Эпизоды
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On Episode 2 of Season 4, Vanessa Moldovan interviewed me on her podcast, For the Love Of Revenue Cycle, which I am excited to share. Since starting the Healthcare Reimagined podcast, I founded a healthcare company, Covered Health, and Vanessa interviewed me about what we're doing and why we're doing it.
At Covered, we are automating the most challenging and time consuming elements of appealing denied medical claims for providers. By streamlining access to diverse databases and inputs, Covered uses technology to helps RCM specialists identify denial root causes, and appeal them.
Vanessa and I came together because we share the same vision: preventing patients from getting stuck with bills that should be covered by their insurance, and helping to empower revenue cycle management experts to resolve those denials with greater efficiency.
We discussed my motivation for starting Covered - my brother Russell's experience with unfair insurance denials during his struggle with Ulcerative Colitis. Our family was hit with massive bills, and at a time when we wanted to focus on Russell’s health, instead we were focused on denied claims. Covered intervenes to help providers overturn denials, and prevent bills from becoming patient responsibility.
We discussed my journey through the Special Forces, Parachute Health, and running sales for healthcare companies, and eventually selling into insurance plans prior to starting Covered. We also spoke about Vanessa's career, and her choice to turn down Harvard undergraduate in pursuit of a life and career that aligned with my values of giving back and sharing what I've learned with others, which is why I started this podcast.
Vanessa and I met, funnily enough, because I was looking for a podcast on denials and found this one! We connected over a shared passion to create a denial resolution tool with the goal of harnessing the multitude of databases & sources of truth that a biller has to access in order to identify the root cause of a denial and create an appeal.
We are not only reducing the clicks required to gather the information, but creating a smart tool that will guide RCM professionals through the decisions required to compile the body of the appeal, and eventually generate it for them.
We addressed Covered’s competitive differentiation within the denial management space, and the rapid advancement of AI and LLMs, which have given an advantage to new companies. We touched on the slow moving nature of incumbents, and why they often don’t succeed in building product lines that are as innovative as their original core offering.
If Covered’s mission to fight back against incorrect denials resonates with you, we want to connect! Especially (but not exclusively) if you are an independent specialty provider group, an RCM company fighting denials, or a regional/community hospital/health system. If you are struggling to address denials as a result of staffing shortages/payer policies/behavior, or you are just passionate about denials, please reach out!
Today, Covered acts as a software enabled services company, utilizing technology and Vanessa to overturn denials (we've returned tens of thousands of dollars to physicians). If you're struggling with denials, we can immediately step in and help you, and help identify trends and root causes. In special cases, we also provide consulting services.
You can learn more about Covered on our website, CoveredHealth.ai. -
On Episode 1 of Season 4 of the Healthcare Reimagined podcast, I spoke with Manav Sevak. Manav is the founder and CEO of Memora Health, which helps healthcare organizations digitize and automate care journeys, and make complex care delivery simple for patients and clinicians to navigate. Manav's journey to building Memora health began with a personal story - a close friend with a chronic diagnosis, who despite being young and tech savvy, found it difficult to navigate his care.
There are three major challenges that Memora addresses: Digitizing clinical workflows, saving providers time by utilizing automation, and allowing patients to use text messaging to get the information they need about their condition.
By looking at the things that happen for every patient, every time, in the course of a particular care episode, Memora has been able to use technology to automate and even standardize certain follow-up procedures. That has cut down on inbox messages and phone calls, and even eliminated them all together. Research out of Dartmouth suggests that people forget up to 80% of what they’ve heard from their healthcare professional. As a result, getting critical information to patients in a digestible format is crucial, and text messaging has proven itself to be a very reliable format for Memora.
The best course of care will vary based on a given patient’s condition and their response to treatment. However, according to Manav, the way patients get reminded to manage their medications, come to appointments, and the way that symptom management are done, should look very similar across clinical areas. What Memora is aiming to build is a best in class process for conveying information to patients and receiving that information back from them.
Memora is also able to leverage its digital approach to ensure adherence to ever-changing guidelines. When the protocols for screening patients for mental health conditions during the prenatal period changed, Memora was immediately able to update their postpartum care program across different care sites to reflect best practices.
Manav and I went on to discuss the challenges of EHR integration for digital health startups, and the challenge of building technology before Memora had access to data from pilot customers. We closed by exploring what percentage of the back and forth between care teams and patients it might be possible to automate in the future, and the tradeoff for early stage founders between staying at a high level and diving into the weeds.
You can learn more about Memora Health on their website. -
Пропущенные эпизоды?
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On Episode 10 of Season 3 , I spoke with my grandmother, Sydell Aaron. Ultimately, we all become consumers of Healthcare, like it or not. On Healthcare Reimagined, I typically showcase healthcare innovation - the truth is that innovations are only interesting in so far as they are making life better for patients. Last week I spoke with my grandmother about her experience as a consumer of U.S. healthcare over the past 9 decades.
Sydell, or Meema as I call her, was born in 1932. In 1929, 3 years before she was born, the first polio patient was saved. In the 1940’s when Meema was a teenager, scientists succeeded in isolating penicillin and antibiotics became widely available for the first time. Before that, you could die from a simple infection. The first kidney transplant was done in 1952, when Meema was 20. In 1964, for the first time human blood was successfully stored. Meema was 32 years old, with 3 children.Meema has already lived 50% longer than the average life expectancy for a woman the year she was born (it was 62 back then). We spoke about her family doctor making house calls, the awe and wonder of medicine before technology that made medical information available to all, and about the trade off between safety and independence as one gets older.
We discussed a few quotes from Atul Gawande's book Being Mortal, and the loss of independence as one ages. One of the quotes from Gawande's book really captured the essence of the challenge Meema faces in her interactions with her adult children. They want the best for her, as she knows, but at times, they infringe upon her freedom in an effort to protect her: "We want autonomy for ourselves and safety for those we love.”
We went on to discuss the framework in which death is addressed in U.S. Healthcare, and a system that selects for those who can and want to fix things (Doctors), when sometimes the best option is not to fix but to provide comfort in one's final days.
We closed with a discussion about Meema's own hopes, desires, and observations after over 9 decades on this pale blue dot we all call home.
Please make sure to check out the Society for HealthCare Innovation's (SHCI) website for more content. -
On Episode 9 , I spoke with Shiv Rao. Dr. Rao is the founder and CEO of Abridge, which uses ambient AI to summarize conversations into clinical documentation. He is also a practicing cardiologist, and previously led the provider-facing investment portfolio for UPMC.
“What did the doctor say?" is inevitably the first question we ask a loved one who has just been to see a clinician. But how often do we get a clear answer ? How many of our loved ones are actually knowledgeable enough to grasp the details of their condition/diagnosis/care plan? Research out of Dartmouth suggests that people forget up to 80% of what they’ve heard from their healthcare professional.
That's what makes Abridge so important, and is likely the reason that over 300,000 people are using the free version of the Abridge app (which you can download here on the app store) to help make sense of medical conversations and share information from clinical consultations with loved ones.
As Dr. Rao pointed out in our conversation, there is a public health emergency occurring in the United States - we do not have the supply of clinicians necessary to meet the demands for care delivery. Compounding a lack of clinicians is an uptick in burnout. The AMA currently estimates that physician burnout is at 63%, and an article in the Journal of Internal Medicine that said clinicians would need 27 hours per day to do all the work that’s required of them. Shiv started Abridge to reduce the documentation burden on physicians, and to provide patients with a digestible, “translated” version of their clinical encounter that they can share with family members.
The benefits are also significant for clinicians. Over 80% of the clerical work that used to be involved in documenting is now getting automated by Abridge - this solution is currently saving clinicians on the platform an average of 2 hours a day!Ultimately, as we discussed, a clinical note has three stakeholders:
Other clinicians on the care team - they need to understand Dr. Rao’s medical differential, and how he was thinking about the diagnosis/care plan.Health plans - Dr. Rao needs to build his note in such a way that the diagnosis and follow-up recommendations can be properly coded and billed.Patients and their family members, who may need to take action based on Dr. Rao’s findings, which they thus need to understand.A single note cannot be all of those things at once. Abridge solves this problem by summarizing and structuring the information to create different artifacts for all three sets of customers.
Abridge has raised $27 million to date from investors like Union Square Ventures, Bessemer Venture Partners, and Wittington Ventures. For more information, you can check out their website: https://www.abridge.com
Please make sure to check out the Society for HealthCare Innovation's (SHCI) website for more content.
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Dylan Beynon is the founder and CEO of Mindbloom, an at-home psychedelic therapy startup. Dylan has been named a top 25 consumer healthtech executive and one of the 100 most influential people in psychedelics. Mindbloom has facilitated 100,000+ psychedelic therapy sessions since launching in 2019, and is now the largest provider of ketamine therapy in the U.S.
Increasing access to Ketamine therapy was one of Dylan's main motivators for starting Mindloom. His family was among the 70% of those living paycheck to paycheck in America, for whom standard treatment would have been unaffordable. Mindbloom is now available in 35 states, accessible to 70% of the U.S. population, and has reduced the cost of treatment by as much as 72% (see linked study).
We spoke about the addiction fallacy related to Ketamine, and the comprehensive study Mindbloom published in the Journal of Affective Disorders demonstrating that their methodology delivers significantly better clinical outcomes than traditional in-person clinics, as well as SSRI’s, talk therapy, and legacy medications. This is a link to the study.
Dylan shared some surprising stats during our discussion:
With SSRI's (prozac and lexapro), 47% of people get a greater than 50% improvement in depression symptoms. Talk therapy is closer to 40%, roughly the same as a placebo. In peer reviewed clinical studies across 1250 participants, Mindbloom patients saw clinically significant improvement in symptoms 60% of the time.Mindlboom has shown through clinical research that their patients are also getting a side effect less than 5% of the time, as compared to the 30-50% of patients who experience moderate to severe side effects from SSRI’s.We moved from the discussion of efficacy to the topic of reimbursement. Ketamine is generally not reimbursed today for depression and anxiety, with the exception of J&J, which in 2019 got S-Ketamine approved for suicidality and treatment-resistant-depression. Unfortunately, it is still extremely expensive - approximately 13x the cost of generic ketamine.
Dylan’s personal connections to depression and SAD are extensive. He lost both his mother and sister to fentanyl overdoses, despite trying every traditional treatment available to try to help them.While Dylan believed that his target customers would be early adopters before starting Mindbloom, he ultimately found that it was people who have struggled with anxiety or depression for a long time. Their average customer today is 41 years old, with more over the age of 57 than in their 20’s. We spoke of some of the other potential causes of the mental health crisis in the U.S. Among them, the poor metabolic health of the average American, which is getting worse. Finally, we discussed Dylan’s learnings across three companies about how to build a successful company culture. We touched on the gap between good and great talent, and the false choice between being direct and honest, and being kind. Mindbloom won the Tony Shay award for transformational company cultures, which is a testament to the work environment Dylan and his team have created.
Please make sure to check out the Society for HealthCare Innovation's (SHCI) website for more content.
Additional links: Chemical imbalance of the brain theory may not be true.
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Dr. Groves is the Chief Medical officer of Banner Aetna, an independently licensed insurance company with a 50/50 ownership split between Banner and Aetna. "We have taken two elite athletes, put them together and said 'who is best at what, and let's leverage their respective strengths going forward.'"
Banner Aetna has tried to be strategic about what services that are currently handled by the care delivery system or insurer should reside with the other. By pushing care management (among other things) to the delivery system, they have been able to eliminate confusion for patients and duplication of efforts.
We also spoke about prior authorization. In the eyes of Dr. Groves, prior authorization is a way to check, "Is this really necessary based on medical literature?" now that the speed at which medical information doubles has gone from 50 years in the 1950's to weeks or months today. At Banner Aetna, half of all prior authorizations are now being done by Banner, which means that Banner doctors are speaking to their peers within the health system when discussing authorizations, and that those peers have access to the patient's record in real time, and can check for missing information.
When it comes to attribution, Dr. Groves rejects the concept of "owning patients", and notes that Banner Aetna patients are often treated by physicians in the Banner Network that are aligned but not owned by Banner. Dr. Groves sees Banner Aetna's role as financing the services that a trusted physician feels his or her patients need, and helping to support the trusted relationship between a doctor and patient wherever it is occurring.
As we moved to a conversation about innovation in healthcare, Dr. Groves noted that technology should always be in service of the relationship between a clinician and patient. Trust, he noted, is what has suffered as technology has created a wall between patients and physicians. Dr. Groves is interested in technology that can streamline back office functions, make it easier for patients to find the right doctor, and assist patients in following through on commitments they have made to their physician to improve their health.We also touched on physician incentives. It has been Dr. Groves' experience over 30 years of managing physicians that whenever you attach reward and punishment to a metric, it immediately starts being distorted. "Intrinsic motivation is dampened by external rewards."
Dr. Groves cited research by Brent James, which indicates that the ease of accomplishing a task is what drives most physician behavior. Physicians are inherently competitive, and thus sharing data with physicians so they can see where they stand in relation to their colleagues is also important. Financial reward is a distant number 3 on the list of what influences physicians. Putting excessive weight on specific metrics results in an overemphasis on a limited set of metrics instead of the relationship and an evaluation of the whole patient.
We concluded by discussing the concept of healthcare versus "rescue medicine." While Dr. Groves concedes that if he was in a car accident there is no place he would rather be treated than the U.S., we have a long way to go to improve the wholistic health of Americans. Whether it's subsidies for high fructose corn syrup, political influence within the FDA approval process, regulation around PBM's, or pharmaceutical advertising, there are many places where Dr. Groves feels national policy contributes to the problem.
Dr. Groves can be found on Twitter and Linkedin.
Please make sure to check out the Society for HealthCare Innovation's (SHCI) website.
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On episode 6 of season 3, I continued my conversation with Dr. Stephen Klasko, who was the president of Thomas Jefferson University and CEO of Jefferson Health from 2013-2021. Under his leadership, Jefferson expanded from 3 hospitals to 18, and saw its revenue grow from $1.8 to $9 billion. Dr. Klasko was #2 on Modern Healthcare’s “100 Most Influential Individuals”. He is also the co-author of 2020’s UnHealthcare: A Manifesto for Health Assurance with Silicon Valley investor Hemant Taneja, and is currently an executive in residence at General Catalyst.
In the second half of this two-part episode, Dr. Klasko and I discussed some of the systemic issues in U.S. Healthcare. We started with a discussion of behavioral health, and how we will need to think differently about clinician/patient interactions to get at the root of the problem, starting with acting more proactively.
The antidote to much of what ails us, in Dr. Klasko's opinion, is healthcare at any address (i.e. Jefferson sent a nursing student into the home of an asthma patient with 10 previous ED visits that resulted from asthma exacerbations. The nursing student discovered mold, and so Jefferson sent a handyman to fix it at a fraction of the cost of an inpatient admission). Nobody wakes up in the morning and says "I am going to telebank", and yet we talk about meeting people where they are (tele-health, homecare, etc.) as though it's novel. Dr. Klasko's vision was that Jefferson would one day no longer be defined as a hospital system, but as a system that provided healthcare at any address. He asks, rhetorically, "Why would you want to be defined by the place where you've in essence failed to keep people healthy?"
Despite advocating un-scaling, in order to innovate, Dr. Klasko freely admits that he grew Jefferson from 3 hospitals to 18. Yet, these mergers allowed him to obtain huge geographic proximity - nobody was more than 10 or 15 minutes from a Jefferson facility. As a result of facilities owned by the hospitals they bought, Jefferson was also able to obtain massive primary care networks, further contributing to the vision of healthcare at any address. We spoke about Tandigm's partnership with Penn and IBC, and what it will take for that partnership to bear fruits for the clinicians and patients involved. Finally, we discussed mergers and acquisitions, and the future of our healthcare system.Dr. Klasko can be found on Twitter and Linkedin.
Please make sure to check out Society for HealthCare Innovation (SHCI) website (http://www.SHCI.org) for more information about our work. -
On episode 5 of season 3, the first of this two-part episode, I spoke with Dr. Stephen Klasko about his unlikely journey from OBGYN to the president of Thomas Jefferson University and CEO of Jefferson Health from 2013-2021. Under his leadership, Jefferson expanded from 3 hospitals to 18, and saw its revenue grow from $1.8 to $9 billion. Dr. Klasko was #2 on Modern Healthcare’s “100 Most Influential Individuals”. He is also the co-author of 2020’s UnHealthcare: A Manifesto for Health Assurance with Silicon Valley investor Hemant Taneja, and is currently an executive in residence at General Catalyst.
Dr. Klasko and I began the episode discussing the creation of the Jefferson Italy Center in Rome and partnership with Gemelli Hospital. Jefferson's presence in Italy highlighted one of the ironies of U.S. Healthcare - while we claim to be on the cutting edge of innovation when it comes to healthcare, we create serious barriers to entry. The CEO of Marriott Hotels in Italy can be a CEO in the U.S., but if you are the head of cardiovascular surgery at Shanghai university and you come to the U.S., we make you retake your residency. We also shun the use of alternative medicine, which is used to treat 2/3 of the world’s population, because it doesn’t fall into the familiar categories of surgery or drugs (Jefferson created the Marcus center for Integrative Health which is taking the best of care that happens around the world that is not just drugs and surgery).Jefferson's uniquely international presence and perspective served the health system well during COVID. Their Italian hospital served as the canary in the coal mine, and allowed Jefferson to have a clear picture of the damage that COVID would ultimately cause long before most of the U.S,. Jefferson had also invested $50 million into Telehealth in 2014 and maintained the pandemic preparedness team it had stood up when Ebola (almost) hit.
We touched on the state-level licensure requirements and how much the emergency protocols reduced tensions around credentialing. The idea that someone might need a different debit card to pull money out in every state is ridiculous, and yet in healthcare, it is the status quo in credentialing because it often aligns with the vested interests of the incumbents.Dr. Klasko blames the system in its entirety for the fact that while predominantly underserved people died because they didn't get care during the pandemic, insurers quadrupled their net operating income because people they thought would get care died.
You can find the full episode here:
Spotify: https://spoti.fi/3D26Ayq
Apple Podcasts: https://apple.co/3eZyovmDr. Klasko can be found on Twitter and Linkedin.
Please make sure to check out Society for HealthCare Innovation (SHCI) website (http://www.SHCI.org) for more information about our work. -
Yuri Sudhakar is the CEO and founder of Nudj Health, which integrates lifestyle medicine into provider care by using a combination of human engagement and technology. Providers working with Nudj can prescribe lifestyle medicine. From there, Nudj steps in using technology, coaches, and more to help patients make the lifestyle changes that improve their physical and behavioral health.
80% of chronic disease can be reversed, treated or avoided with proper lifestyle choices. And over 40% of all premature death in this country is related to lifestyle choices.The idea for Nudj emerged while Yuri was working on the previous company he started, which was focused on aggregating data from implantable cardiac devices, pacemakers, defibrillators, and implantable loop recorders.
As they began to engage with their patients and help them turn on these remote monitoring devices, they began to learn a lot about them- more than just the data that was coming across the device. Specifically they started to learn about the mental health of these patients - many of them were anxious, depressed, or had some type of stress in their life, and that was driving the behavioral or lifestyle choices.
The larger learning for Yuri and his team was that everything is connected. Doctors cannot just give patients material on their lifestyle choice and then treat their physical health with medications and procedures. With Nudj, providers are seeing depression (-45%), anxiety (-43%), and insomnia (-50%) scores dropping dramatically in conjunction with the physical markers that are indicators of improved health, like blood pressure scores, weight scores, lipid panel scores, etc.
Yuri blames the reimbursement structure and lack of available resources for the lack of integration of lifestyle medicine into healthcare thus far. Just because something is obvious, Yuri notes, doesn’t meant it is easy to make it operational.
One of the best things about Nudj for doctors is that there is no upfront cost - since they are the treating team, they bill for the services that they and Nudj provide, and pay Nudj for their contributions only after they themself have been paid. Yuri calls it "value as a service", and the idea is that Nudj works together with providers to create value, and when value is created, then and only then is there a financial exchange.
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Laura Purdy was an active-duty Physician prior to entering the civilian sector. She joined the military because of her sense of patriotism, and because she wanted to focus on patient-care. When she joined in 2005, the Army allowed physicians to just be physicians, and focus on their medical skills before all else. As that culture shifted, Laura decided to leave when her contract ended and explore new opportunities.
Towards the end of her time in the service, Laura began exploring the telemedicine space, and has worked with/for dozens of companies across the industry. We discussed Laura’s belief that 20 years from now, virtual care will be commonplace in every household. Her hope is to help enable that success at the policy and company level. We touched on how allowing clinicians (as is the case in the military) to practice to a higher scope of licensure would solve many of the problems of access that we face in the U.S. today. When I asked why that doesn’t happen, I got an interesting answer: Laura believes that healthcare is too arrogant. The archaic notion that the only people capable of delivering healthcare safely and well is doctors is, in Laura’s mind, dead wrong.
“As an industry, we need to check our egos at the door - all clinicians have the same goal, which is to work on solutions and to do it safely and responsibly as a team.”
Laura believes that there are many situations where clinicians don’t really need to see a patient in person, just as you don’t need to see a bank teller every time you need to do a bank transaction.
We discussed that over the last few years, regulators have realized that tele-health is not going away and that there is a need to embrace technology and the development of new ways to create doctor/patient relationships.
In the last part of our conversation, we discussed Open loop, where Laura serves as the Chief Medical Officer. Open Loop is a fully staffed telemedicine operation that encompasses staffing, execution, revenue management and reimbursement. In short, a total telehealth medical experience.
When I asked Laura what she would talk about if she had 60 seconds with President Biden, she did something unexpected. She told me that Instead of just telling him, she would ask him to tell her what he wants to improve in our healthcare system, and that she could then tell him how tele-health will help achieve his goals and initiatives.
In dozens of interviews, nobody ever answered that question by suggesting that they would ask a question, instead of just prescribe a cure. The humility to lead with a question is something that we need more of - check out this episode and learn more about Dr. Purdy. You can connect with Dr. Purdy on Twitter or Linkedin.
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In 2019, we lost more than 14,000 Americans to firearm homicide and more than 36,000 to car accidents. As a point of comparison, every year, diet contributes to approximately 678,000 deaths in the U.S., due to nutrition- and obesity-related diseases, such as heart disease, cancer, and type 2 diabetes. In the last 30 years, obesity rates have doubled in adults, tripled in children, and quadrupled in adolescents. While of course some of these conditions have genetic components, there is no question that the food we eat (and are marketed) has played a role.
I spoke with Josh Hix, CEO and founder of Season, to learn more about how he and his team are using food as medicine. Josh previously started and sold a company called Plated, a meal-kit delivery service that was bought in 2019. It turned out that while people had signed up for Plated to explore new cuisines, to do something new with their spouses, and a host of other reasons unrelated to diet, they ended up with better health outcomes 6 months later. Most people did not start because they wanted to get healthier, which was an important learning for Josh.
When a National payer contacted Josh a few years after he'd started the company to tell him that consumers had told them they'd seen dramatic improvements in their health outcomes as a result of using his service, it planted a seed that Josh has only now had the chance to explore as he's built a company that uses food as medicine. While it has been known for some time that food has a huge impact on health, the status quo of pre-prepared meals doesn't work for everyone.
While a prepared meal is helpful for a patient who isn't ambulatory and can't cook, it has to be delivered in a consumable way. For some, a generic prepared meal is great. For others, let's say a newly diagnosed diabetic, being told to lower sodium intake when working two jobs and cooking for a family of four of picky eaters is not actionable, nor is being sent home with food that will not meet the needs of the whole family. What is missing is an emphasis on personalized prescriptions for patients on which the patient is able to take action. This is what Season does remarkably well. So how did we get here?
The chronic disease burden we have today is not even close to what it was 100 years ago. According to Tufts, 85% of Healthcare spend is related to food, meaning 16% of our GDP. While we have more processed foods in the market today than at any point in history, the only thing that Josh expressed with certainty was that when we use food as medicine, and put more nutritionally dense food into patients diets, we can manage if not reverse chronic disease. And that is exactly what he has set out to do.
Season recently announced partnerships with Geisinger, CommonSpirit, and Cricket, and and $8 million round let by LRV Health, Bain Capital, 8VC, HealthyVC, and angels including Max Mullen, founder of Instacart, and Toyin Ajayi, Co-founder and CMO Cityblock health.
To learn more about Season, you can check out their website. -
It is often stated that the average American fears spiders more than death. We can probably add sharks to that list too (did you know that the risk of being attacked, not dying, is 1 in 5 million?). After Jaws came out many Americans canceled their beach vacations. But what are Americans doing about the fact that 1 in 7 of us ultimately die of cancer? The popular narrative is that it runs in your family, and you get it or you don't. It turns out, however, that 70% of cancers are based on lifestyle choices. Last week I spoke with Dr. John Whyte, the CMO of WebMD and the author of Take Control of Your Cancer, now a bestseller on Amazon.
Dr. Whyte and I spoke about some of the tangible things you can do to lower your risk of getting cancer, like sleeping more, and eating more fish. We started our discussion with a topic that is the focus of most of Dr. Whyte's day job - misinformation. In an age where opinions dress up like facts, it is comforting to know that every piece of content on WebMD is reviewed by a medical expert, and has a source, a link to the credentials of the reviewer, and a date.
Dr. Whyte started a daily Coronavirus news show as a means of getting people information, which has changed so rapidly over the past 2 years. We spoke of the importance of staying relevant, and distilling what the public needs to know into manageable clips. John believes that if we give people better information, they will have better health. Fake news is a problem, but fake medical news is quite literally Dr. Whyte's problem, and it is killing people.
Recently, Dr. Malone was a guest on Joe Rogan's podcast, which created an upheaval in the medical community. I wanted to dive into some of the controversial content with Dr. Whyte, so we touched on natural immunity versus vaccine-induced-immunity, and which the data says is more effective.
As Dr. Whyte appropriately noted, nobody who is hospitalized with Covid thought they were the one that was going to have a bad outcome, and so it behooves us to do everything we can to protect ourselves. We still need more studies, and better instruments to detect various measures of immunity, until which it is not possible to definitively state if natural immunity is as strong as passive immunity.
While there has been a lot of buzz about the low mortality rate of Omicron, John was quick to point out that it isn't just like the flu. Particularly for those people with underlying conditions, Omicron can push them over into acute states, and so while it may not be Omicron that kills them, their underlying condition might well.
We ended with the discussion on cancer I alluded to at the start of the notes. 1 in 7 Americans die of cancer, and many more are diagnosed in their lifetime. Millions of cases are diagnosed each year, and 600K people die each year in this country of cancer. John noted that while we speak to patients often about how to reduce their risk of diabetes, and other chronic diseases, we don't often talk to people about how to prevent cancer.
We know sleep is one of the most important factors in determining cancer risk, and that shift workers have significantly increased instances in hormone based cancer (i.e. Prostate, and Breast Cancer). Some governments have even started to reimburse those workers who have developed cancer at an earlier age.
Dr. Whyte noted that what we eat is as powerful as a prescription drug (and my next guess will be Jon Hix, CEO of Season, who has created a platform for food as medicine). Data has increasingly shown that red meat causes an increased risk in rectal cancer. The biggest change folks could make, according to Dr. Whyte, is to consume more fish. Stay tuned for more on food as medicine next week! -
Imagine if your employer gave you the choice between paying 20% out of pocket for your surgery/specialist visit/X-ray at the local name brand hospital, and having the same service done at a different location where care quality was higher for $0 out of pocket. For employees of companies that work with David Contorno and E Powered Benefits, this is a reality.
50% of Americans get health insurance from their employer, and most employers rely on brokers to give them advice on how to cover healthcare. Unfortunately, their incentivizes are not aligned. The average health insurance broker makes commission, so as the cost of the health plan they sell to an employer goes up, they get paid more. As David Contorno is fond of saying, if you look at our health system today, almost everything that goes wrong is the result of someone or more often everyone involved being better off when care quality goes down, or when price goes up. That's why David decided to change his model.
David's firm. E Powered Benefits, exclusively provides value based health plan management for companies by sharing up front fees, never taking commissions, and creating provider relationships that incentivize high quality low cost medical providers. Their business model has produced average 1 year savings of 40%, as well as substantially reduced cost for employees. These two things are basically unheard of in this space. My conversation with David was eye-opening.The stereotype of insurance companies is that they love to deny claims. As I learned in speaking to David, that’s not exactly the case. The MLR, or medical loss ratio, says that every health insurance company must spend 85% on healthcare costs. 15% is then left for overhead and profit. Therefore, the only way for insurance companies to increase profits is for costs to be higher. What ultimately ends up happening is that high value care (defined as care that is likely to cure you or treat you with the least intervention possible) ends up being harder to get approved.
We also discussed the underutilization of Primary Care, and how when health system employ doctors, often the way they pay them incentivizes low quality, high severity/cost care. RVU’s, or relative value units, means doctors are paid on how much value (i.e. revenue) they’re helping to generate within the Health System. If you go to a doctor at that health system with a back problem, writing you an opioid script and sending you to a back surgeon for a consult is far more lucrative than sending you for PT outside of the system.
We touched on the new hospital transparency law, which theoretically should make it easier to understand Hospital billing. Unfortunately, the law required that hospitals post a machine readable file online, and many have taken advantage of that verbiage to post files that are machine readable but human unreadable. Even worse, some hospitals have put code on their website that prevents it from showing up on Google, which means you have to go to the hospital website and search for a page made intentionally hard to find which is ultimately unreadable by a human.
Finally, we spoke about David's transition from a commissioned broker to an innovator and disruptor. David used to get paid hundreds of thousands of dollars a year from name brand insurance companies for changing employers to their brand away from their competitors, and for resigning existing employers. When he realized this was causing more harm than good, he closed his business, and started a new company with a model where he is paid a flat fee on an exclusive basis with his employer partners, with bonuses for cost savings and better outcomes.
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Bettina Hein is the co-founder and CEO of Juli (www.juli.co), Pixability and SVOX. She is a serial tech entrepreneur and has built successful tech companies in Europe and the U.S. She is a global leader at the World Economic Forum and a judge on the Swiss version of Shark Tank.
Juli is a chronic condition management platform that was developed to help people use their healthcare data to nurse themselves back to health. Juli has a consumer-facing app that ties in data from wearables with user generated data to help patients identify triggers for their conditions, and suggests “levers” to pull that can help them ameliorate their symptoms. Currently the platform is used for asthma, depression, migraines, chronic pain, and bi-polar disorder.
While most other chronic disease startups have a human component, like a call center, Juli reduces costs by using an AI-generated bot. Though Juli went live only 6 months ago, the app already has 6,000 consumers, and Bettina is launching her first clinical trial with the University College of London for consumers with asthma or depression.
Bettina is an optimist, and saw the silver lining of starting a company during a pandemic in the ability to recruit the best and most diverse team to develop her technology. It also allowed her to stay at home and be with her children while running the company. During COVID, consumers got more and more comfortable using their devices for health, which has helped accelerate Juli’s adoption.
We spoke about the challenges of being a female entrepreneur. Bettina fundraised twice while pregnant, and fielded questions about her commitment to her company that most men never have to deal with, even if they have kids. The second time she fundraised while pregnant, Bettina decided to use it to her advantage, and told investors that, “you get the pregnancy discount if you invest before this baby pops!” It worked!
According to Bettina, there are three things that make a startup founder successful:
Naivety – You have to be naïve to embark on the adventure of starting a company, because if you knew what was really ahead, you would never start in the first place. Hutzpah – Having the guts to put yourself out there. Perseverance – Strap yourself in…it’s going to be a long road to success.Bettina has high hopes for the future of chronic disease management. What gets Bettina particularly excited is the ability to get all different types of data about what people are experiencing in real time, which can then be correlated to symptoms to understand what is happening with their health. Bettina believes this is ultimately going to revolutionize the way we treat patients, as we will be able to determine with greater certainty who needs what treatment and when.
Finally, what do tinder, advertising, and Juli have in common? Listen to find out!
Please make sure to check out Society for HealthCare Innovation - SHCI's website (http://www.SHCI.org).
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For 37 years, Dr. Nate Link has worked as a doctor, and now as the Chief Medical Officer of Bellevue, the oldest (and one of the largest) hospitals in America. Bellevue can trace its roots back to 1736.
In one of my favorite episodes to date, I interviewed Dr. Link about his new book, The Ailing Nation: Lessons from the Bedside for America's Leaders, which can be found here on Amazon. Dr. Link shares personal stories, such as the tragic passing of a head nurse at Bellevue from COVID-19, which devestated the hospital's staff.
We spoke about the importance of extreme ownership in leadership, and understanding the difference between a bad actor making a mistake for preventable reasons, and a systemic error that is the fault of the system (and thus the leadership that overseas that system).
Dr. Link spoke of the importance of agreeing on a goal. Bellevue dropped its mortality rate for severe sepsis to 14%, significantly below the state average of 25%. The same gap analysis that allowed them to do that could be useful in achieving agreed upon political aims. The problem in politics, as Dr. Link and I discussed, is that we don't set common goals as a country. For instance, almost everyone agrees that Americans should have affordable healthcare -politicians just disagree on how to get there. Many Republicans believe we need to accomplish that through free enterprise while many Democrats believe in a single payer system. The key, according to Dr. Nate, is to agree on a finish line and work towards getting to the ultimate goal - in this case, affordable healthcare for all.
Dr. Nate believes that just as the healthcare industry learned from fields like aviation, politics has a lot to learn from the reforms that have improved healthcare in the past several decades. As an example, the "sterile cockpit" rule that dictates that pilot not speak during critical parts of landing and takeoff has since been applied to nurses when distributing medications, and significantly reduced errors in dispensing meds.
If you are interested in medicine, politics, or both, I would highly recommend this episode.
You can find the interview on:
Apple Podcasts (https://bit.ly/NateLink)
Spotify (https://bit.ly/DrNateLink).
Please make sure to check out Society for HealthCare Innovation - SHCI's website (http://www.SHCI.org), and our Linkedin Page (bit.ly/SHCILIP).
You can learn more about Bellevue and the NYCHHC network at www.nychealthandhospitals.orgYou can find Dr. Link's book, The Ailing Nation here: https://bit.ly/TheAilingNation
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Dr. Sanjay Subramanian is the founder of OmnicureMD. Omnicure is a mobile first Tele-ICU platform that allows remote specialist to connect to connect with onsite healthcare providers without excessive costs.
Dr. Subramanian started the company to address the inefficiencies he observed over his 25 year career as a critical care doctor. Omnicure makes it easy for specialists to connect with patients by effectively “Zooming” the specialist in with PCP and nurse practitioners.
During our conversation, we discussed regulatory Barriers, which Dr. Subramanian described as the biggest issue he has had to confront in trying to grow the company. Every state has its own unique licensing requirements, which further contributes to the lack of accessibility of critical care physicians. Dr. Subramanian stated that the critical care physician shortage will never go away, and it will only hurt the patients who are in need of critical care. COVID helped
accelerate tele-health technology, but according to Dr. Subramani, permanent systems need to be put in place.
In addition to physician shortages, high costs also prevent hospitals from having sufficient (or even any) critical care doctors on staff. With Omnicure, with the push of a button, hospitals can access critical care specialists, which has been shown to lower patient mortality rates and lengths of stay.
Omnicure can interface with the existing hospital EHR's, and can stream real time vital sign data and bedside-monitor-device data. While Omnicure is deployed and working today, it is also preparing for the future. As we discussed the move away from the hospital, Dr. Subramanian noted that you can provide tele-critical care anywhere. Not just in the hospital or ICU. -
A month before the start of the Pandemic, Dr. Pate stepped into a new role at Lifebridge. As the Chairman of the Division of Psychiatry and Behavioral Health at LifeBridge Health, he was charged with uniting the behavioral health leadership of the 5 hospitals for psychiatry. We touched on a number of interesting topics throughout our discussion.
Cost of care: Maryland has a total cost of care model that uses a hospital rate setting commission to set rates across the state on a yearly basis in order to create budgets. While it has resulted in reasonable cost containment, it excludes mental health, psychiatry, and outpatient care.
Telehealth: Prior to the pandemic, Maryland Medicaid had a narrow definition of who could receive or deliver tele-health, which made it very restrictive, and inaccessible to most. That definition was relaxed based on CMS guidelines during the Pandemic, and allowed patients who couldn't travel to continue getting treatment. One of the main points Dr. Pate sought to drive home was that in psychiatry, there is no statistical difference in the effectiveness of care based on the mode of delivery. Though change came slowly, and was brought about in large part due to the Pandemic, there is now legislation in MD to make tele-health a permanent change.
One of the more shocking stats that Dr. Pate shared was that although there is a 2-4x higher cost associated with a co-morbid psychological diagnosis, as a country, we're spending half of what we spent 30 years ago on behavioral health services.One of the quotes from our conversation that stuck with me touched on the disparity between the way physical and mental health are addressed in this country. "There are 2 health care systems in this country, which are separate and unequal. We have a medical system which is more open and permissive in the way its allowed to bill and admit and treat patients, and then we have a mental health system which is incredibly restrictive in terms of access to quality and to services. "
When I asked who was to blame for this, though Dr. Pate believes for-profit-payors are a large part of the problem, he also holds himself and his peers responsible. He noted that for a long time, his profession refused to meaningfully participate in a more medicalized approach to treatment, and in measurement based care.
When I asked Dr. Pate how we could make things better, he had several solutions:
Reintegrate mental and physical health services. We should federally legislate medical necessity criteria, which currently have nothing to do with quality, and were created by MCO's.We have to legislate the types of organizations that are able to manage the healthcare of our systems - we should not allow for-profit insurance companies to be in the Managed Care business. Tens of billions of dollars in pure profit are being drawn out of the pockets of patients who have the greatest needs, since most of the big insurers manage most of the medicare and medicaid across the country. If we can provide folks with incentives to produce high quality care, that is one of the solutions to our health care criss. The more we can globally budget and include all services, and move towards national healthcare, the more we can improve healthcare. -
On March 2nd, I spoke with Alon Joffe, CEO and founder of Eleos Health. Alon served for 6 years in an elite combat search and rescue unit of the air force, and left the military as a second lieutenant. During his military service, Alon was heavily involved in developing a mental health first aid program to deal with PTSD, which is what ultimately motivated him to start Eleos Health.
The prevalence of behavioral health issues in America today has been called an epidemic - 1 in 3 Americans now struggles with Anxiety, Depression, or both. Unfortunately, given provider shortages/burnout/turnover, the existing infrastructure is insufficient to meet this demand. That's why Alon co-founded Eleos Health.
Eleos Health is a Care Intelligence solution that is transforming the delivery of behavioral healthcare. Using Voice Ai technology that runs in the background of psychotherapy sessions, Eleos captures key insights from sessions. By understanding what’s important, Eleos is able to generate the baseline for the clinical note. In a recent case-study, they found they could reduce documentation time by 42%. Patients whose clinicians use Eleos also get better faster and more frequently - learn more here. Eleos empowers clinicians to focus on care personalization, and not on data-collection.
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If this Pandemic has taught us anything, it is that nothing is more important than health. Mahatma Gandhi once said, “It is health that is the real wealth, and not pieces of gold and silver.” And yet, they are more related than Gandhi insinuated.
Healthcare innovation, and particularly advances in vaccine development, has been on the forefront of the world stage over the past year. As we begin 2021, it is a good time to look towards the future of digital health, and see what technologies might impact our lives in the years to come. None of that innovation happens without funding, however, which is why the Society for HealthCare Innovation - SHCI brought together Israel's top Healthcare VC's for a discussion on funding for digital health in 2021. Israel is known as the Startup Nation - Israel has the 3rd most companies listed on the Nasdaq, after the U.S. and China, despite having the same population as New Jersey! On January 20th, I moderated a panel with Guy Ezekiel from Pitango, Allen Kamer from Qure, Netalie Nadivi from Triventures, and Amir Blatt from Almeda Ventures .
The panelists addressed the following questions:
1) What do you/your fund view as the biggest focus area in the digital health space in 2021?
(2) I just joined a company named Eleos as the head growth. Eleos, just for those that don't know, removes administrative tasks from therapists workloads, and provides clinical tools that empower therapists to provide better care. And when I say better care, we've actually been able to prove a 55% reduction in depression symptoms within 6 weeks using Eleos, which is 20% higher than the baseline for evidence based treatment and medication. There isn't really anything like it in the market. So my question, which some fellow entrepreneurs may share is, when you are bringing a new technology to the market in the digital healthcare space, what GTM strategies have you seen be successful ? Particularly through the lens of payors and providers.(3) Obviously given Israel’s size, in order to be successful, company’s need to move beyond Israel's borders pretty quickly. How do you validate business models outside of Israel?
(4) Over the last five years there has been a growth of corporate interest in Israeli innovation, many have set up shop - so to speak. And generally, there are more investors than ever trying to fund the next big healthcare innovation coming out of Israel. How do you address this challenge/opportunity?
(5) The impact of COVID transcends the physical harm it has done to millions of people and world economies. In the US and around the world, we are in the midst of a behavioral health crisis. Where do you see the biggest challenges in behavioral health today (i.e. access to care vs. quality of care), and what emerging technologies do you think will play a pivotal role for these new behavioral health startups?
(6) We are seeing a shift from digital health solutions that are used mainly as a "system of record" to the newcomers which are ‘system of intelligence’ - clinical decision support, AI, etc - where do you see the biggest potential and the main challenges? -
The fourth episode of season two of Healthcare Reimagined was recorded on December 28th, 2020. I interviewed Yoav Fisher, head of technological innovation and digital health for a nonprofit called HealthIL. Yoav and his team work with companies (both Healthcare providers and large companies) that are in need of technology to help them solve problems. Yoav helps them define their needs and challenges, and then helps match them with relevant startups. The challenge specific approach to innovation that HealthIL has adopted starts with a deep understanding of the problem. Only once the stakeholders truly understand the issue does Yoav match them with startups that might be able to help.
In March and April, Yoav screened 400 startups in Israel to see which ones could address the shifting needs of healthcare organizations in the wake of COVID. Ultimately, he found that 8% were viable, and 1/3 of those were immediately deployable.
Yoav doesn't just sit at the intersection of providers and startups. One of the less obvious parts of Yoav's job is what I would call innovation therapy. He works with providers to make sure they actually understand what they need and why they need it, and helps the relevant stakeholders come together to create an environment where innovation can thrive. Yoav will put people within a department of a Hospital in the same (virtual) room in order to categorize the different aspects of a challenge, as a means of determining what the most relevant solution might be. This means diving into the needs of each stakeholder, finding the overlap, and getting them to agree on exactly what it is they need and why they need it. Yoav also stressed the importance of the company searching for a solution having a mechanism in place for dealing with external innovation. Without that, even the perfect partner that solves their need exactly won't be able to help them.
You can contact Yoav online:
Email: [email protected]
Linkedin: https://www.linkedin.com/in/yoav-fisher-47b31/ - Показать больше
