Outcomes Rocket Podcast_Jennifer Goldsack & Ryan Vega: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
Hey Outcomes Rocket Nation! Saul Marquez here. I want to introduce two outstanding guests to you today. First I have Dr. Ryan Vega joining us. Dr. Ryan Vega serves as the chief officer for the Office of Healthcare Innovation and Learning as part of the Veterans Health Administration office. His focus is fostering the discovery and spread of grassroots and strategic and innovative solutions, practices, and products across the VA. He’s focused on advancement of competencies and innovation and simulation through workforce development, combining the use of clinical simulation and training to further enhance the utilization and uptake of emerging healthcare technology and practice today. He’s developing innovative approaches to testing payments and also service delivery models that reduce the expenditures while preserving or enhancing quality of care. Prior to his role that he’s serving and now he served as Chief Quality officer at the Richmond VA Medical Center, and prior to that, eight years of clinical training and experience. Dr. Vega is board certified in internal medicine and has been involved in research and practice in the areas of health informatics, clinical quality improvement, patient safety, and many more. And also joining us today is the outstanding Jennifer Goldsack. She founded and serves as the CEO of the Digital Medicine Society, also known as DiMe, a nonprofit organization dedicated to advancing digital medicine to optimize human health. Previously, Jennifer spent several years at the Clinical Trials Transformation Initiative. It’s a public-private partnership founded by Duke University and the FDA and working in research at the hospital of the University of Pennsylvania. First in outcomes Research in the Department of Surgery and later in the Department of Medicine. More recently, she helped launch the Value Institute, a pragmatic, research, and innovative center embedded in a large academic medical center in Delaware. Jennifer is also a retired athlete, formerly a Pan American Games champion, Olympian and world championship silver medalist. I want to welcome both of you to the podcast. Thank you so much for joining me today.
Ryan Vega:
Hey, thanks for having us.
Jennifer Goldsack:
Thanks for having us, Saul.
Saul Marquez:
It’s a true pleasure. And so, you know, this topic of, of, of digital innovation in healthcare is huge. And so to tee us off, real quick, Jenn, I’d love if you could just share a little bit more about what DiMe does, how do you add value to the healthcare ecosystem? And then, and then, Ryan, you could share with us a little bit more about innovation at the VA.
Jennifer Goldsack:
Fantastic. So, Saul, if I was going to give you and your listeners the official party line, I’d tell you that DiMe is a global nonprofit dedicated to advancing the ethical, effective, equitable, and safe use of digital medicine to redefine healthcare and improve lives. What does that actually mean in practice, I think is the important part. We are really, we’re certainly not a tech-determinist at DiMe, Saul, but we believe that there are fundamental challenges across the global healthcare ecosystem, some of which can be well addressed through the use of emerging digital solutions. Whether that’s the flow and the volume of data, new and existing sources of data, that have now been digitized. Our ability to analyze those data for information to improve decision making, or whether it’s our ability to fundamentally change how we think about healthcare and stop waiting for patients to present sick at the doors of the clinic before we help them, catching information about them sooner, move healthcare upstream and better care for people, that’s the promise that we see in digital. But the likelihood of these very complex and diverse industries, we have sort of conservative healthcare over here. We have very sort of bullish tech coming together and getting those solutions right is low without assistance. So that’s the purpose of our organization. How can we bring together the technology ecosystem with the healthcare ecosystem and build fit-for-purpose solutions that help don’t harm, that’s what we do, Saul.
Saul Marquez:
Love it, that’s really meaningful work. And, and this partnership with, with Ryan, Dr. Vega at the VA. Ryan, walk us through what innovation looks like for you guys.
Ryan Vega:
Sure. I joke that part of our job is proving people wrong, that government can be quite innovative and can lead in a market such as complex as healthcare. But, but on a more serious note, our mission really is the mission of the VA, is to care for individuals. And I harp on that notion of caring for people because healthcare exists in a continuum. You age, you get older, you have ailments, and unfortunately, we deal with chronic conditions or acute conditions, and all of those are a part of you, but they don’t just happen in an episodic fashion. They don’t just happen today and then tomorrow you’re completely back to normal if you have a heart attack or, God forbid, something more catastrophic. And so we have to think about this idea of caring for people across a continuum while recognizing that the health system was designed to just be reactive to those episodes. And so innovation for us takes a whole couple of different lenses. What it’s really about is how do we redefine the system and the markets around those systems that enable us to continuously engage with veterans to move health dream as far upstream as possible, sorry, healthcare as far upstream as possible. And really to focus on how we produce health, how every interaction, every doctor’s office visit, every interaction with a, scheduling … clerk creates some meaningful experience that actually helps the veteran achieve health, not get better, but actually achieve some degree of health and get back to some level of functionality. And we do that through a whole host of different things, but that’s really our North Star. That’s really what guides us. And when we look at our partnerships with folks like DiMe and other either nonprofit or big Fortune 100-500 companies, it’s really been a blessing for us because they’ve really bought into that mission. They’ve helped us understand how to move the systems and the sometimes really, really big mountains that surround us further upstream in support of the American veteran.
Saul Marquez:
That’s really great. Ryan, thank you for that. And Jen, were you going to make a comment there?
Jennifer Goldsack:
I was, and actually, I want to get back to, to Ryan’s joke almost about proving people wrong and how government really can be incredibly innovative and move quickly, one of the, almost an unofficial tagline we have here at DiMe, Saul, is clinical quality work on a tech timeline. I think there’s a lot of confusion now in the marketplace that you can either be deliberate and evidence-based, and that requires a time frame of years or decades, or you can move fast and break things because that’s the mantra of tech and what we seek to prove, and I’m proud that we do so every day at DiMe, is that you can move fast and fix things. And one of our strongest partners in this endeavor is, in fact, our colleagues at VA. And it’s very, very interesting because not only do they have the correct and aligned incentives in order to really bring forth the promise of digital innovation to improve the lives of veterans, the system, and the people who care for them. Learnings as the nation’s largest integrated healthcare system, we can extrapolate those learnings from innovation across the rest of the industry. The alignment in Mission, Ryan, to your point, this idea that it’s not about the tech, it’s not about the shiny object, we’re not going to tech our way out of the challenges we have around caring for people, but it’s about thinking about what are we trying to do here? What’s the problem we’re trying to solve for? For whom? How can we do this reliably, repeatedly, equity, equitably, and at scale? And that, frankly, is the, the playing field that we find in experience when we are lucky enough to partner with our colleagues at VA. There’s a very thoughtful approach to innovation and innovation at scale that’s quite, quite exciting and quite frankly, is something I think everyone in healthcare should be watching. And one of the reasons we put out our playbook, because there’s so much success we can already point to from our colleagues at VA, vis a vis digital innovation.
Saul Marquez:
Yeah, that’s, that’s fantastic. And thanks for the, for that, for rounding out that, that segment with those comments. I love what you said, clinical quality work with tech timelines. I’m going to use that again, by the way, that’s fantastic. And Ryan, you know, it’s that chip on the shoulder mentality that, that really kind of helps get us up sometimes as innovators in healthcare. Talk to us about it, first I’d like to hear from you, Ryan, and then Jen. What is it that makes you tick? Why? Why healthcare? What inspires you to do the work that you do?
Ryan Vega:
Oh, that’s a lengthy story. I’ll condense it very quickly. I’ve, for probably the better part of my life, especially when I was a kid, I was a patient, a consumer of healthcare. And I think that in some ways I was completely adverse and got nauseous when I went in hospitals towards my collegiate years. I didn’t, wanted nothing to do with medicine because medicine in my eyes was what I couldn’t do, things that I wasn’t allowed to do in terms of playing certain sports or my ailment and sort of living with chronic pain and all these operations and being in therapy, etc.. So it was this interesting paradigm, and sometimes certain events in our lives lead us to kind of reconsider things. But I think what drives me even to this day is that experience and this just unwavering belief that there’s got to be a better way to do this, right? And this is usually the provision of care, the experiences of care. This was in the mid-nineties, but I still remember lugging around my MRIs and X-rays going from doctor to doctor to doctor, and what’s concerning is that 20 years later, people are still doing that, and so I think that’s what motivates me. I think it’s being a patient and knowing that there is a better way and being committed to pushing those boundaries of how we must continuously find new and better ways to create those meaningful experiences.
Saul Marquez:
Thank you for that, Ryan. Yeah. And we’re still faxing things. I had a guest today, the only, I mean, besides drug dealers, patients, like the medicine system is the only one that uses pagers and fax machines.
Ryan Vega:
Correct.
Saul Marquez:
So definitely a need to touch that. And by the way, I go there because we do need to be light about it, and that’s how we make change happen. So, so certainly an opportunity for us to take note here of what Ryan said. There’s, there’s a, there’s, change needs to happen. Jen, how about you? What makes you tick? What got you into healthcare?
Jennifer Goldsack:
I wish I had as much of a compelling story as Ryan, but I think this probably just tells you more about me potentially having some challenges of my own than much else. But, Saul, you and I were talking before we started recording, in a previous life, I was an athlete and very lucky to compete at the Olympics and do all sorts of things. And for a lot of people, the transition out of that kind of lifestyle is incredibly challenging. You spend years waking up every day, doing hard things and trying to be the best in the world. Where do you find the satisfaction in your next career? Not dissimilar to veterans, in fact, right? But it’s a moment where you think about where’s the meaning in the next part of my career? Lucky to be trained as a scientist, lucky to have moved from the UK to the US with a sort of vastly different healthcare system during the passage of health reform, and that was my heart problem. That was the challenge that I wanted to do next, I was able to apply my research background. I was able to apply a big side dose of stubbornness and tenacity, right, to, I have no problem banging my head against the wall until I’m bruised and that will break bricks down, and to some extent in building Ryan on the great examples that you shared, we have been slow to move, but I think that pointing fingers and being angry and, you know, berating people for the resistance, it’s not even resistance to change, but for our slowness to change is not the right way to do this. We have to deeply understand why these things have been so entrenched. We have to get to the heart of the matter around what are the incentives that are inhibiting us from moving forwards on behalf of not only the patients that we’re all here to serve, but the clinical experts. It’s, their job is not easy right now. We see that in essentially an exodus from a from a vocational profession. We need to do better for everyone. And so that’s what attracts me, Saul, it’s a mission-driven, hard problem that requires some second level, perhaps tenacity in order to actually break through. But I think, you know, as we talk about the challenges in healthcare, as we talk about and consider slowness to change and Ryan is, is, gives much better voice to this than I do, but it’s not to be frustrated with people, it’s not to point fingers, it’s to actually think about what are the challenges at the heart of the matter that we need to get to in order for innovation not to be a burden, or not just to be nibbling around the edges of the problems that we face, but to actually be truly transformative as we bring innovation to the fore.
Saul Marquez:
Thank you for that, Jen. And yeah, you know that, that tenacity is critical and a lot of the problems that we’re faced with, the macroeconomic impacts to the system post COVID, it’s, it’s a challenge, right? And so I would love to hear more from, from, from you guys. Ryan, how specifically do you think you guys do things different or better than what’s already out there?
Ryan Vega:
Yeah, I never try to contextualize it in terms of comparing one or the other. I think the VA has a lot of unique pieces that enable us to do a lot of what we do, meaning that I don’t feel the same market pressures financially as the commercial players, and I have a set population of individuals who I have a mission. We all, leave is a sacred mission and the opportunities to test solutions over longer periods of time, meaning that, that the time to that value realization for me is very different than the pressures of time to ROI for a commercial system. And so I think what that affords us to do sometimes does it take more risk, it allows us to let solutions mature more over time instead of cutting and running. And then equally, I think because we are so large and so diverse and have such a broad demographic, I think it has taught us the importance of patience and replication. If there is one thing I think that we do very well, it’s appreciate the need to understand the market that you’re going into. What I mean by that is that Florida is not Alaska, California is not New York, the veterans that live there are going to be different in terms of what challenges they face in accessing care, what their experiences are with care, what their desires are. And so I think it gives you this rich appreciation for entering into this market cannot just be as simple as I have a great solution, and thus it must be everywhere. It has to really be understanding how the solution creates a meaningful experience for both patients, the clinicians that care for them, the caregivers, their communities, etc.. So I think that’s one thing we’ve done really, really well, is appreciate that nuance of the market. And then I also think it’s appreciate what challenges we have, right? Our market pressures are always going to be different. So I never say, you know I never compare and say, well, why aren’t other commercial health systems doing what we’re doing? Well, maybe it’s because they can’t, maybe because some of the constraints that they have have not fully enabled them to. But you do see a lot of big systems out there right now. The Auctioneers, the Intermountain, the Kaiser’s, the Mayo’s, the Cleveland Clinics of the world, they’re doing amazing work. And I think they are a leading example in a lot of ways of, of how we can and should go. I’m biased, but I also think VA is at the top of that list as well.
Saul Marquez:
So yeah, I would agree. And and a lot of the work that, that you guys are doing has led to, to, to innovative solutions technologies, devices that, and medicines that, that have scaled our nation. So huge kudos to you and the team over there, Doctor Vega, on the work that that that you guys are doing, it’s meaningful, it’s impactful and a big thanks from, from all of us and I’m sure listeners you’re probably thinking yeah, big time, thank you. And so, and so Jen, Ryan, tell us, you know, setbacks are sort of defining. I think for a lot of us, they define our Northstar, they define why we do what we do. Tell us about a big setback and what a key learning from that setback was and what hurdles do you envision going forward?
Ryan Vega:
Yeah. Jen, I may be stealing the most obvious one, but COVID. I think it, in and of itself has fundamentally changed so many facets of our lives and particularly healthcare. I think the biggest concern in terms of that setback is going to be what impact deferred care has on our entire system? Look, I was on service not too long ago, and I saw a couple of unfortunate cases of individuals who had now progressed to needing dialysis or veteran who had a heart attack months ago and never sought care. And so these are all anecdotal, but I know that the big commercial insurance companies, just from colleagues I have, they’re they’re worried about this, I know that the rest of American health systems, hospitals, providers are worried about this. And so I don’t necessarily look at it as a, as a set back, although I think it was something that we had all of this momentum, and then you have this event that changes the trajectory of so many different markets. And so my hope is that what we learned from that and the opportunities we saw with things like expanding telehealth accessibility through payment, at least pulling down some of the regulatory barriers that existed before recognizing how frail the supply chain is and going to new technology just as additive manufacturing or 3D printing, and just realizing how much we can harness these new opportunities and make them part of the way we provide care has got to be continuously at the forefront, it’s going to be very easy to revert back to the mean, right, to acquiesce back to normal because you do have this huge setback and now everything sort of feels like it’s going back and, you know, it’s comfortable to be back to where we were. But I think there’s huge challenges on the horizon while simultaneously enormous opportunities for us to do a lot of things differently and better.
Saul Marquez:
Yeah. Thank you for that, Ryan. And I think normal is no longer an option, right? I feel like it’s changed so much. Jen, you care to comment on that’
Jennifer Goldsack:
I think, you know, Ryan, you’ve hit the nail on the head here in terms of not only was COVID and everything that came with it a setback in so many ways, right, for all of the people that we’ve lost, all of the strain on systems, for the brilliant clinicians that we’ve lost through a variety of different ways as a result of this crisis. I also want to loop it back to some comments you were making previously, Ryan, about how, you know, VA and other leading health systems, regardless of size, appreciate the ongoing sort of local nature of the needs of the patients that we’re all here to serve. You know, veterans in California are not like patients in New York. And I think to one of the things we saw during the pandemic, driven with the best of intent, was the scaling of digital solutions that were either not yet ready for primetime or that were locally excellent but weren’t certain for extrapolation. And if we want to talk in bumper stickers, right, the fastest way to kill a good thing is to overreach. And there have been too many news articles around, well, this perfect algorithm that was used in this particular hospital that relied on processes of care instead of underlying clinical data actually harmed people in this other environment. I think that has been a setback for the field because it erodes trust. Whereas actually what we did was to quickly turn to try and rely on these tools without having that evidence base, without having a deep understanding about how these tools were solving problems and thus how we needed to behave in order to make sure that the benefit was always outweighing the risk. I think this is something, again, let’s get back to our mission at DiMe and trying to make sure that these best practices are broadly available, that folks don’t have to make these mistakes for themselves, being able to point at some of the best practices we see in innovation at VA is actually a really powerful and compelling way to do this, let’s not tell you what good looks like. Let’s show you what good looks like. Unfortunately, we have too many cases, so back to your question of where things have gone awry. But the possibility is there, that is not a predetermined outcome, and we simply have to get better at recognizing what are the benefits and for whom when we reach to the digital toolbox, not a silver bullet, when we make that choice, And what are the potential risks and harms that we need to be eyes wise, wide open to, to make sure that we are thinking about can we afford to make this investment based on the time it’s going to take for value to return to us, and what’s the appropriateness of scale for this particular solution? And you know, Ryan, that’s something we’ve written about already in a couple of different places, but I think bears repeating here.
Saul Marquez:
Yeah, Thank you, Jen. And folks, by the way, if you look in the, in the show notes of today’s podcast, you’re going to find links to a lot of the resources that, that we’re chatting about, the innovation at the VA, the, the amazing value that Jen and our team at the Digital Medicine Society are doing, including some of the playbooks. I’m opening up a loop here, but Jen will tell you here toward the end about those playbooks and the value that they can provide to you, your business, your organization, because there is a lot of work being done right now that does not have to be duplicated. And a big, big of the efforts that I think are exemplified by Jen and also Ryan here, is the collaboration, the collaboration that will lead to more good. So thank you, Jen, for that. And so, you know, there’s a lot of trends in tech that have come on the tail end of COVID. What’s a trend or a healthcare tech that will change healthcare as we know it today?
Ryan Vega:
Always the million dollar question or I guess today it’s a billion dollar question or maybe trillion, depending on how you slice it, right?
Jennifer Goldsack:
Well, let me take a cut at this, right? Because I think to some extent, Saul, I think it’s a red herring question. You know, US healthcare is a four point something trillion dollar industry, right? If you are an app developer and you walked into which by the way, is substantially bigger than the GDP of France, if you developed a bit of technology and you walked into President Emmanuel Macron’s office somewhere in Paris and said, I have a bit of software that’s going to fix France, you’d say you are ridiculous, yet we hear it all the time. What is the one bit of technology that’s going to truly transform our complex healthcare system? Spoiler alert it doesn’t exist. I think the two pieces that will stand out for me, and Ryan pile on here with your thoughts, the first is ultimately the digitization of healthcare is about data. It’s about flows of data and information and our ability to know about people, to reach people in ways we haven’t been able to before, it’s about those flows of data, our ability to analyze them. I would also say that we need to move away from a mindset of the individual innovations and individual technologies point, 500 point solutions in a clinic wrapped around a patient are not going to help anybody. We need to think about a more holistic approach to putting these pieces together that when we think about innovation, it’s not can we shoehorn another software product in? Is there a wearable? That’s not what we’re doing here. It’s about a more fundamental reimagining of what healthcare even is. And I think that’s really, really important, we need to move away from that sort of tech forward approach.
Ryan Vega:
Yeah, I’ll take a stab at this one. I think the idea of bio fabrication, the idea of bioprinting, the ability to harvest one’s cells and create new organs and whatnot that would revolutionize modern medicine, for, for a whole host of reasons. And I’m hopeful in our lifetime we’ll see, and there’s actually a lot of work going on right now that gives me quite substantial hope that we’re going to see in our lifetime bio fabrication. That one stands out to me because it literally transforms modern medicine, right? I think all of these other solutions, such as AI and connected devices, they’re been around, they’re there. What’s missing is the health system orientation for how these change the game. And so in my mind, what’s really going to move the needle are solutions within those classifications or in those markets that enable physicians to get back to the bedside and not be inundated with administrative work, enable patients to choose providers based upon really good insights and data that that provider is going to match the experience that they’re looking for, which means we’ve got to start collecting patient reported outcomes and really move the needle on understanding and defining value far more holistically than we’ve measured quality or self reported quality. To me, that’s what’s going to change medicine, that’s what’s going to change both the experience and the delivery. And so I heard this the other day, and so I can’t take credit for it, but I heard that what will have to change, the only thing that’s really going to make a difference is if we target the supply side of the equation, because the demand side is always going to be far in exceedingly limited capacity than what the supply side can meet right now. And that’s what we must target. So it’s all of those solutions, I think, that have the opportunity. It’s whether or not we can apply them in such a manner that they truly transform the supply side of the equation and actually meet the patient demand, which is something that is both individualized and something that is far in excess of what we can meet today.
Saul Marquez:
Love that. No, I appreciate that. And yeah, you know, the problem is huge, Jen, to your point and and Dr. Vega, to your point, tackling it one piece at a time is a great way to move the needle forward. The, the supply side, you know, looking for ways to bring scalability, be it through a wearable in a hospital at home program or whatever it might be, this is how we tackle it. And, you know, it’s certainly great to know that minds like yours are working on this. So, so thank you both. Here, toward the end of this podcast, I’d like to ask both of you for a closing thought, and the best place that the listeners could follow your work and learn more about what you’re up to.
Jennifer Goldsack:
Fantastic. So let’s see, I think a closing thought is that, Saul, to your very kind comments right now, there are great people working incredibly hard trying to figure out how to make the industry that we all work in, an industry that exists to care for people and to improve the lives of people can be better. I think maintaining that as our North Star and being very critical about when we hear about the promise of digital innovation, what is the problem that it’s trying to solve for? Is it appropriate for scale? What does good look like? Who are the people that we need to bring with us? We have plenty of evidence that when we do that well, we truly can be transformative. And I think it’s the confidence and the discipline to keep directing our energies in that direction is what’s going to push us through. And then you asked, where can we find information on that? So our website at DiMeSociety.org has an enormous amount of resources there, they’re all open access, everything we do in the pre-competitive arena is out there for access. And then, Ryan, I might ask you to speak a little bit in your remarks about upcoming IEX, which is such a great opportunity to see the very best of innovation at VHA at the moment.
Ryan Vega:
Sure. My thoughts, and maybe this is the optimist in me, I’m actually quite excited about the future. I think that all markets are eventually disrupted, I think healthcare is in the middle of the early stage of that disruption. I think we’re seeing folks enter the market, that non traditional health players who are going to cause some disturbances and ripples and those are going to be good in the long run. And so I’m quite optimistic that as we continue to go through this next decade, as we see technology push the boundaries of what’s possible, as we see more players come in that want to change the paradigm. I think we’re going to come out of this at the end in a much better place than we are. So I’m actually quite optimistic and both excited. I don’t pretend to know what the next decade is going to look like, I don’t think any of us do, and I’m also quite certain that it’s those solutions we aren’t even seeing coming that are going to really create ripples and make changes in the patients and providers lives. But I think it’s an exciting time. To Jen’s point, we do have an upcoming event at the end of October. It’s called The Innovation Experience, hosted by the Veterans Health Administration, a three day long event, there’s an in-person and virtual component. If you type in VHA Innovation Experience into any Google being, any type of search engine, it’ll come up. And it’s really both a celebration of our incredible employees and our veterans and the work that we’re doing to drive innovation. But perhaps more importantly, it’s also about sharing insights. We pull collective of leaders from across the American health system market, as well as folks who are from other industries. And it’s really about sharing insights, sharing knowledge, discussing the challenges and opportunities and how we approach it. So we, we want it to be twofold. One, the demonstrate to everyone the work that’s going on on behalf of our nation’s veterans, and two, to share that knowledge. And so you can also look for VA innovation or Office of healthcare, Innovation, and Learning. Those are other buzzwords that you can search for it. You can pull tons of resources about the work that we’re doing across VHA.
Saul Marquez:
That’s fantastic. Thank you, Doctor Vega, and folks, we’ll leave a link to that event in the show notes, so make sure you check that out. As I say to to everybody listening, if something today resonated with you, don’t just stop at listening, take action. Check out that link, click on it, get the report from Jen, get get more info on this meeting with Dr. Vega. Make it there, do something about it. And with that, I want to say thank you to you both, Doctor Ryan Vega, Chief Officer, Health Innovation and Learning at the Veterans Health Administration. Jen Goldsack, the founder and also CEO of the Digital Medicine Society, such a pleasure to have you both here today.
Ryan Vega:
Yeah, thanks so much.
Jennifer Goldsack:
Thanks, Saul. I appreciate you having us on.
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