: [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] Outcomes rocket listeners welcome back once again to the outcomes rocket where we chat with today’s most successful and inspiring healthcare leaders. I’ve got to say thank you so much for the support. We’ve seen our listenership grow tremendously and I feel like what we’re doing here is resonating so do me a favor I invite you to go to outcomesrocket.health/reviews. Give us a rating and review let us know what you think what you want to hear and it makes our day whenever we hear from you all. So I invite you just go to outcomesrocket.health/reviews. Let us know what you think. I have an amazing guest for you today. His name is Shakil Haroon. He is the CEO and founder of MPIRICA Health Analytics they try to combine consumer friendly measures of medical quality attainment with cost information to help consumers and employers pinpoint the highest value provider in any location. It’s a pretty cool thing that they’re doing over there and the experience that Shakil has and his team I mean this guy’s been across the entire SAS experience from his experience as a leader at Microsoft through his experience in sales at Spring wireless Axelle technologies he’s got an amazing platform upon which to build an amazing platform for you the listeners and also patients and health care so I want to open up the microphone to Shakil, just say thank you for being on and then fill in any of the gaps that I missed in your intro. Welcome to the podcast.
Shakil Haroon: [00:01:54] Well thank you for the opportunity Saul. Really glad to be here and as I mentioned I think your focus on outcomes is important. And you know that is our goal as a venture to shed more light in what are the true outcomes in U.S. healthcare. Thank you also for that kind introduction. I sometimes think that my various experiences here paint me as a serial entrepreneur and and maybe in some ways that’s that is the case. I’ve come to healthcare and find a lot here to apply my background particularly the analytics side of things which I find incredibly fascinating there’s a treasure trove of information here for a data geek to get immersed in. So I appreciate being able to talk to you today about all this and my experiences thus far.
Saul Marquez: [00:02:39] Absolutely Shakil and definitely serial entrepreneur is would scream at me too from what your experience and of what you’ve done what is it that out of all the things that you have done that made you gravitate toward the medical sector what got you in.
Shakil Haroon: [00:02:54] Well I got into this particular venture a few months after the acquisition of a company that I was part of the founding team. So back in January 2014 Excellus technologies which was in the software security space was acquired and left me with a lot of time on my hands and maybe the luxury of being able to spend a few months thinking about what’s next. Like most entrepreneurs you tend toward trying to solve a problem that you’ve encountered personally and I suppose that was true in this case for sure. I grew up overseas and one of the aspects of my upbringing was having family members get on planes trains and go and get healthcare abroad. That was something that I experienced growing up it was a big rigmarole an entourage would leave and return a couple of months later and you know in my own immediate family we had the situation. One of the most important questions is you know how do you pick a provider that you’re going to travel across the globe to go see. And like most healthcare consumers their choice was made largely on hearsay such and such. Hospital is renowned and such and such. Doctor is a miracle worker. And that’s the basis how people in those care settings. So I wanted to address a problem that I’ve kind of grown up with and delve into. Well how do you know that these are the best places for you to go to especially these are your loved ones and you want to see them come back home. Well you know that once you traveled all this way let the place you’ve ended up is in is truly the best place for you. So I decided to go in and try and tackle that problem applying some background in technology maybe a more analytical approach to problem solving. My background is I’m a little engineer by education and so tend to gravitate towards numbers and analytical approach as opposed to kind of. Taking at face value. You know whatever claims a hospital or a physician has. So I wanted to go in and take a look at the numbers and the actual data to back up these claims of excellence and to be able to advise people coming to the United States from foreign countries some 500 600000 people do that every year and provide them a resource where they can match up with the best providers given their particular condition. And then the business quickly evolved from that point when I discovered that well not only people overseas have no idea as to who the true best performers are but you can be in the same city across town and not really know who the best provider might be for your imper placement your knee replacement your heart surgery. It’s all very much hearsay reputation driven business record actual data supporting these claims to being Mercal workers is a well-kept secret. Let’s put that that’s. I want to I wanted to crack that problem. And that was the really the genesis of Karega.
Saul Marquez: [00:06:01] Now that’s a really great call out. It’s definitely an opaque process. As a patient you want to get care. It’s not the easiest to really understand and aside from hearsay are really awesome marketing billboards or buses. It’s just hard to really understand hey you know what are the metrics behind this claim and what you’re doing is awesome. You know you’re taking the bull by the horns and you’re saying wait a minute this is possible we actually can. And so I’m excited to hear a little bit more about how you guys have tackled the challenges and maybe some success stories you’ve had to date but super exciting and kudos to you and your team for putting this grand vision together and start nipping away at it.
Shakil Haroon: [00:06:45] Well thank you. Yeah well it’s a new area that’s fraught with mystery and to a great extent that mystery is highly profitable for the practitioners. It’s also complex. I’m not not to say that this is entirely the product of wanting to keep the performance hidden but it is a complex area. You know how do you measure the quality of a particular facility or are an individual physician when you’ve got such a huge variance in the conditions of the patient the socio economic realities of the patient. So these are complex subject matters to deal with. So we we had a very rich environment to go in and seek out in trying to solve this. But I think what we have today is the start of some very reliable metrics that are starting to improve our even end goal tests that we were onto something. And so we’re eager to share this with consumers and payers particularly employers out there.
Saul Marquez: [00:07:44] Shakil and it’s really really great as your platform available for consumers today or are you guys still in the working and out stage.
Shakil Haroon: [00:07:53] No it is it is certainly available at https://www.mpirica.com/ where we offer up some 44 or 45 different procedure categories to consumers for them to check out. So for anyone to host the 5000 hospitals around the country consumers can go in and for free check out the performance of the facility in their area. So if you’ve got high risk high cost procedures that you or a loved one are contemplating we offer a free service that you can go and check out who might offer the best care in your area. And sometimes the results that you’ll see might be a surprise. But again we’re trying to do is to focus on true outcomes and less on the marketing that goes into this field. There’s hundreds of millions of dollars here at stake at any given facility for the procedures that they perform. And so there is an intense desire to stand out and be recognized as the best of the best. What you’ll find is that when you’re taking a look at the actual data or the actual outcomes from episodes of care that were done sometimes the reputation winds up and many times it does not. So we’re we’re here to pop the bubble of you know marketing and introduce the actual reality of outcomes to the benefit of consumers in scale.
Saul Marquez: [00:09:17] So cool. And so I want to take this a little bit deeper let’s dive into it right. You and your team have put together what’s called the Empiric quality score which is basically what everything that a consumer would go in and choose a provider with is based off this score. Can you kind of walk us through what that score is put together from the bits and pieces so that the listeners have a better understanding of it.
Shakil Haroon: [00:09:41] Sure. Try to provide a high level explanation here of what what goes into production of being Perko or Costco or as I mentioned earlier this is a very complex undertaking. It’s not as simple as totaling up the number of deaths that occur at a facility or the number of complications that occur and that at the end of that you’ve got a spreadsheet that tells you who’s the best and who’s the worst that is actually a very misleading way to do it because it does not take into account the patient risk factors. What is the health of the patient walking in the door. Because if you’ve got patient with diabetes with heart problems that might be old and sick. The outcomes that you’re likely to get even though you might be an excellent surgeon are very likely going to be inferior to an otherwise healthy individual walking in the door for care. So this issue of risk adjustment or factoring in the patient condition is critical to getting an accurate measure of hospital or physician performance. And we do that we consider some 500 risk factors that are about assessing how risky the patient is to treat and how likely it is that a given course of care is going to be successful. So after this risk assessment we then predict the expected performance of a hospital or physician across key outcomes measures such as severe complications the likelihood of mortality in patients the likelihood that a patient will complete the procedure but then have to come back in for a do over or what’s called a readmission. So these are key outcomes measures and what’s important about these outcomes measures is that they are not really subjective in nature. They are binary and so when they occur there really isn’t much interpretation that needs to go on a readmit as a readmit. Obviously mortality is quite clear and similarly severe complications can be tracked. We then compare these predicted values with actual values. So we take a look at claims data for example and say well did the predicted readmit actually occur. And from that comparison between the predicted and the observed were able to determine how well a facility or a physician is doing if they’re doing better than predicted for a given risk profile of patients. That is obviously a mark of a good surgeon or a good facility. But we don’t just stop there. We have to see a consistent pattern. So over hundreds of episodes of care and in the case of a surgeon over four years of data that surgeon has to consistently do better than predicted in order to earn a high empiric score. So things can go wrong and surgery is risky sometimes for unforeseen reasons. Those outliers don’t count in our situation unless there is a pattern that’s observed again over several hundreds of episodes of care and over a multi-year period. So what we end up with is a very accurate measure of a facility or or surgeon performance over a multi-year period and where the predicted values or be the observed values are doing better than predicted. We award points natto in that approach an empirical score of 600 and above indicates a facility or a surgeon with an excellent track record of care. These are the surgeons that are able to take high risk patients and consistently produce great outcomes. These are the surgeons who have the fewest avoidable problems remember problems will occur in surgery settings. It’s by its nature a high risk effort but it is those facilities and those surgeons that are able to produce the fewest problems despite a high risk patient environment. Those are the guys we want to celebrate. Those are the guys that we want to bring to the attention of consumers and payers ultimately for you or your loved ones. Those are the providers that you want to go out there.
Saul Marquez: [00:14:06] That’s pretty cool. And it’s like. And I’m just thinking through this and looking at the lay out of your of your tool here. Shakil, you know it’s a lender will not lend you money if you have a bad credit score. So why would you lend your body to a provider with a bad empirical score.
Shakil Haroon: [00:14:25] Well that’s that’s a great way of putting it. And it does point to the issue of trying to avoid risks wherever you can. Absolutely. Is an innately risky undertaking and I think you know hospital executives will be will readily acknowledge that. But can you minimize that risk can you avoid taking unnecessary risks. That is what we’re up to to help you do and the risks are real. The difference between the best performing surgeons and the ones that are poorest performing in any surgical category is a four to five hundred percent sometimes more delta. So that difference is significant. You would not get behind the wheel of a car that had a 500 percent safety difference between the best and the worst. So similar reasons you wouldn’t want to be treated by somebody that has a four or five hundred percent worst track record than a better practitioner or especially because more often than not and almost without exception every city has both levels of performance so you can very easily direct yourself and loved ones to the better end of the performance range rather than subject yourself to the risk at the lower end.
Saul Marquez: [00:15:42] And that’s a really great point. And I like how this is coming together and listeners if you haven’t taken a look at this it’s worth just visiting and checking out the layout here. Go to MPIRICA.com and you’ll see what we’re talking about here the layout the scores. The risk is red for below average outcomes. There’s yellow for fair outcomes there’s green for excellent outcomes. And at the very least go get a feel for what things could be in health care today as it relates to outcomes. As a consumer if you’re an employer think about the value that you’re getting for your health care for your employees and is does it measure up to what you’re paying for. These are the things that we’ve got to be thinking about as people that are consumers of health care. And I think what Shakil and his team put together is exemplary. Shakil, tell us a time when you made a mistake or failed. Take us to that moment. And what did you learn to make MPIRICA much better or just your approach in healthcare. Excellent.
Shakil Haroon: [00:16:52] Thanks for the question and kind of puts me on the spot as a startup company. Mistakes are kind of what we have for breakfast. So sometimes it’s hard to pick out one that really stands out but I would offer up an example of our getting excited about this idea of sharing cost savings that would accrue from picking the best value provider with the employee and in particular what I think we did not choose well or decide well was to invest in the platform technology that would make these these cost savings offers directly to the employees. Sometimes being too early with an idea is has the same net effect as being wrong. And so I think in that regard we were certainly too early in that regard. It was a mistake. However we are following the same approach configured with benefits consultants and that is proving out to be more in line with where the industry wants to go as opposed to making a platform and software means of delivering that financial benefit to the consumer. So that would be perhaps one thing that I would do differently if I roll back the hands of time. It’s really a benefits consultant driven program as opposed to a software platform program. So I think I think the choice of how we delivered that capability was in hindsight way too early. We’re sort of putting that code on the shelf until the market matures a lot more and when it does we’ll roll it out again. But it’s clear that right now the software capability is very early and it’s better delivered by other channels.
Saul Marquez: [00:18:39] That’s a really great learning, Shakil and the fact that you kind of able to assess the situation and identify that hey the benefits consultant this is where we got to we got to aim our efforts at and that you’ve done it and now you’ve had some success with the benefit consultants. So you found your sweet spot but that code isn’t garbage you’re just putting it on the shelf for future use. I think it’s smart.
Shakil Haroon: [00:19:01] Well hopefully the market will catch up. We think it will the consumer is still the ultimate person affected by what we do financially as well as in health. So having this information available in a saw software platform is something that directionally I believe will happen just have to the crystal ball gets a little cloudy as to when Ma.
Saul Marquez: [00:19:25] Totally get it. I totally get it. Sure kill give us an example of one of the most proud moments that you’ve had in this health care sphere to date.
Shakil Haroon: [00:19:36] I think that for us as an early stage company gets us excited and feeling that we’re accomplishing our mission is having the information out there certainly to the benefit of consumers and to payers health plans etc. But there is another audience that we also pay attention to and that is health care legislators regulators that are responsible for monitoring the situation at large. So I would have to say that one of the things that I’m most proud of is being an information resource to our own state of Washington legislators and in particular our State Senator Karen Kaiser is somebody that had reached out to earlier this year to provide information as to the state facilities and the variance in quality that we’re seeing across two dozen procedures that we cover. So just providing this information I thought was a high point of this last year and we’ve also done similar outreach to our state congresswoman who is in Washington voting on various initiatives around cost and quality transparency and making that available to consumers nationally both at the state level as well as nationally I feel particularly proud of you know on an early stage company delivering information of this sort is so critical to literally millions of patients both in state here in our homes in Washington as well as nationally.
Saul Marquez: [00:21:09] Now that’s really exciting and I didn’t even think about that information Netsch that you’re creating here and pretty cool for our people running the country at the local level on a national level to having a resource such as yours so hey an invitation to the policymakers to check out the information on this website as well because get to make informed decisions if you’re going to make good decisions. Shakil, let’s pretend you and I are building a medical leadership course and what it takes to be successful today. It’s a 101 course are the ABC of Sharqiya. And so what I’m gonna do is give you four lightning round questions will give me some prompt responses and then we’ll finish up the syllabus with a book. Now you recommend to the listeners ready? Awesome. What’s the best way to improve health care outcomes.
Shakil Haroon: [00:21:58] I think adopting an independent scoring approach that you can spread internally at first if you’re more comfortable doing that and having everybody be aware of where you stand relative to your peers nationally for the procedure categories you’re working. So not all are possible score that nobody is particularly accountable for but score that each and every department can post up on their walls and say hey here’s how we’re doing against our national peers. And look at us we are number three in the country or we’re number 75 in the country. And what do we need to get to a better position. So I think you can’t manage what you can’t measure. You can’t improve where there are no metrics. So adopting an independent unbiased metric that is actually objective is probably one of the most important things that can be done and that’s proven by the way to be effective. I think that’s probably the best way to improve healthcare outcomes let people know how they’re doing and manage them to it.
Saul Marquez: [00:23:02] I love it. What’s the biggest mistake or a pitfall to avoid.
Shakil Haroon: [00:23:05] Believing in your own press. Well you know there are huge dollars here at stake. There’s thousands of employees livelihood at stake. It’s natural for large organizations to want to put their best foot forward to the consuming public and in this case hospitals want to be known as uniformly excellent throughout all of their service lines and all of the doctors on staff and nurses on staff are just miracle workers. I mean that is very much the marketing message they want to promote. I think believing in your own press in this case can be dangerous because what it does is is limit true improvement from happening and especially where you have hospitals that are similarly situated in terms of patient risk. You now get to be able to measure against their performance and say hey how are we doing with the same risk of patients or the same challenges if you will. So getting overly invested in your own marketing message leaving in your own press I think is a danger. It’s a mistake. It’s a pitfall.
Saul Marquez: [00:24:14] How do you stay relevant as an organization. Despite constant change.
Shakil Haroon: [00:24:18] As a high tech entrepreneur we’ve been the beneficiary of taking advantage of change and good companies and achieve success of personally as well as in business because we were good at taking advantage of change. So I think that it starts with a philosophy of not accepting change as just inevitable but but actually capitalizing on the opportunities that change brings. So investing in things like innovations teams strategies teams that report in at the very highest level of the organization seems like a great idea to me. So if you’re accepting that changes is going to happen in every industry and probably faster than you think then having a team who wakes up in the morning thinking about how to take advantage of the changes that are happening in your industry whether it’s health care or anywhere. I think that’s an investment that pays off great dividends.
Saul Marquez: [00:25:16] It’s a really great insight. And finally what’s the one area of focus that should drive everything else in your organization.
Shakil Haroon: [00:25:24] I think it’s about execution. At the end of the day if if you’ve got the right teams focusing on the right innovations and betting on the right innovations then it’s a question of well how are you going to actually make it so. How are you going to ensure that all of these informations get delivered at the right quality and at the right time. So having team very focused on execution and reporting out on their progress versus versus your organization goals I think that’s absolutely critical. We can all have the best ideas in the world and be philosophically bought into change in all of these new concepts. But if we’re still sitting around a year from today with no progress to show for it well it doesn’t really matter a whole lot. So at the end of the day it truly is about executing and taking action. I think certainly our organization as a start up are very much focused on that and I think that’s probably true across the board.
Saul Marquez: [00:26:23] That’s a great message and Shakil, what book would you recommend to the listeners on the syllabus.
Shakil Haroon: [00:26:30] Well maybe go off on a surprising tangent here in that it’s not a health care book. My upbringing overseas makes me relate to writers with similar background. In this case one of my favorite books of all time is love in the time of cholera by Marquez. Wonderful book actually deals with a lot of themes that entrepreneurs have to deal with solitude sticking through it for years and years and decades and in some cases yeah but not a health care but it’s certainly a personal inspiration.
Saul Marquez: [00:27:00] I love it. It’s a great recommendation and listeners all the things that we’ve talked about today the syllabus that we just created for you. The book links to Shakil’s Web site. All of them could be found at outcomesrocket.health/shakil. That’s S H A K I L you’ll be able to find all the show notes the syllabus as well as links galore. You’ll be able to do that and so no you you not to write. That’s why we do this for you to make sure that all this stuff is found easily Shakil, before we conclude I would just love to hear a closing thought. And then the best place where the listeners can get a hold of you.
Shakil Haroon: [00:27:36] Know well you know closing thought is health care. We’re going through profound change consolidation. And it doesn’t look like the end is in sight. I think accepting that we are all in this together patients providers payers and accepting the transparency and data is going to be the guy to our future in a future where we all drive both in terms of health as well as financially. Those are the thoughts I would have in closing we have an exciting time ahead. But again for those organizations that are capable of adapting so nothing that I haven’t seen in any industry which I’ve been investing in both career as well as financially the ones that get out on top are the ones that are best at adapting to the change that is happening. Exciting times in healthcare. I look forward to getting the next wave of change.
Saul Marquez: [00:28:28] And Shakil what’s the best place for people to get in touch with you.
Shakil Haroon: [00:28:32] Best is email firstname.lastname@example.org So look forward to hearing from your listeners.
Saul Marquez: [00:28:42] Hey Shakil thank you so much. I know you guys are definitely doing a lot to ramp up the accountability for outcomes so keep up the awesome work. Well they’re going to be filing what you guys do. And again I want to thank you on behalf of the listeners for sharing your wisdom today.
Shakil Haroon: [00:28:59] Appreciate the time. Good luck to you.
: [00:29:04] 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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