Latest / CareTalk: Healthcare. Unfiltered. / Unlocking Personalized Medicine Through AI Data w/ Bradley Bostic

Transcript

Unlocking Personalized Medicine Through AI Data w/ Bradley Bostic · CareTalk: Healthcare. Unfiltered.

• 0:00
  Personalized medicine is a longstanding dream for patients, but it's not become reality.
• 0:04
  So how can diagnostics and AI combine to make the promise come true?
• 0:14
  Hi, everyone.
• 0:15
  I'm David Williams, president of Health Business Group.
• 0:17
  And I'm John Driscoll, senior advisor at Walgreens.
• 0:19
  Our guest today is Bradley Bostic.
• 0:21
  He is founder and CEO of HC1 and Health Cloud Capital and host of Boombastic Health, who's transforming health care through data-driven invitation.
• 0:30
  Well, before innovation and invitation, but before we hear from Bradley, I want to take the chance to thank my family for making a big effort to get together for Thanksgiving and especially those who are coming from thousands of miles away.
• 0:42
  It's gonna be great to see everyone and especially to gather in person to say happy birthday to my dad.
• 0:48
  This month, November is all about gratitude and along with my family, there's someone else we don't thank enough ourselves.
• 0:55
  And that's ourselves.
• 0:56
  So it's sometimes hard to remind ourselves that we're trying to make the best sense of everything.
• 1:00
  And in this crazy world, that isn't easy.
• 1:03
  So here's a reminder to send some thanks to the people in your life, including yourself.
• 1:07
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• 1:13
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• 1:23
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• 1:26
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• 1:35
  Let the gratitude flow with BetterHelp.
• 1:37
  Visit betterhelp.com slash care talk to get 10 % off your first month.
• 1:42
  That's BetterHelp, H-E-L-P dot com slash care talk.
• 1:47
  Bradley, welcome to Care Talk.
• 1:48
  Thanks so much for having me on.
• 1:50
  It's a pleasure.
• 1:51
  Better than saying welcome to slash care talk and don't do that.
• 1:55
  Yeah, that wouldn't work.
• 1:56
  David, I'm just so happy and grateful that we have Care Talk.
• 2:00
  mean, we've been at this for a while and now folks like Bradley are jumping into the deep end of the pool and doing the same thing.
• 2:07
  This is really exciting.
• 2:08
  David, do you want to just remind people that one of our recent guests has been recognized by the White House?
• 2:14
  Yeah, sure.
• 2:15
  mean, John, we're among the cabinet picks, or the FDA pick anyway, is one of our recent guests who was just on here speaking about his book.
• 2:24
  So Marty McCurry has been nominated, is going to be put forth to run the FDA.
• 2:30
  And I think it could be pretty good.
• 2:33
  So, you know, Dr.
• 2:34
  Marty Macri and then now Bradley, you be careful.
• 2:37
  You could get recruited to DC.
• 2:39
  Possibly.
• 2:40
  Yeah, maybe I could do that in my spare time.
• 2:43
  That sounds good.
• 2:44
  Let's talk about lab testing Bradley, because that's where you spend a lot of your time.
• 2:47
  And how important is lab testing for the healthcare system?
• 2:50
  I mean, it's something you hear talked about like as an ancillary or something like that, which is almost really the definition of not being central.
• 2:57
  Yeah, I created HC1 more than a decade ago now, because I realized that over 80 % of all diagnostic decisions are based on lab information.
• 3:09
  Yet we tend to think of as healthcare executives, the lab as a cost center.
• 3:15
  You know, if you look at the overall budget for a healthcare system, typically lab is in that like 3 % range just in terms of the straight cost.
• 3:23
  And so that's, you know, has been a proxy for the value or the importance of lab.
• 3:30
  And it's really a a miss if you don't leverage your lab as a strategic asset across the healthcare system.
• 3:39
  If you think about the fact that a physician only has what seven minutes on average to spend with their patient and they're going from visit to visit throughout the day, they don't have the time to go comb through a long longitudinal list of laboratory tests.
• 3:56
  And so they're looking typically at like a point in time bit of information and making some kind of a prescription or some type of a therapy decision or providing some kind of guidance.
• 4:06
  But what we figured out is that this lab has hidden gold inside of it.
• 4:11
  And if you really leverage it, you can not only make health care much more personalized by diagnosing people more effectively and even getting proactive and preventative more effectively, but you can also drive up the bottom line for the entire health care system.
• 4:25
  And so that's why lab is incredibly important to health care delivery.
• 4:30
  So Bradley, what is it in the, you know, most people get, to extent they look at lab results, and this is doctors as well, it kind of looks like a weird fax kind of data, you know, whether you're within or outside of a particular norm or standard that's specific to the different lab machines or lab testing service.
• 4:53
  What can, are you getting at that's beyond the basic in or out?
• 4:59
  notification that most people get on their labs.
• 5:02
  Yeah, there are a couple of sides to that, John.
• 5:05
  One is if you look at the testing that is run, whether you're healthy or sick or somewhere in between, you'll have some type of lab testing performed.
• 5:15
  The question is whether or not you're getting the optimal testing and whether or not that testing is being looked at in an overall puzzle.
• 5:25
  view that really takes into consideration key trends and even combinations of different test results.
• 5:31
  So it's much more involved in general than just looking at a single data point.
• 5:37
  So you're right.
• 5:38
  There's this sort of mess of information.
• 5:41
  You're looking for some type of inside or outside the range.
• 5:44
  Are you doing the optimal tests to begin with?
• 5:47
  And then are you seeing the subtle changes over time that can be indicative of really serious future illness?
• 5:53
  For example, with CKD, chronic kidney disease, you can have patients that are in all the time, patients are missed, individuals are missed that ultimately are trending toward a CKD crash.
• 6:06
  And it's because of the fact that these are very subtle changes and it might even look like you're still within range with a creatinine test, for example, over time.
• 6:15
  So first step is optimal testing, which the general term for that is lab stewardship, which is not a sexy term at all, but it's the term that You know, yeah, not at all, but it's the term that, you know, laboratorians and healthcare system chief medical officers have come up with for this idea of ensuring that you don't overutilize or underutilize testing.
• 6:37
  Generally, it's about a 20 % over utilization of laboratory testing that happens in a healthcare system, which sounds like a big number and it is, but the other side that's even more concerning is about 40 % of testing that should be occurring is actually missed.
• 6:53
  So somebody, for example, that has borderline diabetes, they're pre-diabetic, they're not getting necessarily their repeat A1C test done in a proactive, preventative way because they're falling between the cracks.
• 7:07
  And that's a really basic example, but there are a lot of those that are out there.
• 7:11
  So it's really taking all of this information.
• 7:14
  that's out in the healthcare system and ensuring that you're looking at the view longitudinally on a patient, all of their lab testing over time and what those trends are.
• 7:23
  And then, cause it tells a story about the patient's health and where they're trending.
• 7:27
  And then also that you're doing the optimal tests to begin with, which sometimes you would assume that, but as you know, it's just doctors are so busy and the protocols that are out there may or may not be based on the most current state of the art lab testing.
• 7:41
  So it sounds like there's good ways to...
• 7:42
  optimize and enhance the testing.
• 7:45
  Now, how directly does that lead into the possibility of personalized medicine?
• 7:50
  Very directly.
• 7:51
  If you think about lab going all the way down to a genomic profile and you're seeing biomarkers that get all the way down to an individual's very unique makeup, know, genetically, this is the future.
• 8:05
  And it's interesting.
• 8:06
  about, I've been doing a lot of work with community pathology groups, looking at how you can better align them with various constituents across the healthcare system.
• 8:16
  And about 80 % of all cancer diagnoses actually happen within community pathology.
• 8:22
  So not within a major healthcare system or center, but literally in these community pathology groups that are more independent.
• 8:32
  you know, those people are going all the way down to the level of saying, what are the biomarkers?
• 8:36
  What are the specific medications or this, the treatment therapies that are out there?
• 8:41
  And, know, the world of oncology is obviously really expanding dramatically.
• 8:46
  So it's everything from, do you have a virus, you know, all the way through, which clearly COVID put a big bright spotlight on the lab, right?
• 8:55
  I mean, before, before COVID, I think a lot of folks knew they had a lab.
• 9:00
  They just didn't know where it was.
• 9:02
  And and then all of sudden he realized like wow, this is the lifeblood of health care So you explode that out to every single different type of diagnosis and you start realizing Wow, there's gold there the other side is in order to as a health care executive Have an effective lab function to take care of patients within your own health care system or hospital You need to buy a lot of equipment.
• 9:25
  You need to set up a lot of automation you need to do a lot of training and typically what happens is you have more capacity available within that laboratory than what you need just for your inpatient population.
• 9:38
  And so that's it's like in a manufacturing setting where you've got a bunch of equipment and you aren't using it all for your own manufacturing.
• 9:45
  So in the case of the lab, there's a thing called outreach that if you do it effectively, it brings better services to caregivers in need in your community who can use your laboratory testing.
• 9:58
  And it also drops straight to your bottom line because you already have this cost and all this equipment.
• 10:03
  So the two sides of diagnosing patients more effectively, being preventative with more proactive lab testing, that improves outcomes and brings down the cost of the healthcare system.
• 10:14
  And the other side boosting the bottom line through an outreach program, it could be a tens of millions in lift in terms of the overall economic impact on the healthcare system.
• 10:24
  So we're not just talking about, you know, a 2 % We're talking about a real growth engine that exists within the health system.
• 10:31
  I want to challenge you a little bit on that because the cost of an inpatient lab is often a multiple of outpatient and one of the challenges is for a lot of those tests, managed care would kind of bias you towards the large community commodity lab companies that offer a lower price.
• 10:52
  But I thought you said something that was really interesting.
• 10:55
  Well, in addition to identifying a new term, laboratory, which clearly you are one of them.
• 11:01
  It sounds like what you're saying is that even with the tests we've got right now, we're missing a lot of signals that if we actually looked at the conventional tests that we've got today more thoughtfully or to deploy them more consistently, we could actually drive better health outcomes.
• 11:19
  I think the CKD, know, that's chronic kidney disease where if you get it wrong to your point, you crash into dialysis, which means your kidneys have failed and you could be on that for a short period of time or even for a life.
• 11:31
  Maybe you could dig a little deeper into that because that would suggest that, you know, we're not seeing the gold we've already got and we're not mining it in a way that's sensible.
• 11:40
  Maybe you could talk a little bit about how we could, before we get into genomics or market shifts, how could we take the tests we've got today and use them more effectively and perhaps more consistently?
• 11:53
  Yeah, well, this is a place where the buzzwords come into play, know, artificial intelligence and using more of these advanced data science techniques.
• 12:04
  this is David loves the whole AI thing.
• 12:07
  You love it too, John.
• 12:07
  You have to bring it up.
• 12:09
  Did he plant that?
• 12:11
  I mean, David was showing off his AI tattoo before the, you know, before the show here.
• 12:16
  So need to make sure we talk about that.
• 12:18
  But it is true that The technology has this ability to see patterns that humans just don't have enough time or, or focus in order to uncover.
• 12:29
  And it's, it's not only your point is an excellent one, John, that this isn't about, immediately getting everybody's whole, whole human genome mapped.
• 12:41
  I mean, this is literally like the tests that already happened through routine customary care.
• 12:47
  are constellations of signals in there.
• 12:49
  that identify these really impactful, critical healthcare discoveries that can make a patient, make a person's life better.
• 12:58
  You we think in terms of patients, what we're talking about is our friends, our family, our relatives.
• 13:04
  Like these are human beings that can have a better life and stay out of the healthcare system if you're identifying these signals more effectively.
• 13:13
  And I'll give you actually a more aspirational example of this, which is something our amazing data science team collaborated on with one of the top pharma companies in the country, in the world for that matter, were able to identify using artificial intelligence that has analyzed historical longitudinal lab data on tens of thousands of patients that ultimately became diagnosed with Alzheimer's.
• 13:40
  We can see in the signals that the system can predictors that tell you this person is highly predisposed to develop cognitive decline down the road like years down the road and You know think about the promise of that think about the because the new medications that are designed to treat Cognitive decline cannot reverse it but they can slow it down so you can start managing these diseases It's like a chronic illness, right?
• 14:08
  And so that's the promise of this is there's so much gold in there that we have no idea we're missing but the technology starts surfacing and it's really exciting.
• 14:17
  So I'm not allowed to talk about AI, John, so I won't talk about it.
• 14:20
  So we started off the podcast talking about how sometimes our guests end up, but they go in two directions.
• 14:25
  One is they start a new podcast or two, they get appointed to a senior level in the administration.
• 14:31
  You already did your podcast.
• 14:34
  in any case- Hey, maybe I'll run for president in 2032 and then you'll really have something to talk about.
• 14:39
  Fair enough.
• 14:40
  That will be something we'll have to preserve the clips.
• 14:43
  But what do you see happening?
• 14:45
  There's a lot of talk about changes coming in the healthcare system and looking at chronic illness and other factors that may be a shift.
• 14:53
  Is that gonna change the way people are looking at the sort of things you're looking at with lab?
• 14:57
  I think it has to.
• 14:59
  And I think value-based care is at least in...
• 15:02
  the answer to this runaway train of expense that we have in healthcare.
• 15:06
  And I think if you're going to do an amazing job of value-based care, you're going to have to be optimal at how you diagnose and predict and prevent illness.
• 15:17
  And what better way to do it than looking at these signals that exist within the lab data.
• 15:23
  The other part though is in order to prove it, you have to be able to connect the dots, right?
• 15:27
  You have to be able to then look at it and say, when all these things happen and these people got diagnosed and then they got treated this way, it costs less to the healthcare system.
• 15:35
  It made the patient outcome better.
• 15:37
  And that's part of what we're doing with our informatics and our technology is not just saying, hey, let's identify the signal that tells you there's risk or there's an issue, but let's actually connect it all the way through to seeing that patient journey and seeing that this did end up resulting in this optimal care pathway.
• 15:54
  that brought that patient to a point where they were as healthy as possible on their journey.
• 15:59
  So the sky's really the limit.
• 16:01
  The other thing, I'll give you an example that people don't realize, the laboratory within a healthcare system is also responsible for managing blood.
• 16:09
  And a blood transfusion's like a liquid organ transplant.
• 16:14
  It's an incredibly critical, important aspect of healthcare.
• 16:18
  And it's also something that if you manage it correctly, patients get...
• 16:23
  well better, get well faster, they avoid adverse events.
• 16:28
  And so an example is with anemia.
• 16:31
  A lot of mothers who are pregnant can be anemic and not identified as such, which can result in really negative impacts on their babies, which people tend to take notice when you start talking about things like that.
• 16:45
  And that's true.
• 16:46
  That's part of this ability to leverage the lab signaling and leverage the information to drive better outcomes.
• 16:52
  goes all way to that level.
• 16:54
  Also, everybody who has surgery, if you end up going in for surgery and you're anemic, you'll get transfused to bring up that iron level.
• 17:03
  And in reality, if you had just been tested a few weeks earlier, you could have gotten some infusions to bring that level up, which avoids a transfusion.
• 17:12
  Like there are these huge, deep, critical aspects to how healthcare is delivered, where the central nervous system runs straight through the lab.
• 17:19
  So it's worth doing because it makes patient care better.
• 17:22
  And by the way, it can help the economics of the health system.
• 17:25
  And last I checked, health systems are struggling a great deal with their profitability.
• 17:30
  Well, that's it for yet another episode of Care Talk.
• 17:33
  Our guest today has been Bradley Bostick, CEO of HC1 and Health Cloud Capital.
• 17:38
  I'm David Williams, president of Health Business Group.
• 17:41
  And I'm John Driscoll, senior advisor at Walgreens.
• 17:43
  If you like what you heard or you didn't, we'd love you to subscribe on your favorite service.
• 17:47
  And thanks for joining us today, Bradley.
• 17:50
  Thank you.
• 17:50
  It was really a pleasure.
• 17:51
  I appreciate it.