Why Continuity of Care Became a Core Focus for This Leader and How She's Improving Outcomes with Anne Weiler, CEO and Co-founder at Wellpepper
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: Welcome back once again to the outcomes rocket podcast where we chat with the day's most successful and inspiring health leaders. I really thank you for tuning in and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have an outstanding guest and an amazing contributor to healthcare. Her name is Anna Weiler. She's the CEO and co-founder at Wellpepper a clinically validated patient engagement platform. She's really focused on this space and has been for quite some time. She's also a health care blogger. Her site healthworkscollective.com is really a site that you all have to check out because she dives deep and wide into all the topics in healthcare that matter and it's very well organized. Just as her and her business are doing for other practitioners they're very well organized in helping them improve patient adherence and outcomes for patient care plans. So without further ado I just want to extend a warm welcome to Anne. Welcome to the podcast.
: Hi. Thanks for having me, Saul.
: It's a pleasure. And anything that I missed in your intro that maybe you want to highlight?
: No, it think was a great intro. We will have our focus on interactive care plan for patients and we've taken the approach to say that if you help patients understand what they need to do and you break it down into actionable and engaging experiences they will actually do it. And so you know I think I'm not the one to claim that but the patient is definitely an underused reserve in the whole health care path and that's really our focus and then we help to scale that clinicians with technologies so starting to observe what's happening with patients and learning the care team that they need help as opposed to saying care team here is a bunch of people you have to manage and more work that you need to do and my backup background as you might tell is in technology. So I spent 10 years at Microsoft before founding this company and including three years running a business group in Microsoft Russia.
: That's pretty interesting. So you start off with Microsoft went over to Russia and loop back around. So now you're in healthcare so tell us a little bit about that what was the spark that got you into the medical sector?
: Well you know like a lot of people and I think a lot of people who came from technology into healthcare. It was a personal experience. My mom contracted a rare autoimmune disease and she spent six months in the hospital. The disease that caused temporary paralysis. And she is in the hospital. So she she had great care and she mostly recovered and she has some permanent nerve damage. But she mother covered. And that problem was she was discharged that she went from having round the clock care and physical therapy and occupational therapy and physician check and all week to a month before she could come back into the same facility for her outpatient. And so during that time we didn't know what to do. We had to hire some private care for her and we couldn't even explain to them what had happened which is basically that she was sent home with no instruction in over a month before she would come back in again. And that lack of continuity of care made me think you know we're in constant contact the rest of our lives with these mobile devices. Why is there this lack of continuity care and health care. And that's where it all started. And we were very fortunate my co-founder and I hear about someone who was at Microsoft. The two of us actually met at a startup in Canada that Microsoft acquired in 2001. But we were very fortunate very early to meet Dr. Terry Alliss, a Ph.D. researcher and professor at Boston University and she what we had prototypes basically and really felt like there was an opportunity to partner. So I was really sort of our first positive nod on the journey with finding a really great research partner who had been completed one randomized controlled trial and one other trial that was sort of quality controlled trial to show that the software works and that it has efficacy and that you can actually engage patients outside the clinic.
: I think it's super great. And thanks for sharing that story. Super glad to hear that your mom's doing better and sort of the spark that got you into this. The road has meandered and you guys have been in it for five years which is a long time for a startup in healthcare.
Well someone said this is about startups in general that half the battle is not dying but I would say I would say in health care also half the diving that's definitely half the battle in that you know we met organizations very early on who thought that we were doing something quite interesting. And then when we were still around two years later then they're like oh you're still here. Great. Now I can work with you. So you know health care and there's a good reason why but they are fairly risk averse. So a number of factors had to come together together to the point that we're at now. And certainly when we first started there then we got questions around. What are you doing? Doesn't really seem like a thing and now we're getting: how are you different from all the other patient engagement experiences? So number of things have happened in that focus in the method put on outcomes and certainly patient reported outcome has been a real a real benefit for us. Certainly Bundall where you need to think about overall cost of care. And then we also see lot of interests where there's an access to care problem and whether that's a specialist who have a very long waiting list. And is there a way to get people on board and engage them before they come in or and certainly in organizations that have a large catchment area with rural I mean even even our researchers at Boston University think of Boston University as being very urban. But they work with specialized patient population who have Parkinson's disease and the people may be coming for three or four hours to come in to the few specialist from the clinic and if they don't have to come back. That makes a huge difference for them.
: For sure. It sounds like you guys are definitely making an impact and without a doubt the hot topic here folks is patient engagement. What do you do when your patient leaves? What do you do when your loved one leaves? And how do you make sure that they get the care that they need that continuity? Ann and her team are definitely focused deep into this and can you give the listeners an example of how you guys have created results, improved outcomes or profitability?
: Definitely. So I think I'll start with some of the research the research studies and the results that our research partners have found. But we also continually are analyzing the patient interactions and the patient experiences within the software to find results and outcomes as well. And that's both on the patient outcomes side and on the effort and cost side from the healthcare innovation. So on the studies we partnered with two different PIs. One with Dr. Terry Alice, she's the director of Boston University's Center for neuro-rehab and they completed a randomized controlled trial with an exercise intervention exercise strength and conditioning intervention. Over 12 months for people with Parkinson's disease. The usual care condition which was a control piece was that you would come in and you would have a couple in person visit and assessment and then you would go home and then they might see them again in 12 months or they might never see them again. And then the visual intervention was a personalized application that had personalized video of the patients in it and the ability to be monitored remotely by a clinician and message with that clinician over the 12 months. So the difference between basically the usual care condition and the group that had the mobile health intervention was a striking physical outcome. So the people with the usual care condition are 12 percent decline in their mobility over a year. And the people in the mobile health interventions found 11 percent improvement and that's 12 percent decline
: It's huge.
: I now and that's what happens each year from the first year you're diagnosed with Parkinson's. So if you can stop that. You keep people self-sufficient you keep them. Sometimes in the work place you certainly keep them out of long term care facility. Now that study we then went and that we put them in additional of an additional research on a couple of things in there because that was not particular like it was. It was not looking at cost that was looking at efficacy. But then of course the next question became well how much did the clinician have to engage with the patient outside the clinic and what were some of those engagements and what was the cost of that really not hard cost because we got wasn't designed into the intervention up front but a couple of things. One was that in working with these people remotely the clinician was able to noticing either the patient message and said something about you know I didn't really like it or I find this one really does exercise that you want me to do really hard or they would also look at them as they were recording their outcomes themselves and seeing whether they were progressing and the clinician was actually able to change the program remotely so she could add in...
: Yeah she could make it harder, she could make it, sometimes she said she just took things off of their programmers. They really didn't like it because her goal was to keep them doing something. So I think I was really key. But then we wanted to also look at sort of the effort of messaging because when you talk to clinicians as soon as you open up the channels for messaging with patients that outside the clinic there's a fear that they're going to become overwhelmed with new work really because patients aren't messaging before we think some of that is actually replacement of messaging can be replaced in a phone call. And then also that messaging can tell you about things that and alert you to think before they would follow adverse about them. So that's why when we were constantly looking at evaluating the efficacy of our product as well as how people are using it. So we went back and we did some analysis on the messaging in this scenario. Again you know we combat the identified the data and did this analysis and applied machine learning to it. When we classified the messages that were sent back and forth during this year. We found that 70 percent of them did not require a response. And then we found that 3 percent of them are urgent. So what's interesting here is that the 70 percent who don't require response were things of patients journalling they were using this to talk about their experiences. And for the ones that were urgent things like you know I had a fall or you know I went to the Ed those other things that you want to reach out to the patient and find out more about. And the other interesting thing was that there was actually no correlation between messages sent by the provider and adherence which actually meant that thinking back to the 70 percent of messages don't need to respond that the fact that they're with someone on the other end that they knew they could get in touch with with this person and that the person was watching their progress whether or not to keep them adherent. It didn't really matter how much that provider reached out a message. So we had a couple. Most of the time the messages were equal. So the patient comes when the provider sends one but we had this one patient who is like them outliers somebody who's been 150 messages that someone and 600 messages and that provider did not match those messages. And those people stayed adherent.
: Interesting, that's the basic feeling that somebody is on the other side ready to support you.
: Yes. That was the key driver now because that study didn't specifically look at cause we actually entered into another study and the Boston University folks were part of that study but it was led by Dr. Jonathan Bean who's an M.D. and a professor at Harvard University. And that study was called a quasi experimental design. And what that meant was that they had done the study as an in person intervention already. So they did a one year study. They had an intervention and they the intervention was to prevent people who were at risk of falls from having a hip fracture so that they knew their intervention works. But it was also very people and in person intensive so people had to come in and again that was part of the conduct in Boston. People had to come in to do the intervention and so well it worked. It was hard for people they often had to find rides, there were a lot of a lot of snow.
: Scalability becomes an issue right?
: And scalability is an issue. So they did the same study the same intervention but then did it with a digital experience so it was very similar to the Parkinson's disease study which is why how we ended up in this and that one they have not published yet so I can't share the details but they did have better than expected. And clinically meaningful outcome though patient outcome patient had improvement during the course of the study. Now the other piece of that study is that there are researchers at Brandeis School of Public Health who are analyzing the cause. We're really excited to see that when it comes out because hip fracture is basically for seniors. You know that's the really the beginning of the end of their quality of life. Once you have a hip fracture your quality of life really declines and risk of increased mortality and also increasing expenses. So if you can keep people from having a hip fracture you know it's going to be good for everyone. So look at comparing the cost of doing the program and helping people at the clinic to the cost of the have fracture. I think we're probably going to see some pretty positive results especially since the cos it was designed as a digital intervention. So the costs should be pretty low.
: Anne, super interesting and no doubt you know once you get that hip fracture it becomes the kiss of death oftentimes. So it's interesting that you guys are focusing there. Definitely a key area. And thanks for sharing that right. I mean you guys are diving deep into the clinical validation truly shows your commitment. Take us through a time when you had a setback or had made a mistake. What happened, what did you learn from that?
: As a technology company. You know I think there's there's always time that you're constantly trying to improve the software constantly trying to improve the patient experience. I think it's not so much around setbacks, sense of making sure that you're continuing to learn as you go along and you're continuing to challeng your assumptions. So you know we have I think that software is both an art and a science especially when you get to be experienced because you think about things that you think intuitively. But I think it should be. But then you also need to continue to test them so very early on we were trying to think about what what is the optimal number of things that you should ask them and to do if you want them to be an adherent. And before we had enough data to to really test our assumption was about three things a day and we are clinicians and they had no idea. And the clinicians sending people home with a list of 20 things to do. And then when we did the thing we found that it was actually five to eight things. I paid half in your care plan is the right number to keep you adherent. So it wasn't so much a setback versus wow. Our assumptions were incorrect. And another place I think it's sometimes again with technology can become very enamored of the technology that you're building and you always have to remember to think about the end user and ask the end user. And so an example there. I'm not sure if you saw that last fall we won me Alexa Diabetes Challenge and..
: Thank you. And a component of our solution there was a voice-powered scale and Gail scanner that looks for early signs of diabetic and when we first conceived of that you know we were just so excited because we thought wow this is really cool. You know advanced technology and then we were talking to one of the coaches in the program who's a behavioral health expert and she said what are you going to do to make sure people aren't afraid of having something to take pictures in their bathroom? And we we were just we all looked at each other and thought how did we not think of those? Those beautiful stories where people go go all the way to market with something and then they have a thought about that. But we got it before we really even tried our first prototype with patient but we were thinking what the value of this is so great that it's going to find these early is going to prevent amputations, of going to prevent hospitalization that we kind of forgot that maybe somebody didn't want them they taking pictures in their bathroom.
: Yup, that's amazing right and a great story to share and for the folks listening if you're working on solutions don't get too enamored with them get the feedback from people. Put it in their hands. Put it on their feet.
: And be willing to have people tell you that your baby is ugly.
: Totally. I love it. What a great share and truly appreciate that. What would you say one of your proudest leadership experiences in health care now that you're in this business have been?
: Well I probably to date would be our announcement that we need at HIMMS that we will have Mayo clinic care plans. So there are best practices for interactive care plans will be available on the Wellpepper platform.
: Yeah that when we started as you know we were as I said we were so fortunate to meet Boston University very early on but I don't know that we as non health care people would have said that our goal was we were going to have Mayo on our platform. So I think that's pretty big and it's something that we've been working on for a long time. So we always took the approach to say that health of them probably would want to you certainly best practices or their own interactive care plan. So we've built a platform is very flexible where you can create any type of care plan from the individual building block and so that this ability for healthsystem to license Mayo clinic care plan is something that's been in our roadmap for a long time that we needed to get to the right moment of having obviously know that the care plans from the leading research hospital in the country as well as health system really understanding what it means to engage patients outside of the clinic so that they will be ready to use the care plan. And you know what I think the great thing about this proudest moment is I'm positive they're going to be even more will be able to build on this and deliver even more innovation.
: That's awesome and congratulations on that. And in our health care economy it's not only important for us to develop cool things that are going to help improve outcomes. It's also important to get impact and his partnership with the Mayo will be an incredible way for you guys to increase the impact that you make in healthcare and super exciting. We had Lee Aase. He's the director of social media at Mayo and he told a story about the Mayo brothers and the things that they did to improve their impact. They traveled the world and they brought people from all over the world to Mayo and talked about what they were doing or learn from what they were doing. And I think you guys are sort of following in that tradition getting into that place where you could just teach other people how this software can help them improve healthcare and it's super exciting. So really really congratulations.
: Yeah you're absolutely right. It is about scaling this best practices and then it's also about learning from the patient interactions with healthcare plans and that's something that you know we couldn't do before. So we had in watching what people do and analyzing their results. It helps improve all of the care plans that help improve how people interact with patients outside the clinic. But we can also really improve care. So you know I talked a little bit about the outcomes that we've seen from research but we also have seen outcomes just in collecting this data that we've been able to identify patients who are at risk of readmission from their reported side effects from surgery which is not usually the thing that when you get your surgical instructions are really about symptoms and certainly the symptoms. Do you have shortness of breath or chest pain. That's the thing you want to look at first because you really should be calling 911 but what we found was that people who were having symptoms that were having side effects through surgery like not nausea or constipation actually had a three time greater risk of readmitting within 30 days. And that wasn't in ambulatory surgery scenario. Now you wouldn't know that unless you are actually collecting data with data from patients in real time. So that's the kind of stuff that that we really are excited about being able to do is finding those outcomes. We also had an interesting situation where one of our customers initially just report deployed patient reported outcomes surveys. So you know the ones that the and other insurers are starting to require to show efficacy of the program and for the first year they only had those surveys and then the second year they added a complete pre and post surgical care plan. And there was a 26 percentage point difference in the people who just were doing outcomes surveys to the ones who had the complete care plan. So again this is helping people outside the clinic will improve outcomes and patients want to do what they're supposed to do that today a lot of the ways they're receiving these materials make it really hard for them to follow the directions.
: Anne, supercool no doubt that your mom would be proud. And you know that experience that you guys went through. Now you're going to help others not have to go through and that's super exciting. Anne, 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 Anne Weiler. And so we're going to write out a syllabus here united together four questions, lightning round style followed by a book and a podcast that you recommend to the listeners.
: Ok. OK.
: What's the best way to improve health care outcomes?
: Empowering the patient and understanding the patients goal. Often the patients goals are very different than the clinicians goal and I think the most important thing is knowing that you're actually meeting the patient goal. So we enable patients to set their own goals and track progress against those goals and that I think is both the biggest motivator but it's also the most important outcome.
: That's a great call out. What would you say the biggest mistake or pitfall to avoid is?
: I think from my perspective as a technologist and I actually think for health systems as well. The biggest mistake is pilotitis. I think that we're at a point now there's clinical research that shows that these solutions work. We know that people want them, we know that they can save money and when you do too many pilot if you don't have the right metrics and you don't it really doesn't signal the right commitment. And so I think jumping in and really deploying something and continuing to improve and tweak it is probably a better approach than a number of small pilot. We're not entirely sure what happened.
Love that an avoid pilotitis people, get committed. How do you stay relevant as an organization despite constant change?
: I think that our technology background really helps we're in that we're constantly looking at new ways to interact with patients. The work that we did with voice came out of that you know and voice is not widely deployed in healthcare yet but I think it has a huge benefit in that the experience is so natural in healthcare you're used to talking to someone you used to being interviewed by someone and so I think the technologies are going to be a really great way to improve. So I think with technology there's always something new and so staying on top of that and then evaluating the impact that it can have on your solution or your patients. That's really what we do. Voice and machine learning I think are the two things that we're really excited about going forward that we'll have a great impact.
: Love that. What's one area of focus that should drive everything in a healthy company?
: The patient.
: I love that. So true. And thanks for walking us through that. What book and what podcast would you recommend to the listeners as part of the syllabus?
: I think everyone should read an American sickness by Elizabeth Rosenthal. It's tough to read because she breaks down everything that is not working in our health care system as well as how we got there. And so there are points when you're reading the first Top of the bank. I don't know if I can go on that very hard to read. But then on the second half of it she provides very actionable things that we can all do. But I also think it's really important just to understand how we got here because you want to undo where we are and you want to approve it. You have to understand the part about my hands down recommendation for healthcare books right now. I know that every year something new about that. That's great. I think that's one that everyone should read and it is now in paperback. And then I think on a podcast I really like a Healthy dose which is from Oxeon and Bessemer so to venture capital guys who are they interview people in the industry. And I really like how they are really teasing out like what are the macro trends like where are we going and also optimistically to. They've had Jonathan Bush on and he was really great. It was one of my favorite podcast because it was just after the thing that happened where they had that agitating shareholder and you know I think he had really taken some of that to heart and those like he could tell how much he cares about the mission that he's on but also like not satisfied with statusquo.
: Love that, some great recommendations and listeners I know we recommend a lot of books here. All healthcare leaders have amazing ideas and has recommended another great one. What we do is I recommend that you go to outcomesrocket.health/audio and you'll get access to blinkist which is a software that helps you reduce the time that it takes to vet out books. I know that the one that Anne recommended is going to be amazing you'll probably buy it but check it out. Anne this has been super helpful. I know that the things that you're doing are truly going to make a difference at Wellpepper. Why don't you close off the session with some closing thoughts and then the best place where the listeners can get a hold of you?
: Well I think closing thoughts. I think we're just really at the beginning of the journey and I think some of the insights that we're going to see from patient experiences and patient generated data out of the clinic are really going to drive improvements in care both in. I think the way that people are able to protect themselves but also clinical insight. So we're very excited about that and about the intra inpatient experience in patient generated data. And you can find us at wellpepper.com. And as you mentioned the beginning we have a blog. We try and talk about topical issues, conferences but we've been to, and if you wanted to get in touch directly you can use firstname.lastname@example.org and promote a follow up with you immediately.
: Amazing. And this has been a ton of fun. I really just want to say thank you for sharing the amazing work that you guys are doing over there and listeners encourage you to check out the show notes and the transcript will provide links to Anne's blog as well as links to Wellpeper and all the amazing things that they're up to so and just want to say a final thank you and looking forward to staying in touch.
: Thank you, so fun to talk to you today and I very much appreciate anyone who is so focused on outcomes.r
Thanks for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.
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