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Manav Sevak:
Welcome to the Memora Health Care Delivery podcast. Through conversations with industry leaders and innovators, we uncover ways to simplify how patients and care teams navigate complex care delivery.
Matt Troup:
Hi, everyone! This is Matt from Memora Health, one of the medical directors and co-hosts of the Care Delivery podcast. I’m excited today to be joined by Dr. Sameer Berry. Sameer, thank you so much for coming on the podcast today. Can you take a moment to introduce yourself to our listeners?
Sameer Berry:
Yeah, sure, thanks, Matt, for having me on. My name is Sameer. I’m a practicing gastroenterologist and co-founder and chief medical officer at Oshi Health.
Matt Troup:
Yeah, excellent, Sameer. Again, thanks so much for coming on today. Much like me, we discussed before the podcast; we’ve both made this journey from clinical medicine to health tech. What was the catalyst for that change for you, and what was really the moment where you decided, I need to make this leap and really move the needle for where healthcare needs to be?
Sameer Berry:
I think so many doctors and clinicians that I work with in the hospital and at my brick-and-mortar job, more and more of us are getting burnt out, realizing that the training that we have and the skills that we’ve developed, unfortunately, we can’t always get patients what we know they need, and this is not a unique story, right? This is a story that resonates with most clinicians. For me, I was always interested, when I noticed the challenges of delivering high-quality subspecialty GI care, I was always interested in how can I solve these challenges in care delivery, right, of access, appointment times, appointment durations. And again, the more you unravel this problem of why can’t we just deliver high-quality care to everyone who needs it? You start to realize how many different kind of layers there are. There’s a provider incentive layer. There is an insurance kind of disintermediation layer, there’s behavioral economics, there’s the patient’s psychology involved in that as well, amongst hundreds of other things, the right IT infrastructure, the right product, and productization of what your clinical model should look like. I could go on and on, but to make a long story short, I basically realized that making incremental improvements was really not going to move the needle. We’ve been doing that for a long time. I personally spent time on hospital committees, doing grant-funded research, running randomized controlled trials, you know, joining kind of public health advocacy work through my professional societies. And while all of these things are really important, we need to continue to do all of those things. I just came to the conclusion that the best way to effect change would be to really try to just take a blank canvas and build a care delivery model from scratch. I was pretty naive at the time in terms of thinking, what would go into that and how complex that was. So I’m fortunate that I met an incredible group at Oshi Health and have really excellent co-founders who can bring those different kind of skill sets in actuarial and data analytics and just management expertise, organizational structure, and all these things coming together to actually make this clinical model possible, and that’s what led me into this world of entrepreneurship and healthcare technology.
Matt Troup:
Yeah, I love that. And you mentioned about being on health system committees and how much was on a similar path as well and feeling like you want to try to make a change from the inside. Why does it feel, sometimes, that you need to step outside of that world to really make meaningful change?
Sameer Berry:
I don’t think you necessarily have to step out of that world to make meaningful change. I’m proud of the work that I was able to do at academic centers and the Veteran Affairs hospitals, private practices, and my colleagues who work in those systems are able to effect change and make an impact. I think if you’re trying to change healthcare delivery itself, it’s very difficult to do that within the incumbent system just because of the macroeconomic factors that are involved, right? A lot of these organizations or institutions have razor-thin margins, so their tolerance for taking on risk or trying something new is a little different, right? They have to really make sure that they can pay the bills month over month. In a venture-backed enterprise, you have a little more flexibility in terms of being able to tolerate negative cash flows or not making money in order to have a long-term effect or a long-term goal. So I think there are macroeconomic factors that are involved. There are definitely cultural components. Physicians and healthcare and clinicians are very risk-averse, and they should be, right? Patients’ lives are at stake. So being able to really think outside the box and try to do something new. It can be culturally, you can hit a little bit of friction in the traditional incumbent model, and then financially from a not a macroeconomic perspective, but more of a individual financial perspective, there are a lot of different stakeholders involved in the traditional incumbent model that all are really trying to protect their interests, right? So like the hospitals trying to protect their interests, the private practices are trying to protect their interests, the insurance companies are trying to protect their interests, and working in that kind of zero-sum competitive model is also really frustrating for somebody with my personality type, where you want to just go make changes as quickly as possible. So I think it just really depends on being self-aware in terms of what’s going to be a fulfilling career path for you. And everybody’s a little different, this is just the career path that happened to resonate with my strengths and weaknesses.
Matt Troup:
Yeah, and you mentioned as you were speaking there about the challenge of being risk averse for a lot of providers or a difficulty, I think, in adoption, a lot of times with digital technology and digital health often hasn’t really delivered on its promises to providers. I know that most of us say we don’t love our EHR or we don’t really find technology all that helpful in the hospital space. Why, historically, has that been the case, and what can we do now as providers in the tech industry to change kind of the narrative around how technology can really improve care delivery?
Sameer Berry:
I don’t actually subscribe to that line of thinking that technology hasn’t made a big enough impact. I agree with your first point, right? We are very risk-averse, and I think we should be, right? You do not want clinicians or the decision-makers at large, healthcare institutions, to just jump at the new shiny object, right? This is not financial technology. This is not digital entertainment. People’s lives are at stake. You can’t just move fast and break things.
Matt Troup:
Right.
Sameer Berry:
But to your second point, if you’ve ever worked at an institution where their healthcare EMR shut down, and you have to do everything by hand, it is, it makes you miss your EHR very quickly. So while things aren’t perfect, there’s always room for improvement. Obviously, we could go down the pathway of talking about how EHRs were designed for billing and not for really care delivery, and that creates a lot of kind of angst among clinicians, but I believe healthcare technology has made a tremendous impact so far. We’re going to continue to see more impact, and I think we just have to live within the world that has been designed for us, right? The model is working perfectly for what it was designed to do. And so this kind of very complex healthcare system, it’s slow, there’s a lot of regulation. Someone once told me that building a startup in enterprise healthcare is like the triple black diamond of entrepreneurship, and that truly is a very adequate explanation of how it feels, but we just have to put one step in front of the other. And even though it’s slow progress, the impact, I think, is there, and we’ve seen it every step of the way. It’s just slow, and I think that’s what people have to reset their expectations.
Matt Troup:
Yeah, and speaking of these phrases that get thrown around in the industry quite a bit, I think you often hear healthcare is broken. We, people say that quite a bit. It’s often like the launching pad to any sort of talk or LinkedIn post. And what do you think is true about that statement, and do you fully subscribe to it?
Sameer Berry:
100%. Healthcare is broken because patients aren’t getting the care that they deserve and, full stop, period. That’s all that really matters. Patients continue to suffer. In my specialty, in GI, there’s long wait times to see one of us in clinic. When we do see a patient in the clinic, we don’t get to spend as much time with them as the patient would like or as the physician would like. The costs are really high, we spend more on IG care than we do on heart disease, than we do on mental health, than we do on trauma. The outcomes speak for themselves, and many of the listeners to your show have heard this analogy time and time again, right, about the cost being out of control, the outcomes being really poor. So we know the healthcare system is broken. There’s something that needs to change, and while incremental improvements do exactly that, they make incremental improvements, it’s my perspective that one of the best ways that we can drive change is bottoms up, just creating a new model, trying to work within the incumbent system best we can, but also trying to keep everything within this new blank canvas so we’re not reliant on these kind of traditional perverse workflows that just make it hard to get patients the care they deserve. So there’s a lot more work to be done, but I think we’re starting to see the early signals across this virtual-first healthcare delivery spectrum that there’s something here. It needs fine-tuning, it needs optimization, it’s not a panacea. Virtual-first care is not going to solve every problem in healthcare, but I think we’re starting to see a signal that the improvements are worth continuing to explore and invest in.
Matt Troup:
Yeah, I agree. And speaking of burnout, burnout is a headline we hear about a lot, too. And you mentioned about the GI space, and I imagine that’s from your point of view, GI physicians have to be all things to all patients, but now you, reinventing that with this multidisciplinary care model. Are you seeing this as a path to maybe offloading some of that responsibility from the desk of the physician?
Sameer Berry:
100%. We all know that today brick-and-mortar GI practices are completely overwhelmed. There’s too many patients. There’s tremendous amount of reimbursement cuts that have occurred in GI. We’ve seen about a 20% cut in the top GI CPT codes over the past ten years, with more cuts coming that have bipartisan support. You combine these reimbursement cuts with the rising operating costs of a practice, it costs more today to buy new equipment, hire staff, keep them motivated, maintain a good culture, and you’re starting to see a lot of disintermediation from insurance companies and health plans with GI doctors because they’re trying to temporize this massive increase in cost associated with GI. So United Healthcare, for example, just announced a blanket nationwide and prior authorization on all endoscopy, right? So these types of blunt instruments to reduce cost, they have a very negative impact on gastroenterologists being able to provide care to their patients. And what can these digital health solutions, whether they’re virtual-first or other companies that are trying to address these issues, what can they do to solve that problem? What they can do is they can help gastroenterologists focus on delivering the type of care that they are really trained to do very well, make new diagnoses, manage complex patients, do procedures, and help offload some of the patients where, you know, seeing a patient every three months in a brick-and-mortar practice just isn’t going to do it for them. There are certain types of patients that need 45-minute visits, that need visits every two weeks, that need to be able to chat back and forth with their care team every other day. Most brick-and-mortar GI practices aren’t set up to handle that type of volume. I work at a brick-and-mortar practice one day a week in New York City. There’s no way we could see our patients every two weeks. We would just, the entire practice would implode, right? So it’s about triaging patients to exactly where they need to go, which is what drives improved outcomes and reduces the unnecessary cost. The cost component really gets reduced in a unique way in GI because patients who have GI conditions, they feel their symptoms every day. So if they’re not able to get in to see their gastroenterologist or they’re not able to get in to see their primary care, and they’re having a GI complaint, they’re probably going to go to the ER and get a $6,000 unnecessary workup. That’s very different from diabetes or high blood pressure or heart disease, or high cholesterol, right? These conditions are associated with really high costs if you don’t engage with the patient. But if a patient with diabetes can’t get in to see their endocrinologist, you don’t really feel your diabetes every day. You might know, okay, I shouldn’t eat that dessert, or I should be more compliant with my medication, but if you’re not, most of the time, the negative impact of that is felt years later, so the patient’s not driving the unnecessary utilization, which is very different, because in GI that’s exactly the case.
Matt Troup:
Yeah, excellent, I completely agree. And as we’re thinking about building these models, and especially with the multidisciplinary model in mind, we, you and I talked earlier a bit about the impact that it makes having a team with a clinical experience help innovate and build in this space people that have been in the trenches. Can you speak a little bit to that and why you’ve prioritized some of those providers to help build technological space?
Sameer Berry:
So important to involve stakeholders who really know what they’re doing when you’re building any business, but I would argue it’s the most important in healthcare, and it’s where I see a lot of founders and companies struggle, because you can have an idea in the healthcare entrepreneurship space that sounds like a great idea, it’s going to solve a problem for one of the stakeholders in the ecosystem, but it could create more problems for a different stakeholder. And the people who understand that interplay the best are people that have had boots on the ground, delivered the care, understand what’s actually happening between the lines. And I can’t emphasize enough the importance of involving clinicians that are delivering the type of care that a company wants to get into and involving them every step of the way, especially when it comes to like care model design, any sort of product work, but even more on the commercial side, right? Sales, designing your pricing, because there are certain things, there’s a certain perspective that they bring to the table that’s just really valuable.
Matt Troup:
Yeah, completely agree. And kind of in a similar vein here, I heard you mention in a different interview that one of the catalysts to really making this jump and getting into technology was, you’re, a little bit of your frustration with not being able to do the job as it was intended to do, and now here you are all these years later and really transforming care delivery in the GI space. What’s really getting you up in the morning and getting you excited about where you’re at now, where healthcare is going, but yeah, feel free to use the platform for to chat about that a bit.
Sameer Berry:
What excites me every morning and gets me going in the morning is, what I do really, first thing in the morning, is roll out of bed, look at my phone, and we have a Slack channel that shows us all the patient feedback that we received for the prior day’s appointments, right? It comes in live. There’s a numerical score, and there’s an optional comment that, I would say about 90 plus percent of patients leave an optional comment. And just hearing the feedback from patients of some patients who have been suffering for decades and finally starting to feel better, finally starting to broaden what they can eat, finally starting to be able to go out without having to look for a bathroom everywhere is really meaningful. So being able to look at that live every day is my favorite part of the day, definitely gets me going. And I just actually returned from our national GI conference, where I spent a lot of time with my colleagues from other GI private practices, colleagues from my … academics, and we’re all facing the same problems, and we’re all excited about this new opportunity for virtual-first care, value-based care enablement services, wrapping around traditional community practices and how that’s just going to unlock so much value not only for our patients but for the clinicians as well.
Matt Troup:
Yeah, that’s excellent, Sameer. It’s a really exciting time to be in the health tech space, and it’s incredible to meet other clinicians like you that are really pushing for innovation and care delivery. It’s been wonderful chatting with you today, just really digging into some of these topics, and just thank you so much for spending the time with me.
Sameer Berry:
Of course. Thanks, Matt. We’ll talk again soon.
Manav Sevak:
Thanks for listening to the Memora Health Care Delivery podcast. For more ideas on simplifying complex care for care teams and patients, visit MemoraHealth.com.
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