: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez
Saul Marquez: [00:00:18] Welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring healthcare leaders. I really want to thank you for tuning in again and I welcome you to go to outcomesrocke.health/reviews where you could rate and review today’s podcast because he is one outstanding individual in healthcare. His name is Dr. Rajiv Kumar. He’s the president and chief medical officer at Virgin Pulse during medical school. He realized that many of the worse health problems we face as a nation diabetes heart disease cancer hypertension etc. are related to the collective unhealthy lifestyle. And so he has pledged to make a difference in this industry. He’s done and as a frontline physician and now for various different companies is doing some amazing things and so what I want to do is open up the microphone to Rajiv to fill in any of the gaps of the introduction and then so we could get into the podcast. Rajiv welcome to the podcast.
Rajiv Kumar: [00:01:18] Thanks, Sual. Glad to be here.
Saul Marquez: [00:01:19] So Rajiv what would you fill in your intro that I that I left out.
Rajiv Kumar: [00:01:24] I think that was a pretty comprehensive. It’s just a little bit about Virgin Pulse. You know I think that may not be a familiar name to a lot of folks on your that are listening to your podcast. We are an employee wellbeing company. We work with large employers all around the world. And our goal is to help them activate their employees to lead healthier lifestyles. We try to kind of go around the healthcare system a little bit and go direct to the employee and figure out ways to motivate them to inspire them and to help them sustain behavior change over time and it’s not just about health care cost reduction. It really is about how do we help people be healthier happier and more productive at work and in their personal lives. So that’s really what our mission is.
Saul Marquez: [00:02:04] That’s beautiful and listeners for those of you who haven’t connected the dots Virgin Pulse it’s one of Sir Richard Branson and Virgin Group companies so you know with a gentlemen like that behind something like this. And Rajiv and as part of the executive leadership team you can imagine some great things are happening.
Rajiv Kumar: [00:02:22] It’s an exciting time for us. We definitely are inspired by Sir Richard Branson leadership. You know his philosophy is if you take care of your employees they’ll take care of your business. So we’re trying to empower employers to take better care of their employees.
Saul Marquez: [00:02:35] So strong. And you know Rajiv it’s really interesting that you guys are tackling this employer perspective of the entire health care equation because costs are soaring. And aside from labor costs it seems like health care cost is oftentimes double digits on that front. What are your thoughts on what should be on every medical leaders have done that today.
Rajiv Kumar: [00:02:56] Well you know I’m biased but I think it has to be behavior change too often looking for a magic pill or a magic device or something to kind of stem the tide of rising obesity and diabetes and heart disease in our country and at the end of the day there’s so much we can do to actually change people’s behavior. A lot of what we’re facing as a result of our diet our physical activity or lack thereof the stress that we have in our lives is just how we how we treat ourselves and how we don’t take care of ourselves. And so I think it’s not necessarily a hot topic. I think it should be. And I wish there was more focus on it. It’s the perennial idea that if we can change behavior we can prevent a lot of disease and we can produce significantly greater outcomes.
Saul Marquez: [00:03:38] And Rajiv what would you say right now. And you know at at Virgin Pulse is an example of how you guys are improving health outcomes.
Rajiv Kumar: [00:03:46] Well I think we’ve really tried to think outside of the box. I think traditional health interventions and health and wellbeing platforms have largely been ineffective and they’ve been around for decades. So we sat around and we said what if we took a different approach rather than making people feel like they’re failures and rather than telling them that they’re sick. What if we actually make them feel successful. What if we make them feel good about themselves right off the bat. What would that do for their self-esteem for their motivation and for their ability to change. Most of what we see in our industry is heavy focus on screening and so employers us their employees to take health risk assessments and do biometric screenings and so forth. And the problem with that is they take a health risk assessment and tells them you’re sick. You know you have high risk your unhealthy. You need to do more to change your lifestyle. You get your biometric screening results and you may have high blood pressure. You may not like the results you get back and that can be very demotivating. And so what we’ve said is is there a scientist out there is there a behavior change model that focuses on success. And we found a scientist by the name of Dr. B.J. Fogg out of Stanford University and Dr. Fogg is sort of a new guru of behavior change and he’s come up with a behavior change model that he calls the fog behavior change model and it’s very simple as model is a formula. It is called B equals M A T behavior equals motivation times ability times a trigger. And so what he means by that is it gets somebody to do a behavior that we want them to do or they want to do. First of all they have to have the motivation to do it. Second is they have to have the ability to do it. And the third is you have to trigger them or remind them to prompt them to do that you’re too often in the kind of behavior change space. We ask people to do things that require either too much motivation or too much ability. So we say something like go to the gym four times a week and exercise for 60 minutes each time you go that takes a lot of motivation. And some people may not even have the ability or really know how to do that. Where to get started and so forth. So Dr. PHOG says Well motivation is hard to change right. You maybe your motivation waxes and wanes on a daily basis on an hourly basis. You can’t really change somebody’s motivation that easily. What you can do is change the behavior you’re asking them to do to make it easier. You can change the ability to perform the action. And so the idea is if you take a behavior like flossing your teeth and you break it down to the smallest tiniest thing that somebody could possibly do. Like floss one tooth and you ask them to do that they can actually do that very easily it doesn’t take a lot of motivation. It’s very quick to do. And if they do that and you celebrate the fact that they did it you can help them build what we call success momentum and then they’re going to feel better about going to the next step and trying something harder. And so in our entire kind of approach to behavior change we break behaviors down into their simplest most basic action. We ask people to do that we trigger them and then when they do it we reward them we make them feel successful we give them social status they might get some kind of points or some kind of reward and then we ask them to do something harder the next time around. It’s a feedback loop that builds up momentum and it changed behavior in a very sustainable way in a very habitual way which is really the key to behavior changes is creating habits.
Saul Marquez: [00:06:43] Yeah Rajiv this is a really interesting model and the science behind it. So I have used your application and I have found it to be really really cool and good to see the science behind it. Now I appreciate the little wins and then you give badges and then on the back. And so listeners if you’re an employer I think you’ll really like to learn that the way that they structure this is in such a way that they help the employee be healthier. So part of the carrot is they use more carrots and sticks in the software they’ll give you or your employer will give you a discount in your insurance if you can achieve certain metrics and along the way you get badges there’s social sharing within the platform. So as a user of it pretty cool and now to put together the science Rajiv is really fascinating to see how you guys put this together.
Rajiv Kumar: [00:07:32] Yeah we’re very excited about it and the best part is that we have demonstrably results over years. We’ve been at this for about 15 years now and we’ve been able to show some pretty compelling and sustainable behavior change over 5 6 7 years with participants so it really does work well.
Saul Marquez: [00:07:46] This year I went to the dentist one more time because of you guys.
Rajiv Kumar: [00:07:50] There you go.
Saul Marquez: [00:07:51] Rajiv what would you say a time within the last 15 years that the organization that you guys had a setback and what you learned from it.
Rajiv Kumar: [00:08:01] As you may know in entrepreneurship there are setbacks every single day as it’s it’s a crazy rollercoaster. You know I started this company precursor to this company which was called Shape Up When I was in medical school. He’s 23 years old and I got very kind of passionate about behavior change and how to prevent obesity or how to reverse diabetes. And I actually dropped out of medical school for three years to build the company. Eventually finished my degree and I decided that I wanted to focus on health promotion and using technology to scale interventions across large populations. So after medical school said of going to do residency actually went back to the company and continue to invest and grow. And then two years ago we were acquired by Virgin Pulse and I’ve stayed on as chief medical officer so as you can imagine as a 23 year old starting a company I knew nothing about how to build an organization. I knew nothing about how to build a technology platform I learned through the school of hard knocks along the way and made a lot of mistakes. I think when I look back rather than sort of kind of picking on one particular event I think one of the biggest mistakes that we made in our company was we started to drink our own kool aid. We started the company on the idea that social support is critical to behavior change that the Millbury will be truly successful at changing their behavior and sustaining that over time unless they modify their social networks that the people around them are supportive and encouraging and catching them when they fall and sort of being conducive to their healthy lifestyle. Because so often we go into the workplace and our co-workers are having muffin Monday and bagel Tuesday and doughnut Friday and you know in a way which sort of sabotage each other in that way you know that happens at home as well right. So you need that kind of social support. That’s sort of where a lot of motivation comes in we saw other companies including our competitor Virgin Pulse focusing quite a bit on extrinsic motivation really kind of financial reward. So paying people to change their behavior. And I think we were very purist about our intrinsic motivation the social you know social incentives versus financial incentives. We worked really hard at that for many years and in it it does work and it does create sustainable and affordable behavior change. But I think because we were so fixated on our own idea we fail to see that the market was evolving and people’s ideas were evolving and in fact the research was evolving. So you know answer is not so cut and dry. It’s not really one or the other. And in fact if you blend the two intrinsic plus extrinsic motivation you could actually have an even greater impact on people and on their behavior. And so you know it’s funny that we ended up joining forces with Virgin Pulse and I think we both sort of moved to the center of that spectrum. You know they came from the extrinsic side we came from the Intrinsa side and we met in the middle. And now our approach is to do both. So I think it was a mistake we made and really kind of just believing that we were right and we were sort of ideological about it and we failed to realize that maybe there were other people out there that were doing things that were valuable as well. We learned that and we really started to thrive when we embraced that sort of broader thinking.
Saul Marquez: [00:10:57] And that’s a great message Rajiv and one of the other things too that that just comes to mind is when you’re in that spell because it does become a spell right you get into your head and what is it that you do. Rajiv to get out of it because so many of us do buy into our own ideas. We we do eat our own cooking. How do we break out of it and see a fresh perspective what would you recommend the listeners.
Rajiv Kumar: [00:11:21] I think they actually seek out contrarian points of view and so people who we disagree with we have spent time listening to them and understanding what they’re working on what their research says you know where they’re coming from. So we spent a lot of time actually listening to learning from our competitors we go to a lot of conferences and we go to things that we might not otherwise go to because they might not confirm our beliefs that might challenge our beliefs and that’s where we thrive. And so I think we’ve just kind of had to remind ourselves consistently that maybe there’s a different way. Let’s not get stuck in our you know conventional way of thinking and I think it’s that constant kind of challenging ourselves and we are putting ourselves in uncomfortable positions that drives us to kind of keep an open mind.
Saul Marquez: [00:12:03] Wow fascinating and a really great tip there for the listeners whether you be an entrepreneur and medicine listening or if you’re an established executive provider or leader in an industry facet you really have to think and surround yourself with a contrarian view sometimes even though it’s not the comfort zone. It may be what helps you see that blind spot that could potentially be fatal to your business and so really great call out. Rajiv thank you for sharing that sir. What would you say one of your proudest medical leadership experience to date as.
Rajiv Kumar: [00:12:36] Well. So for years I’ve been working with populations both in employer groups as well as in the community sort of running these kind of behaviour change campaigns fitness challenges and competitions grassroots efforts to help people through their life. And you know I think my proudest moments really when people would come up to me and you know even though I wasn’t their primary care physician I still think of them as patients but people would come up to me and they would say things like You saved my life you know not really you but this program saved my life and you know I’ve gone off my medication. You know I was a diabetic and I’ve reversed my diabetes and I’m off on medication. You know I lost so much weight that my knees no longer hurt. And I can walk again. You know it took my grandkids to Disneyland for the first time and I was actually able to keep up with them. So it’s really those moments and there are hundreds of them in my head. The people that I’ve met that we’ve actually had an impact on and using technology and people we never met before. But using technology and using the science and figuring out a way to sort of engage then we were able to help them and empower them to make small changes that led to huge results and I think you know those are the proudest moments. You know I don’t know if the leadership or not but that’s certainly where we get our excitement from or what gets us out of bed every morning.
Saul Marquez: [00:13:46] Yeah for sure that’s definitely leadership. Rajiv and behind the motivations that you do this every day is there any story that you want to share that really got you into this because you have such passion you know behind passion.
Rajiv Kumar: [00:13:58] There’s a story there are a ton of stories for me when I was a first year medical student I was shadowing physicians and working in their clinics and seeing a lot of patients and it just struck me that there were so many patients. The majority of them struggling with how do i lose weight. How do I eat healthy. How do I be physically active and how do I if I have a condition like hypertension home or lower my blood pressure how do I lower my cholesterol. We had no tools to help them. We really didn’t. Other than just some sort of empty advice right. Go on a diet. Join Adjaye and go check out weight watchers. We were sort of resigned to the fact that they probably weren’t going to change their behaviour and ultimately we would put them on medication and that would be sort of the end game and that was frustrating to me because I knew that people had potential to change and we just simply weren’t giving them tools and understanding what would work. So I really thought you know how can we prescribe health and wellbeing and is there a resource that we can send people to or a program that we can give them that would be truly successful and I couldn’t find one and so I created it and that was you know originally called Shape Up Rhode Island which was our kind of precursor to our company shape up and now Virgin Pulse. So that’s sort of what my motivation was was I just didn’t want to feel resigned to the fact that we would have to prescribe medication for everybody. I felt like we should really be focusing on prevention. And when I talk to people who did change once in a while we would get a patient that would say you know I lost 20 pounds or you know they would come in and their blood pressure would be down and we would say you know what did you do. And they always said the same thing. I had an exercise buddy. I formed a group of friends and we motivated each other. My family did this together it was always a social thread and that was my sort of inspiration. So you know let’s figure out a way to connect people and this was at the dawn of a kind of social media around 2004 2005. And I thought you know maybe we could sort of take a Facebook like approach and kind of bring people together online to support each other offline and that’s what we did.
Saul Marquez: [00:15:47] That’s so awesome. And listeners dare to be the change you wish to see in the world. And Rajiv found himself in the situation where he just didn’t accept the fact that empty promises were going to be what he gave patients and he thought bigger. He saw a couple of things at work and he ran with it. So I think Rajiv embodies that quote is he was the change you wish to see in the health world. And with that has been an amazing ripple effect of better outcomes for patients. Stories that continue to come in to his inbox of people’s lives that he’s changing. So the question is What can you do. What do you today find unacceptable and health. And what are you going to do about it. Because it’s doable. You just got to move it little by little and it’ll eventually get there. Rajiv what would you say an exciting project or focus that you guys are working on today.
Rajiv Kumar: [00:16:39] We’re spending a lot of time around artificial intelligence. We believe that one of the Keys to Motivating people will be sort of giving them personalized highly relevant recommendations of things that they can do. And so we’re trying to use artificial intelligence to learn about people over time and also to learn what makes people successful over time. So we’ve got millions of people on our software that use our mobile application on average three times a day. We’re collecting 7 billion data points every single month everything from biometric results to Health Risk Assessment results interests goals activities healthy habits you name it we’re collecting the data through our platform. So what we’re trying to do is kind of track who’s successful and what are the things that they do in what order do they do them. That helps them succeed in the program and if we can match persona profiles we can kind of put other people on that same track to be successful and it is very hard to program that with rules. And so we’re using artificial intelligence so that the platform itself can learn over time and then guide people in a much more successful way. And that’s really I think one of the most exciting areas in healthcare technologies the use of A.I. to create highly personalized highly relevant experiences that will drive people towards success.
Saul Marquez: [00:17:51] So in five years if your AI focus works what would you be able to do.
Rajiv Kumar: [00:17:56] What we will be able to say is you know you’re a member of our of our platform we would be able to say you know saw other people like you have done this next step and that next step has led them to this result would you like to do that as well. And we don’t necessarily as individuals need to know anything about you but the platform does sort of ascertain who you are and what you like to do and what’s your health status and your demographics and all about it. Now it’s starting to coach you in a very automated way and hopefully we’ll be very successful because it will understand what you’re likely to gravitate toward and want to participate in. And so the platform will guide you through behaviors through programs and interventions that will provide motivational messaging that will pick you up when you fall down and it will be the sort of coach in your pocket that seems to know you so well and feel like it’s sort of part of you. And that’s really what I think the dream is.
Saul Marquez: [00:18:46] I love it man. And you know what. Rajiv you’ve done such a great job just building this and partnering with Virgin and getting it to where it is that I have no doubt that you’ll get it there I sort of got goosebumps when you started saying what the vision is in five years and to think it’s not too far away. Even with like I was sitting with my wife over the weekend we were going to watch a movie and Netflix does this like match you know 89 percent 90 percent match and sure enough when one of those matches is high without fail we enjoy the movie. Answer You know and like similarly if you’re a patient and these guys over at Virgin Pulse are putting this engine together and you are in a certain state or in a certain point in your care and they make a recommendation for you How inspiring is it to know that you have something at your fingertips to be able to to make adjustments in what you’re doing and that will make you healthier and happier. And that’s inspiring Rajiv. So man keep it up. This is really exciting.
Rajiv Kumar: [00:19:42] We will we will we’ve got big plans are making a lot of investment in research and development. And I feel like we’re just scratching the surface so there’s there’s a lot more to come.
Saul Marquez: [00:19:50] Love it. So Rajiv getting here to the end my friend. This has been a really great conversation. Let’s pretend you and I are building a medical leadership course on what it takes to be successful in medicine. It’s the 101 of Dr. Rajiv Kumar and so got four questions lightning round style for you. Followed by a book and a podcast that you recommend to the listeners. You ready.
Rajiv Kumar: [00:20:11] OK.
Saul Marquez: [00:20:12] All right. What’s the best way to improve health care outcomes.
Rajiv Kumar: [00:20:15] Focusing sustainable behavior change.
Saul Marquez: [00:20:18] What is the biggest mistake or pitfalls to avoid.
Rajiv Kumar: [00:20:21] Believing in quick fixes change is hard it takes time and requires multiple vectors and multiple approaches over a significant period of time.
Saul Marquez: [00:20:31] How do you stay relevant as an organization. Despite constant change.
Rajiv Kumar: [00:20:35] Constantly experiment with new ideas and you embrace failure.
Saul Marquez: [00:20:39] What’s the one area of focus that should be driving everything in your organization.
Rajiv Kumar: [00:20:43] Adopting the consumer mindset understanding what people are doing in their personal lives and how healthcare can be more relevant to them and more similar to the types of programs and services and products that they’re engaging with on their own time.
Saul Marquez: [00:20:56] And finally what book and what podcast would you recommend to the listeners as part of the syllabus.
Rajiv Kumar: [00:21:01] Well I’ve got a couple of books that I find that I keep going back to in the course of sort of entrepreneurship and health healthcare technology not necessarily healthcare books but they seem to be so relevant and kind of timeless. The first is crossing the chasm by Jeffrey Moore. It’s been around for years. It’s not a new book but it’s really about kind of high tech entrepreneurship and how do you bridge that gap between the early adopters of an innovative and disruptive solution and the early majority which is sort of where most people are. So the visionaries versus the pragmatist a lot of people can get visionaries to adopt their new way of doing something but they fail and getting sort of the rest of everybody to sort of come along. And I think it’s just it’s a fascinating book that has ramifications for almost any type of entrepreneurship entrepreneurship whether you have your own company whether you’re trying to innovate inside of a larger company. I think it’s a really relevant book and we go back to it again and again. Another author that we really kind of embrace here is Patrick Lynch Siani. He’s written a lot of books about how companies should operate. The one that that really resonates with us is the Five Dysfunctions of a team you know at the end of the day we can have the best ideas in the world and the best innovations. But a lot comes down to people and how do we get people to work successfully together as a team to execute. And that’s kind of a industry across product. It’s all about people. So the Five Dysfunctions of a team sort of looks at what are the reasons why teams fail to achieve their maximum potential and why companies and ideas often fail and how you can avoid that. And how do you kind of consilium best in a team and teamwork. And so I think that’s a book that I would highly recommend that everybody read.
Saul Marquez: [00:22:38] Wonderful. And what podcasts would you recommend.
Rajiv Kumar: [00:22:40] Well you know I love your podcasts so keep listening listening to your podcast. I think there are so many podcasts out there. There’s not one that kind of stands out for me. I keep trying to experiment and I’m just constantly listening to a lot of it for ones. I kind of like the idea of don’t pick on podcasts just constantly kind of rotate and you know experiment and try a bunch of different ones and see what you think.
Saul Marquez: [00:23:02] Love it. So there you have listeners the 101 of Dr. Rajiv Kumar Go to outcomesrocket.health/Rajiv. That’s R A J I V. Ivy you’re going to find all the Schoenaerts to our discussion today. Full transcript as well as the syllabus that we put together links to the books that he recommended. And by all means the understanding that he just shared with us is going to make a difference so go back home and relisten. If you found something inspiring. Before I conclude Rajiv I love if you could just share a closing thought and then the best place where the listeners could follow you or get in touch with you.
Rajiv Kumar: [00:23:37] My closing thought would be that there is so much opportunity for innovation in this space of behavior change. Lots of people are going after it. There’s massive amounts of venture capital and private equity money being invested and we’re just scratching the surface of what’s possible. Mobile technology wearable technology artificial intelligence all of that is opening up tremendous new opportunities for us to reach people to engage them and to improve their lives so I think digital health and health technology is a very exciting space right now and I hope that you know all your listeners are thinking about how they can leverage that in their own personal work to better achieve their goals and improve health outcomes. Best place to learn more about what we do is virginpulse.com which is our Web site and you can also find me on Twitter @rajivkumarmd.
Saul Marquez: [00:24:24] Outstanding Rajiv. Hey just want to say thank you again for sharing your story. Your words of wisdom. And we’re excited to keep up with what you and Virgin pulsa are up to. So thanks again from all of us.
Rajiv Kumar: [00:24:35] Thank you.
: [00:24:39] 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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