Latest / StartUp Health NOW Podcast / UCSF’s Dr. Michael Blum Talks How COVID-19 Changed Expectations Around Virtual Care at the Highest Institutional Levels

Transcript

UCSF’s Dr. Michael Blum Talks How COVID-19 Changed Expectations Around Virtual Care at the Highest Institutional Levels · StartUp Health NOW Podcast

• 0:00
  [on-hold music] A lot of that, the, you know, the startups and the vendors have been saying for a long time, "We can do this, we can do this."
• 0:18
  And we were saying, "That's nice, but it's not really doable from an overall perspective." That's changed.
• 0:24
  Now, it's very much doable, and if you're not delivering a high quality video experience with clinical connectivity, so with the ability to monitor things, you're falling behind.
• 0:34
  That's incredibly different than it was a year ago.
• 0:39
  [upbeat music] Welcome to Startup Health Now, the podcast where we talk to the entrepreneurs transforming health and discuss the health moonshots they're working to achieve. I'm your host, Logan Plaster.
• 0:54
  This week's episode, we get an inside look at one of the biggest, most advanced hospital systems in the United States, and how it thinks about health innovation.
• 1:02
  This episode was pulled from a recent Startup Health expert office hour, where I interviewed Dr. Michael Blum, the Chief Digital Transformation Officer at University of California, San Francisco. Dr.
• 1:12
  Blum, who is a trained cardiologist, assesses and deploys health tech across UCSF's multilayered health system. On this live session, which was attended by a panel of founders from the Startup Health portfolio, Dr.
• 1:25
  Blum shares what a successful integration looks like, what he looks for in a startup partner, and how COVID-19 changed expectations around virtual care at the highest institutional levels. I hope you enjoy.
• 1:38
  [upbeat music] Dr. Blum, really, uh, happy to have you with us for our conversation today. My pleasure. Thanks for having me.
• 1:51
  So, uh, why don't we start by, uh, having you help us understand your institution, UCSF, uh, its size, its reach in the community.
• 1:59
  I feel like that'll be a good, um, sort of groundwork to understanding the scope of your work and kind of how, uh, health innovation plays into it. Sure. So UCSF is a, a large, you know, complex academic medical center.
• 2:15
  Um, probably not as well known on the East Coast, um, in the middle of country, but on the West Coast, certainly, um, very well recognized. One of the top academic health centers in the country.
• 2:28
  From a research perspective, it's always one of the top, if not the top, NIH, uh, research grant funded organization. Um, large schools of medicine, uh, dentistry, pharmacy, and nursing, and graduate school.
• 2:45
  It's one of the five, now six, campuses of the University of California that are healthcare campuses.
• 2:52
  Unique thing about, um, the UCSF campus is it's a health sciences only campus, so we don't have any, um, undergraduates and have limited graduate programs that are only health science graduate programs, which is great because it allows us to just focus on healthcare.
• 3:10
  Um, solely are 100% focused there. Um, yet it means we don't have some of the resources of a typical university in terms of engineering resources, um, computer science resources, which are relevant to this discussion.
• 3:24
  Um, we have a, you know, approximately 1,000 bed, in-patient beds, um, and, um, the campuses are spread throughout San Francisco. Um, and we have affiliates throughout the Bay Area.
• 3:39
  We have affiliation with Marin General, um, to the north, Washington Hospital, John Muir, and, um, growing, uh, set of partners throughout the Bay Area. Awesome.
• 3:51
  A- and what are your responsibilities there as Chief Digital Transformation Officer?
• 3:57
  Um, so I guess the easiest way to think about it is that I'm responsible for driving digital transformation from the old healthcare world, um, where we were limited to the electronic health record and internal, um, you know, digital activities, which are pretty much had been translation from paper to electronic activities.
• 4:18
  Try to take us from that world to a data-driven world, um, where the patients become consumers and get treated, um, as though they're consumers with choice and educated, um, and engaged in their healthcare.
• 4:33
  So really moving, um, you know, healthcare forward the 20 years that we've kind of missed a little bit when the rest of the world went through a social, mobile, digital transformation, and healthcare has been lagging in that.
• 4:46
  So my responsibilities are, um, to really create the, the data and analytics infrastructure, the engagement infrastructure, the, um,
• 4:57
  um, taking the systems of record through systems of engagement into systems of experience that really allow people, um, to interact with healthcare when they want to, how they want to, in a much more patient and consumer focused way.
• 5:11
  Gotcha. Now, now you also, uh, take the lead with the Center for Digital Health Innovation, which I've heard you describe elsewhere as a startup within a large health system, uh, these two worlds, uh, colliding.
• 5:26
  A- and I wonder how that role kind of interacts with this more overarching role with the, um, university system. Yeah. Great question. So, um, that's right.
• 5:36
  We started the Center for Digital Health Innovation about seven years ago now. So not really so much a startup anymore.
• 5:43
  It's actually grown, um, we're pushing 100 people in the center, and have done, um, you know, about $65 million worth of activity through, through the center, um, without taking...
• 5:56
  It started, the center needs to be self-supporting within the university, um, so there's no ongoing funding support. Um, so-And we've had some really great accomplishment through some of our larger collaborations.
• 6:08
  Some of the work you might have seen is some of our, our machine learning, our AI development work with GE, where we develop the algorithms that they are now building into their chest X-ray equipment to detect collapsed lungs, pneumothorax, um, and, um, breathing tube, endotracheal tube placement in patients who are on ventilators.
• 6:29
  Very relevant now in the COVID time, um, where the resources are getting stretched, and we really need to rely on automation and new technology. So very timely work there.
• 6:40
  And then we've had, um, work with a series of startups around, um, more of the, um, consumer patient-facing activities I described.
• 6:48
  So the center really drives a lot of the innovation work, um, across into the health system and the care delivery space, where we're working on the digital patient experience initiative. Got it. Got it.
• 7:01
  So it sounds like- So they really go hand-in-hand. Got it. So it sounds like it's a bit of a, a front door kind of leading into, uh, the technology that makes it to the larger health system. Yeah.
• 7:12
  We develop we-- technologies, if we can't find them anywhere, if we can buy them, we buy them. Um, then we put them into pilot proof of concept scenarios. And then ones that work, we scale out across the health system.
• 7:26
  Well, that's a great segue into my next question, because, you know, one of the reasons why we wanted to have you on Expert Office Hours is to understand sort of the inner workings of these integrations, how you work with partners, how you work with startups.
• 7:40
  I see on the call we've got, uh, Murray Brazinski from Conversa, who I know you've done, um, a, a partnerships with, and we, we can sort of talk about that as a case example later.
• 7:51
  But, you know, when it comes-- I know when it comes to startups working with health systems, you know, the, the devil's in the details in figuring out how is this dance really gonna work.
• 8:01
  So I wonder if you could kind of break it down for us, maybe start by talking about, uh, how often do you assess new technologies to deploy, uh, and just what does that process look like? Sure.
• 8:13
  Um, you know, so that's a process that probably, you know, looks different depending on the size and the complexity of the center you're dealing with. For us, um,
• 8:25
  when we were first starting and early in the days of the Center for Digital Health Innovation, if there was an interesting startup that approached us that seemed like they had some cool technology that could potentially be, um, impactful in healthcare, we looked at many, many of them.
• 8:41
  We in- we actually did deep dives on over a hundred startups, did, you know, superficial looks at several hundred. Um, and we had a lot of validation partnerships and so on.
• 8:53
  But we've really transitioned over the last, um, I'd say the last two years to
• 8:59
  where we focus on, um, matching our, um, digital patient experience roadmap and the needs that are driven by the roadmap to the startup community.
• 9:09
  So whereas previously we were relatively opportunistic, what great interesting things were out there, now we're very much driven by what are the needs, um, of the care delivery and health system to really, um, transform and, and move forward along that, you know, um, that transformation into a consumer-oriented organization that delivers care and delivers care as a service rather than a bunch of big buildings.
• 9:36
  So we look at that strategy, we look at the, you know, the tactical steps along the way. Say, okay, what don't we have? What do we need? What great startups are there in this space or established companies?
• 9:47
  They don't have to be startups, um, in this space. And, um, we develop partnerships with them. It's, um, you know, how we started our work with Conversa, which has turned out to be fantastic for the campus.
• 9:59
  What would you identi- what would you identify as some of those top patient need trends right now? So, um,
• 10:09
  as I started with, there, there, there are the, you know, the systems of record that an organization has, and those are, you know, fairly established, well defined, EHR, things like that, and warehouse and so on.
• 10:23
  But then once you get the next level up into the systems of engagement, I think that the, that space gets tremendously interesting, um, and is usually a space that's lacking in healthcare organizations.
• 10:34
  So you think of, of the patient experience and the, you know, the opportunities that CRM, customer relationship management, has presented to the rest of the world and changed the way we interact, um, that space is, is just being really, um...
• 10:51
  is very early in healthcare. Um, and that's the space where I think there's a huge amount of opportunity really engaging with patients and knowing your patients, um, throughout their longitudinal experience.
• 11:02
  Um, so that's one of, one of the really big spaces, is really having that middle layer of engagement.
• 11:09
  What-- The place that everyone usually starts is the systems of experience and really looks at the apps, and everyone wanted to just bring an app into healthcare and figured that was really gonna change things.
• 11:19
  And, you know, we've kind of gone through a space, a, a process of realizing that, um, while there are a bunch of really great apps out there, the key to success here is really, um, bringing the apps into the organization, integrating them in with the systems of record and systems of engagement, so that you can really build, um, an end-to-end longitudinal and acute episodic experience for the patients.
• 11:46
  Got it. So assuming that a technology is addressing one of these core needs that you've identified, uh, what are some of the other attributes that you start looking for in a potential partner company? Yeah.
• 11:59
  So, um-It depends a little bit on, on where the, which the, which area we're looking at.
• 12:08
  'Cause, you know, in some spaces, think if you're looking at a, a very data intensive space, if you're looking at remote monitoring or something like that, you're gonna be...
• 12:17
  One of the criteria you're really gonna evaluate against is the engineering chops of the company, um, where they've s- where they've had success before integrating. Who have they already done integrations with?
• 12:28
  How well do they speak FHIR and things like that, um, that you really wanna know they're up to speed and have deep engineering roots that are gonna be able to, um, really get over the humps at, at engineering challenges.
• 12:42
  Um, then, um, what EHR integrations have they really done? So that, that, you know, the EHR integration piece really spans all of these activities 'cause you've gotta be able to get back to the EHR for sure.
• 12:54
  And, um, you know, lots of great companies can, um, you know, can talk integration. It's how many have you actually done, and where can you really...
• 13:04
  Who can you call and say, "Yeah, these guys were fantastic and got our, you know, our EHR integration done in a reasonable amount of time." And, um, that's a, that's a challenging space for sure.
• 13:16
  We get approached by a fair number of, of younger companies that want us to carry the water for them, or at least either get them in the App Orchard or do their first integration, um, so that they can get some traction.
• 13:29
  And we totally get that and are sympathetic to it. And if it's a smaller focused effort, sometimes we'll do those.
• 13:36
  But at this point in, um, you know, in the maturation cycle and where we are, we'll usually look for people who understand how to do the integrations and have already done them. Got it. Got it.
• 13:48
  So y- we've talked about sort of meeting the correct needs, having the engineering chops.
• 13:53
  Uh, when it comes to assessing them, is it primarily that technical, uh, hurdle, or is there also a, a mindset component in terms of the kinds of people you're looking to partner with- Yeah...
• 14:04
  assuming that they've met, they've met the engineering threshold? Yeah. So that's a great question also. Yeah, absolutely.
• 14:11
  Um, you know, early in this, um, adventure, we heard a lot from companies who were here to disrupt healthcare.
• 14:20
  They were here to tell you everything you were doing wrong and everything that could be done like it was done in the consumer world, and had, you know, a modest or no real experience in the healthcare space, um, other than knowing that the exper- that the consumer experience in the healthcare space was pretty poor.
• 14:37
  And their perspective was, if you would just act like the consumer space, everything would come along nicely and you'd be great.
• 14:43
  And that, you know, there's lots and lots of experience of that not really working out well.
• 14:49
  So what we look for is a, um, a maturity of thought and a maturity of vision in the, in the startups, that they realize that we've gotta bring, um, contemporary technologies into our, um, you know, to our providers, to our patients, uh, to our administrators, that give everyone the experience that they get in their everyday lives, yet they still need to respect the complexity of the process and the human elements of the process, and a lot of the technical debt and infrastructure that healthcare already has in place.
• 15:24
  So that's a, that's, you know, a big ask for, for, uh, very young companies driven by very young innovators, because you need a lot of experience to really appreciate the, you know, the complexity there and the need to address the multiple challenges at once.
• 15:42
  Um, and the other piece is [clears throat] the time it takes to do a lot of that work. Um,
• 15:48
  you know, it's not, "Okay, we're gonna work with you for two months and do your integrations, then we're gonna, you know, leverage it to go get 25 additional customers."
• 15:56
  If this is, um, an earlier, um, integration or it's a validation opportunity, there's a lot of work that takes a while to get done before you can really, um, start moving on.
• 16:08
  As things get more mature, scaling happens much more quickly. Um, but there's gotta be a sense of, you know, significant amount of patience involved in the, uh, in the earlier experiences.
• 16:20
  Did your thinking about that, how you vet startups and partnerships, did it change, uh, due to COVID-19 throughout 2020?
• 16:30
  Um, I'm not sure that the way we vet the companies changed as much as our belief, um, that what the companies were offering was more doable.
• 16:41
  So the, the dramatic change, um, to video, to video nationally instead of just video in your local geography, you know, the technologies have been there for a long time.
• 16:53
  Um, but the regulatory framework and the payment structures just didn't support that kind of activity.
• 16:59
  Now you can do video at scale, which enables a lot more activity around, um, remote monitoring, um, going along with video. So there is more, I'd say, belief that, um, that it can work.
• 17:12
  There's a lot more evidence that the patients... You know, we always said, "Oh, the patients, they're gonna love this.
• 17:17
  They're gonna love not having to get to us and to park, and to deal with all that, all that headache going through traffic." Um, but it was just kind of a belief.
• 17:26
  Now w- you know, when we went to the point where we were doing 75% of our visits were at video, um, actually I think we were almost at 90% during the worst of it, but, um, you know, now we're probably down to 50, 60%.
• 17:39
  It's clear that it works, and it's also clear that we need more technology associated with it to really deliver high-quality care to our patients.
• 17:48
  Um, so a lot of that the, you know, the startups and the vendors have been saying for a long time, "We can do this. We can do this."
• 17:55
  And we were saying, "That's nice, but it's not really doable from an overall perspective." That's changed now.
• 18:01
  It's very much doable, and if you're not delivering a high-quality video experience with clinical connectivity, so with the ability to monitor things, you're falling behind.That's incredibly different than it was a year ago.
• 18:14
  Yeah, and changing so rapidly. Um, so we've been talking about integrations a bit more, uh, in the abstract, kind of how you think through it, ah, theoretically.
• 18:24
  Um, we're lucky to have Murray Brazinski from Conversa on the call, and so this could be a nice time to segue into kind of a case study.
• 18:32
  Uh, you, you've worked with Conversa, you've, you've, um, brought things, eh, to the public during COVID-19, ah, over the last eleven months.
• 18:43
  So maybe you could talk through, and, and Murray, I invite you to come off mute as well, uh, if, if the timing's right, to, uh, kind of talk, talk us through that process and kind of what made that successful, were there challenges, et cetera.
• 18:58
  Sure. Um, so the first thing that's important to think about, um, is that, you know, healthcare organizations generally looked at technology as they were implementation projects. Um, there's, you know...
• 19:13
  It's more the, you know, the exception that you build teams that look at it from end to end as, um, you know, needing to think from product perspective, to really think of, okay, what does the user experience look like?
• 19:26
  When we start designing, we don't start designing from, "Okay, I'll go ask the doctor what they want," but you think of what is an overall experience gonna be, and then you start doing with, um, experience user, experience designers.
• 19:40
  They look at the entire problem to define what the problem is, and really an end-to-end solution as though you would do it if you were developing a product.
• 19:49
  Um, we started, um, moving in that direction, you know, probably a year before the pandemic, um, really came on, and so we started talking to Murray, and, and, um, it was really around how are we gonna build a capability, um, to increase our, our virtual care capabilities, our patient engagement capabilities, um, and how are we gonna get, really be getting into the remote patient, you know, and virtual interactions.
• 20:20
  Um, so we had started that conversation and were making some traction when the pandemic really hit.
• 20:26
  Um, and it was the fact that we had capabilities already in place on our end to think about what would design look like, and that we had the partnership with Conversa to say, you know, we can deploy a, a, rapidly deploy a virtual care platform, that right when the pandemic hit, and we realized we needed to screen everyone coming into our organization, the two came together beautifully.
• 20:49
  And together we rapid- they built, we rapidly deployed screening of ten thousand people a day before they come into the facility, and eventually screening everyone who's going through the facility.
• 21:00
  Um, but it, it happened, you know, in a way that was because we had already built the design thinking around it and what the process looked like, um, and we were fortunate enough to have Conversa, you know, in, in the fold already to really leverage that and go forward quickly.
• 21:18
  Uh, it was a great experience.
• 21:19
  It was really fantastic because the organization for the first time really got to see the benefit of, of starting from that product experience, from building, you know, uh, multifunctional, cross-functional teams rather than just, you know, a group of technologists trying to build something, um, and played out really well.
• 21:39
  So, um, and Murray, you can certainly comment on the experience as well. Yeah, uh, no, I think you hit on all the critical elements.
• 21:46
  I mean, it, I don't think it would've worked nearly as well if we didn't have the trusted relationship at, at the start. But, um, as Dr. Blum just said, I mean, we...
• 21:57
  It, it's not, it's not very common to have a CDHI at a large academic health center that has design thinking, product expertise, project management expertise, and clinical expertise already there, as, as Michael said, integrated.
• 22:12
  So we... It was interesting. It's probably... I can't think of any other examples to this extent where the, the solution development team was made up that integrally with the partner.
• 22:24
  So in this case, UCSF was really driving the boat on COVID, and they were talking with... You know, I don't know if you guys,
• 22:31
  um, know this, but, you know, San Francisco's health department was the first in the country that had this mandate, and it was a pretty hard mandate, right, to have screen everybody coming into health facilities.
• 22:41
  So when we started working together, this was all hands on deck, twenty-four by seven.
• 22:46
  UCSF was talking to the CDC directly on a very frequent basis, and then we had this team that was really, you know, it's sort of like, you know, Animal Farm, when you look from, you know, chair to chair and you can't distinguish between the person and the animal.
• 22:58
  We couldn't distinguish between UCSF and Conversa from our point of view. It was really that tightly knit, a team that was developing this product.
• 23:04
  So this was a true collaborative product development process, which is what I think what made it successful at that speed and, and be able to go out and scale that quickly knowing that it was gonna work.
• 23:14
  I think the outcome was also really obvious to people. You know, the, as Murray said, the, you know, the dictum from the public health department came down so suddenly.
• 23:23
  It was like, okay, now you gotta go ask everyone who's coming into your facilities all these questions and document it all.
• 23:30
  And the next day, we had lines that were forty-five minutes long of people trying to get into the hospital for their shifts.
• 23:36
  I don't know, it was within, I'd say two weeks later, we had the thing stood up and people were going, they were doing it all. And we had two lines.
• 23:44
  We had the line for people who hadn't, you know, um, signed up for the chat to do it, and then we had the line for people who had. And one line had no people in it, and the other line was still a half hour long.
• 23:54
  It was, it was really an amazing, amazing intervention and a, a great experience. It's the easy P- it's the Easy Pass, uh, phenomenon. Exactly. That's, exactly right.
• 24:04
  Like you- It's like you drive to the bridge, and you always wonder who all those other people are that are sitting in the line that didn't bother, you know, signing up for Easy Pass.Um, you know,
• 24:15
  w- we can use this as sort of an example. And, and Murray, you know, feel free to jump in, uh, over the next couple questions as it applies to your experience. But, um, you talked ab- Michael, uh, Dr.
• 24:25
  Blum, about, uh, you had an existing relationship and, you know, we've got startups on this call, you know, um, 350 startups in StartUp Health. Uh, curious about how to get in front of someone like yourself.
• 24:39
  So, so how do you, um, you know, how do you first come across startups? Um, how do they get on your radar, uh, within cer- different segmented parts of, of, uh, the market? Yeah, you know, I, I have such sympathy.
• 24:56
  I, you know, for the, for the startups that are really early on trying to get into the, into the healthcare space, um, and trying to get into bigger organizations in particular.
• 25:07
  Because, um, where we are now with the pandemic, it is really, really difficult to generate oxygen, to, um, to do the work that's right in front of you already and for another startup to, to, you know, have room in an organization to, to get to a proof of concept is really, really difficult right now.
• 25:29
  So, um, you certainly have to lo- knock on a lot of doors, but you also have to know, um, what it is about your delivering that that organization needs and who is the person in the organization to talk to.
• 25:43
  So, um, you know, in our organization, I'm responsible broadly for this huge effort, so coming to me with a, with a relatively, you know, um, new application, if you don't understand what we're doing already and how it might relate to it, it's really hard to have that conversation.
• 26:03
  Yet, I'm also sympathetic that from the outside without knowing someone and getting that information, it, it becomes, you know, really difficult. So you have to have a champion.
• 26:12
  You have to have someone in the organization, and that's from your network and building personal relationships, that you've been able to have a conversation
• 26:21
  and get someone in the organization at a reasonably senior level that can be your champion and get the conversation with others.
• 26:28
  I mean, you know, sad to say, but I get a bunch of emails, you know, cold calls, emails from whole bunch of chief commercial officers and, you know, marketing people, and they don't get a lot of attention.
• 26:41
  But when it's someone who I know, who I've worked with, who I trust, and says, "Hey, we know you're working in this space, and we've got this, you know, this great company that we know," would you talk to them?
• 26:50
  We'll talk to them. Um, so it's really- Mm-hmm...
• 26:53
  it, this time, because there's so limited bandwidth and, and everyone is so limited on time, is really increased the premium on your network and on who, who you've got as supporters and advisors that can really get you in front of people.
• 27:08
  Interesting. Yeah, w- uh, you know, I know there's a couple questions in the chat about opportunities within specific verticals.
• 27:14
  We've obviously got 12 different health moonshots, so folks working in addiction, working in nutrition.
• 27:21
  So what I'm hearing you say is that within these different verticals, there's gonna be a champion that's, that might be the person to go to in their network before it next, necessarily gets to your level. Yeah.
• 27:34
  Um, I think that's one of the, you know, that's one of the great ways. Now, um, it, these are all double-edged swords, right?
• 27:41
  'Cause if I get 50 people knocking on my door saying, "Oh, we need all these different apps all of a sudden, go integrate them," and I say, "Well, that's really great, but we gotta get in line here 'cause we can't, you know, run down the road of doing everything all at once."
• 27:55
  But it, it's still, um, if you can, um, if you can find the needs, um, that the leaders are having in the organization and, and there's a lot of alignment between what the problem you're solving is a problem they have, you're much more likely to, you know, to get some traction with the organization.
• 28:15
  Um, it's really tough for, you know, a, a cold calling approach right now is, um, is really a struggle. Yeah. Yeah.
• 28:24
  Uh, David Sarabia's got a question in the chat about the value of, of publishing your results, of, of publishing your work. David, could you ask that question? Hey, guys. How are you?
• 28:36
  Good, good to meet you, Mis- uh, Michael.
• 28:39
  Um, my, my question was really revolving more around publishing results, not of so much outcomes, but of best practices and things that work during complex integrations, more for, for, let's say for the CIOs that might find value in that in healthcare systems.
• 28:53
  Wondering if you see that as a, as a something that can be valuable? 'Cause, I mean, we actually rolled out in a very similar way as you, Murray, with a full blast.
• 29:00
  It, the, the teams merged with, with our, with our enterprise deployment over at Karen, where it looked like one team, and we went full blast design thinking exercises. We introduced that to that, to that provider.
• 29:11
  And the integration became, uh, really, I think, uh, a mix of, of our, of our senior executives' experience, uh, in deploying healthcare software, uh, from virtual health and, and, um, in very large, uh, provider systems and also in, uh, in, um, in payers.
• 29:30
  Uh, taking those best practices, but then adapting it to, to our startup environment, where we didn't have the resources to go full blast into the BRD process and the traditional trajectory that a larger organization has.
• 29:41
  And wondering if you think that would be a valuable thing for us to do and, and the, and, and as we start now scaling into, into other healthcare systems. Yeah, absolutely.
• 29:51
  I think that, you know, whether you wanna call them white papers or if they're more, you know, a little bit more academic in their description, I think that there is more gray area, um, in there right now, how you, how you write it and how it gets published.
• 30:05
  But we definitely, as an industry, need more examples of how successful integrations worked, everything from real hardcore data integrations and writes into the record.
• 30:16
  The more examples of that there are, the better they're gonna be, 'cause there's still, each one is like the first time anyone's thought about it, and it's heavy lifting.
• 30:24
  Even though we have the technology that should be able to do it, it's still not, you know, a, a really smooth road.
• 30:31
  So-Yeah, I would encourage folks as they're working with, um, you know, reliable partners in the, in the healthcare space, whether it's, you know, larger community partners, big IDNs, academic partners.
• 30:44
  As you develop a solid experience, figure out a way to get that into the literature. I mean, it's not only good for the customers, but it's great for you guys. Yeah. Um, gets a lot more interest.
• 30:54
  And I do have a follow-up on that one just regarding change management, 'cause that was really the biggest challenge really, was deployment was not as difficult as actually getting people to use it.
• 31:02
  And I, I said to the clinicians, and I see Murray laughing there.
• 31:04
  Um, you know, and, and on that end, what were the key learnings from your guys' experience, Murray and Michael, um, in actual change management, in getting adoption to happen?
• 31:14
  So the best change management is when the government man says, "You can't come into my organization until you've, uh, done what we want you to." Um, but you're, you're absolutely right.
• 31:24
  Um, and it's, um, you know, there are several pieces of that.
• 31:27
  It's who is, you know, what level and who's the champion that's, um, kind of starting the project off, and how much control or influence do they have over the environment that you're trying to change.
• 31:40
  And if you don't get those conditions right, and you're working with someone in a technology group who really loves it, and you put in some new technology that's fantastic, but the customers haven't really bought into it, and, um, they're not gonna be willing to change what they do, then it doesn't really matter, right?
• 31:55
  So you've got to build, build those cross-functional teams from the get-go, really make sure you understand the, the, what the problem is.
• 32:02
  I think that, um, you know, change management is certainly an incredible piece of it, but it starts before the change management to know that you've actually got your...
• 32:12
  You've defined the right problem that you are trying to change, and that you've got champions who are willing to do that. Otherwise, it can be a very frustrating experience.
• 32:24
  Uh, David, just a reminder to, uh, to, uh, mention who you're with and kind of one sentence of what you guys are working on, just as context. Oh, yeah. Sorry, I didn't introduce myself. David Straub.
• 32:34
  I'm the founder of, uh, In Recovery. [laughs] I always put you guys first. I, I, I l- I rarely promote myself, which is probably a bad thing.
• 32:41
  But, um, we, we're an addiction recovery platform that came out of my own experience with addiction. I'm a tech guy.
• 32:46
  I've been, I've sold two companies, major exits in Silicon Valley, um, and then fell to addiction and, um, basically now In Recovery has built out one of the first real, uh, end-to-end, I think, uh, fully integrated, uh, addiction care management systems from pre-treatment to inpatient to aftercare and full cycle, really leveraging the care transitions as well as, um, um, being able to personalize care and carry people throughout their entire care trajectory with a lot of human support as well, not just tech.
• 33:15
  Um, but yeah, uh, love to learn more about what you guys have going on. I know UCSF is huge with addiction and, uh, addiction care treatment. Um, love to connect d-down the road. Yeah. That's a, a huge issue.
• 33:25
  And what-- I love what you said about the care transitions piece in there, because traditionally that's where we've lost and where a huge amount of errors come from, and that's not just in the addiction space, in the behavioral health space in general and in the chronic disease management space.
• 33:39
  So that's one of the goals of the whole end-to-end solutions, are, um, finding where those risks are in the transitions and then figuring out which pieces we can automate, which pieces we can support with better, you know, data delivery, and which pieces need some more human in them.
• 33:55
  Um, there's no more money or bandwidth in healthcare to keep throwing more humans at things, but we've got to free them up from some of the non-value-added work that they do now, um, so that they can do much more patient-facing, direct, um, support work to improve the experience.
• 34:13
  If we could stop having people sitting at desks doing scheduling activities and working with insurance companies to push paper around and all of those horrible things, we can move them towards filling in those gaps that the technology doesn't automatically do.
• 34:28
  I completely agree. We're actually launching a, a... We're kicking... Sorry, uh, Logan, on this last piece. I'd love to include you. We're, we're working on something with John Morgenstern, uh, from, from Northwell,
• 34:38
  um, and, um, and Jim, um, M- McKay from UPenn, uh, and where we're creating a, a, really using the In Recovery platform to leverage, um, actual research, um, and deploying research quickly.
• 34:51
  And I'd love to interface with you at some point to, to try to include UCF's regimen there 'cause I think what we're doing there is really, really interesting. Thanks for the question, David. Um, Dr.
• 35:01
  Alexandra Greenhill, you had a question in the chat about this trend of healthcare organizations, health systems, uh,
• 35:09
  deciding between building it themselves or, or buying it and finding a partner and kind of the tension that exists there. Uh, could you, uh, come off mute and, and ask your question? Thank you, Michael, for the comments.
• 35:21
  And, um, I'd just be curious to how you handle this. You know, in, in medicine, we have the t- see one, do one, teach one, and so we seem to have the same mentality around, like, well, building an app is easy enough.
• 35:32
  And so we run into a number of people who say, "My brother-in-law knows somebody in India who can build you an app for fifty thousand," or ambitious large health organizations saying, you know, "We don't wanna buy Epic or Cerner.
• 35:46
  We can build our own." And we've all seen most of these projects not succeed. And so how can we take our experience, and I wish I was one of the young ones running around building a startup, but I'm not.
• 35:57
  Uh, I, I really like the comments about lessons learned, and how can we help everyone not start from zero
• 36:04
  on this, but actually consider that no other industry builds their own tools, that they typically, you know, buy technology from somebody whose main mission is to build technology and then collaborate with them to make it better?
• 36:17
  Yeah. So it, it's a great question, and I think we've evolved to the point where we would prefer not to build anything.
• 36:24
  Um, we only build when there's absolutely, you know, nothing that's gonna work for us, um, in a target ar- in a target space.Um, but that is, you're right, that is a little unusual when it appears to be so easy to build an app that solves a problem.
• 36:40
  You have to start from the place that the app isn't the problem.
• 36:43
  Um, you know, the, the, the delivery mechanism, critically important, and it's the pointy edge of the stick from the customer's perspective, so it's gotta be really good.
• 36:52
  Um, but there's so much infrastructure, and workflow, and change management, as we were just saying, for anything to work, that, um, the organization has to decide they're going to solve all of the problems end to end, um, not just plop another app on top of something to really make it, really make it work.
• 37:11
  Um, so we've, um, and we have this conversation all the time, 'cause even though we-- that's where we are, we still have lots of really smart faculty members and really smart graduate, you know, students, and, and we've got, you know, Berkeley across the bay.
• 37:26
  So people are inventing all kinds of apps and technologies all the time. They, "What is wrong with you?
• 37:30
  Why won't you just take our technology or our app or thing that's gonna fix the world and just put it in your space, and things will get better?" That is, like, ten-year-old thinking where we started from.
• 37:40
  It's really gotta have a strategy. You have to pick what your early targets are. You have to keep working the integration angle and the systems of engagement angle.
• 37:50
  Um, without those, the, the apps, you just get too many of them. They, then you have the problem of how do the patients choose which ones they're supposed to use.
• 37:57
  If a patient's in three different clinics, and each one's using a different app, they go crazy.
• 38:03
  So the whole thing, um, in a big, complex organization like ours has to be orchestrated really carefully, and that means, you know, your brother's app is probably, not you, but, [chuckles] you know, whoever's brother's app or sister's app or, you know, is, is not really the solution to the problem.
• 38:20
  Uh, Dr. Greenhill, uh, re-remind us who you're with and two sentences about what you're building. Uh, so I'm a, a family and emerge doc.
• 38:29
  We're building care team technologies, which is a solution that sits horizontally across and tries to solve the problem of transitions, but also the multitude of apps, and sort of imagines the world of bring your own device and how can you make all of that not chaos, but, uh, actually, uh, a coordinated and effective, uh, function around patients who have seven-plus, um, healthcare conditions on average and need all of these to be effectively working in a twenty-four-hour day.
• 38:59
  Yeah. Yeah. I, I, re- I agree. It's...
• 39:01
  I would love to hear that because, um, you know, that's the, the same way we look at it, is that it's the transitions and it's, um, you know, if you look at our, our version one of the patient experience, it was MyChart from Epic, right?
• 39:16
  Um, and then you say, "Okay, well, this doesn't do everything, and it, the things it does do, doesn't do fantastically, so we need something better."
• 39:23
  And the evolution there was some places and some of our competitors went out and just re-skinned MyChart. Still had MyChart under the surface, but it was just, had a prettier front face on it.
• 39:33
  Um, and then, you know, the next evolution is you've really gotta rebuild that piece of infrastructure.
• 39:40
  You know, your EHR is, um, patient-facing client is certainly part of that, but does not own the whole thing, and then you can start putting apps on top of it.
• 39:49
  Um, so the patient still has a single experience, and then your systems of engagement know which patients are already registered with which apps and so on, and then you can have a single-- you can present to them a single experience that makes sense instead of the, "Okay, go find your app and download it from an app store somewhere."
• 40:08
  Um, but that is a big investment, and that's why I like to hear people thinking at the platform level of, "I can deliver this as a platform to org-organization."
• 40:17
  'Cause we have the wherewithal to start, you know, having an engineering effort, partnering with people to, to build that out over time, but most organizations don't really do that.
• 40:27
  So I think that that end-to-end platform-based thinking is gonna be very successful. Thanks for the question, Dr. Greenhill. Uh, Dr.
• 40:36
  Blum, uh, I've heard you speak previously about this shift in mindset at, at UCSF from, uh, being more provider-centric to really a, a, a mindset around in-in-innovation that is consumer-centric.
• 40:50
  And, uh, I, I wonder if you could just kind of flesh that out a little bit more, kind of where you see your institution on that journey and kind of what that means for, you know, health innovation going forward.
• 41:04
  So, um, yeah, that's a really, you know, really fascinating one. When you're-- we're at, you know,
• 41:11
  we're at an inflection point in general in healthcare, where, um, we have to stop thinking that we're the, the priests and the priestesses of healthcare and health, and everyone else is just supposed to come to us, and then we do some blessing, and then they get better, um, to, you know, we have to be delivering health as a service.
• 41:31
  Um, and that means health and healthcare and wellness and acute care delivery when it's needed. And that means we not-- have to know people throughout their experience.
• 41:41
  And you can't know people by sitting inside your four walls and, you know, guessing what's going on with them.
• 41:47
  You've gotta be part of their lives, and you've gotta be, um, getting to them in, you know, omni-channel kind of ways, just like the rest of the consumer world does.
• 41:56
  So an ex-example is if someone is out there searching, you know, so everyone, not everyone, many, many, many people get their healthcare information from Google now, right?
• 42:06
  It's the primary source of healthcare for, for people around the world.
• 42:11
  So if someone's Googling something, if you're Googling a product, then every vendor of that product knows about it and starts sticking ads next to it when you do it.
• 42:21
  Well, doesn't it make much more sense if we already know you, and you're already a patient of ours, and you're looking for information, and, you know, we've got a program that is one of the top programs, that we proactively ought to interact with you on that?
• 42:34
  So it's much more about-Getting to the customer, the consumer, meeting them where their need is, than waiting for them to call us in the clinic.
• 42:42
  I mean, how ridiculous is it that if they're already out there looking, they might be looking for themselves or because it's a mother or a sister needs help.
• 42:50
  But we ought to be knowing that and saying, "Hey, this is what we do. Matter of fact, we do this as well as anyone in the country. Let us help you do this.
• 42:57
  Um, here is the information that, you know, we've figured out from clinical trials that we've run and, and by the way, there's a new program in this space." And that's the kind of consumer-facing stuff.
• 43:09
  If you ask each of the clinicians, they're like, "Oh, yeah, of course, we ought to be there." But their version of that is still frequently, "As soon as the patient calls me, I'll talk to them about it."
• 43:17
  And that's just very much the old world that we've gotta get out of, um, into a much more progressive way of treating people like customers, or they're gonna take their, you know, their customer choice, and they're gonna take it somewhere else.
• 43:30
  As the care gets much more democratized- Yeah...
• 43:33
  and becomes much more available to you regardless of where you are, so geographically untethered and democratized because of the technology, people are gonna have to compete at a different level.
• 43:45
  Organizations are gonna have to compete at a different level, just like the rest of the world has been changed.
• 43:51
  Just this morning, I was speaking to a, a, a cardiologist with one of our companies, us2.ai out of Singapore.
• 43:58
  Uh, she was talking about the democratization of cardiology through AI and really talking about hu- the, the need for humility among providers to recognize that the knowledge is being shared, which I feel like you're, you're sort of touching on, which really gets at a, a culture shift among providers, really thinking about who holds the knowledge, uh, and how tightly they hold it and how, how much that's shifting.
• 44:25
  Yeah. So I don't, I don't remember if you said in the beginning, but I'm a cardiologist. And so cardiology, just because it's a, um, a technology-based undertaking... Oh, a second.
• 44:37
  I need two seconds to do something, um, that is very consumer-facing right now before you have a dog barking very loud. Be back in one second. Go for it.
• 44:46
  [chuckles] Hey, Logan, while you're waiting, I'd add something, uh- Yeah, go for it. Okay. So we just, it, it, to loop together some of the things that were brought up because it's fascinating.
• 44:57
  We, and my recommendation is, um, try to identify a couple of key intimate relationships that you wanna build rather than sort of shotgun, because we, we...
• 45:10
  It, it's a great success story with UCSF from a Conversa standpoint, but we started talking to them over two and a half years ago, and we were very persistent, and you have to know when it's not gonna happen, too.
• 45:19
  But I didn't actually meet Dr. Blum until we were signing our agreement. So I didn't get to... I tried to get to him, trust me. But we went in. He has a great team.
• 45:29
  We spent a lot of time with that team understanding their strategy because we kept going in and saying, "This is what we can do."
• 45:35
  And it became very clear that they were redesigning their whole digital patient experience. Michael, I was telling the story about y- before how you said it's difficult for a startup.
• 45:44
  I was saying you and I didn't even meet till we were signing our agreement. You have a great team. We spent two years knocking on the door and trying to understand the strategy.
• 45:52
  And because of that, we were in the mix, and so when the strategy was, um, further evolved, um, then it was clear how we could fit in. We positioned it as a platform.
• 46:00
  We actually invited UCSF's head designer, head product people to be part of the process before we even had an agreement to give us some advice and guidance.
• 46:08
  So we, we, um, chose to make investment in a small number of systems that we thought were doing innovative things. We wanted to build intimate relationships. It led us to publishing, so we've published together.
• 46:20
  Um, you know, we talked about COVID, but, you know, CDHI just put out a great, um, uh, case study on this home spirometry kit that Conversa's a part of. There's a broader set of services in it.
• 46:33
  But lung transplant patients, I think all living lung transplant patients were offered the program, and it's a very, very high engagement rate.
• 46:40
  And, um, you know, all of that, it just looks like this overnight success, but it, it was two years in the making of trying to understand the strategy and figure out, how do we become part of it?
• 46:48
  We're, you know, we're really a, um, in a support role, and we have to understand what we're supporting in a lot of depth, and we can't develop it and say, "Here, we built this."
• 46:56
  It would never work, and that's what led to the collaboration that I think ultimately was, you know, successful. Yeah.
• 47:01
  And that goes to several points I agree, Murray, is one is you can't do that if you're just building an app and throwing it over the transom and saying, "Here, this is what works." That doesn't happen.
• 47:11
  Even if you have the specs for it, you gotta really be deep into the process. And it also is a great example of how transformative the time and the work can be for your overall strategy. You know, we, we take a...
• 47:24
  So UCSF is one of the best lung transplant centers in the world. Our, our outcomes are demonstrably better than just about everyone else's.
• 47:32
  Yet we always just looked at it as, you know, our patient population is just around, you know, the, you know, the Bay Area and a little bit beyond that is our catchment area.
• 47:42
  Well, in the current world, you need to be thinking far more broadly than that, right? Because everyone's competing for these same patients.
• 47:49
  So our ability to project that care, um, much further just happened in, you know, very obviously with this program. Now, after the transplant, we send a spirometer out.
• 48:00
  They have, you know, they have an app, and they can report back to us. It eliminates a tremendous amount of the need for the patients to come back, travel away to us.
• 48:07
  Now you can go beyond the Bay Area to this program can be a national program or an international program for that matter.
• 48:14
  So it's really, you know, changing the way people, you know, people think about where the care is and, and what needs to happen for it.
• 48:24
  Murray, I love you m- that you made that point about it looks like an overnight success, but you had really been working on those relationships for a long time and even kind of working those relationships up the ladder, finding champions at different levels.
• 48:36
  Uh, it's a process.
• 48:38
  It's not just a matter of meeting the one perfect right person.Uh, there's a, a nice, uh, question here from Shereen from Yumlish, uh, about, uh, pushing innovation to the home and getting into people's hands even before they know they're sick, and the different ways that a, a big health system can kind of reach into the home.
• 48:58
  Uh, Shereen, you mind coming off mute and asking your question? Yes, absolutely. Thanks, uh, thanks, Logan. Um, hi, Dr. Blom. So Shereen- Hi... Abdullah here.
• 49:06
  Um, one of the biggest things is, you know, when we're talking about delivering care at home and really making it more predictive so that we know even before the patient knows that they need that kind of care, what are some active, I guess, i- initiatives to that end to where you see points of entry to be able to provide that kind of service and sort of, again, flag that early on, um, for the patient in their care journey?
• 49:28
  Yeah. So it's a great question. It's one of my favorite spaces, um, for a couple reasons. The, the jigsaw puzzle that's required to make this work is really complicated and super cool.
• 49:39
  Um, you know, we've seen multiple academic studies that, that hospital at home or care at home, um, is far more effective, more cost-effective, and more satisfying for the patient and the caregivers.
• 49:54
  Um, and it's been shown over and over again. Yet, the number of failures in development of hospital at home and care at home programs is greater than the number of academic papers around it.
• 50:06
  So it is not a straightforward, "Oh, okay, this area works. Go deploy your people."
• 50:12
  It, it turns out that, um, it's really not scalable, and even though you can take care of a pneumonia more effectively, you can, you know, an organization can do one or five or 50 of them, you can't do hundreds and thousands of them, which is when you wanna get to your space where you're really being predictive, that means you've gotta be, you've gotta be actively monitoring thousands of patients, and that doesn't happen with people doing it.
• 50:36
  It happens with AI doing it, and we're still in a space where the AI is fairly young and not completely believed, and a lot of it is not yet validated.
• 50:46
  So organizations are a little bit hesitant or a lot hesitant to invest the resources, um, on their side, the design, the implementation, the integration resources, to build out a program that would get to where you wanna be.
• 51:00
  I think, you know, those are, there's some friction in there, but where you wanna be I think is really the right place. That's, uh, I, I use those same words.
• 51:07
  I say, "I wanna know that you've got a problem before you know that you've got a problem." That's a relationship, right? That's providing health and wellness to you, is you think you're doing fine, but I can tell you...
• 51:18
  And there are newer technologies coming along, and not just digital technologies, but there are molecular technologies coming along that I know what, I can know what your risk of a cardiac event is,
• 51:30
  you know, over not a 10-year life, not a 10-year span, which is what the current guidelines are, but I can know to a one or a two-year span, and I can tell from, you know, various biometrics when something wrong is happening before you notice it.
• 51:43
  I can tell from your heart rate recovery after you exercise, that you're not doing... So a whole bunch of stuff and, but we don't have that ability to have all that monitoring.
• 51:52
  So that gets to why do you work with an academic, because y- you gotta develop that science, and it takes a long time and a lot of money. This is the bad news for a startup.
• 52:01
  So, you know, we worked with, with GE, um, to develop the AI that reads their chest X-rays. So you may have seen some of this publication, but we can detect collapsed lungs, um,
• 52:14
  you know, as well as a radiologist, but we do it instantly on the machine now. So as soon as it, the m- X-ray's shot, it's read, right? If there's a finding.
• 52:24
  That took years to develop that and then years to validate it so that it could actually make it all the way through the market. So it doesn't take that long to develop a first algorithm.
• 52:34
  It takes a long time and a lot of data to validate some of these algorithms and really build them, and that's, that's the piece that's really gotta come along, you know, to really get to where you wanna be so we can have thousands of, you know, and tens of thousands of patients.
• 52:49
  You know, our catchment is, you know, three and a half million patients in the area, you know, and 20 million in the greater area.
• 52:57
  So we have to have a system that can monitor huge, huge amounts of that, and, um, I think that's one of the next...
• 53:05
  You know, if you look at five-year chunks, that's o- one of those goals, is to really establish that relationship with everyone and be proactive about it. A great question, Shereen.
• 53:15
  Uh, uh, quickly remind us who you're with and just a couple sentences of what you're building. Absolutely. So, uh, Shereen Abdullah with, uh, Yumlish.
• 53:23
  And what we're doing at Yumlish is we're creating an AI-based nutrition therapy platform, um, with a strong focus in the Latino community with diabetes.
• 53:33
  And, uh, to the, i- in fact, to the question, I, I was curious largely because in what we're doing today and the way we're offering it, we're able to flag things like if there's a food insecurity issue, a mental health challenge, just because of these interactions that we're having from a nutrition standpoint.
• 53:48
  And when you talk about nutrition, everything else comes on the table, too, right? Um, so we- we're starting to flag this.
• 53:53
  But again, I just wanted to w- thank you for sharing that, um, because I wanted to see sort of what that looks like from a five, 10-year lens to say, uh, how can we then effectively predict these types of things within this overall, uh, intervention for nutrition in managing, uh, lifestyle?
• 54:10
  Nutrition's been one of the, you know, the critical spaces in all this. Has obviously so many knock-on effects, and when you're having a conversation, as you said, you can find out a lot of other things.
• 54:19
  I think it suffers a little bit because the, you know, the data, there's a lot of controversy around the data.
• 54:25
  Um, a lot of constantly changing perspectives on the data, but it's gotta be, I completely agree, it's gotta be a whole piece, one important piece of the conversation. Mm-hmm. Thank you. Thanks, Shereen.
• 54:37
  Well, we're getting near the top of the hour.
• 54:39
  Something we always do at the end of Expert Office Hours is, uh, give everyone on the call an opportunity to reflect back to our expert, uh, a, a, a top insight, something that they're gonna take away today.
• 54:50
  We probably only have time for one, uh, maybe two if they're fast. So drop your name in the chat or raise your hand in the chat orUm, or you can come off mute perhaps. But, uh, uh, be thinking about...
• 55:05
  Well, drop your name in the chat if you'd like to share what your insight is to, to Dr. Blum, and, um, I see- Hey, Logan, can I make one, one more quick comment? Yeah, go for it.
• 55:15
  Um, you know, we were starting down that thread of getting the automation out to the, to the customers, consumers, and patients, and how it's gonna change the, the change management scene.
• 55:24
  I said, "As a physician, I look at this as such a huge opportunity because if we can get out of this space where I spend all my time documenting and asking questions, and we can use the technology to do that, what I look forward to is being able to sit with the patients and deliver the, you know, the care they need and all the typical care that we think of, but also have the relationship to develop to give them the emotional support that they need, um, and the caring that they need to then engage in all of the other things we want them to do."
• 55:53
  Yeah. The nutrition piece is great. I spend a lot of time talking to people about if you eat better, you'll do better. If you exercise better, you'll do better. But that's 30 seconds, you know, of a 20-minute visit.
• 56:04
  If we can use technology to cut out a bunch of the front-end stuff, um, w- I can deliver more care, caring care to people, which is what I look forward to. That's great. I, I love it. Let's see.
• 56:20
  I'm gonna, I'm gonna, I'm gonna pick on you, David, since you just popped into the chat. What's your, what's your insight? [laughs] You always do this to me. I love it. Um, yeah, but, you know, I, I just...
• 56:31
  Y- really just what you just said, Michael.
• 56:32
  Uh, this is great because we, we really are focused on, on outcome tracking beyond just are they, or in our case, are patients using drugs or not, to really are they reintegrating and having a better life.
• 56:43
  And to your point of how much technology can drive that relationship building with providers is so key, and something that we have in our, in our, in, in our hands that we can actually empower.
• 56:55
  Uh, I love that aspect so much, and thanks so much for all your insights today. All right. That's, that's our time. Uh, Dr. Blum, thank you so much for, for taking the time with us for this Expert Office Hour.
• 57:07
  Thank you for the work that you're doing at UCSF. Um, it's gonna be, uh, even more critical as we move into the n- into the new year a- and as, uh, health just keeps transforming at, at a radical pace.
• 57:19
  So we're excited about your work, and appreciate you taking the time to talk to us. No, it was my pleasure. I just wanna thank the whole community.
• 57:27
  All the work that you guys do makes my work not only far more interesting, um, but powerful in, in our ability to, to reach out and project the care. So keep it up. Don't get frustrated.
• 57:38
  Or when you're frustrated, keep going, 'cause I know this, this is a really hard space. Been there with you guys. [outro music] And, um, really just wanna encourage everyone, keep it up, persist, and great things happen.
• 57:58
  So... StartUp Health invests in health transformers from around the world who are committed to achieving audacious health moonshots.
• 58:04
  If you wanna learn how you can join this community of entrepreneurs, or if you wanna connect with one of our 330 companies, go to startuphealth.com. Thanks for listening to StartUp Health NOW. We'll be back next week.
• 58:16
  [outro music]