Latest / StartUp Health NOW Podcast / Building the Rails: The Systems That Power Innovation | Live @ Civic Health Forum

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Building the Rails: The Systems That Power Innovation | Live @ Civic Health Forum · StartUp Health NOW Podcast

• 0:00
  So what if you actually could obviate that entire experience, and you can put the, put in the homes of 330, 340 million Americans primary care in that it... with a tech stack. And this isn't, this is not science fiction.
• 0:14
  We actually have the technologies to be able to do this, and we're extracting what is now brick-and-mortar based healthcare. We're putting it in the homes, and we're actually doing what? Prevention.
• 0:23
  We're doing what is the intersection of public health.
• 0:26
  The technology exists to do essentially everything that we do now in that first primary care setting of, of healthcare in brick and mortar, and you can put it in the home.
• 0:38
  [upbeat music] Welcome back to Startup Health NOW, the podcast where we celebrate the entrepreneurs and innovators who are transforming health.
• 0:49
  So the, the focus of this session is to really kind of set the frame for what we're talking about with the rest of the day, which is, you know, where are the biggest gaps that we see, you know, related to this field of prevention and public health and what we're broadly, uh, referring to as civic health.
• 1:07
  So to have this discussion, I brought on stage with me, you know, three incredible leaders across this space, and let me have each of them maybe just give a, a brief introduction to who they are and, and how they, how I lured them onto the stage.
• 1:19
  [laughs] Go ahead. Hi, everyone. My name is Nirav Shah.
• 1:23
  I'm a general internist by training, trained at Bellevue here for many years, at NYU, then went on, um, to be the health commissioner for New York State up in Albany for four years.
• 1:32
  After which, I've been at Kaiser in California for a few years. But any excuse to come back to New York, uh, is a good excuse. It's really an honor to be here. Um, good afternoon, everyone.
• 1:42
  First of all, thank you, uh, for the invitation. It's a honor and a privilege to be here. Uh, my name is Girish Nadkarni. I'm a internist as well, uh, clinically, um, nephrologist and critical care physician.
• 1:54
  Um, and, uh, I'm tr- did all of my training at Mount Sinai, so, uh, been in New York since 2009, so I've been part of the pain [laughs] with the [laughs] Knicks' 53-year old, uh, 53-year drought.
• 2:07
  Uh, and, and this might make you like me more, Mikal Bridges lives next to me. Ah. [laughs] So I saw him yesterday and congratulated him. [laughs] You did? [laughs] Uh, well, my wife did, but, you know, we are a unit.
• 2:21
  [laughs] I'll take the credit. [laughs] Um, so I have a, a, I'm at Mount Sinai Health System. I have a interesting role.
• 2:29
  I'm the chair of the Department of AI, the Windreich Department of AI there, which is one of the first academic departments of AI in its kind in a medical school in the country. Um, so that's my academic role.
• 2:40
  But then I have a clinical and operational role as, uh, the chief AI officer for the health system, uh, thinking about responsible deployment of AI.
• 2:47
  What that means in practice is now the clinical and operational sides both hate me equally. [laughs] Hey, everyone. [clears throat] Susan Monarez. Um, thank you, Jay. Sarah, amazing, amazing.
• 2:59
  Thank you for, for all you did to coordinate this.
• 3:02
  Um, so I, uh, I am a PhD microbiologist, immunologist by training, and I have had the incredible good fortune over the course of my career to sit at the forefront of health technology innovation across a number of different organizations, uh, at the federal level.
• 3:18
  Um, some of the acronyms you'll know, some you won't. Uh, totally fine. Uh, so the first organization I helped establish was BARDA, Biomedical Advanced Research and Development Authority, which was
• 3:29
  a derivative organization from the DARPA paradigm that was established, which was intent on, uh, driving the development of, of next generation vaccines, therapeutics, and diagnostics for emerging infectious diseases, pandemics, or intentional bio threats.
• 3:43
  Um, I went on to work at a number of other, um, uh, innovation organizations over the course of my career.
• 3:49
  Uh, the second to last place I worked was helping establish the Advanced Research, um, uh, Projects Agency, ARPA-H, for, for health, uh, which was, uh, really, I think, at the centerpiece of, of the previous administration's goal towards driving, uh, health technology innovation for everyone to improve health outcomes for everyone.
• 4:08
  Uh, and then I spent a brief period of time working as, as the head of, uh, um, the CDC, uh, which was the, the global leader in, in public health.
• 4:16
  And so I am the, the, uh, insatiable, irascible, the person who wants innovation in public health more than anyone in this room, and, uh, I'm just so excited to be part of this forum, and I, I look forward to the conversation.
• 4:30
  Great. Well, I think we have a time for a great conversation with, with all these people. So I'm gonna start with something, and, and, um, I'm handing out this document.
• 4:39
  This is a policy paper that, um, I wrote for our organization about, um, you know, the need for more investment in AI and prevention in public health.
• 4:47
  And, and one of the biggest challenges that, that a lot of, I think, those of us on this stage feel all the time is that there's often a, a sort of conflation between what's healthcare and what is public health and prevention.
• 5:00
  So I wanted to, to start, Nirav, Nirav, with you. You were previously the, the state health commissioner for New York, and you've worked at all aspects, large scale healthcare delivery and in public health.
• 5:08
  How would you frame what distinguishes prevention and public health from, from healthcare? Yeah, and so when people think of public health, they always start with prevention.
• 5:17
  Unity, Sarah, o- others always use that word prevention, and that is, uh, one of five things I would talk about when I talk about public health.
• 5:25
  Prevention, certainly, and we all know what that means and looks like, from clean water, clean food. Uh, protection. Protection from shared risks, hantavirus to heat strokes, and everything in between.
• 5:38
  Promotion is part of public health, where we try to promote the conditions, safe streets, high quality nutrition, iodine in salt, that leads to good health.
• 5:50
  Assurance, which means assurance to specific care, uh, TB treatments, uh, maternal mortality and, um, maternal child health. Those are care delivery parts that actually fit with public health.
• 6:01
  And then the last one doesn't fit nicely, it's knowledge. Like the measurement around surveillance of disease, cancer rates, all of that falls under public health.
• 6:10
  Now, from public health to healthcare I think of this actually quite simply. Uh, public health, uh, i- is the denominator, healthcare is the numerator, right?
• 6:21
  We think about the one person in front of us when we're in, in a clinical visit. Public health thinks about all of us collectively. We think about upstream when it's for public health.
• 6:31
  Downstream, meaning w- what happens... Because public health wasn't in- sufficient, uh, for the individual patient. We think about how the money flows as well, right?
• 6:42
  If you think about it, for every dollar spent on public health we can save $5.60 in healthcare costs according to the Trust for America's Health. When we ran... When I, uh, I was in New York,
• 6:56
  Medicaid spent $1 on water fluoridation and saved Medicaid $14 in children's dental bills. You don't get those kind of returns on Wall Street unless you invested in SpaceX early.
• 7:09
  Um, so you know, I think of personal versus collective, there's a lot of, uh, complimentary functions between public health and healthcare, and I think that's why you brought us here- Yeah...
• 7:18
  in terms of, uh, figuring this out. Yeah. And, um, I'll jump first to Susan and then I'm gonna come back to, to Girish.
• 7:22
  Um, and Susan, you obviously had some time in, in the highest levels of leadership at the federal government. Um, how did you sort of explain it to policymakers or think through it to yourself?
• 7:32
  Because so much of what you do, did for a long period was about developing new technologies, um, but then you also had a role in leading the nation's public health agency as well. Yeah.
• 7:41
  I mean, I, I'll just pick up a lot on, on what Nirav said, is, um, the problem when we talk about public health is if you lead with public health, what...
• 7:50
  And, and you really want to advance health outcomes, you've actually already lost su- such a large proportion of those who would be funders.
• 7:58
  So you know, Nirav was, was talking about the return on the investment if you, if you invest in public health.
• 8:04
  And what, what I've come to realize is, is that when you, when you contextualize it that way, the, the people whose pockets are actually being filled by the downstream when you don't have public health, there's, there's this, there's this, um, uh, loss of, of...
• 8:18
  Well, if we, if we don't actually have that, you know, six, $6 of revenue when we, when we don't, uh, invest in the $1 prevention, this will change fundamentally how we do business. And actually, I wanna...
• 8:29
  How many investors are in the room? Just raise your hand if you're an investor. So just a small number. I think that's, that's great. I, I, I actually think that we need to get more investors in the room.
• 8:37
  And I, I'm just gonna, uh, again, you know, a lot of what Nirav has said is, is, is how I think about public health, but I want to give one quick anecdote. And I promise, Jay, it'll be relatively quick.
• 8:46
  I was talking to an investor about an idea that I thought could have an incredible ROI, and it really is predicated on the idea that when you talk about healthcare, most of the time you're thinking about brick-and-mortar.
• 8:58
  And I actually think brick-and-mortar healthcare is one of the cruelest monopolies that we have in, in what it is to be a human.
• 9:06
  And, and the reason I say that is that if you don't have access to brick-and-mortar, if you cannot afford it, if you cannot get there physically, you are denied care. You are denied healthiness.
• 9:18
  You're devi- you're denied wellbeing.
• 9:20
  And I was talking to this investor and I said, "What if we actually scaled what is primary healthcare in, in a healthcare situation, and you moved it up and you put it in the homes, and you actually developed a tech stack so that..."
• 9:35
  I mean, when's the last time you went to a primary care provider? You don't have to raise your hand. Uh, uh, I'll raise my hand on this one. And you actually had... It was worth your time. You took a day off of work.
• 9:44
  You went there. You sat in the waiting room. You finally got to be seen. You said, "You know, I have an ache, pain," this, this, that. You brought your child there.
• 9:50
  And they looked at you and they said, "Well, you know, maybe we'll give you an antibiotic," you know, uh, what, uh, come...
• 9:55
  Or, or, or we have to refer you to a secondary or tertiary, um, you know, care, so you had to take another day off and go out there.
• 10:01
  So what if you actually could obviate that entire experience and you can put the, put in the homes of 330, 340 million Americans primary care in the, i- with a tech stack? And this isn't, this is not science fiction.
• 10:14
  We actually have the technologies to be able to do this, and we're extracting what is now brick-and-mortar based healthcare. We're putting it in the homes, and we're actually doing what? Prevention.
• 10:24
  We're doing what is the intersection of public health.
• 10:27
  The technology exists to do essentially everything that we do now in that first primary care setting of, of healthcare in brick-and-mortar, and you can put it in the home. Well, you know what the investor said to me?
• 10:42
  [clears throat] This will work in the Bay Area of California. This will work in Kendall Square in Boston. This may work in some parts of New York City. You cannot scale this. And I said, "That's a first mover.
• 10:52
  You have the opportunity as a first mover to get it across this country."
• 10:55
  What is the mo- Then we, we had this, this very fascinating debate about margin and ti- time, and this, this investor, who I respect very, very deeply, said, "You cannot make me 10X return of, of, of my investment, $500 million or more, in 18 months.
• 11:11
  You can't do it 'cause the tech stack isn't there. You can't deploy it. You can't test it. You can't get it out there." That is the problem.
• 11:17
  When we talk about public health and we see investors sort of saying, "This is not where I want to place my resources," if we can actually flip that, if we can actually say what public health truly is, which is keeping people out of brick-and-mortar, creating a more accessible, more equitable healthcare system, then we'll have achieved success.
• 11:36
  Great. Well, thank you. Let's see, uh, let's see if, uh, the, we can do that convincing, uh, to the rest of this panel. [laughs] Girish. Okay, so now you are...
• 11:44
  We've been talking a little bit more about what happens outside of the hospital, and you are now the chief AI officer and running AI transformation for one of the largest, most well-respected, um, healthcare organizations in the country.
• 11:55
  How do you see where sort of, you know, prevention and these community health endeavors intersect with the work you do?
• 12:02
  'Cause I have to assume that majority of your work is how do you operationalize within the clinic setting, but how do you also think about this for the out-of-hospital setting or, or for the patients that come in and need that follow-up for prevention, um, later on?
• 12:16
  So- I, I just wanna like emphasize one concept that was said earlier, which is the concept of health span, right?
• 12:25
  And the fundamental issue in my mind with health span in this country and across the world is there's a basic translational gap between what we know and what works in order to add healthy years to life and what we actually do in clinical medicine at scale.
• 12:45
  And that gap is because of a variety of reasons. You know, um, health systems are at fault here for, you know, not pushing hard enough.
• 12:53
  Like for example, um, um, you know, I see a lot of patients with heart failure and, uh, you know, it's proven again and again and again in clinical trials that goal-directed medical therapy reduces mortality, keeps patients out of hospital, gives them better quality of life, so on and so forth.
• 13:11
  But 10% of all eligible patients with heart failure are on goal-directed medical therapy and, you know, 90% is the gap that we're trying to fill, right?
• 13:23
  So I do think, and I'm bringing this back to AI, could be a very valuable solution in closing that gap in care, which in turn leads to improved prevention and leads to improved outcomes down the road, right?
• 13:40
  For example, um, if you ha-- and we are starting this work with agents right now. If you had a agent call you right before, you know, you're getting a, a, to make-- before your colonoscopy, right?
• 13:54
  Whi-which is a preventative measure to prevent colon cancer down the road. Telling you how to prep, personalized to you, right? Guiding you through the prep.
• 14:01
  And I just turned 40, so I had a colonoscopy and it is not a pleasant experience. [laughs] Mm-hmm. Uh, the prep is not a pleasant experience. During the actual colonoscopy you go to sleep, so that's great.
• 14:12
  [laughs] Best nap I ever had.
• 14:16
  Uh, but like if you had an agent calling you, making sure you took your prep, like 20% of colonoscopy appointments get canceled just because the, you know, they don't prep adequately at home or couldn't follow the instructions, et cetera, et cetera.
• 14:31
  Similarly for goal-directed medical therapy, right? If you had an agent telling you, um, um, uh, uh, you know, you should take these medications and remind you on all of the time. That technology exists right now.
• 14:44
  It's kind of in our pockets, all of our pockets, right? The delivery system for that exists right now.
• 14:48
  You know, there are, yes, there are regulations which are different state by state, um, um, even city by city, that may not let you to do this. And I'm not saying, you know, go wild.
• 14:59
  This needs to be tested and validated and assured, uh, to make sure that it works, but the technology for that exists right now, right?
• 15:06
  The question is whether there is a cohesive movement across the different stakeholders in this, which include health systems, would include agencies, include policymakers, in order to make this sort of, uh, fr- as frictionless as possible.
• 15:21
  Because studies have shown time and time again the more friction that you have to doing a particular thing that it might improve health, but chances are the drop-off increases.
• 15:31
  So I mean, it-- the moral responsibility here is to try to decrease friction as much as possible and make it easier to do the right thing, right?
• 15:39
  And that, you know, by itself will add, um, uh, years to the health span, like healthy years to the health span, lead to prevention at scale. And you know, all of us have a role to play with this.
• 15:50
  Health systems, because sometimes they are the primary point of contact, public agencies, policymakers, and we have to align around that sort of north star, right?
• 15:58
  We have to make the right thing to do the easy thing to do. And we should think about this as fundamental infrastructure, right? Prevention should be a fundamental infrastructure because,
• 16:10
  you know, I talk to investors all the time.
• 16:12
  No one like argues when you, uh, wanna invest in cloud-based or AI-based infrastructure because they know that it's gonna cause or lead to significant benefit down the road, right?
• 16:22
  No one should be arguing about creating this stack as fundamental infrastructure for our country because, you know, that's gonna like verifiably, provably, demonstrably lead to better outcomes down the road.
• 16:35
  And th-then, you know, AI is sort of the great lever.
• 16:38
  And obviously there are risks there, and we have to go into it clear-eyed and use our best rigor and our best implementation and our community-engaged approaches to make sure it's equitable, it's fair, it's responsible.
• 16:51
  But, you know, sort of behooves us to use all of the resources at our disposal in order to make prevention as fundamental infrastructure. No, I, I mean, that's a great point.
• 17:00
  I was just, uh, thinking about a great basketball line which I always follow, which is the, uh, the best ability is availability, right?
• 17:08
  [laughs] You know, like players that are amazing but get injured all the time aren't very useful. The same is true for our humans, right?
• 17:13
  If you want your humans at work, you want them in school, they have to be available to learn. They have to be available to work, and the fundamental guarantee is that you are not sick. You don't have nausea and vomiting.
• 17:24
  Your body isn't falling apart in some way. Um, Nirav, so we've heard a couple of ideas discussed along the way.
• 17:30
  You know, Susan's talked a little bit about sort of this sort of, uh, we'll call it democratizing or decentralizing access to health, uh, technology as well as health av- um, uh, information.
• 17:40
  Suresh has talked a lot about making these systems frictionless. Where-- You, you've worked obviously in a lot of different areas. You're now as more on the funder side.
• 17:48
  Uh, previously you were the funding recipient side. Where do you see some of the biggest opportunities that are, that are being missed right now or that are underfunded?
• 17:57
  Um, and maybe some of the work that you're thinking of funding yourself or implementing yourself as well. Thank you.
• 18:02
  Um, you know, we, we love when government works with the private sector, and we see very few examples of it.
• 18:09
  I think the best, biggest example recently was Operation Warp Speed, when we were able to collectively get together, prioritize the need for vaccines because government prioritized it, it convened the right people, and, and the private sector delivered.
• 18:24
  And at the same time, COVID showed us a lot of things that didn't work, whether it was PPE, whether it was communication about public health, uh, whether it was data, and what are the data sources, and what do we believe.
• 18:35
  So there are a lot of opportunities for the public and private sectors to work together. I think when it happens, works well, we do extraordinary things. Um, one example is right now
• 18:46
  with Susan's, uh, departure from the CDC, our entire nation's infrastructure for data reporting is now, um, broken.
• 18:55
  Uh, I don't know if you know this, 23 states, uh, and jurisdictions have been defunded for reporting our disease surveillance l- rates.
• 19:02
  Everything from COVID to malaria to hantavirus, 23 states are no longer funded for that. So the private sector st- stepped up.
• 19:11
  I called a few friends together, and in Silicon Valley, they just built the whole system, which was a-- to the CDC's, uh, you know, not, not blaming you, it was a green screen system. [laughs] Literally green screen.
• 19:24
  That was version seven in the cloud, a green screen system. I don't think young people know what that is. It's literally a green screen. [laughs] It's terrible.
• 19:32
  And, and now with AI, with TEFCA Rails, so that the interoperability of the data, hospitals don't have to fax the data to the health department who have to type it in manual, and it's one way.
• 19:43
  That whole system is now up and working, and two states, one, uh, happens to be in this room, uh, represented here in the Northeast, have funded it to the tune of eight figures.
• 19:55
  It's going to fundamentally bring AI and all the benefits of what we know forty years forward [laughs] from what we had, uh, to today. So, um, I- I'm not supposed to announce this.
• 20:07
  Uh, uh, I think there's supposed to be s- uh, a special event for this, but I couldn't help myself. So look at civicstratum.org.
• 20:13
  But we're very lucky to have this kind of opportunity to fundamentally transform public health thanks to AI, thanks to the private sector who built an open-source, federated, um, cloud-based system that costs nothing compared to what we used to do.
• 20:30
  Yeah. And this is-- So I'm glad you made a s-- you ma- made, uh, gave us your announcement here as well because, you know, this is fundamentally what I think we need to see as a big shift.
• 20:40
  And, and so I'm talking to everybody out there who's a, a founder or working in an early-stage company, or if you're in big technology or you're an investor,
• 20:48
  there are so many ways in which we can impact health that are not immediately visible to, to the average person because most of your know- your knowledge about health comes from, you know, what you see in the hospital, the clinical setting.
• 21:00
  But there's all these backbone infrastructure components that are really the systems that keep us all healthy, um, that are critical.
• 21:06
  Um, Suresh, you know, you're obviously working probably on a number of different [laughs] activities all across, um, you know, your large hospital system.
• 21:14
  What is, you know, one or two activities that you're working on that you think are most exciting and most likely to be impactful in, in the near future, um, or, or things that you're struggling with and wish that you could get more investment into?
• 21:26
  Um, s- so I'll tell you one thing that sort of is again on the theme of health span, right? I, I'm an academic re-- I'm a recovering academic researcher.
• 21:36
  [laughs] And, uh, I study this, uh, particular condition called amyloidoses, where protein gets deposited in your heart. And, you know, it's--
• 21:46
  the gene for it is extremely frequent in, uh, Black Americans and Hispanic Americans, almost one in ten to one in twenty-five.
• 21:53
  And, uh, um, you know, there was nothing to be done for it until, like, three, four years back, um, when there are now drugs that sort of prevent the deposition of, uh, the protein in your heart.
• 22:04
  Now, how do we, without genetic testing everyone, which one day I'm sure we'll get to, how do you find out that particular gene, right?
• 22:12
  So, you know, the-- here's where sort of AI is sort of magical in my-- or not magical, but math- mathematical in my opinion.
• 22:18
  You can look at an ECG of the heart and diagnose amyloidoses just from the ECG of the heart, and, you know, you can call patients back in, put them through a confirmatory diagnostic test.
• 22:28
  This is happening at scale at Mount Sinai right now, and get them on the medication, right?
• 22:32
  So I think that that's where sort of the fundamental promise of prevention in- infrastructure comes in because with AI, you can sort of diagnose and risk stratify many more things using commonly
• 22:45
  available lab tests or, uh, diagnostic modalities, just looking at them with, uh, you know, a fresh perspective or a n- new technology.
• 22:54
  But then you can also improve access because, you know, instead of one person sitting there calling patients, you can have, uh, sort of agentic systems calling patients.
• 23:04
  And then that's how I think the whole care p- paradigm will change because instead of the primary care visit that you talked about, Susan, I think there'll be a primary care visit in the future where, you know, you can have an agent personally at home that's supervised by a doctor.
• 23:19
  But the doctor now can see a panel of five hundred, a thousand patients, as opposed to, like, the hundred and two hundred maybe that we used to see. Yeah. Mm-hmm. Right? And so it massively expands capacity and scale.
• 23:33
  The thing that I am most concerned about is, um, um, culture and within the healthcare system because, you know, there has-- If you look at the public perception for AI, because of a variety of different reasons, more people than not have a negative perception about AI, predominantly because of, uh, these things that it'll cost jobs, et cetera, et cetera.
• 23:57
  I don't see that, to be honest, uh, because I do think that it'll lead to a massive expansion of the things that we can do and our capacities and our ability to scale prevention, health span, and, uh, healthcare delivery to things that were to sort of close that translational gap.
• 24:13
  But it's a thing that we have to sort of acknowledge and contend with because, you know, perception and emotions are things that drive decisions.
• 24:24
  All right, Susan, you now finally have some time to be out of the clutches of the federal government. I loved working in government.
• 24:30
  I thought it was incredibly satisfying because there was a tremendous amount of, you know, influence that you could have and, and do really important things. But now you also have the freedom to do new things.
• 24:39
  So what are you most excited about in, in sort of applying all that you've learned, uh, related to technology and investment and, and now with AI, you know, to work in the areas that some of the things you've mentioned before, but maybe other things as well?
• 24:51
  Yeah, I mean, the, the first thing I have to say is that, that the shape is coming back for my, my head from not having to bang it against the wall nonstop- [laughs]... to try to get things done. Um, so that's enjoyable.
• 25:01
  Can wear hats again. Um, [clears throat] and no, I mean, I think, I think one of the, the, um, concepts that I have really started to embrace in this, this time away from government,
• 25:11
  government is slow by a certain amount of design.
• 25:14
  There's guardrails, there's governors on it to make sure that, uh, the, the, the federal government doesn't, um, get too far in front of something and, and introduce, um, vulnerability, safety risk and other things like that.
• 25:25
  Now that I'm on the outside, the concept that I'm coming back to and I'm having so much fun is, um, leapfrog. Leapfrog, leapfrog.
• 25:32
  So taking, so I, I'm gonna clone Girish and, and Nirav 'cause he's, he's also amazing and he just won't take no for an answer.
• 25:38
  [laughs] But the idea, and what Girish has just talked about, is leapfrogging technology is where you can leave in place legacy.
• 25:45
  Uh, so legacy go slow, you know, make sure that there is something that, that is continuing to allow for, you know, whatever, whatever part of, of healthcare or public health is, uh, needs to exist.
• 25:56
  But, but not using that as the, as a, a sticky mechanism to slow down the pace of innovation, but taking this entirely do- different concept and leapfrogging to what, what future do we wanna live in, in, in 20 or 30 years, and how do we pull that future forward in the next five to 10 years?
• 26:13
  And the great thing is, as Girish was talking about it, is that AI is that frontier.
• 26:18
  I mean, healthcare will be the last place that we really see this incredible technological revolution that's coming with AI because it is the most complex.
• 26:26
  Biophysiology, c- biochemistry, how medicine, how clinical, um, the, the clinical interaction of a, a, you know, particular drug therapeutic or whatnot and, and how it actually interacts with the human body.
• 26:36
  We're still building that knowledge, so AI can't jump and layer onto that.
• 26:39
  And so I think as a system of systems approach, as we start to drive and really, uh, build out our understanding of what health is, what individual, what population health is, and you put onto that the, what is happening in AI, and you actually can leapfrog from where you are from where you're gonna go, I think we're gonna see incredible benefits to human health.
• 27:01
  And, and I'm, I'm, uh, really, really enjoying it.
• 27:03
  I just actually got back late, late last night from, um, a series of meetings over in Europe, and they were all talking about, how do you invest in technologies in emerging markets?
• 27:13
  And, you know, historically what we've been thinking about in low and middle income countries is we have to have that sticky go slow, you know, adopt technologies as that, uh, that have been proven out in the, in, in emerged markets and, and, and put them into emerging markets.
• 27:25
  I think that's an entirely different philosophy than what, what I'm seeing now in European markets working with, with low and middle income countries, especially as the demographics are completely different.
• 27:35
  When you look at the, the countries of Africa, uh, their population's completely different than ours.
• 27:40
  Uh, the vast majority are under, uh, uh, 25, and it, and their ability to embrace leapfrog technologies and, and, and think about, you know, how we, how we would incorporate the preventative technologies is entirely different than what we're doing.
• 27:53
  And they might be, have a net exporter, uh, once they actually can provide these technologies.
• 27:57
  So I have to say, I have, I don't know that I've had as much fun as I have in the past nine months in my entire professional career, and it's, it's really absolutely wonderful to be out and, and driving towards these, these new innovation technologies.
• 28:09
  Great. All right. So, um, I'll just make a quick plug here. I spent three years in Ethiopia working at the African Union trying to build the African Public Health Agency, Africa CDC.
• 28:19
  I would encourage people to invest in Africa. I mean, your pictures, what you see on television, you haven't been there, are not the same. Median age is 19.
• 28:26
  50% of the population is, is, y- they are ready to embrace all of these things in a way that Americans and Europeans are not always [laughs]. So just a, a side plug, much as I love New York, think elsewhere too.
• 28:37
  All right, we have two minutes left, and I, in that time I wanna frame this and, and put you, uh, you know, in a position of power.
• 28:45
  Uh, I think everybody in this room is aware that there's this, like, massive flood of wealth, um, you know, coming in from the major IPOs that are happening.
• 28:53
  Um, and there's a real prediction that there's gonna be this new wave of philanthropy, 30, $40 billion a year annually.
• 28:59
  If you had the ability to allocate that capital in some way to advance prevention and public health, how would you do it? You each have 30 seconds. [laughs] Well, I, I already have a plan. I have- Okay. [laughs]...
• 29:11
  they're, they're welcome to just write me a check. No, it's this, it's, it's putting this tech stack in the homes, uh, to obviate the need for primary healthcare.
• 29:18
  And, you know, 33, uh, 33, 330 million Americans have these, this tech stack in their homes. It's AI-based.
• 29:25
  It's actually tailored to the, to the h- the, the health of the, the individuals, uh, within that, within that home, within that community. Um, we can do this. It, the technology exists.
• 29:34
  It will transform healthcare in America. All right. Girish, you got that 30 to $40 billion a year. Where are you spending it? Um,
• 29:43
  so first of all, I think, just echoing Susan, if the delivery mechanism exists through smartphones and other connected devices, use that as the tech stack, uh, in order to, like, deliver on-demand, proactive, personalized, uh, preventative care to patients so that we increase health span and improve that.
• 30:02
  Second is make sort of communities and patients part of the solution and, you know, help them co-develop and build this, and that can only be done with investment.
• 30:12
  And the third thing is change allocation of AI in clinical care. Right now, a lot of the investment in AI in clinical care is going towards back office solutions and note writing.
• 30:24
  You wanna get to a place where the note does not have to be written because you have prevented the thing that's had the note write in the first place. Exactly. All right, closing words.
• 30:32
  So we know that, um, uh- When nothing bad happens, public health is working, right? When the water out of your tap is good, like in New York City versus in Flint, Michigan, right? We know...
• 30:45
  A- and the problem is all of these externalities we don't hear about until it's too late. And what we were able to do in New York under Medicaid was the, the data that showed the investments in public health made sense.
• 30:57
  A dollar in water fluoridation, $14 saved in children's dental bills. Uh, a dollar in supportive housing, uh, $2 in homeless shelter savings, right? Things like that that we know.
• 31:10
  It's our imperative as we make these investments to uncover these externalities.
• 31:16
  Tom Frieden in 2009 in, in New York City talked about a penny per ounce sugary beverage tax would lead to $1.2 billion in c- uh, in the coffers of New York State, a 10% decrease in obesity, and many, many other things.
• 31:32
  We could probably pay for all the GLP-1s for everyone if we did that today, right? I'm not suggesting that's the answer, but we don't measure these externalities.
• 31:40
  If we now, with AI, have the opportunity to understand the opportunity costs of what we're doing, and then invest in the prevention upstream, we'll make a lot of money, and we'll make society a lot better, and it'll actually be prevention and public health focused as opposed to healthcare focused, which we need as well.
• 31:59
  But we don't need $5 trillion of it. Great. Oh, that was absolutely perfect. Thank you for, uh... I wish I'd given you my own talking points, but you made them better. [laughs] [audience applauds] Great.
• 32:08
  Thank you all very much for this panel. I really appreciate it. [upbeat music] And finally, an invitation to all of the extraordinary health transformers.
• 32:20
  Whether you are a startup, someone building the future of health, or whether you are an investor, funder, or buyer of the solutions out there in the marketplace, this is an invitation to you to join the Startup Health member community.
• 32:35
  Learn more at startuphealth.com. Look forward to hopefully seeing you soon.