Episode: 210

Assessing the Impacts of Social Determinants on Population Health with Rob Fields, SVP, Chief

A Digital Health Solution for the Silver Tsunami with Victor Wang, CEO at care.coach
EP. 87
15 min 7 sec

A Digital Health Solution for the Silver Tsunami with Victor Wang, CEO at care.coach

Episode 87

A Digital Health Solution for the Silver Tsunami with Victor Wang, CEO at care.coach

A Digital Health Solution for the Silver Tsunami with Victor Wang, CEO at care.coach

: [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: [00:00:20] Outcomes rocket listeners, welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring healthcare leaders. Really want to thank you for tuning in and I invite you to go to outcomesrocket.health/reviews where you could rate and review today’s amazing guest. His name is Victor Wang. He is the CEO at care.coach. Victor got started tinkering with tech at the age of six. Programming role playing games and he worked in telemarketing environment research aerospace main factory in particle physics, oil sands, medical robotics, and the military before grad school at MIT and starting a career as a health care entrepreneur. This guy’s pretty interesting had a chance to meet him live at Health 2.0 where I really gain an appreciation for his work. So what I want to do is offer him a warm welcome to the podcast. Victor. Welcome.

Victor Wang: [00:01:14] Thanks for having me, Saul.

Saul Marquez: [00:01:15] It is a pleasure my friend and so maybe if there’s any gaps that I left out in your intro maybe there’s a good chance to fill it in.

Victor Wang: [00:01:22] I thought that was a pretty flattering intro.

Saul Marquez: [00:01:26] Thanks man. Hey you know it’s real. It’s true it’s it was really fun to kind of do a little background on you man. You’ve done a lot in a very short time and and it’s exciting to see the new wave of entrepreneurs doing some pretty cool things like you. And so what is it that got you into health care to begin with.

Victor Wang: [00:01:45] Yeah actually I mean it was this company is what it was and I don’t think that starting it off I really thought of it as a health care company.

Saul Marquez: [00:01:56] Ok.

Victor Wang: [00:01:56] It’s more of solving a problem kind of a company. Those kind of based from family experience with now and my grandma in Taiwan and just going through trying to support and care for an older loved one remotely. And how challenging that is and then just trying to solve that problem. And I guess I kind of thought of it as like senior care but not necessarily health care to begin with.

Saul Marquez: [00:02:24] Yes.

Victor Wang: [00:02:24] And it has evolved a lot since then.

Saul Marquez: [00:02:27] Yeah. Know it’s really interesting the evolution and you said it really wasn’t health care was more so solving a problem that that you had personally. So are you are you using the technology to to care for your parents your grandparents now.

Victor Wang: [00:02:42] One day she actually speaks Mandarin oh doesn’t really speak English at all.

Saul Marquez: [00:02:47] OK. OK.

Victor Wang: [00:02:48] So we have to have a service that works currently in English and Spanish only.

Saul Marquez: [00:02:53] Oh nice. So you got Spanish in there too. Yeah.

Victor Wang: [00:02:56] And you know one day Mandarin.

Saul Marquez: [00:02:59] Hey you got to start somewhere. And the point is you got your vision. It was inspired by family situation. And so now you’re here. Fast forward to today. Can you give the listeners an example of what you believe needs to be done on healthcare leaders agenda.

Victor Wang: [00:03:15] I would say the aging population. I’ve just I don’t know what kind of answer you’re expecting but you know this is kind of my field and it’s actually kind of boggling to me how some people don’t have this theme of aging you know on their agenda are in their awareness of actually you know not going to name any names. Very senior people like CMO is a top academic or things like that like oh you know I notice you mention this. How come like aging and the fact that there’s a thousand baby boomers retiring every day and the changes that health care faces when dealing with this kind of you know older adult population with multiple chronic conditions and so on that come with age. You know how is this aging of the patient population factored into this overall strategy of viewers because you can’t just think of people as individual diseases that you’re treating when it comes to geriatrics and you know it’s just surprising that

Saul Marquez: [00:04:21] Yeah why do you that i. Why do you think that is Victor why do you think aging is a bigger part of the overall strategy and plan and human thought process. Why do you think that is.

Victor Wang: [00:04:33] I think there’s a lot of answers to that question. I mean one from the perspective of medical education I mean I’m not a doctor I happen to be wearing a fake lab coat right now. This simulation going on there. I don’t even have a Ph.D. but as far as I know I’m in that case you really have to go into a geriatrics kind of a specialty to really grok what it means to care for elderly people because I feel like a traditional medical education even my limited understanding obviously think of people as you know what are the problems that need to be treated. And it’s very individual and I would say even until now we don’t really have a robust complex you know multiple conditions kind of a model that’s been widely accepted and understood by most physicians. Even things that are considered innovations relatively new like the diabetes related disease self management programs and things like that they’re really focused on single conditions and you know if you look at the statistics that people get old there are very few people you know in retirement age and beyond have one chronic condition.

Saul Marquez: [00:05:50] Right.

Victor Wang: [00:05:50] And so that kind of mindset doesn’t really work. But everybody still kind of stuck in that kind of a mindset of treating individual conditions. Medical education is potentially some other issues and this starts to get into you know caregiving and it can be hard to reach people who are caregiving for older parents. But it’s also just not a topic that’s you know in the popular mindset particularly sexy right. In a way. You know it’s cooler to talk about like stent technology or something like that than it is to talk about you know your mom or dad who is ailing and can’t drive anymore. You know maybe needs help getting dressed and things like that it’s kind of a touchy subject for a lot of people and it’s kind of a topic that people tend to shy away from a little bit. It’s a little bit taboo as well to talk about a certain kind of elder care related things. There’s a lot of issues at play I think.

Saul Marquez: [00:06:49] Yeah that’s really interesting. Vicker you can dive into some really really fascinating thoughts there particular this idea that not only are we siloed as far as communication in healthcare but also you know siloed in the way that we approach different chronic conditions and different specialties. And I do look at this as as an opportunity for the leaders of healthcare listening to the podcast right now to ask themselves what is it that you can do to remove the silos and think of this horizontally rather than vertically think that a patient goes through an entire continuum of care. A patient can have more than one specific disease to take care of. So the ideas that Victor’s sharing here specifically in the elderly it’s very important that we start thinking more broadly. So Victor appreciate you highlighting that and the things that you guys are doing at care.coach are really tied into this. Can you dive into a little bit more about what you guys do there and what makes you guys unique in the market.

Victor Wang: [00:07:52] Sure. So the short version is we psychosocially support complex high name high risk patients across the continuum of care. So in the hospital or at home to drive health care outcomes and that sounds incredibly broad. It’s basically what we do and because we’re focusing on this population which is very high need and high risk and I don’t by default say elderly in there but in many cases that’s kind of implied. But when you work with this kind of a population necessarily that’s the easiest way I can frame what we do because if I were to go into the exact outcomes that we drive you know it varies. So for hospital customers we’re reducing delirium occurrence and risk when you do detect it and increasing the detect ability of delirium and then that’s one way that we actually reduce fall rate among hospitalize Alder’s and there’s other ways that we reduce foller among houseflies others where you can also help to engage and redirect people to reduce the need for restraints in the hospital which is a huge thing. And then at home completely seemingly completely different environment and we’re supporting people to alleviate depression and anxiety. That’s kind of what we’ve been known for for a while but then on top of these social relationships we’re coaching people to better manage multiple chronic conditions like heart failure plus diabetes plus COPD plus hypertension loss depression plus you know they get anxiety related emergency department visits that are otherwise avoidable. Now these are the kinds of patients that we work with and I don’t think it would be very easy to point to any specific technology startup that does all this charitable. You know that’s actually what makes us unique and in a long winded way is we actually support at a personal level these very complex high need high risk patients that otherwise are completely underserved as far as technology point solutions.

Saul Marquez: [00:09:53] Yeah that’s interesting that there and would you say that your solution falls under the self-management sort of movement of technologies and processes that drive individuals to take care of themselves across not just one disease but basically everything that they’re dealing with.

Victor Wang: [00:10:10] Yes essentially and beyond just the clinical indications like you know we’re going to put together this self-management program for heart failure and diabetes that’s been done. It’s a feat to do a good job. Although it’s been done so I think what sets us apart even from that is just the personal support that we’re providing. So we have this avatar actually that talks with people and with research that shows that it actually builds friendships and a real social relationship with that person.

Saul Marquez: [00:10:37] A little dog.

Victor Wang: [00:10:38] Yes.

Saul Marquez: [00:10:39] I showed it to me at the meeting super super nice. Tell us a little bit about that. The avatar and sort of what role it fills in this. You call it a psycho social aspect of the service that differentiates it from the typical chronic disease management.

Victor Wang: [00:10:54] Sure. So what people see is the little dog the cat Yeah and it’s pretty disarming when you see it because it’s just adorable little dog or cat.

Saul Marquez: [00:11:03] Oh there’s a little cat too.

Victor Wang: [00:11:05] Yeah there’s a cat a cat lover, Saul.

Saul Marquez: [00:11:07] Well you know we do have a cat. And yes I am. So how do I use the cat.

Victor Wang: [00:11:12] OK. Well let me know if you. Maybe in a few years or something. Yeah. So you know they see this little pet and as kind of disarming Richter’s what’s actually happening is a lot of complexity in the background. So what we’re doing is we’re realizing that in order to adequately support this highly complex isolation you really need real people. And there’s there’s other startups out there trying to do things like what we’re doing. But do you know social robots or some artificial intelligence. You know maybe one day in a couple of decades we’ll get there.

Saul Marquez: [00:11:52] Right.

Victor Wang: [00:11:52] But in the meantime we’re recognizing that real people are the best at providing this kind of high touch personal support. And so we have real people that we hire all over the world 24/7 that provide this kind of social interaction conversation and really can talk with somebody, pray with them, with listen to what’s troubling you, know talk through some issues that are going on or share in things that are that you’re interested in or that make you happy and really provide that level of support any real people. So that’s what we have. Now you have a problem when you have a team of 24 7 people all over the world providing this kind of support is you will have to talk with several different people at minimum throughout the week. And depending on what time it is or if you wake up at 3:00 a.m. and you need to talk to somebody in the middle of the night it’s going to be probably different than the person you talked to. This is day afternoon. Let’s say right the avatar is there to unify the care team and to have that persona which is not particularly helpful for elderly patients.

Saul Marquez: [00:12:51] That’s very interesting. Yeah. And does the voice change or is that stays the same too.

Victor Wang: [00:12:56] Stays the same. So we can change the voice so we have for example of Stanishev voice engine and you know we can change the pitch or the speed depending on the person’s listening preferences or impairments. But for a given Avatar once you’ve picked a good voice it’s just the same.

Saul Marquez: [00:13:13] Oh that’s so awesome. So the whole team can speak through the Avatar it stays the same. So there’s continuity for the person using.

Victor Wang: [00:13:20] Exactly yeah.

Saul Marquez: [00:13:22] That’s really sweet.

Victor Wang: [00:13:23] Now and then it’s kind of like a more lighthearted fun non-judgemental kind of a relationship than you would have with like a virtual doctor or like a virtual nurse or something like that.

Saul Marquez: [00:13:35] Wow. And that’s really cool. So who pays for it.

Victor Wang: [00:13:38] So our customers pay for it. It’s what we call them customers.

Saul Marquez: [00:13:42] So like I guess I’m just wondering if it’s typically the hospital the insurance company.

Victor Wang: [00:13:49] Was that it’s tongue in cheek manner so because I was going to say right now we working with hospitals and these special health plans that gacha targets for elderly people. So it’s actually an interesting concept if the listeners don’t know about it. There are these things called Heyst health plans or program of all who care for the elderly is. So if anybody is listening and hasn’t all their parents for example perhaps needs to go into a nursing home soon anything and doesn’t want to because he wants to do that and he might want to look into the potential availability of one of these pace programs because they’re basically an alternative model where if somebody is qualified to go into a skilled nursing care under Medicare or Medicaid coverage they can instead take that coverage and stay in their own homes not go anywhere. Yeah and the pace health plan is everything and they will actually take you to a day program. They’ll pay for the shuttle shuttle you back home they’ll pay for home nursing visits as necessary and so on and this model of care is basically caring for people that would otherwise be in a nursing home. So that’s one kind of organization that our avatars are very helpful for. As you can imagine for this very high need high risk kind of a population.

Saul Marquez: [00:15:03] Victor, I think what you’re doing is really awesome. And you know I put myself in the shoes of somebody going to through this and just getting to that point of life where yeah you know you really start depending on others again kind of full circle. I wanna stay in my house. And so if you’re a listener if you have an elderly parent or grandparent and you find yourself in this place where you’re in a bind and you know you may have to take them to a elderly home consider this program that Victor just just mentioned and the space programs. And so what I’ll do is Victor if you can share the link. All included in the show notes as well as a link to the things that you provide but definitely a really great alternative. Victor let’s talk about some of the outcomes that you guys have created. You mentioned delirium mentioned fall prevention. What would you say one of the proudest outcomes you’ve been able to achieve with this technology and your people. Obviously it’s not just technology it’s people.

Victor Wang: [00:16:03] Yeah I think he basically said it’s the falls and the delirium outcomes are probably the pinnacle of what we’ve achieved so our history. So we actually started over five years ago as we started to develop the product. As you might imagine if you know several years ago when this was an idea it might have seemed kind of like a crazy idea like let’s get these people are all over the world like no other country has to staff these avatars and very cost effectively provide high amounts of psychosocial support to older adults in the US through these talking dogs.

Saul Marquez: [00:16:43] You know when you put it like like I think it is.

Victor Wang: [00:16:50] So we actually started out just kind of you know there a prototype like testing it. And some of our early rece. I mean you have to actually test this out. And we found sort of New York’s great professors at a university doing some research with their nursing students and computer science students. And we actually found that our original hypothesis was true is that you know you put together this crazy system and you actually can combat loneliness and provide social support to people and that was really powerful because it was like boom we basically achieved our initial goal as far as the feasibility of the product to do this and then we did some more research and actually University of Washington has a few papers published already about how we help to combat depression like the Paish Q9 Servais improve measures of social support like Yemo social support sub skills. So there are several published papers on that and then we’re kind of like OK. So as a business as a social enterprise you know if we can scale this up this is great we solve loneliness. But as a business where’s the value in solving loneliness. So we realize that we could actually scale much better if were you know making driving more value to whoever customers are and we drive a lot more value and incidentally save lives and deliver more social value if we layered on top of that these clinical outcomes beyond just making depression is a clinical outcome but I mean things that are even closer to actually the things that the doctors care about in the hospital the nurses care about the hospital like Delerium or falls. And so we realize that when you have this psychosocial relationship with somebody you can use that to help you know influence behavior towards risk mitigating healthy behaviors. So then we did other research for example what you just mentioned in the hospital that was a 95 patient study where we showed in excess of 80 percent reduction in fall rate among hospitalized elders by affecting behavior you know making sure people ask for help to go to the bathroom instead of getting out of their beds alone by getting people to do cognitive orientation tasks and cognitive exercises and wear their glasses because of vision impairment is actually a major risk factor for delirium. And to do all these different things and elicit all these different needs out of the patients on top of this friendship in a way that is protocol driven based on evidence you know saves people’s lives.

Saul Marquez: [00:19:26] Is what matters. Yeah that’s really interesting Victor so thanks for walking us down the path there of how you guys are adding value and it’s interesting right. Like here’s a note to the entrepreneurs listening. You could start somewhere with an idea and then get to the point where you realize that hey you know while I’m creating good and doing good they may not Not necessarily be a financial model behind it to support what you’re doing without margin there is no mission. And so what Victor did with his team they pivoted and they found a way to impact something that affects the bottom line of these providers. And you guys did it beautifully and you found some some great areas to focus on. So don’t give up on your idea, people. Think through the things that you’re doing and think how you could broaden what you’re doing don’t just abandon because there’s no model behind it right now. And Victor is a great example of of doing just that. Victor give us one of the proudest leadership moments you’ve experienced to date.

Victor Wang: [00:20:28] Proudest leadership moments.

Saul Marquez: [00:20:31] You’ve been on the stage at TED MED you’ve Ted health. You’ve done a lot of really cool things you’ve been published on different magazines you’ve done a lot of cool stuff but out of all the things that you’ve done what sticks out as one of your most proud moments.

Victor Wang: [00:20:45] I would say it’s just having this team that’s stuck with me a.

Saul Marquez: [00:20:49] Tell me a Little bit more about. I mean it’s a chance for you to give them kudos right now.

Victor Wang: [00:20:53] Yeah I’m proud of my team and you know we all really believe in the mission and just the fact that we’re all still working together after so long and you know so committed. It says a lot I think and we’ve been through a lot together. Like my co-founder Schwall like we’ve been working together for over five years now and then another example is my wife.

Saul Marquez: [00:21:17] Very important part of the team.

Victor Wang: [00:21:18] Who I met at an aging conference called Aging in America. So we made this it’s like newbie table. And I was like wow OK let’s get lunch. I don’t know. She was impressed that I was like some young guy out there presenting some research outcomes of an avatar and she kind of felt me kind of inspiring. You consider that to be a leadership moment because that got me the date and then we reconnected after the got married. She joined the team she started volunteering because she wanted to help. And you know now she’s with us full time. I think that right there is probably my proudest leadership moments.

Saul Marquez: [00:22:09] Hey congratulations. I Like that is that is pretty amazing. You did it. You met the woman of your dreams. You guys just bonded over common interests and now you guys are both doing better for the world. So that’s an amazing story. Thank you for sharing that. What’s her name.

Victor Wang: [00:22:28] Brittany.

Saul Marquez: [00:22:29] Brittany Brittany your husband loves you. And I could tell. I could see I could see him right now he’s he’s like beaming. So that’s awesome man. Congratulations. Tell us a little bit Victor about an exciting project that you’re working on within care.coach.

Victor Wang: [00:22:44] Sure. We’re always working on a lot of stuff because we’re a complex system of people and protocols and technology. I feel like I can’t talk too much about the details but yeah I got into it.

Saul Marquez: [00:22:59] I don’t want to put you in a bad spot either.

Victor Wang: [00:23:01] Yeah a lot of it has to do with like automation. So we have a very unique position as far as our technology. So a lot of other companies are approaching it from the point of view of let’s build this ultimate artificial intelligence that’s going to be able to do what we see in the movies. And that limits the kinds of interactions and patients that they can actually have an asset whereas we don’t have that limitation. So we in a pretty unique place where we are you know our avatar is literally the best friend of a lot of our patients. I know that’s probably hard to believe but it’s actually.

Saul Marquez: [00:23:36] I believe it man.

Victor Wang: [00:23:37] Yeah and you can actually believe it that University of Washington I wish them the kind of things that we talk about with. I mean if you imagine that we had this technologically enabled entity this best friend kind of a relationship and we’re getting the data from that it puts us in a very powerful position to potentially leapfrog with a lot of other people are doing it. We have a very unique set of data so we have a lot of things that are in the pipeline because of that.

Saul Marquez: [00:24:06] I think that’s really interesting. And yeah you know the nice thing that you just highlighted Victor is the IPA when you come up with a strategy. It’s not only about what you do but it’s also about what you don’t do. And I think you’ve highlighted very clearly that you guys are going to embrace artificial intelligence. But guess what you don’t have to go all the way and you’re not going to do it all the way in. And I think there’s beauty in that and that you know your strengths and you’re going to leverage the tools to augment. You know I like to think of AI as augmented intelligence not just artificial right.

Victor Wang: [00:24:41] We’ve developed a very strong understanding in this healthcare context of what people are inherently good at versus what software is inherently good and yet our entire system is just around kind of marrying the two. That’s beautiful man possible.

Saul Marquez: [00:25:00] I love it. It’s exciting to hear that you guys have other things brewing over there so definitely we’ll be following you guys to make sure I stay on top of the cool thing that you guys are up to. Victor let’s pretend as we get closer to the end here we got about three 4 minutes left but pretend you and I are building a medical leadership course on what it takes to be successful and medicine today. It is the 101 or the ABC of Victor Wang. So we’re going to write a syllabus. I got four questions for you. That’s going to be lightning round style day. And then at the end you’re going to provide a book that you recommend for the listeners you ready.

Victor Wang: [00:25:33] OK.

Saul Marquez: [00:25:34] What is the best way to improve health care outcomes.

Victor Wang: [00:25:37] To understand truly understand why they’re not where you want them to be.

Saul Marquez: [00:25:45] What is the biggest mistake or pitfalls to avoid.

Victor Wang: [00:25:48] Thinking that you know more than you do.

Saul Marquez: [00:25:52] Love that one. How do you stay relevant as an organization. Despite constant change.

Victor Wang: [00:25:58] Keep learning reading getting out there. I know what other people are up to. Keep an open mind.

Saul Marquez: [00:26:03] Finally what’s one area of focus that should drive everything else in your organization.

Victor Wang: [00:26:08] Your mission whatever that is.

Saul Marquez: [00:26:11] Love it. Stay clear on that. And finally what book would you recommend to the listeners. Victor.

Victor Wang: [00:26:16] I’ll be a little biased because there’s mention of us in there but the new mobile age by Dr. Kvedar.

Saul Marquez: [00:26:22] Love it. The new mobile age Dr. Kvedar. So listeners take these nuggets of wisdom Don’t worry about writing them down the links to the book the links to Victor’s company and all the things that they’re up to as well as the pace site which he’s going to provide to us go to outcomesrocket.health/Victor and you’re going to find all the show notes as was these resources. Victor, this has been a lot of fun. Before we conclude I would love that you just shared a closing thought and then the best place where people could get in touch with you or follow you.

Victor Wang: [00:26:53] Well I thought, geez, this was fun. Let’s do things sometime later.

Saul Marquez: [00:27:01] We’d love to.

Victor Wang: [00:27:01] As far as how to get in touch with me. victor@care.coach don’t add a .com.

Saul Marquez: [00:27:09] No .com listeners you get that it’s care.coach They make sure that their data is awesome Victor.

Saul Marquez: [00:27:18] Hey this has been a blast. Really appreciate you spending time with us and looking forward to having you back on soon.

Victor Wang: [00:27:24] Thanks so much, Saul.

: [00:27:29] 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.

Recommended Book/s:

The New Mobile Age: How Technology Will Extend the Healthspan and Optimize the Lifespan

The Best Way To Contact Victor:

victor@care.coach

Mentioned Link/s:

https://www.care.com/

Finding a PACE program: http://www.npaonline.org/pace-you/find-pace-program-your-neighborhood
A recent Reuters article about some of the stuff with do with PACE: http://news.trust.org/item/20171023113851-u2etw/
Some of our research and publications: https://www.care.coach/publications.html 

One of the UW papers with free full text is: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333281/

Episode Sponsors:

Healthcare Podcast

A Digital Health Solution for the Silver Tsunami with Victor Wang, CEO at care.coach