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Collaborative Innovation Within Health Systems: Wisdom From an EVP & Chief Digital Officer · StartUp Health NOW Podcast

• 0:01
  Welcome back to Startup Health Now, the podcast where we celebrate the entrepreneurs and innovators who are transforming health. I'm Logan Plaster.
• 0:08
  [music] So I get the pleasure of talking with many, many founders of healthcare startups.
• 0:13
  I consider it a perk of my job because each founder, each new idea inspires me and gives me hope that we're on the cusp of some major breakthroughs.
• 0:23
  Then reality sets in, and I'm reminded just how hard it is to go from an idea, even a brilliant one with validation, to commercialization and broad use.
• 0:33
  It's one thing for a founder to find a single clinic to use their platform or device, but a common question is, how do you get your startup adopted at a large hospital, or better yet, a hospital system?
• 0:44
  Do you just call up a chief digital officer or a chief innovation officer and they'll get it all sorted? Not exactly, according to our guest today, Sara Vaezhi, Chief Strategy and Digital Officer at Providence.
• 0:57
  For one thing, the role of hospital chief digital officer has changed dramatically.
• 1:01
  A one-month period after I joined, um, uh, a- after I stepped into this role, a third of my counterparts, um, in other organizations as CDOs were no longer in their jobs.
• 1:12
  So how can a startup work with a hospital system effectively? What do hospitals look for in a startup, and what are some of the red flags for a project that's gonna go nowhere?
• 1:23
  And what are the greatest pain points for which hospitals are actively seeking solutions today?
• 1:28
  To answer these questions, we invited Sara Vaezhi onto a master class, which are virtual sessions we hold in front of a live audience of founders from the Startup Health community.
• 1:38
  We've cut that session down to share the highlights with you here, and we've included some of the founder questions from our Q&A as well, since they're very practical and relevant. Let's dive in.
• 1:50
  [music] Today, our guest is Sara Vaezhi, Chief Strategy and Digital Officer for Providence, a network of fifty plus hospitals, more than a thousand clinics, and serving more than five million unique patients.
• 2:05
  Uh, Sara has been a leader in digital innovation for years. You've probably seen her name around, and she's been on the main stage, places like Health and Vive.
• 2:13
  And we wanted to have her on a master class to talk about connecting the dots between frontline health innovation and digital transformation at the health system level.
• 2:22
  We're gonna hear about how her work has shaped Providence, uh, her macro view of the market in twenty-twenty vo- twenty twenty-four.
• 2:30
  But then we're gonna get tactical about how Sara thinks about adopting new technologies, like the things that you're working on on this call, and how they collaborate with startups more generally.
• 2:41
  So Sara, thank you so much for joining us today and taking the time out of your schedule. Great to be here. I, I love these types of, uh, things and these types of conversations.
• 2:51
  Always, um, are just as enlightening for me and a lot of fun, so thanks for having me. Awesome. Awesome.
• 2:56
  Well, we, we love having you here, and I know we're gonna have some great questions on the latter half of the episode, of the conversation. So let's start by understanding your role a bit more.
• 3:06
  Uh, in our pre-call chat, uh, you told me that the role of health system chief digital officer, CDO, has really evolved and changed.
• 3:16
  So maybe you could tell us a little bit about your, your role more generally, and then how that role has changed in the industry. Um, sure.
• 3:24
  So, uh, just by way of a little bit of background and context, I've served, um, within Providence for just over eight years and stepped into the CDO role, uh, a couple of years ago.
• 3:36
  And, um, i- it was a really interesting time. It was March of twenty twenty-two.
• 3:41
  There was this major, I would call it like a macroeconomic collapse within health systems in that, um, uh, in particular, like, uh, premium labor, contract labor just went through the roof and, um, and inflationary expenses went through the roof.
• 4:00
  Um, the reason why I'm telling you all of this is that within a one-month period after I joined, um, a- after I stepped into this role, um, I'd of course been with Providence for a while already, um, a third of my counterparts, um, in other organizations as CDOs, um, were no longer in their jobs.
• 4:18
  Hmm. And many health systems actually, um, stopped doing digital, whatever that means, right? Like, they, they cut their digital and innovation teams in particular.
• 4:29
  And the reason for that is that, you know, sort of the six to, you know, eight years prior, the, um...
• 4:35
  you talk to one chief digital officer, you talk to one, there was a lot of experimentation and dabbling, and frankly not a whole lot of, uh, thesis-driven work around, like, why are we doing digital? Why is it important?
• 4:47
  What does it mean for the system? Uh, how does it serve the system, both in terms of, um, you know, disruption, um, as well as supporting the core, uh, business model of a system?
• 4:59
  And so it just-- there wasn't a clear articulation of the value, and certainly not only the articulation, but there was no measurement [chuckles]. There was no, um, there was very little focus.
• 5:11
  Uh, and so, you know, just, like, kind of doing this, like, skimming, kind of dabbling, jumping from here to there.
• 5:18
  We used to, you know, I, I talked with a lot of CIOs as well, and it was sort of like the CIOs had to do the crappy work, and the CDO got to do the fun stuff.
• 5:29
  And again, like, none of that is, you know, m- material in terms of driving transformation or supporting a business model or any- anything like that.
• 5:37
  And so, uh, we were, to some extent, in danger of that as well, though we had had a much more sort of focused set of things that we were doing, primarily around access and navigation and driving, uh, engagement and focusing on a couple of clinically specific domains i- with respect to mental health and health equity in particular.
• 5:57
  Um, but even more, you know, what happened in twenty twenty-two, out of necessity, we were forced to focus.
• 6:05
  And the thesis that we kind of came down on w- um, as it related to, um-Uh, why digital, uh, exists within the system, but also how we pulled in other parts of, of the organization toward, you know, a well-articulated objective was that we were in place to drive sustainable growth for the system.
• 6:25
  And, um, what that meant was to have a front end for the system that from discovery through delivery and beyond, um, really brought the consumer and the provider together.
• 6:38
  So take out the friction, make it simple, you know. Uh, um, uh, enable access. Uh, enable a personalized experience.
• 6:46
  Uh, it's very much the sort of playbook that other industries that have done digital transformation and made a difference, like in travel or communications or whatever, that you all have seen, that's, that's the same principle that played out there and is now finally sort of playing out in healthcare.
• 7:04
  In some cases, it was sort of, I would say, summarized as consumerism in healthcare, though we don't think that it has necessarily anything to do with consumerism per se.
• 7:14
  Um, because I think in a consumerist model, there's sort of this presumption that the aggregator is the consumer, and that's not what we're saying.
• 7:21
  We're saying the health system is a platform that can really help bring patients and providers together, and digital's role is to facilitate that.
• 7:29
  So, um, with that sort of philosophical thinking, um, what I'm responsible for, what I have responsibility for in the system is marketing, and that's not just digital or performance marketing, it's all marketing.
• 7:41
  Uh, digital channels, so web, mobile, you know, search experiences, e- ecommerce and syndication. So, you know, online booking, those types of things. And then we also have a product development, um, incubator.
• 7:55
  So I, um, in many ways empathize and live [laughs] in the world that you all do as founders as well, where we build platforms as a service, we build software as a service, and we then create new companies.
• 8:08
  We spin them out and then make them available to the broader market. Um, and we can talk about why we do that. What's your thought process in the build versus buy conversation?
• 8:18
  We could have an entire one-hour session exclusively dedicated to this, and I'll start by saying that we, uh, from an electronic medical, uh, record standpoint, l- we use Epic.
• 8:31
  Um, and so if we were to do any build, buy analysis as a system at the sort of feature and functionality kind of from that lens, um, we would always select Epic because Epic can basically build anything under the sun or it's on their roadmap or, you know, some other version of that.
• 8:48
  And, um, but ultimately, build, buy is much more than just features and functionality. Um, and part of the role of digital in driving sustainable growth is both from a technology and a business lens, right?
• 9:01
  So you're not thinking about it from an IT perspective. You're actually thinking about it, um, about your problems from a business as well as how do you solve the business problem with technology perspective.
• 9:14
  Simply put, our process is such that we really carefully identify the problem that we're trying to solve. We get really deep.
• 9:22
  Like, we're not just saying high level like, "Oh, we're trying to navigate folks to the right venue of care." Like, that's relatively, that's a facile statement to make, and it's not particularly unique.
• 9:35
  Um, everyone's kind of trying to solve that problem. Um, but we get very specific about what we mean, and, uh, we look at it from a business model standpoint.
• 9:43
  So what is this business model that is important to us, for instance, and what kind of business logic do we have as a system?
• 9:49
  What does our capacity and operating model look like that would also influence the technology from a solution perspective? Then we look internally.
• 9:58
  We do in many cases leverage Epic because it frankly, like, it's a feature or a functionality is fine or, like, some IT build within our core IT organization is also okay. That's a possibility. That's step one.
• 10:12
  Um, often though, uh, just feature-- like standing up new features doesn't fit the bill. And so we then look externally to the market.
• 10:22
  Again, we get really deep because we're not just, uh, where it's not like an RFP process where you check the box. It's a, um, it's really a business evaluation process.
• 10:31
  We also, um, you know, so we look at, um, any partner from, from multiple lenses. How do they help us manage our, our many business models, frankly? We live in a mixed, um, w- mixed world.
• 10:43
  It's not just fee for service or, uh, value-based care. It's combined. And us, for instance, being forced to navigate the transition economics ourselves and make a decision is often very difficult for us to do.
• 10:56
  And so, like, a platform that will help us manage in a mixed model is, is always helpful. So that's just one example. Anyway, we look pretty holistically.
• 11:04
  And then lastly, we look out, um, if we don't find something, that's where we sort of evaluate build opportunities. But where we build is in a very narrow niche.
• 11:15
  And the reason we've gone through this agai- again, like sort of extensive process of identifying what we're very good at and what the market is good at and, um, we know, you know, we've got, uh, unprecedented [laughs]...
• 11:28
  I mean, we're part of the system. We're actually very closely tied into the system. We, uh, so we have access to operators.
• 11:35
  We have very, very deep access into the core infrastructure, and so we know, like, how the APIs work. How well are they documented? You know- Yeah... it's at, at that level of, like, extreme depth.
• 11:47
  And we, um, also know where are there unique circumstances in which we are the only ones that are positioned to have access to that core environment, and therefore, it would make it better for us to build versus a point solution out, um, company out there.
• 12:00
  Yeah.
• 12:00
  So we go through this whole analysis every time, and there also needs to be other things like the market size needs to be sufficiently large because it needs to, you know, we really wanna build venture-backed companies.
• 12:11
  N- not, we're not trying to build features and then pass them off as companies. So there- Yeah...
• 12:16
  it's a, it's a pretty, uh, it's a pretty high bar.Uh, you know, we're having this conversation in front of dozens and dozens of founders of healthcare startups, relatively early stage, bunch of problem-solvers, uh, who I'm sure would love to know what some of your greatest specific frustrations are, some of the problems that you would love to have someone solve.
• 12:36
  We still are very clunky when it comes to s- supporting self-service.
• 12:43
  Um, and in particular, it's, it's been historically very challenging for us to parse intent of the user and then, um, uh, support them in connecting to workflows that enable self-service.
• 12:57
  Uh, now of course, with LLMs becoming more available, uh, for utilization, we are building sort of navigation pathways, uh, for self-service and for other sorts of w- light clinical, administrative, pop health type use cases.
• 13:15
  We're trying to solve now other problems around that are more caregiver-facing. We call all the folks that work within Providence caregivers.
• 13:21
  So if you were to go and shadow one of our, our caregivers in a clinic, um, especially those who work more in, like, sort of care management or, um, uh, administrative, uh, capabilities, they've got, like, sticky notes all over their monitors.
• 13:37
  They've got, like, notebooks. They've got six different applications, and they don't have one unif- unified workbench.
• 13:44
  So it really fragments their flow, and it causes a lot of challenges for them in terms of how productive they can be. That's one, uh, very caregiver-focused problem.
• 13:55
  One very technology-oriented set of problems is that, you know, fortunately, we only have a couple of use cases where we're applying generative AI today.
• 14:04
  But, um, we need to have consistent tools, infrastructure, LLM ops, SecOps, DevOps, annotation methodology- Mm-hmm... all that stuff, um, so that we can start deploying, um, uh, LLMs at scale. That's another example.
• 14:22
  We don't have... Like, nothing like that exists today. Mm. So those are a couple of very specific areas. We're always working on expanding access.
• 14:29
  That's another kind of big area, and there are subdomains within that as well. Okay, let's get really pragmatic here.
• 14:35
  Let's say there's a founder listening to these challenge areas like being clunky on self-service, and they're like, "I have, have I got the solution for you."
• 14:44
  Let's talk about tech adoption and how you think about working with a startup. Uh, what are some of the things that you look for? And let's also then talk about some red flags, things that you would try to avoid.
• 14:56
  You'd be surprised at how many folks don't do this [laughs], which is, like, having a really clear understanding of the problem you're trying to solve and the wa- ability to articulate it.
• 15:03
  I still hear from folks who, you know, are kind of all over the place, or it sounds like they're solving, you know, for, you know, climate change and w- world hunger and, you know, uh, connectivity and interoperability.
• 15:17
  Like, it's just, it's too, you know, focus, value prop. Focus what are you trying to solve for, um, is step one. Um, and then- Can I pau- can I pause you there? Yes.
• 15:26
  Because, you know, part, part of the reason to have a call with someone like you is to understand straight from the source what the challenges are at a level that most people don't get visibility on.
• 15:37
  And so do you have suggestions on the best way to understand the true problem? There's, like, the perceived problem. You do a little research- Yep...
• 15:44
  there's that problem, and then there's the true problem, and sometimes only someone at your level, uh, has the true visibility. Is that fair to say?
• 15:53
  I would say I am not in the category of people that is, like, deep in the work, right?
• 15:57
  So I'll tell you, like, philosophically and, like, in some maybe in a highfalutin way, but when you go and you sit with our patient registration representatives, like, I saw how much clicking and cutting and pasting they had to do, or the fact that, like, when, um, you know, the schedulers and the registration people are two different people.
• 16:19
  And so you might get something scheduled, but you can't do a verification of prior auth and, um, you know, network eligibility, et cetera, et cetera, et cetera.
• 16:28
  And therefore, there's lots of breakage and a lot of last minute cancellations because we couldn't get, we couldn't verify someone's insurance status, right? Like, you won't know that.
• 16:38
  You won't actually know that someone calls and can't get someone to pick up the phone unless you go and sit there. Mm. And so, like, playing the ground game is, is critical, and that's really hard to do.
• 16:51
  Like, don't get me wrong.
• 16:52
  I'm not, uh, I'm not saying that's an easy thing to do, but, like, getting clever about how to access folks on the ground is probably, once you've got this, like, sort of high level, like, we think there's an opportunity there, is really critical.
• 17:07
  Like, I- and I've talked with, like, you know, other folks in the industry about this. We're all kind of trying to solve the same problems.
• 17:14
  It ultimately gets down to how you're solving the problem makes all the difference in the world when it comes to driving adoption within a system. Okay. Okay. Sorry.
• 17:23
  Let's get back to your answer about how you work with startups, what you look for and what you're avoiding. A lot of, uh, you know, humility around what you, we, what you do and don't know. Engagement.
• 17:34
  If it's a clinical solution, you gotta work with clinicians. And, like, it, you're not really a clinical solution if you haven't worked with [laughs] clinicians to, to build. So those are, those are some big ones.
• 17:46
  Providing, um... You know, especially depending on, like, y'all are, you know, founders, and so I assume a lot of, uh, uh, s- the solutions that you're building are relatively early stage.
• 17:57
  And so, um, it's really critical to get in that, in the environment and offer things up that might help you get access to special parts of the tech stack. I'll give you all an example.
• 18:09
  Um, many, many years ago, we were doing some work in provider directory. Now, this is, like, so many years have gone by, right? So lots of, lots has changed in that domain.
• 18:18
  Um, but we were working with a company that was building their solution-And they wanted access to Epic because they needed to build the connection between Epic and the, the credentialing systems that provided a lot of the provider data, and that was not something that we as a system had done before and didn't really know how to value that.
• 18:38
  And so they actually gave us warrants in their company in order to encourage the integration with Epic, and for us to deploy the resources that we needed to deploy, again, solving that problem for them.
• 18:51
  So be willing to work creatively, um, and provide, you know, access to your environment or just give visibility.
• 19:01
  Do, you know, not just demos at a high level, again, like what are the features, but, um, get in there, um, with folks around how your tech is architected, if you have, if you have it built out already.
• 19:13
  If you don't, work with folks to really capture the requirements, not from people like me. I, I'm not on the ground, and I'm... therefore, I'm useless. And so the deeper you go, the better.
• 19:24
  I'm good for, like, strategic context and what is the health system thinking about, and in general, what's digital doing and what's marketing doing and what's experience doing and corporate strategy and all that stuff.
• 19:36
  But it's not... The, the clinici- it won't resonate with an actual operator until... unless it's been co-built with folks, like, sitting shoulder to shoulder.
• 19:45
  If you require data to be sent to you, that is gonna be a uphill battle. Like, if you're trying to train models, there are probably other ways to get that data that you don't need it from a health system.
• 19:57
  It'll take you 25 years. Uh- I wanna get more, I wanna get more into that data sharing and maybe a little bit about AI, but first, let's take a few questions from- Sure... audience. Adam Schultz from Minder.
• 20:10
  You know, as you, as you figure out organizations that you wanna work with, do you ever invest in them?
• 20:15
  Do you actually make investments to help them develop their technology, or have you ever funded pilots to help them get to the point to where they're ready to pilot it with your organization? And how does that work? Uh,
• 20:25
  a really interesting question. If there's, uh, sufficient sort of conviction in the area, yeah, like we... By the way, like I never recommend running a free pilot.
• 20:38
  That's just a recipe for disaster, um, and languishing in health system abyss forever and ever, so don't do that. We have funded folks to do experiments.
• 20:50
  Now, it depe- if it's like a highly sensitive clinical, like if it was like, for instance, a, um... We actually did do this ultimately, but required a lot of, uh, clinical, uh, backing.
• 21:03
  There was, um, safety planning for suicide, um, suicide prevention, in particular in our EDs when folks were in sort of this crisis, um, moment.
• 21:14
  Um, and we ended up doing a pilot that we paid for, um, because the core clinical, like, scientific, uh, model was in place, and they just needed to test it in an operational environment of, of a large system.
• 21:27
  So we paid for that and, um, and then w- worked, uh, because we were really testing whether, like, t- testing the effectiveness in an environment versus the efficacy in sort of from a theoretical perspective.
• 21:41
  So, um, so yes, we, we absolutely do do that. Um, when it comes to, like, med tech, if folks are in med tech, like, that's not really something that we do. That's more like we already...
• 21:52
  It has to have gone through the 510[k] and be, you know, FDA cleared. Um, so it highly, it's highly dependent.
• 22:00
  Um, but ultimately, it comes down to finding a champion with sufficient conviction, and then m- more or less anything is possible from there. Any, any tips on finding that champion with conviction?
• 22:11
  Unfortunately, it is only done through brute force right now.
• 22:15
  Um, and you know, we had talked many years ago about doing sort of like a social graph of healthcare and, like, who in what organization is responsible for what.
• 22:26
  That is not really a possibility right now, and with health systems m- moving around quite a lot, lots of, uh, attrition when it comes to different roles and just sort of health systems are going through quite a bit of change at the moment.
• 22:43
  Um, you just gotta get into, like, the research, what people have talked about, what they've written about, and it, it really is brute force.
• 22:51
  Now, sometimes, uh, you can find someone like me, where I know a lot of folks, um, that I can connect with, right?
• 22:58
  Like I have no business talking about support for Parkinson's, for instance, but I can connect folks, [laughs] right? So that's the other, that's the other way to, to do it. Nice. Adam, thank you for your question.
• 23:10
  Let's go to Dr. Alexandra Greenhill from Careteam. Go ahead. I am a physician, and, uh, we've come up with a platform that enables us to manage patients with complexity.
• 23:21
  So if there's many providers, many organizations involved, this is an infrastructure that spans across- Mm... and allows to involve the patients, uh, so they can self-serve and... And so, um,
• 23:33
  w- we're now more mature, s- 17,000 patients helped, and we're sort of in the sales process. And I had a number of very practical questions around, like, do...
• 23:44
  Our solution is so horizontal, and it's the opposite of the point solution. So, like, do people procure these? Do you do procurements? What does that look like?
• 23:52
  Um, everyone tells me I need to go do more research, and yet I see decisions being made where that is not even a question on the RFP.
• 24:00
  And so, you know, um, any practical advice you have as to, like, we think we've built something that is a game changer, and we know it because of the people who are using the platform now.
• 24:11
  How can I get this into more hands faster?I hate to break it to you, [laughs] but, uh, and I'm not gonna tell you something that is... So I think those horizontal solutions are the, the direction of the future.
• 24:22
  The challenge is that they're very difficult to sell. Uh, I speak from personal experience in that we build a lot of horizontal solutions, too.
• 24:31
  I mean, those platforms are intended to knit together, that we build, are intended to knit together point solutions.
• 24:37
  And it, you know, you gotta go talk to, like, every single person in the organization, it feels like, before you can actually, it, uh, sell. So that's the part that's hard.
• 24:48
  For solutions like that, and, uh, you know, take this for what it's worth given that I don't know that much about your, your platform, um, it's actually more of a top-down sale than a bottom-up sale. So go...
• 25:01
  So if, if you have a value proposition, for instance, around, like, it helps, um, manage total cost of care because it's, uh, you know, you're knitting together all these different solutions and you're, instead of folks having to, you know, like, your, your end user as the patient is getting shuttled around from one thing to another, and then it lowers compliance, and then their adherence goes down, and then they have some sort of critical, um, uh, sort of health es- escalation or something like that, um, uh, this knits it all together, and therefore, you know, we've seen reduction in ED admissions of it's XYZ, and, you know, this much cost savings.
• 25:41
  Take that to the CFO. So you take it, you know, you go to that level, and then you, and then they will start to, like, cascade it, right? Because that... And, and you may not be able to go there directly, right?
• 25:54
  You might need to start with, like, the value-based care people. At the, at some point, the, it, the CFO drives a lot of that, uh, evaluation. Because they're thinking about it all up.
• 26:05
  They're not thinking about it from a, a line of business budget. They're thinking about it from, how does it roll up to enterprise value, and that makes a big difference.
• 26:14
  So those horizontal solutions, you're gonna have to do more and more of that versus, like, I'm gonna go just to go talk to the folks that do chronic disease management, right?
• 26:23
  Like, it gets hung up in all sorts of other o- operational challenges.
• 26:28
  You know, the other place that you could, uh, kind of start, if there is someone that's, like, in charge of all up, like, virtual, like, telemedicine, um, remote patient monitoring, you know, all of those types of, like, things that ena- like, technologies that enable a different business model a- around care in the home or remote care, like, they will start to get that, and they may be your entry point.
• 26:53
  Yeah, we appreciate that candor.
• 26:54
  And, you know, that aligns with a lot of, uh, conversations we have around really finding mission fit partners, really finding people where you're aligned with what they want, like talking to that CFO about, uh, reducing costs.
• 27:06
  Shireen, let's go to you for your question. Sure. Thanks. Thanks, Logan, and thank you for your time, Sarah. So Shireen with Yumlish.
• 27:13
  Uh, we are scaling digital nutrition solutions, largely focused on underserved communities.
• 27:18
  Um, my question to you, Sarah, was really around balancing sort of this innovation investments with the other side of sort of these economic pressures like inflation, and labor, and you touched on this just a second ago- Yeah...
• 27:32
  and then delays in reimbursement from, from payers as well. How are you balancing sort of both, how do you make room for innovation while also trying to manage the P&L? Um,
• 27:45
  uh, so what we've done as an organization, I'll put it this way, um, is that, uh, after March of 2022, we kicked off a,
• 27:55
  y- you know, I would say a 24-month effort to recover and renew the system, and, like, it's been all hands on deck for that time period.
• 28:06
  Now, um, it's actually probably going to extend through the end of, you know, uh, this year or halfway into next year, so it's really extending into, like, almost 36 months, um, because the challenges have been a lot more, um, more, uh, like, material than we thought.
• 28:21
  Um, so it really has been all hands on deck.
• 28:24
  And when it comes to, like, a group like my, my organiz- like, that I'm responsible for when it comes to digital innovation, um, what it has done for us is it's aligned us more with enabling the core, right?
• 28:36
  There's sort of this notion of, like, should we be disrupting ourselves so that others don't disrupt us? That was sort of a common refrain in health systems, you know, five plus years ago or so.
• 28:49
  And no one's talking like that anymore, partly because, you know, we've come to realize, like, Providence, for instance, cares for f- over five million patients a year, and the disruptors still haven't gotten to that scale.
• 29:01
  So we gotta keep the system together [laughs] in some way or another, right? [laughs] Like, people still need cancer care.
• 29:07
  People still need, um, uh, you know, um, transplants, and they need, you know, they need a lot of services.
• 29:14
  They still need primary care, and they can't just rely on these other sort of, uh, folks that are frankly nibbling around the edges.
• 29:22
  So our core system is valuable, and it is essential, and it has forced us from an innovation lens to say, from an innovation perspective, how do we support the core?
• 29:31
  Um, and it's actually, I think, uh, kind of started to shape an interesting discussion in the industry, which is that, um, you know, a- again, like, five years ago, we i- we collectively were saying all these things like health systems are going to be disrupted, and Amazon had a disruptive, um, uh, sort of, uh, aspirations as well.
• 29:53
  And I think we are all collectively as an industry more moving toward, let's make a better system. Like, don't worry about disruption, right? Like, you gotta just take care of the people that need care now.
• 30:05
  Um, and that, uh, and that has forced a lot of different discussions.That's helpful. I'll just do a quick, a s- super quick follow-up to that, Sara.
• 30:15
  Uh, one of the contexts for my questions to you is, you know, as, as innovators and startup entrepreneurs we really struggle to understand, um, o- one, where, what, where the problem is really painful that we can go in and solve- Yep...
• 30:28
  right? The other side of it is also making sure that the dollars exist there so then we can go solve those problems. 'Cause like you said, free pilots are- Of course... are no fun for anyone.
• 30:37
  Um, so having said that, would you say those relationships are stronger with payers, providers? Where, where would you recommend, uh, startups to, to seek that alignment?
• 30:49
  If you have something that has a ne- um, I would say a near term ROI of under 18 months, health systems are a good bet, um, because they're moving more, more quickly than they used to.
• 31:03
  Um, and now if it's like it only works under risk and only with like s- you know, that makes it a little bit of a harder calculus because then you need to, um, determine, like, how do you selectively apply it and operationalize it and all that stuff.
• 31:18
  But if it's, um, if you have a model that, uh, can either be flexible within the payment environment or is agnostic to the payment environment, um, and can deliver an ROI of less than 18 months, go with the providers.
• 31:34
  The payers, now that depends, [laughs] right?
• 31:37
  Like, if you're going with, um, like, regional, um, reg- like, smaller regional, um, plans are in a world of hurt too, and their tech infrastructure sucks 10 times worse than health systems. Um, it's bad.
• 31:52
  Like really, really bad. Like, I'll give you one example. We, we have the ability to, to do SSO. They... Their, their technology doesn't even allow for it. Like, it's not even like, oh, they don't want to. They can't.
• 32:04
  They cannot do it. So their technology infrastructure is so weak that, um, that it, it will just prevent you from even being able to engage in that. Um, now they may be, you know, uh, willing to, uh, partner on, um, on,
• 32:24
  uh, certain things that will save them from a total cost of care standpoint, but the challenge is that they will need you to already have validated data, and you gotta get that validated data somewhere, right?
• 32:37
  So, um, often your validated data will come from a provider. Appreciate the question, Shereen. We're gonna try to squeeze in one last quick, uh, question.
• 32:45
  After that, we're gonna allow you to share back, as we always do in our master classes, one biggest insight that you heard.
• 32:51
  So, uh, while Beth Sanders from LifeBio is asking her question, if there's something that you've heard that was helpful to you, drop it in the chat and I may call on you at the very end.
• 33:01
  So Beth, why don't you come off mute? Hi, Sara. Thank you for this. I just... You kind of h- touched on it here, the, the relationship between the health plan and the health system.
• 33:12
  It, it just feels like I'm, I'm feeling like they're coming together more and more and they're, you know, your, your personalization, um, more focus on wellness maybe more than sickness.
• 33:23
  Is that where this whole thing is heading? And especially with a massive aging population. Is Providence looking at that and going, "Well, we better get ahead of this on the wellness side or we're gonna be overcome?"
• 33:36
  Uh, yeah. So I, I'll break your question up into a couple of different parts.
• 33:40
  Um, personalization is, uh, something that, uh, um, uh, I think all, all systems, all pr- uh, payers, like, we're all kind of on that journey in differing, like, varying degrees of, with varying degrees of success.
• 33:55
  And, um, and, uh, uh, we're gonna see that theme more and more. Now, whether health systems and payers are gonna come together to do that, I think, is an entirely different question.
• 34:05
  Um, payers, you know, first, uh, diversified into services and pharmaceuticals, and now they're diversifying into actual care delivery and, um, and that's how they're building the connection.
• 34:18
  They're not actually leaning into the existing providers. They're building health systems without hospitals, and that allows them to capture more data and pl- and, um, play chicken even more. The, um, the, uh...
• 34:33
  and then the Blues and, like, other regional plans are just really struggling, frankly, and like to back to our previous conversation, don't really have the capabilities, I would say, to, um, meaningfully, um, enable a, uh, a, a joint experience.
• 34:49
  Now, some may sort of o- overcome some activation energy, um, and but i- we've, we've not seen that play out so far.
• 34:57
  Um, then the question is, like, uh, to your point around, like, the aging population, we're going to see more and more tailored ecosystems of care rather than, um, rather than, uh,
• 35:12
  um, you know, sort of one size fits all.
• 35:15
  The challenge is, like, what we've seen so far in that space, like the first wave of those companies like Oak Street and Village MD, like, have very challenging operating models, [laughs] right?
• 35:27
  And so, like, they are really heavy from a workforce standpoint, really struggling with scale. They're caring for, like, 100,000 patients, you know, after however many years and however many billions of dollars.
• 35:39
  And so, um, so I think that's, like, um, you know, we're gonna have to figure out, like, yes, it, it's important and it, that's gonna be the expectation.
• 35:51
  But how it actually gets operationalized is, I think, TBD, and there's gonna be a different wave of that going forward. Beth, appreciate the question. We are basically at the end of our time.
• 36:02
  Sara, I wanna give you a chance to sort of, uh, give one piece of parting wisdom or advice to this group. You know, we've got a few dozen founders on the call, and many more, uh, who will listen to it afterwards.
• 36:14
  Um, how should they be thinking about health innovation in 2024, uh, as, a- a- as it pertains to-Connecting the dots from early stage innovation to really the health system level, five million patients, and wanting to see that impact reach real patients
• 36:33
  Find a partner, uh, early if you can, and, um, and get as close, like, shoulder-to-shoulder with them as you possibly can.
• 36:42
  I mean, I think, you know, there are, uh, health systems, I've been in healthcare for my entire career for the most part, like, you know, and adjacent.
• 36:50
  Like, I was in med tech, and then I was in policy and health services research, and now, and then, um, management consulting, and now as an operator.
• 36:58
  Um, and, uh, it is very different from what it was 20 years ago, right? And as many of you probably who have been in healthcare for quite some time as well have seen that evolution. Um, and so the, um, the...
• 37:12
  So finding a partner that will, uh, that will help you actually see the ways by which the problem needs to be solved and getting ahead of some of those things that hi- that have historically been intractable, I think is, like, really, really critical.
• 37:29
  Very nice. Uh, uh, well, let- let's have one quick insight, uh, from Nicole Cook from Alvey. Why don't you, uh, share, share your thought? Yeah. Thank you so much, Sarah. This was an incredibly helpful session.
• 37:40
  Really appreciate it.
• 37:42
  I think for, I mean, everything was really, really informative, but some things that resonated strongly with me is just that we need to ensure that our value prop is very clear, um, but also that the problem we're solving is also very clear so that it makes sense to those stakeholders.
• 37:57
  Um, but at the end of the day, we, you know, getting buy-in from the CFO and making sure our solution is financially compelling will be what ultimately sets us up for success. So, um, again, thanks so much.
• 38:07
  Really appreciate it. Sure. Can I say one last thing too? Yeah. Just to build on what Nicole just said.
• 38:12
  Um, when, when we have, um, uh, partners or potential solution companies come to us and say, "Hey, you're gonna, like, lose on all these things, but then you'll make it up on growth," don't say that. It never happens.
• 38:25
  The growth never materializes. Never ever, ever. And then we're just left holding the bag. And, um, I think health systems are finally, like, realizing that, right?
• 38:35
  Like, "Oh, we've been holding the bag for all this time," and, like, we can't all be trying to grow and, like, all be, um, attributing growth or value to the same, you know, to, like, it's the same growth, but we're getting it attributed to, like, 10 different things, right, who are all trying to take credit for it.
• 38:50
  So there's gotta be something more there, and, um, and that'll just help your conversation. I love it.
• 38:58
  Sarah, you were clearly candid on this call, and as David Haddock said in the, in the chat, your depth of knowledge is impressive, and so we really appreciate you sharing with us today. Um- Great questions.
• 39:09
  Very nice to be with all of you. I love, I love what you all are doing, and, um, let me know how I can support you. Thanks everyone for showing up, and I hope to see you on an upcoming master class. You take care.
• 39:20
  Thanks, everyone. [upbeat music] Thanks for listening to Startup Health NOW. We'll be back again with another episode next week. [upbeat music]