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Saul Marquez: And welcome back to the podcast. True pleasure for having you tune in again today have a treat. His name is Dr. Joe Smith. He’s the CEO at Reflexion Health. In his role as President and Chief Executive Officer of Reflexion Health. It’s a digital health Corp company by the way. Joe Smith leverages decades of strategic engineering and clinical expertise in the health I.T. Field to lead the company efforts to bring personalized healthcare in the homes of patients across the U.S. Prior to joining the company, he served as the Founding Chief Medical and Science Officer at West Health Institute, a nonprofit nonpartisan medical research organization that provides funding for Digital Health Corp. Dr. Smith’s leadership background also includes serving as the Vice President of emerging technologies for JNJ, Senior Vice President and Chief Medical Officer of Guidant Boston Scientific Cardiac Rhythm Management Division and Professor of Medicine of Biomedical Engineering at Wash U in St. Louis. So wonderful experience and I’m thrilled to be able to open up the mike to Joe to welcome to the podcast. Joe welcome.
Dr. Joe Smith: Hey thanks for having me.
Saul Marquez: It is a pleasure. Now that I leave anything out in that intro that you want to share with listeners?
Dr. Joe Smith: Probably only that my best job to date has been being the father for two young men. So I’ve certainly enjoyed that as probably my biggest accomplishment.
Saul Marquez: That’s awesome. I can relate. I’ve got a young little guy he’s about to be two years old but man is it rewarding.
Dr. Joe Smith: Absolutely.
Saul Marquez: So Joe what got you into healthcare?
Dr. Joe Smith: Thanks for that question. It’s one I don’t ponder that much because it feels as natural to me as gravity but if I had to think about it probably comes from growing up with with a mother. My mom had rheumatic heart disease which she got having rheumatic fever in the epidemic early in the 19th century. I mean early in the 20th century sorry. So I was her travails through the healthcare system kind of dotted my upbringing in my youth and so watching her get ministered to with medicines and then finally getting surgery and a mitral valve replacement and seeing all of that kind of gave me a vision and an opportunity to really to follow I think this is Martin Luther King Day so to follow one of MLK quotes about service and that that in fact the need you need to ask yourself what are you doing for others. So it was the combination of that kind of philosophical bent together with early experience that channeled my interest in healthcare.
Saul Marquez: Love it Joe and a very personal story so I appreciate you sharing it. And so here you are. I mean you fast forward all the years and now you’ve done a lot and you’ve been able to impact and serve a lot. And so I love to hear from you. You know today what do you think health leaders need to be thinking about, what needs to be on their agenda at the top and how are you approaching it?
Dr. Joe Smith: So again kind of a really really good question. I’ve been with a career in healthcare I’ve kind of grown up with a deluge I think of knowledge and information as we’ve gotten better and smarter in healthcare. You know I did all my training in Boston where there’s a flavor of eminence based medicine right. You walk the halls with the Giants and the best that there are and you learn how to how to take care of patients and manage healthcare challenges by studying at the feet of giants. And I’ve watched us move to where the amount of data, the amount of evidence, the amount of proof, so that you turn to evidence based medicine is now ever present. And in fact it’s becoming our biggest challenge is to keep up with the information that’s been generated by billions of dollars of medical research. And lots of innovators to where it’s now, it’s now functionally impossible. I think we’ve got more than a million publications in medicine every year. We’ve got thousands of clinical practice guidelines that are published or updated every year. We’ve exceeded the capacity of the average practitioner to be able to integrate that information and apply it to the next patient that they see. And so for that reason I think we have to turn our interest toward artificial intelligence and using technology to provide us this the best aid we can in terms of interpreting and integrating all of the information that’s available now and growing at an exponential rate. And so I think A.I. has to be on everybody’s mind as something to integrate to help medicine move forward. And the other thing is the impressive cost burden we have you know it’s been said that in the US, we consume 18% of our Gross Domestic Product on healthcare spending which is the largest both per capita and in total of any country in the world. And I don’t think we get value for money when one looks carefully where I think Bloomberg just published a study that said of of the 58 national healthcare systems they could rank in terms of efficiency we were tied for next to last. So that can’t feel good. I think it’s also clear that of the OECD countries, we are number one in cost and number eleven in value. And so I think we’ve got to focus on using appropriate technology for which we should be grateful. There’s a lot of billable to lower the overall cost of healthcare delivery. Otherwise I think we have too much of an opportunity cost in this country where we could use that money to do other things to help us be better.
Saul Marquez: Yeah. Joe some great highlights and couldn’t agree with you more on both fronts you know on the A.I. front I think it’s becoming more and more realistic for us to say what can I do as an individual with A.I. versus even five years ago it was a little more far fetched. I mean we’ve come a long way. So I’m interested to hear you know as we as we dive deeper into the episode your thoughts on that maybe some of the work you guys are doing at Reflexion, your company, so maybe you can share with us something that you guys are up to a time when you guys made a big difference by doing and thinking things different.
Dr. Joe Smith: So for us at Reflexion we just took a look at the way people are recovering from accident or injury or surgical joint replacement or surgery in general and the notion of physical recovery in a post acute care setting seemed to disadvantage the patient a bit. We would ask people who are trying to recover to come back and forth to the clinicians office for physical therapy or we would at times have physical therapists visit them in the home which is a similarly awkward circumstance for many when there’s technology that’s readily available that can educate and monitor and coach and reward patients to do their therapy in the safety and comfort of their own home, it just had to be kind of developed and refined and then made available. And so that’s been the early mission of Reflexion Health is to take the post acute care setting for patients and change it so that they can actually get the professional guidance admittedly largely stored within computer algorithms and cute interactive avatars and low cost 3D imaging technologies but give them the opportunity, empower them to do their therapy there with the rest of their recovery at home. So we’ve built a technology platform that facilitates that that is connected to their clinicians remotely so that they can easily, safely, and at low burden to them at low burden meaning they don’t have to travel back and forth. They don’t have to worry about getting their brother in law to drive them back and forth the therapy sessions, they don’t have to pay for parking, or co-pays and clinicians get to observe kind of an unprecedented amount of information because the way we’ve built the technology images the patient it does skeletal reconstruction and estimates joint angles and limb velocities at 30 times a second and runs that up against algorithms for the appropriate way they should be moving to give the patients realtime feedback and to document for the clinicians just what’s going on. And so we’ve taken kind of our own medicine and said “look aren’t there appropriate bits of technology that can make healthcare for the patient a little more centered on them where they would like to get their care and also do this in a way which is much cheaper than kind of traditional measures of care.”
Saul Marquez: Interesting and so fascinating work Joe and so mainly focused on the end of the experience at the acute facility taking them home for recovery. So we’d love to hear from you. Just an example of a time that you guys made a difference or you know you really helped improve outcomes through what you guys are doing.
Dr. Joe Smith: Sure. So I’m classically trained as first an engineer and then as a cardiologist so I really value kind of quantitative information and proof of value. I think in the space of A.I. or digital health as people are calling it or even digital therapeutics, there’s a fair bit of hope. There’s even some hype but there’s not a lot of proof. So for us to distinguish ourselves but also to know that we’re working on something that can truly matter. We bit the bullet and did a no arm’s length prospective randomized controlled trial comparing this notion of virtual physical therapy, virtual recovery at home with the standard of care with what people are typically used to getting. So we did that with Duke Clinical Research Institute the I think the largest academic clinical research organization in the US had them run it for us and got the results a little while ago which which were gratifying. They showed that not only are the clinical outcomes as good or better than routine kind of face to face therapy but it also happens in a way that the patients love. We got net promoter scores that are better than Apple products and Amazon services and also with the tremendous savings to the healthcare system. So we found that we pulled out about twenty eight hundred dollars in healthcare expenses using a virtual approach. So for us this…
Saul Marquez: It’s huge.
Dr. Joe Smith: Is one of those things where it’s good for the patient. It truly is patient centered. It truly is value based which is what we need in our healthcare system is to return back to kind of making sure we get good value for money. And it also delights patients. They enjoy this. So all of that feels like it’s a win win win.
Saul Marquez: I love it. What a great example Joe and fascinating. These things are becoming more real. Today actually, I for the first time did a yoga in my living room with an online instructor. And it’s just incredible you could do today. I’m like…
Dr. Joe Smith: How did that go?
Saul Marquez: It went awesome I love…
Dr. Joe Smith: That I suspect it went just great. You know there’s…
Saul Marquez: It went wonderful.
Dr. Joe Smith: I obviously follow the space a fair bit now and there’s some surprising data on kind of behavioral medicine where if you’re undergoing kind of talk therapy with a therapist to help you work through some issues it looks like doing so remotely is incrementally better than doing it face to face. Oh there’s probably some important dynamics around making sure you’re absolutely comfortable as you work through some issues. And so it makes perfect sense to me.
Saul Marquez: Yeah. This is the feature today folks. So you’re listening to this and maybe the skeptical side of you is saying “Man no way.” Well I want to tell you yes way and start thinking about this seriously whether you’re practicing you know physical therapy won’t be the taxi cabs of yesterday or a fear provider thinking through what you could do to get lean and to make your customers patients happier. Definitely intriguing work here by Joe and his team and so take this seriously. So what would you say as you’ve grown the company and you’ve done what you’ve done, what’s a setback that you had that you learn from? Tell us about that.
Dr. Joe Smith: Yes. So I think if you ask that question of every entrepreneur or small company, CEO, you might get a flood of every day has some victories and some skirmishes and some losses. I think in general there’s probably a theme to kind of the missteps that one can make and one is it’s pretty easy to overestimate what you can get done in a particular period of time or underestimate the resources required for us the challenges of managing across a very diverse cohort of folks because we have you know we have artists, we have user experience professionals, we’ve got really hard core coding engineers and algorithm developers and folks that are really quite knowledgeable about computer vision and so to keep all those together each with their own sort of cultural dynamics, I think that’s a challenge. It’s one I think we all rise to but it’s certainly a challenge. I’m like geeky engineer cardiologists and so I often focus more on the rational and the analytical as opposed to the kind of cultural behavioral emotional bits. And so I certainly need to needed to build out my EQ in addition to my IQ so that I could understand that it’s very important to build a culture that that respects that great diversity in order to get the most out of everybody. I don’t know if that completely answers your question but…
Saul Marquez: Yeah. In a nutshell it’s it’s definitely the having them mix these different groups to get it done at the same time respecting the logic and emotions of both to make it happen in a good culture. Yeah. You know by all means it’s not easy and kudos to you for being able to get it off the ground and get it going so the other side of the coin is some proud moments. I’d love to hear one of your proudest moments has been to date with the company?
Dr. Joe Smith: So with the company it’s it’s probably every time we culminate a new release where we get something all the way done and get it out and then hear back from the patients about how this has been great for me. This has helped me the notion of we’ve just had some horrific snowstorms in the across the Midwest and the Northeast and we have patients that we serve across the US now and so hearing that the snowstorm was disruptive of everything else in their life except for their therapy because they could.
Saul Marquez: I love that.
Dr. Joe Smith: That’s right. Hearing that from patients that they got better so much faster than they thought or hearing from a husband who’s changed we know where he’s gonna get his surgery done so that you can take advantage of the more convenient way of getting his rehabilitation accomplished. All of that although that feels just terrific. But I’d say on par with that is hearing from the employees about how they feel like they’re really making a difference right that they hear these stories and it gives them real meaning and purpose to be able to know that at the other end of their technology they’re actually helping somebody with a medical challenge that feels terrific.
Saul Marquez: That’s outstanding. I would definitely be proud of working behind a technology like yours. And so by all means Joe, keep up the awesome work. It’s definitely making a difference. Tell us about an exciting project you’re focused on today.
Dr. Joe Smith: Yeah so I would say that in again and in two ways one is we’re taking the core technology and doing what our customers are asking us to do to expand this into either other parts of the body or other conditions. And so it feels great to have clinical pull right. So from people who are telling us hey could you please stretch your you know what you’re thinking of doing with this technology and and help us here whether it’s with young people who are struggling with ACL repair which is can be a lot the recovery can be long or if it’s older folks who are struggling with the long recovery associated with having their shoulders repaired. Could we please focus on that. The other thing that that is also pretty exciting for us is not a year and a half ago we we made an acquisition of a company in Boston called the Learning Corp. At the time it was called Constant Therapy but we renamed it to Learning Corp, in there we’re focusing on using a similar approach of home based kind of automated smart learning approach to do, speech language ,and cognitive therapy in the home. And I’m really excited about where that company is going. We’re growing users every day where we’ve committed to doing a prospective randomized controlled trial with the FDA to make sure that we can prove out the value that so far the patients tell us we have. And so I’m very excited about those two opportunities now combining to be an opportunity for us to bring most of recovery to the home to where patients are so that they can do this in a way that’s under their control but also in a way that’s respectful of the resources that we have to kind of garner in healthcare.
Saul Marquez: Well I think it’s brilliant especially in the recovery phase where mobility is a challenge. Why not meet customers and I keep seeing customers purposely meet customers where they are. I think this is the future this is the way that it’s going to work. Joe love this super exciting. I mean just horizon viewing with you is as fun Let’s pretend we’re building a course here for the listeners. The one on one of Dr. Joe Smith and I’ve got five questions for you. Lightning round style followed by you recommend the listeners, ready?
Dr. Joe Smith: Go.
Saul Marquez: All right what’s the best way to improve healthcare outcomes?
Dr. Joe Smith: I think the best way is to focus on quantitative outcomes. Right. So it is instead of focusing on a process or focusing on volume which we tend to do or focusing on making hospitals better, I think we’ve got to focus on making care better and focus really on outcomes. We do this in every other every other industry. We have quality systems that have feedback directly related to outcome. And in healthcare we’re still not all the way there. We talk about patient centered healthcare but yet we ask people to come to hospitals that looks more like Doctor centered healthcare to me. And so I think it’s an issue of focus.
Saul Marquez: And what would you say the biggest mistake or pitfall to avoid is?
Dr. Joe Smith: To respect too much the status quo. I think we have convinced ourselves that our health care system is great in the absence of any proof of that. Instead it’s in the presence of demonstrable evidence that we’re not hat great. We’re incredibly expensive and we don’t have terrific outcomes on a national scale compared to international metrics. And so I think we’ve got to develop a kind of a healthy challenge of the status quo and realize that there’s an awful lot we do because we’ve done it but not because it’s been proven to be the best.
Saul Marquez: Love that. And how would you say is the best way for your organization to stay relevant despite constant change?
Dr. Joe Smith: So it’s realizing that we need to disrupt ourselves as much as anyone else would be willing to. And so it is not enough to be the best on any given day you have to keep envisioning what could be the better future. And so I think we have to devote ourselves not just to making the current product great but to making the next product better.
Saul Marquez: What’s one area of focus that drives everything in your organization?
Dr. Joe Smith: It’s the patient I just cut back from the JP Morgan healthcare meeting and I would say I heard all sorts of vocabulary words but the patient as a word was used too infrequently. I think we put it right up in front of everybody that we are patient centered, value-based, and data driven. So if you can’t say those three things in the company you don’t get to stay here very long. And so I do think if we keep our eye on the patient, what they need to get better, make sure that we provide real value, and then that we’re not selling snake oil that we really have to prove that that value exists to the patient and the healthcare system. I think that’s how you stay. Not just relevant but you stay ahead of the ball.
Saul Marquez: Love it. And the last one here Joe is is a two part question. What is your number one health habit and what is your number one success habit?
Dr. Joe Smith: Oh gee I’m going to have to honestly just say that I’m a better preacher than I am as a student. My health habits are not so great so I’ll demure and say I’m a persistent and tardy student of good healthcare habits. What was the second question?
Saul Marquez: What is your number one success habit?
Dr. Joe Smith: I think it’s dogged determination to communicate as well as possible. I think I’m really good at the quantitative and analytic part but it turns out that that’s not enough for people to hear they need to hear the kind of emotional core I think my mom used to say, “people don’t care what it is you’re going to say until they know why it is you’re showing up” and so I think meeting with the rationale for why we’re all together and making sure that people can grasp that themselves and aligns with their own values. That’s probably the thing I work hardest at.
Saul Marquez: So insightful Joe. Love that. And what book would you recommend to the listeners?
Dr. Joe Smith: So I really like Yuval Noah Harari’s Sapiens so it’s not the easiest to read but I think in 400 pages, he works really hard to provide color and context for who we are as homo sapiens and how we got here. Our kind of brief tenure on the planet and tenuous as it is but also you know why we do some of the things we do. It provides I think real genuine context for how it is we interact with each other, why it is that groups are only so big and that habits are as they are. I think it provides a little bit of introspection at the same time some color and context about us.
Saul Marquez: Great recommendation Joe and folks if you want to get a link to that book or just our entire transcript, the mini syllabus that we constructed for you just got to outcomesrocket.health in the search bar. Look up Joe Smith or Reflexion. You’re gonna find all that there. Joe, we’re here at the end I’d love if you could just leave us with a closing thought and then the best place where the listeners could learn more about you or the company that you’re leading here.
Dr. Joe Smith: So again it is we’re calling this a Martin Luther King Day and I was looking across some of those quotes and one that I found particularly useful was almost always it’s the creative dedicated minority that has made the world better. And so I think for a little entrepreneurial companies that are trying to make a difference in healthcare I think it’s really easy to get squashed as you run against the status quo. I think it’s important to realize that most of the important impactful change that occurs occurs by a small army of the committed. And so I would say you know if you believe in what you’re doing, keep your head down, and keep pushing.
Saul Marquez: Love it. What an inspirational message Joe. And folks. For more information on Dr. Joe Smith and his company just again go to outcomesrocket.health and look it up there. Joe thanks again for your time and really really appreciate the discussion we have today.
Dr. Joe Smith: Thanks a whole bunch. Thanks for having me.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.
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