Latest / StartUp Health NOW Podcast / Market Strategy & Insights With Aetna’s Brigitte Nettesheim

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Market Strategy & Insights With Aetna’s Brigitte Nettesheim · StartUp Health NOW Podcast

• 0:00
  [on-hold music] Welcome to Startup Health Now, the podcast where we celebrate the innovators and entrepreneurs building the future of health. I'm India Edwards.
• 0:18
  This week on the podcast, we sat down with Bridget Nettesheim from Aetna, a CVS Health company.
• 0:23
  In this conversation, Bridget shares how she and her team develop market strategies and what they look for in partnerships that strengthen member experience.
• 0:31
  Bridget also gave an insider view of best practices to connect with Aetna, like focusing on personalized engagement, access to care, and reduced costs.
• 0:40
  This session was hosted by Startup Health's Logan Plaster in front of a live audience of founders from the Startup Health portfolio. Enjoy.
• 0:47
  [upbeat music] I'm Logan Plaster, and I get the privilege of being your host for the next hour.
• 0:59
  Today, I get to welcome Bridget Nettesheim, Aetna's President of the North Central Region and Joint Ventures.
• 1:06
  In her role, Bridget leads market strategy and has a big impact on how Aetna and CVS, uh, uh, relate to conserm- consumers, big employers, as well as providers.
• 1:19
  Uh, we're gonna get into all of that today, as well as learn some of the rules of the road for how startups can work directly with Aetna and CVS to grow and to scale. So it's gonna be an awesome conversation.
• 1:31
  Uh, excited to have all of you, uh, along for the ride. Bridget, welcome to today's Fireside Chat. Thanks, Logan. It's great to be here. Let's start with you. Let's get to know you a little bit.
• 1:44
  Tell us a little bit about your background. Uh, very interesting roles. I say roles 'cause you got two jobs, uh, at this company, uh, listed here. Uh, tell us how you came into this position.
• 1:55
  Did you join before or after, um, the acquisition of, of Aetna by CVS? Sure. Um, and maybe it helps to understand a little bit more about my background.
• 2:06
  I'm a farm kid, literally grew up on a farm in the middle of nowhere Illinois. Um, joined the military to be able to afford college.
• 2:14
  Uh, I was lucky enough to, or fortunate enough to go to the military academy at West Point. Um, didn't even know what I was getting into.
• 2:21
  Uh, and so that may tell you a little about me in terms of when my back is against the wall, I'm gonna make the boldest move I can. Um, and so flew helicopters when I was active in the Army. Nice.
• 2:34
  Super fun, but it also tells you a little about me. I, I'm somewhat fearless. Uh, cautious, have to plan, but fearless. I joined actually Caremark, believe it or not, the, the PBM.
• 2:49
  Uh, I joined that company my first civilian job. It had noth- Caremark had nothing to do with CVS at the time. Uh, I worked there, went into provider strategy consulting, went to get my MBA, and then moved into Aetna.
• 3:06
  Uh, provider strategy consulting was amazing.
• 3:09
  Uh, I, I will always appreciate that work that I was able to do, but I recognized that no one on the provider side who was doing this management strategy consulting understood the payer side.
• 3:20
  It really bothered me, so I thought, "Oh, I'm gonna go learn the payer side and go back into consulting." So I joined Aetna, believe it or not, in two thousand five, and so that was long before CVS acquired us,
• 3:36
  um, and had various jobs there. So I worked, uh, in medical economics, in finance, in network. And, and network, not network contracting, but really innovative network solutions.
• 3:49
  Uh, I worked in our national accounts organization with our largest
• 3:53
  employers who purchased health services, uh, and then moved into this little startup group that didn't even have a name at the time when we knew ACA legislation was pending.
• 4:06
  And our charge was, "Hey, figure out how we diversify revenue streams, and let's think through how to do that by helping providers with this concept of the ACA legislation and what they're going to need."
• 4:21
  We didn't even have a term for value-based care at the time. Um, but what services they're going to need or how we can support their efforts in that.
• 4:29
  And that became Aetna's Accountable Care Solutions organization, which ultimately ended up in building five joint venture health plans.
• 4:38
  And when I say joint venture health plans, these are affiliate health plans of Aetna, now Aetna and CVS, that are jointly owned, typically fifty-fifty, by a provider organization and the payer, which is, which is Aetna.
• 4:54
  Um, so I'm able to run that portfolio. I still sit on the board of all five of those. Uh, I don't directly run them. We have our own C-suites that run them. I also ran, and I, and I say this 'cause it just changed.
• 5:09
  I ran a, essentially a P&L, which was our Medicare and commercial health plan for the whole Midwest, um, for a few years, and have recently been asked to take on going back into the employer side, um, in terms of being an administrator and a health insurer for our largest employers.
• 5:30
  So that would include employers that have both the PBM on the, on the C-- on the Caremark, CVS side, the Aetna side, um, as well as some that work with Aetna only.
• 5:43
  Bridget, I gotta dig into your story just a little bit because of the West Point piece and flying helicopters. It's just, um, uh, it, it's too, too good to not, uh, go a little deeper on.
• 5:52
  Everyone on this call is really trying to be the best kind of leader that they can be for their own little unit, which, their, their startup, you know?
• 6:00
  And, and I just, I think about the lessons of, of leadership that you learned at West Point and, uh, were able to bring into the business world, and I wonder if there's just some, like, top line, uh, words of wisdom that you could share with folks in this call, um, aboutSome of the leadership lessons that you learned that you think really apply to small business units as well.
• 6:21
  Yeah. I mentioned one, that's be fearless but plan. And so do not fear anything if you have great plans, and that is not one plan. That is plan A, contingency plan B, contingency plan C and D.
• 6:38
  And in order to do that, lesson two is have a team that is ready to execute on those at any given time. Trust them. Trust that they know and understand your mission, your purpose.
• 6:51
  They trust each other, most importantly, right? So that means we can't, as leaders, micromanage. We cannot do it all ourselves, and we shouldn't 'cause that limits us and that limits the business that we run.
• 7:04
  Um, so those are, I think, the most important aspects that I continue to lean on, uh, from West Point. Other than that, kind of the big picture strategy, always thinking big picture strategy.
• 7:17
  'Cause, yeah, you may be one little cog in a giant wheel of healthcare, but understand the dynamics of what's going on in the military that may have been geopolitical, uh, as much as understanding the other forces that you're fighting against at any given point in time, and it's no different in the business world.
• 7:35
  What's going on from a federal legislative, um, and sort of political environment? What's going on at a state level? How do those interact or not? Who are the compet-- Who's the competition?
• 7:46
  Who's the new competition that's emerging? What could they be doing? Um, very similar in terms of thinking strategically all the time as well. I love it. That's great.
• 7:56
  Uh, just a re-reminder to everybody that, uh, Bridget and I will have a Q&A ourselves for a bit of this call, and then I want you to be really thinking about how you wanna interact.
• 8:05
  And as soon as you have thoughts and questions that you would like to ask, uh, drop it into the chat and I'll invite you into the conversation.
• 8:12
  So, um, Bridget, you give me a-an overview of your job or your many jobs there at Aetna CVS.
• 8:19
  Uh, but let's, let's get down to your day-to-day and specifically kind of s-what are some of the biggest challenges that you face, uh, in that position? Yeah.
• 8:28
  So I'll give you a perspective of my role running, um, health plan P&L, commercial and, and Medicare.
• 8:37
  Um, and it's not that different, but I'll sort of add on some of our biggest customers and what they're facing right now.
• 8:44
  So some of the challenges are just the complexity of working with multiple entities across the har-- healthcare spectrum to make it easy for consumers of healthcare.
• 8:57
  So we consider every one of our members as Aetna a consumer. We certainly have consumers across the entire CVS spectrum.
• 9:07
  And so how can we get away from manual bills and EOBs that are very electronic, right? Um, that's what they're supposed to be. But how do we get away from the manual ones that are really hard to understand?
• 9:23
  How do we have a pharmacist understand benefits at the point in time a consumer is seeing that pharmacist?
• 9:30
  How do we work with multiple types of provider organizations, so that's large health systems, that's primary care physicians, that's specialists, um, that's long-term care facilities, multiple layers of provider organizations across multiple markets as well?
• 9:49
  So that complexity in and of itself is so frustrating to every single consumer of healthcare, including me, and I guarantee including every single one of you. So the biggest challenge is how do we make it simpler?
• 10:06
  All the time, how do we make it simpler? I wonder if it'd be helpful to kind of drill down into one of those areas of complexity and look at really how you are trying to make it simpler.
• 10:16
  So obviously, those are sort of big bucket areas that we all agree on, our frustrations need to be made simpler and you're-- but you're obviously dealing with actual solutions and the folks on this, these calls, this call are, are trying to build actual, uh, solutions to, to fit those problems.
• 10:32
  So may-maybe just as a case study, is there a particular area that you could, um, dig down into and show us what you are working on? Yeah. So I can give you two.
• 10:42
  I can give you one that has more history and where we are today, and then I'll move-- and that will be, um, access through telehealth, um, which was very different five years ago than post-pandemic or coming out of a pandemic and how that's accelerated.
• 10:56
  So talk about that first.
• 10:58
  And then second, I'd like to talk a little bit about price transparency and all of the pending-- Well, we have some federal mandates out there, um, but we-we're pending regulations on much of that, and how are we thinking about that in terms of creating simplicity.
• 11:13
  So the first I'll talk a little bit about virtual care. When we started in the virtual health care realm, I think there was Doctors on Demand, Amwell maybe a little bit, Teladoc.
• 11:28
  I mean, this was years ago, and we wanted to bring that access to, right, expanded access, more simplicity to the general commercial and Medicare population, starting with commercial.
• 11:42
  And I will tell you, we worked with Teladoc for years and couldn't get more than literally a two to three percent uptake in using any type of virtual care services.
• 11:54
  And at that point in time, it was primarily, or it was almost all primary care. We just couldn't get an uptick. We did through one of our joint ventures because we can create, um, we can create pilots.
• 12:08
  So an organization doesn't necessarily have to scale big to do a pilot or be able to scale big at that point in time.
• 12:15
  We started working with all of Aetna and CVS was working with Teladoc, and we said they're just not quite-Ready to work with as many, um, different provider nuances as we need in this joint venture.
• 12:31
  'Cause remember, our partner is a provider at this point in time, so we can't compete with them directly. Well, Ninety-eight point six came in, said, "I think we can do this.
• 12:40
  I think we can create something that works for you, Banner Health System,
• 12:45
  solve your problems on your needs for virtual care," remember, pre-pandemic, um, "and we can, we can work with you, Aetna, on your side and not interfere with anything you have going on across your large, um, carrier services."
• 13:00
  Great, let's try it. And we racked our brains, and we worked our tails off to get that up and off the ground. Within six months, the pandemic hit.
• 13:10
  And all of the fighting with CVS and Aetna to get this thing in place, 'cause internally, I do a lot of that. I have to fight with multiple competing organizations and interests.
• 13:21
  Um, within six months, the pandemic hits, and Aetna and CVS turned to us and said, "By the way, we need that solution to be scaled across the whole US right now." Um,
• 13:35
  and so we're able to work with Ninety-eight point six to scale that as fast as we could.
• 13:42
  Th- And honestly, one example of how a pilot solution, we were able to scale it very quickly, um, bring that to market as fast as possible, and it worked well for everyone, um, involved at that point in time.
• 13:59
  So hopefully that gives you an idea of sort of how we started. We were trying to solve an access problem. The whole industry wasn't moving that way.
• 14:08
  Um, I will never say that we were fortunate to have a pandemic, but in this case, we were fortunate to have a partner who could help us react to a problem that was exacerbated by the pandemic. Um, a second area.
• 14:21
  Are you okay, Logan, if I go into the second area? Sure. Go ahead. So let's think about price transparency, and there are a few of you on video.
• 14:29
  How many of you are knee-deep in the concept of the federal regula- or federal mandate for price transparency? If not, I'll give you a little background. Just a quick background, if that's okay, Logan. Yep. Go for it.
• 14:43
  There are a few components to a federal mandate. It started under the Trump administration. It is continuing through the Biden administration. So pr- think of price transparency on a few levels.
• 14:57
  Ultimately, the goal is, um, and actually, Alex Azar, um, I saw him and Donna Shalala on a panel. I was fortunate enough to see those two on a panel in August.
• 15:10
  And Alex Azar said, "We did this because we believe it will be a fundamental or foundational shift in how healthcare works in being more consumer-friendly."
• 15:23
  And so price transparency, effective one/one/twenty-one, the first part of it, the providers were supposed to, at minimum, to be just compliant, um, have machine-readable files available
• 15:38
  that were publicly available that show the prices they charge for services. Can you-- For any of you who work with hospital systems, imagine the complexity of that.
• 15:51
  I'd say twenty percent of the way there right now, and that was effective one/one/twenty-one. Um, now se- it's been pushed back a little, seven/one/twenty-two,
• 16:02
  payer organizations, and that isn't ju- those aren't just, I'll say, insurer organizations. So this includes self-insured, large self-insured employers. We have to provide the same type of information.
• 16:16
  How much are we paying for services to different providers for each service? Imagine how complex this is. Um, the initial sort of first wave of this is going to be minimally compliant.
• 16:32
  Are we just compliant with the law at this point in time or the regulations that are coming down? Okay, great. That's gonna cost a fortune, and we're gonna do a lot of work.
• 16:42
  So the work I'm doing, I'm the executive sponsor for it within Aetna and across CVS right now, is thinking about five years from now, what do we want this to look like? How do we lead the way?
• 16:55
  How do we start to integrate all of this information across a PBM, across insurers, across all of the access we have to different provider organizations to make it consumer-friendly?
• 17:11
  So they're not just these ugly machine-readable files sitting out there, but we actually have tools available that truly give consumers a view as to what they will be charged on both a personal level, so what are they personally responsible for, and also access into, um, what the total cost is, because that's just as important for all of us to think about access at a, at an affordable price.
• 17:41
  So that was a really long answer to a short question. Actually, that's very helpful, Bridget. Um, and I know a lot of folks on this call are working, whether directly or tangentially, in that price transparency arena.
• 17:51
  Uh, that relates to this next theme I wanna get into, which is the fact that you interface, uh, between Aetna, CVS, and some of the world's biggest, uh, employers.
• 18:00
  Uh, I think you told me Bank of America, Cisco, Marriott.
• 18:04
  And so often, health startups think that if they can just get in with one of these employers, um, that, that they'd be able to grow and scale, you know, with a single client versus going direct to consumer.
• 18:17
  This is seen as a, you know, a, a strong go-to-market strategy.
• 18:20
  And, um, so you've got this incredible vantage point of really understanding how these big employers are thinking about health innovation, about how to spend, uh, about what they value.
• 18:31
  Um, and so I, I, I wanna sort of spend a minute thinking about, um,Large employers and, and how they make some of these purchasing decisions.
• 18:40
  So just top level, sort of how would you describe how some of these, I named three, how they're thinking generally ar- about health innovation right now? Yeah. A loaded question [laughs]
• 18:52
  because there are probably different archetypes of, of purchasers. I call them purchasers. This, this is behind the US government and in- inclusive of state government.
• 19:03
  So behind government, commercial employers are the largest purchasers of healthcare services in the US. And oh, by the way, right, the fastest-growing industry in the US.
• 19:14
  And so it's very important how they purchase, what they're thinking. Um, a couple of things. One, understand the influencers. So who influences the purchasing decisions of these large organizations?
• 19:29
  The benefits consultants. Do not overlook the benefits consultants.
• 19:34
  The Aons, the Willis Towers Watsons, the Mercers are gonna work with your biggest, and then it goes sort of down, and I would say just hundreds of other ones who will work with middle-- mid-size employers and small employers.
• 19:51
  Very important to- Oh. Can you guys still hear me okay? You, you, you said, "Very important to," and we were all, you know, just waiting with bated breath.
• 20:07
  Just my internet literally just kicked out on me, so I had to log back in, and I'm so sorry. You-- wait, you look good right now. You- You can hear me okay? Yeah, you're clear right now. You look- Okay.
• 20:19
  You're, you're, you're totally clear. You said, "It's very important to..." Uh-oh. This is gonna be extremely dramatic.
• 20:33
  This is a good opportunity for anyone, uh, to start thinking about the questions they wanna drop in the chat. There haven't been any yet, and I, and I wanna see a few. Okay, Bridget, you're back. I'm back.
• 20:43
  Did you decide-- did you jump, uh, to a different line? [laughs] Yes, I'm so sorry. No worries. This happens, um, more often than I would like to admit.
• 20:53
  But anyway, um, it's important to understand those consulting firms, their influence over all of these, um, purchasing decisions, and they have their own interests also. So remember, every solution that maybe
• 21:12
  m-my team is trying to put together at Aetna and you're trying to put together, those consulting firms are also trying to put together their own solutions, be it care management solutions, be it,
• 21:27
  um, very specific chronic condition solutions. Think of them as sort of healthcare point solutions, we would call them. Yeah. They're trying to do the same thing. So they're major influencers on these decisions.
• 21:40
  But then when we look at the employers, well, what do they care about, and how do they make purchasing decisions? And, and I will say different archetypes.
• 21:49
  It's very important to understand the employer that you're trying to work with. So are they a value buyer, okay? They're just gonna go with the cheapest option because you know what?
• 22:00
  They run a retail operation, they're Nordstrom, and it is not an easy time for them right now. They're a value buyer. That's it. Well, I'll say price buyer at this point in time.
• 22:12
  Um, are they in an industry like healthcare where the war for talent is really tough right now? So they're actually thinking of benefits as an added, um, way to retain and recruit.
• 22:29
  Are they looking at being-- are they Goldman Sachs or BCG or McKinsey, and they want the highest-end services and the coolest next new thing? Um, very important to understand that as well.
• 22:45
  And by the way, this fluctuates over time. It depends on the industry they're in, it depends on the labor market. Yeah, go ahead.
• 22:51
  Speaking of fluctuating, any tactical advice on really ascertaining the, the archetype of your purchaser, really understanding these changes? 'Cause you said it, it, it comes in and flows out.
• 23:03
  So two things that I always study. One is the industry. So what is the industry that employer is in? Do I understand the dy-dynamics of that industry? And two, what's going on in the labor market overall?
• 23:19
  And that doesn't mean like the economist projections for labor market necessarily, but look at all the HR websites and say, "Okay, what are they thinking about from an employee recruitment, retention perspective?"
• 23:32
  Um, right. Do they need help with the work at home hybrid solutions, and what can we offer that would help them with that, right? That's a very timely topic for them.
• 23:43
  So I always look at, um, now I can't remember, SHRM website, the Society for Human Resources Management.
• 23:50
  It's a really good website that you can go onto and just hit, literally click through and say, "Okay, what are the hot topics for HR benefit managers right now?"
• 24:00
  One trend we're beginning to see, and I hope it continues, is that benefits are falling under either the CFO, 'cause it's a huge liability sitting on the books at any point in time if you're self-insured.
• 24:15
  So either the CFO or the bringing in a physician to run, uh, benefits, which I think is probably the best solution. Quest Dia-Diagnostics has done that for a while. It is absolutely, in my mind, a best practice.
• 24:30
  Um, and especially when there's a partnership between the physician, um, leader, and the CFO really thinking through trade-offs of what health services cost and what is beneficial to the workforce.Hey, I wanna get really specific about, you know, how does a startup really...
• 24:50
  Uh, you, you said you needed to, uh, know and get the attention of a benefits consultant, but really how, uh, does one go about that? Um, and, you know, w-what are some of the specific challenges?
• 25:01
  You said some of these groups are trying to create their own point solutions, and I just wonder if, what your thoughts are on what sort of gaps are then left that, uh, startups really do need to step up, uh, and fill.
• 25:15
  So are you seeing some themes in terms of, um, specific challenges that benefit consultants are facing right now? Um, I don't know if I would say benefits consultants are facing challenges.
• 25:28
  I would probably reframe that question, if that's okay, Logan, to say what challenges are we facing across the healthcare industry? If we think of every US [laughs] like, everyone who lives in the US- Yeah...
• 25:41
  as a consumer, what challenges do we have? And where do you wanna focus in defining those challenges? Is it in health inequities?
• 25:51
  We have a lot of challenges in the inequity of access to healthcare services, um, at the same level across ZIP codes. I live in Chicago. I mean, we see it every single day.
• 26:04
  So literally, you can just hone in on one piece of where we know there are issues and how we try to solve them, or we can go globally and say, you know, I have 50 solutions I can piece together from, um, you know, thinking through, what are they called?
• 26:25
  Like, the people who set up the benefits internally and, and help you do all of that, um, to
• 26:33
  someone who's gonna provide telehealth services to who actually helps administer my health plan to who administers my pharmacy management to who... Right? I mean, you can literally bolt on sort of 50 different solutions.
• 26:48
  So one of the issues is how do you pull all of those solutions together and make it simple for an employer who really is trying to do best in class across multiple areas that they're accountable for?
• 27:02
  Um, that, that's a major struggle for employers right now. Like, we struggle with it enough as Aetna trying to pull all of our solutions together and make it simple. Yeah.
• 27:12
  Y-you know, the purpose behind my question was this idea that, you know, to get to the employer, you gotta get to the benefits consultant, and to get to anyone, you have to understand their challenges, their specific challenges to really reach them.
• 27:24
  But you're saying you have to balance that with this understanding of how the whole fits together. Is that what I'm hearing? It is.
• 27:30
  So I'll just give you an example of how we as Aetna or CVS may come across a new idea, or any one of your businesses. And believe it or not, it's through things [laughs] like LinkedIn. Hey, publish a quick...
• 27:45
  You don't have to do this, some great peer reviewed white paper, right? Put some opinions out there, and it might not be LinkedIn, you might do it through other platforms. Um, how do you do that?
• 27:56
  How do you get on a circuit of getting in front of people? So sometimes that's, um, Health Evolution Summit, which is a very big and important, um, I think forum for healthcare leaders.
• 28:12
  How do you, how do you get to the table there? And initially, it's maybe how do you just attend and start to pitch your idea.
• 28:19
  Uh, and then you start to get on the stage and talk about it, or smaller forums or whatever that is. I think the-- that still works. That is still how, you know, we all get to know you and your businesses.
• 28:35
  Is that what you were asking about? Yes. Yeah, no, no, that's, that's super helpful. Um, uh, I, I do wanna drill down even further into how Aetna-CVS partners with startups.
• 28:46
  Uh, maybe just some, just some, uh, basic lightning round. What, what stage would a company need to be at to, to partner with you? Um, w- you know, how do you invest? How does the process work?
• 28:59
  So first of all, we do have a fund that invests in digital solutions. We do not yet ha-- It's relatively new.
• 29:08
  Um, I would not say we have this list of 20 questions to answer and you're in at this point in time, but we think that's very important.
• 29:16
  We think the digital front door is critical, and we want to facilitate a lot of work in that area. We're not gonna get it done ourselves.
• 29:24
  No matter how much we spend, we're never gonna be able to do it as well as, um, a startup company or a smaller company will. Um, so, so that's one area, just to let you guys, you guys know that.
• 29:38
  Um- Wh-when did that begin? That's, that's a new initiative? Yeah. Not... Well, like within the last year, I think. Okay. We announced it during the pandemic. Okay. Do, do you recall,
• 29:47
  uh, w-we can share information about that, make sure everybody knows. Literally, there, there's, um... We did media blasts and stuff on that one. Cool. And I apologize for not knowing the exact date. No, no, no.
• 29:59
  It's all good. Um, okay. So in, in terms of, um, stage, and you said you don't have, you know, a, a specific 20 questions, but just general bru- brushstrokes.
• 30:10
  Well, I do have some questions that I would ask first, and my recommendation is, number one, always pick a pilot. Do a pilot because working with someone like a CVS can crush you.
• 30:22
  It's the o- for those of you who did any sort of studies in your MBA work, uh, it's the Walmart conundrum. Awesome, we got the big customer. Now you're beholden to the big customer. So, um, I would say pick a pilot.
• 30:35
  Learn, test and learn constantly. It's the way to get to know someone. That's certainly the way we helped 98.6 scale very quickly. Um, I think it's a really good model.
• 30:45
  Um, but here, I did, I did write down my questions, Logan, 'cause you warned me. You said, "What are your questions? What do you ask?" So I do ask, hey, um-What are your purpose mission values?
• 30:55
  So go-- Right, I'm going back to my West Point references earlier. That's not just me, it's very important to CVS. We, we would not want to take on reputational risk inadvertently, I will say that.
• 31:10
  Um, we do have many resources who work compliance, who work media relations and communications.
• 31:16
  And as burdensome as that sounds, right, the more aligned we are on mission, values, um, the easier it is to get through that sort of process. Um, the second is: How connected can you be?
• 31:28
  So, um, whatever solution you're bringing to the table, can you connect with other vendors and/or with...
• 31:37
  And believe me, across CVS, we work with more vendors than I can count on, um, all of my fingers and toes twenty times over. We do. And so how connected can you be? How flexible, um, in terms of that?
• 31:50
  And how flexible do you wanna be? It's okay to say, "No, we can't be flexible there," but just have an opinion on that. Um, the next is, I talked about it: Can you scale? And it's okay to say, "No, not right now.
• 32:04
  We need a year. We need to learn more over the next year." That's okay. Just answer it. Like, can you scale? If so, when?
• 32:12
  If you're never gonna scale, you know, how should we think about the scope of how we work together? Um, another one is: How are you funded?
• 32:21
  So we're very careful about if you're funded and backed by venture capital, private equity, uh, what's the ownership structure? When's the expectation that you flip?
• 32:32
  It has happened before where we literally sign a contract with someone and then, you know, a month later they're sold to Optum, so they, they would be a competitor of ours, and then, right, it's just a big hassle.
• 32:44
  So we're careful about asking that, and that's why we do it. Some of it's reputational, some of it's business risk, that kind of stuff. Um, and then kind of related to that: What's your end game?
• 32:55
  What do you want for your business? Hmm. And, and have an opinion on that. It can change over time, and I get that, but be very definitive there about what your end game is. Those were great, great questions, Bridget.
• 33:07
  Um, I wanna get to a couple of questions in the chat. Let's go to Jim Feng from Fixable. Jim, you can come off mute, explain what you do, and ask your question. Hey, thank you for this. It's been great so far.
• 33:21
  A lot of, like, deep down knowledge in regards to, uh, getting to market. Uh, speaking of which, uh, that's my question.
• 33:27
  Um, from a go-to-market strategy, um, do you suggest companies with market-ready solutions to first win with the consumers and the customers and, like, the individual corporations, and then work your way, you know, from the bottom, work the way up or, you know, versus a top-down, um, strategy, so some of the, some of which you already pointed to today?
• 33:47
  So you said "or," I would answer "and." Um- [laughs]... and it's, it's more about there are multiple, [clears throat] excuse me, multiple channels in the healthcare realm, right?
• 34:00
  So I talked about government paying, commercial employers paying. There are providers who pay for services. Um, and you can sort of go down the list of how it can work. And, and I would say don't pick a channel first.
• 34:17
  Test, do multiple, um, even if they're just pilots, uh, have multiple channels that you're working through to see where you're resonating best and/or where you think you can grow the fastest.
• 34:33
  And hey, we all run into each other at some point in time. Even a ninety-eight point six sells directly to employers, they sell to provider organizations, and they sell to payers.
• 34:44
  And at some point in time, um, in fact, I just had a conversation with one of the executives, he said, "You warned me this was gonna happen. Now we have all this channel conflict, and I've gotta choose, uh, what I do."
• 34:56
  But they were able to scale very quickly by doing that and then have the choice instead of someone making that choice whether the channel was closed to you or not. So I hope, I hope that was helpful.
• 35:08
  Oh, that was perfect. Uh, some of the strategy I think we took from the beginning is as well, but, uh, you know, wish I had this conversation, you know, two years back.
• 35:16
  [laughs] It's, it's crazy trying to [laughs] figure out multiple channels that you're selling through and, you know, what their needs and desires and wants are.
• 35:25
  But I think if as long as you, at the heart of everything you do, think about the consumer, um, you'll figure it out. Thanks for the question- Thank you... Jim.
• 35:36
  Uh, let's go to another question in the chat with, uh, Rehan Farooqi from, uh, In Recovery. Can you come off of mute and ask your question? Yeah. Thanks, Logan. Hi, Bridget. Thanks so much for this great chat.
• 35:49
  I'm a growth advisor at In Recovery, and I had a question around how you're thinking about B2C addiction care and thinking about substance use disorder as a chronic disease and how that's managed, and if you've had conversations internally or with other companies of delivering that in a more affordable and accessible way, either through the pharmacies or directly to, uh, beneficiaries.
• 36:17
  So, Rehan, topic of, right, the pandemic is how do we integrate the concept of behavioral health or mental health, whatever you would like to call it, with medical because they're so interrelated.
• 36:30
  Again, from a consumer perspective, why do we have mental health benefits, behavioral health benefits, and then medical benefits? W-why are we doing that? And so we work constantly to integrate the two.
• 36:43
  So yes, this is very important to us. Um, our CEO, who I'm just gonna put a plug in for her, was named Fortune's number one most influential woman in business, uh, Karen Lynch, that she came from Magellan Healthcare.
• 36:56
  And, and so this-- she knows the behavioral health world-In and out. She knows the medical, um, insurance world in and out. And so we do a ton of work to integrate all of this.
• 37:11
  Substance abuse, um, addiction assistance and substance abuse are very critical to everything we do.
• 37:17
  And then I would say, Rehan, personally, I sit on the board of an organization called Community Anti-Drug Coalitions of America, where we work through local communities to fight substance abuse, um, and to combat addiction.
• 37:35
  And so, yes, it's important. It's so personally important to me that, um, that's what I choose to do in my free time. Yeah, no, that, that's so great to hear. Um, I'd love to connect offline about that as well.
• 37:46
  I do a lot of health equity work in addiction as well, and understanding that addiction care is not a right, it's a privilege, and seeing how we can try to deliver that outside of the treatment centers directly to patients.
• 38:00
  Um, we've seen a lot of, uh, startups in this space focus on t-telemedicine, uh, delivering, you know, MAT therapy. We, we think that there's a wider potential here and would, would love to hear your thoughts on that.
• 38:15
  Yeah, and honestly, providers are struggling with this tremendously.
• 38:19
  I work a ton with Allina Health in Minneapolis, and their retiring CEO, a wonderful woman named Penny Wheeler, she's very passionate about this, and she is about to, I think, lead an effort at a state level on trying to define how the state is tackling, um, a lot of the behavioral health issues.
• 38:43
  So I think that would be a good conversation. To the question, Rehan, I...
• 38:47
  You know, I think this gets at a larger, very interesting question about, uh, the future of healthcare delivery and kind of how a company like CVS plays into that as a, a community node of health.
• 38:58
  I think I saw a press release that just a couple of weeks ago, CVS announced it was investing twenty-five million in affordable housing in Louisiana, I think.
• 39:07
  And I, I was curious your, your thoughts on how that speaks to this larger integration of what, um, the definition of health is and how a company like CVS and Aetna is gonna be thinking about the social determinants of health going forward.
• 39:22
  So we actually announced before that six hundred million of investment [laughs]... of that [laughs] social determinants of health. So Louisiana is one place we're doing it.
• 39:33
  We've done it in Denver, we've done it in Virginia, we've done it in the Atlanta area, we've done it in Chicago. Um, just understanding that housing is a basic human need, right?
• 39:44
  Shelter is a basic human need, and without that, it's very tough to think about higher order concerns, uh, regarding your health. And so we'll continue to tackle it through housing.
• 39:58
  Um, we do a ton with different food pantries, right? Organizations that just provide nutritional food as well, so it's not just about housing. Uh, we really think about social determinants.
• 40:11
  We go down to a zip code level as local leaders, um, and I represent Chicago often in these conversations. We partner with the county, the city, the state. What can we do? What are or- other organizations doing?
• 40:25
  How do we fill in, um, some gaps there? So it's not really about, "Hey, let's get some press for CVS." It's really about how do we build healthier communities?
• 40:35
  And it's our-- it's, it's really our obligation to think about how we use our retail footprint, um, how we use the pharmacies and the pharmacists that are very trusted, um, in communities, how we work with health systems to get them in line with giving, um, to a lot of these causes as well.
• 40:56
  I, I know those social determinants are very personal to everyone on this call, and so I wonder if there are particular gaps, uh, that you're seeing that...
• 41:05
  Yeah, I'm always trying to, uh, understand, you know, connect the challenges of our guests with those, uh, projects that our founders are working on.
• 41:14
  Are there specific areas, whether it's housing or something else, where you think there's a particular need for healthcare startups to step in and really bring their innovations to the table? Yeah.
• 41:25
  So, so I'll start with housing. And we don't just throw money at a housing development. This is a connected community so that there is access to healthcare, um, either within that development or right next to it.
• 41:39
  And I'm not saying it has to be a CVS pharmacy, a MinuteClinic or anything like that.
• 41:44
  We want to make sure that there's comprehensive view there, that there are social services nearby, that there's access to healthy food. So no one's traveling fifteen miles to a grocery store, right?
• 41:59
  Is there public transportation right there? We're trying to build these healthy communities that are affordable, allow people to work, um, are supportive even from a financial perspective.
• 42:12
  Sometimes we may have financial, um, assistance and/or even financial advisors who come in and are there for a full day talking about financial health, um, et cetera. So there's a lot we- Yeah...
• 42:28
  well, uh, it's much bigger than just, just housing, I guess, is what I'll say. Yeah. No, no, that makes perfect sense. I mean, you're not making these investments in specific...
• 42:37
  I mean, it's easy for us to break down social determinants into these different areas, and yet it's this integrated health approach.
• 42:44
  And your organization has a unique ability to touch people in their lives in a longitudinal way, which is really interesting.
• 42:52
  Um, let me go to another question in the chat, this time from, uh, Robbie Bustami from, uh, Biotics.ai. Robbie, why don't you come off mute? Sure. Thanks, uh, thanks, Logan. Hi, Bridget.
• 43:03
  Um, really great hearing your, your insight and, uh, everything you have to say.Um, so, uh, my question's around, uh, the, uh, growing use of AI in, uh, in healthcare and, um, uh, with healthcare providers leveraging AI for reducing costs and increasing efficiency.
• 43:19
  Uh, within, you know, with, uh, health insurance providers today, I know there's a kind of growing, uh, amount of, uh, input from a lot of different healthcare providers in figuring out how to standardize AI in, uh, in, in their medical coding.
• 43:34
  Um, and I was wondering if companies like yourself, Kaiser, uh, um, Collective Health are also providing input.
• 43:42
  I know, like, a lot of digital healthcare companies are actually participating in sort of the standardization of that process, like athenahealth, for example.
• 43:49
  Um, so I was wondering, like, what is the current state from, from your perspective on how, uh, AI can be, uh, not just integrated with, you know, healthcare providers and their solutions, but how, uh, insurance companies can help, uh, support that integration, um, through covering a lot of the costs?
• 44:04
  Uh, and also, what is the standardized process? Because I've seen, I've seen this kinda go...
• 44:07
  There's a lot of different ideas, a lot of different avenues, at least within, um, Medicare, on how they can do this, and it, it seems like they're still-- it's still very much in the, the early stages, so. I know.
• 44:16
  I wish the, uh, the, that CMS or even CMMI was really pushing this. It would be helpful to have some standardization there. They're not.
• 44:25
  I'm not gonna sit here and pretend to be the expert on AI, but what I will, um, sort of advise on is, "Hey, you're, you're sitting here thinking, how do we pay for all of this work?"
• 44:37
  The trick with-- and I will say this, the trick with providers is typical-- typically thinking about quality. How does this improve quality, and then it's worth, um, investing in?
• 44:50
  And then if you think about insurers at large, whether it's employers or, you know, insurers or Medicare themselves, um, it's how do we lower the cost of medical services overall by doing this?
• 45:05
  And then it pays for itself, so you have an automatic return on investment. Easier said than done, and I completely understand that. Um, but that's really what we're all looking for at the end of the day.
• 45:18
  The government is looking for that as a large payer. Employers are looking for that. Insurers are looking for that. Kaiser is looking for that. Kaiser is a great place to start, because that's a, um...
• 45:29
  it's really a hospital system, physician organization that's run by a payer. Um, and so they're constantly looking at-- 'cause that's their business model.
• 45:40
  They are constantly looking at, how do we balance consumer, um, experience and cost of care, right? And, and they nailed it in a lot of places, like in a really positive way.
• 45:55
  Um, and so they're-- your thought on bringing them in and, and testing and learning there is a really good one. Okay. Great. Yeah, that's, that's, uh, really insightful. Thank you. Thanks for the question, Robbie.
• 46:07
  A quick question from Richard Hambury from Sana, who asks, uh, "Does the company need to have FDA approval before, um, seeking a pilot with your company?"
• 46:17
  Um, if it would be anything related to, um, vaccines, you know, drugs, anything like that, yes, or at least conditional approval, right? Emergency use, yes.
• 46:31
  Uh, we did a very large, we call it the Return Ready program, with employers. So we weren't just vaccinating people at our retail locations. We were going to employer locations and vaccinating.
• 46:46
  And remember that we were doing that. And hey, we worked with the CEOs of, of AstraZeneca and Pfizer and J&J. Um, they had conditional FDA approval, so. Got it. Uh, both-- Yes, that's great.
• 47:02
  Both Rob Athwell and Jeff Blackwood both sort of asked the same question, the million-dollar question.
• 47:07
  If someone feels like they have a solution that Aetna CVS really needs, what is the best way to pitch that idea, uh, and reach out to the right person at the right time?
• 47:18
  Um, right person at the right time is you'll probably never hear back for the first twenty times you reach out. Don't stop. Um, reach out in different ways. It-- I'm, I'm just gonna be...
• 47:28
  Like, you guys can reach out to me now that, now that we've talked, and that's fine. I'll try to get you to the right people. Um, will do my best.
• 47:35
  I cannot guarantee that the right people answer, um, all the time, so be persistent in that.
• 47:41
  Always pitch the problem you're solving, not the, not the product or the service that you have, 'cause that is just a delete so fast. It is, "Here's what... Here's the problem as I understand it.
• 47:55
  Here's what we're trying to, you know, solve. We'd like to work with you. Are, do-- are you seeing the same problem?"
• 48:02
  You know, bring that discussion and say, "We ha- we have what we believe is a solution, and we'd love to pilot it with you." Very nice. It's really, really helpful. Um, we're getting towards the top of the hour.
• 48:14
  I wanna give folks an opportunity, if they, if they've got a sort of greatest insight from the conversation that they would like to, to share back as a way to kind of reflect back what they've learned, you can drop it, uh, in the chat, and I'll call on you.
• 48:26
  Uh, a few things that I wrote down that really stuck with me, uh, this idea of understanding the, the archetype of your purchaser and, and just the different ways that one can be a student of the market.
• 48:39
  You talked about reading, uh, about the labor markets, reading about HR on, on SHRM, uh, really doing your homework to understand the, the changing archetypes of your purchasers, which I thought was, was really wise.
• 48:52
  And then secondarily, um, really understanding the, uh, the risk, um, profile of a company l- uh, like yours.
• 49:01
  You said you really take reputational risk, uh, seriously in understanding, um, which kind of goes to, you know, how far along your company is. Uh, how will that be perceived?
• 49:12
  You've got a big media footprint and pre-- you know, uh, PR, uh, landscape that you're, you're taking into account. So really thinking about the reputational risk of your purchaser as well.Great comments.
• 49:28
  Oh, go ahead, Bridget... I would say Logan is, right, the, the Walmart conundrum. Be careful what you ask for, 'cause you may get it. [laughs] So j- just be ready, right?
• 49:38
  It's, it's a big undertaking to work with, whether it's a large employer, um, on any front they're working on, whether it is a large insurer, any, any company, it can be a big undertaking.
• 49:52
  And don't undersell yourself, but don't oversell yourself too much. I'll always be in the market selling things that I know are, like, ah, 75% of the way there. We're moving.
• 50:04
  Um, you know, but if you're only 40%, be really careful. You know, I'm gonna squeeze in one more question, 'cause I see somebody here that, uh, I haven't seen in the chat, uh, before.
• 50:13
  So Sydney Collin, I'm gonna go ahead and let you come off mute, uh, and ask your question quickly. Hi, Bridget. Thanks, Logan.
• 50:21
  Um, I was just quickly wondering, do products need to be covered by insurance before you'll work with them?
• 50:26
  Uh, we have a mobility aid that helps people with mobility disorders be able to decrease falling and improve mobility. And then Sydney, I didn't catch your question.
• 50:36
  I, I heard what you're doing in terms of improving mobility, but I didn't hear the question. I'm sorry. Remind us what company you're with, Sydney. Deoro Devices is the name of the company.
• 50:46
  NextStride is the name of the product. Um, and my question is, do products need to be covered by insurance before you'll start working with them? Um, yes. Before we can actually pay for them.
• 50:58
  We do have, um, an entire committee that, uh, defines if anything is experimental and investigational.
• 51:07
  And if at a point in time there's a medical device, a drug, um, some sort of new regimen that is experimental and investigational, we may have very specified use cases that, um, are...
• 51:23
  that we will approve payment for. And again, we would pilot that. So let's say, oh, this is really important to do in our Medicaid population.
• 51:32
  Um, and let's try it with our Illinois plan, because that would be the right place to do it. So there are opportunities to do that, Sydney. Got it. Okay. Thank you so much, Bridget. Appreciate the question.
• 51:44
  Uh, quick final question for you, Bridget, to wrap up.
• 51:47
  You know, we've been very tactical and strategic about how to get in with, uh, purchasers, uh, employers and your company, but, uh, I wanna step back and think more, uh, big picture, kind of more of your health moonshot vision for what's really possible, what exciting things are possible in 2022 and beyond if these pieces really come together and some of these, um, uh, projects and visions for, uh, you know, investing in social determinants of health really come together.
• 52:17
  What gets you optimistic and excited about the year to come? So I talked about it, price transparency.
• 52:24
  And I don't know if that's the year to come or it's five years from now, but the day a healthcare consumer can understand what something is going to cost them, we can't even go to the primary care physician and understand what we're gonna pay necessarily.
• 52:40
  Um, and so the day that happens, we have a competitive marketplace. Mm. And that is so very important.
• 52:47
  With, with an underlying support structure from a government that really cares about the health of its citizens, um, and those who live in the, in the country. So yeah, I am idealistic about price transparency.
• 53:02
  I'm also... I totally believe in the market forces and helping them work.
• 53:07
  I just wanna make sure we're doing it all together, and we don't allow, you know, one company, whether that's a CVS or an Amazon or one massive health system to sort of define what that is, right?
• 53:21
  How, how do we all work together, um, and push each other ahead? Bridget, it is refreshing to hear that perspective from you in the position that you have at, at Aetna and CVS.
• 53:31
  So I, I'm optimistic that they have you in a position of leadership there. Uh, really appreciate you taking the time with us over the last hour.
• 53:40
  You're really sharing candidly, uh, how you work and what your vision is for the company. I think I speak for everybody when I say we appreciate, uh, the wisdom that you've shared. Uh, so thank you.
• 53:50
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• 54:06
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• 54:12
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• 54:20
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• 54:34
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