis of normal impression, so on and so forth. You can start imagining what that patient journey looks like, the harm that’s been caused to that patient and the associated costs to the plan.

Saul Marquez:
It’s the beginning. You guys are tackling the beginning of it in a way that that makes a difference, and for the employers listening to this, you’re, I think, an OK. Interesting. There’s an opportunity for us to potentially do this better. How does it work? And for somebody that maybe this is resonating with, Ron, what steps do they take to to check you guys out and how does the process work?

Ron Vianu:
So in terms of checking this out, I mean, obviously, folks can come to our Web site and we’re very active in various conferences and folks and come up to us and either email or reach out to us directly by phone in terms of how it works. The way the program was designed was really to be seamless and relatively low administrative friction both to the planet, to the patient. And if you think about how most people today get their imaging services. They’re typically sitting at a doctor’s office and that doctor’s ultimately struggling with some sort of diagnostic dilemma. Not entirely sure what’s wrong with this patient. So they’ll order an MRI. That process often occurs with very little patient involvement where they’re going online, searching through a network of providers and selecting one on behalf of that patient based on a variety of preferences the doctor may have, the plan may have, so on and so forth. So what we’ve done and this took close to two years of effort. We’ve integrated directly with those workflows so that if an employer or a plan wants to ultimately implement the Covera program, it’s fairly seamless for those folks that have those processes already in place.

Saul Marquez:
Love it. That’s big. A lot of times. One of the biggest hurdles is, is it’s it’s too much work. It’s friction. You know, you said frictionless is key. So as as a provider, let’s take the provider lens. I mean, what’s in it for them and what are people doing today that you guys could help with?

Ron Vianu:
So if we take a step back and think about the provider community generally, there’s a lot of criticism around obviously fee for service, lack of price transparency and a lack of visibility into quality. And so if you think about the price variability in any physician market, whether it’s radiology, orthopedics, given that there’s no visibility into quality, it’s hard to really interpret what is the meaning behind. And can we infer value given the price of variability? And what we’re providing to the radiology community really is multifold. One, we’re giving them the ability for the very first time of the specialty to be able to demonstrate the value of what they do as it relates to quality. And so if I’m a radiology practice and I’m investing in the latest technology and I’m hiring some of the best physicians to work at this practice today, there really is no reward for that directly other than the fact that you receive satisfaction that you’re providing better patient care. But from the payer perspective, historically, those physicians are receiving the very same reimbursement. And if those physicians have decided to be slightly more expensive in the market, the payer community historically has also moved patients away from those centers that have invested in better technology, better physicians in order to provide better care. And so what we really provide to that community is not only visibility for themselves, but visibility that they then can share with others around the quality of care that they’re delivering to their patients and how that quality of care ultimately transforms itself to better outcomes for their patients, which has been this missing link for many years, because like any practice, to the extent that they impact other practices downstream, it’s very difficult for physicians to understand that cascading impact. And so we support the radiology community in one, helping them demonstrate to patients, other providers and payers alike that they’re not a commodity service. And then we quantify what that means in terms of how different centers are doing relative to different pathologies and illnesses. And finally, and perhaps most importantly, not only do we engage in this primary research about quality, but we give them back fundamental results that helps them shape how they actually care for patients on an ongoing basis. So it gives them the tools to think about how do they improve the care of their patients, which doctors may be best suited for, which patients that walk through the practice, which equipment may be best suited for, which patients and so on and so forth. And this is something that previously they had very little visibility into.

Saul Marquez:
Love it. That’s very interesting. And at the end of the day, you know, payers are looking for evidence. And if you’re a provider organization and you know, you have quality outcomes and you want a better way to prove it, sounds like this might be an interesting way to for you to do it. So appreciate you driving down that path for us. Ron, you know, the thing that comes to mind is, is how about the manufacturers? Are you guys doing anything with them? The people that actually make these machines?

Ron Vianu:
So that’s an excellent question. And what I will say about the manufacturers is they’re trying to maintain some distance from this general discussion only to the extent that they’re serving the entire population. And to the extent that some providers may be better than other providers, that’s maybe not a discussion that they want to necessarily enter. Having said that, different technologies can have different impacts on patient outcomes. And so. We are having several discussions with some of the major manufacturers of imaging equipment to understand to what extent can we collaborate with them from a research perspective.

Saul Marquez:
Fascinating. Yeah. And in the end, that does translate into outcomes again. So fascinating. Your approach to including all of the stakeholders is exemplary and one that I think that many of us listening should take a note because it is what leads to success in providing solutions to to the health care ecosystem. What would you say is one of your biggest setbacks, Ron, as you’ve been building this one and what key learning came out of that?

Ron Vianu:
So I get that question frequently, just generally as as an entrepreneur that’s had companies that have been successful and companies that have failed. And I don’t really think there’s one unique setback that really has been the setback that has provided me the most information, if you will, from a learning perspective. It really is an experience over a lifetime where for at least in my estimation and others agree with this. Generally speaking, which is that failure really is the best method of learning. And to the extent that I tell this to folks, even internally to say, you know, one can make a mistake and that mistake can be across a broad spectrum of areas. Well, one shouldn’t make that mistake three times. And so as I think about both at Covera and prior to cover the sorts of things that we’ve done in the past, it’s really it crosses the spectrum of are we picking the right partners? Are we focusing on the right solutions? And I if I would have to say the single biggest mistake slash setback that I’ve made in any of my efforts is really not putting the right resource around the right efforts or understanding the skill sets of people relative to the sorts of things they can accomplish.

Saul Marquez:
It’s a good call out in general for anybody looking to to make an impact. It’s getting those those skills aligned, making sure that your your focus areas are backed by the dollars. Those focus areas are the right ones. If you had to identify a key thing that you’re most excited about today, Ron, what would you say that is?

Ron Vianu:
It’s something that we’ve been talking about this entire time. And as I mentioned, I have since college, I’ve been an entrepreneur my entire life and early on in my career solving any problem with something that excited me. And so doing something that would shave 15 percent off of time of a particular mechanical process would be interesting, or building an application that may allow people to engage in stock purchases and example more efficiently or with a lot more information at their disposal to make educated decisions that would excite me. What excites me the most today at Covera and it really is going to change the trajectory of my entire professional career going forward is engaging in something that has such a profound impact on patients directly and similarly is supporting all these other stakeholders. And so for a lot of the efforts that I’ve engaged in previous to Covera, the impact on patients may have been adjacent. They may have been secondary or tertiary type impacts where improving efficiency or approving transparency in and of itself is going to improve the system as a whole. And by as a byproduct of that, of course, patients benefit. But our work today that we’re doing one is receiving incredible support from the payer community, which in and of itself is incredibly unique. I believe today we have in our pipeline 20 percent of the U.S. population of folks that are actively engaged with us to understand to what extent can they apply what we’re doing. And when you think about that, as it relates to the number of patients that will ultimately be able to impact, that’s really what excites me. The fact that day in and day out we are reducing the number of misdiagnosis that patients are experiencing and the profound harm, the catastrophic impact that it has on those patients. That’s something that honestly motivates me through what typically is a difficult experience, which is scaling a startup and building a new market where one doesn’t exist.

Saul Marquez:
Yeah, and that’s that’s definitely exciting. And the level of impact that you’re going to have on patient outcomes on people’s lives. I mean, it doesn’t get better than that.

Ron Vianu:
Right. And then again, this is not something I think that I’ve been able to experience previously. But once I’ve experienced that, I realize that is where I need to focus my time and attention on a go forward basis, even post some universe where I’m not involved in Covera.

Saul Marquez:
Yeah, I love it. So if you had to recommend a book run to the listeners, what what book would you recommend?

Ron Vianu:
So that’s a challenging question. I used to be a voracious reader. And so every year I would have a different favorite book. But maybe if I can just tweak that and say what was the book that was most impactful to me over my life? The book that I would recommend folks to read, which may be a little bit dated, is Zen and the art of motorcycle maintenance. I’m not sure if you’re familiar with it, but it is a book and I forget what the tagline of the book was, but it’s really about philosophical inquiry and trying to understand meaning in the universe from a philosophy professor who is the main character of this book. And for me, what was interesting about this book was really just more of a from a philosophy perspective, a really data driven approach to trying to understand meaning in the universe, which I thought was fascinating. So a definitely a good read.

Saul Marquez:
Yeah, that’s very cool. Great recommendation, Ron. Thank you for that. Listeners, you know where to go, just go to outcomesrocket.health in the search bar type in Covera and you’ll be able to pop up the show notes as well as links to CoveraHealth.com and the books that Ron recommended, as well as a full transcript of our discussion with him. Ron, thanks so much for your time today. It’s been a really interesting discussion. The impact you guys are making is huge. Before we conclude, I’d love if you could just share a closing thought. And then the best place for the listeners could reach out and connect with you.

Ron Vianu:
Sure. And the only closing thought that I can really provide as it relates to our activities in the market is that one of the things we’ve described here that I think has been foundational to our success is really understanding the needs of all stakeholders in this closing thought really is for both plans that are thinking about programs and building them to other entrepreneurs that are thinking about launching companies to solve problems within healthcare. And so the closing thought really is around servicing the entire ecosystem in order to be able to drive adoption for whatever you’re trying to bring forward to the market. And so for us, obviously improving quality in radiology is one of the most foundational things that we can do. But we’re doing that within the context of helping doctors, payors, plans and obviously serving patients at the core. And for us, that is one of the most important things that we can communicate to folks with respect to these sorts of activities and ask for reaching out to us. As I mentioned earlier, folks can come to our website. We attend most of the major health care conferences. And so we’re a very friendly group of folks. So people wanted to come up to us and ask those questions. We’d be happy to answer them.

Saul Marquez:
Outstanding, Ron. Really appreciate it. Again, folks, CoveraHealth.com, check them out or go to the show notes outcomes racket that health and type in Covera and the search bar will take you straight there. Ron, thanks again and really appreciate your time today.

Ron Vianu:
My pleasure. Enjoy talking with you.

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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