Healthcare Reimagined Corey Feldman

On Episode 9 , I spoke with Shiv Rao. Dr. Rao is the founder and CEO of Abridge, which uses ambient AI to summarize conversations into clinical documentation. He is also a practicing cardiologist, and previously led the provider-facing investment portfolio for UPMC.

“What did the doctor say?" is inevitably the first question we ask a loved one who has just been to see a clinician. But how often do we get a clear answer ? How many of our loved ones are actually knowledgeable enough to grasp the details of their condition/diagnosis/care plan? Research out of Dartmouth suggests that people forget up to 80% of what they’ve heard from their healthcare professional.

That's what makes Abridge so important, and is likely the reason that over 300,000 people are using the free version of the Abridge app (which you can download here on the app store) to help make sense of medical conversations and share information from clinical consultations with loved ones.

As Dr. Rao pointed out in our conversation, there is a public health emergency occurring in the United States - we do not have the supply of clinicians necessary to meet the demands for care delivery. Compounding a lack of clinicians is an uptick in burnout. The AMA currently estimates that physician burnout is at 63%, and an article in the Journal of Internal Medicine that said clinicians would need 27 hours per day to do all the work that’s required of them. Shiv started Abridge to reduce the documentation burden on physicians, and to provide patients with a digestible, “translated” version of their clinical encounter that they can share with family members.  

The benefits are also significant for clinicians. Over 80% of the clerical work that used to be involved in documenting is now getting automated by Abridge - this solution is currently saving clinicians on the platform an average of 2 hours a day! 
Ultimately, as we discussed, a clinical note has three stakeholders:
Other clinicians on the care team - they need to understand Dr. Rao’s medical differential, and how he was thinking about the diagnosis/care plan.Health plans - Dr. Rao needs to build his note in such a way that the diagnosis and follow-up recommendations can be properly coded and billed.Patients and their family members, who may need to take action based on Dr. Rao’s findings, which they thus need to understand.A single note cannot be all of those things at once. Abridge solves this problem by summarizing and structuring the information to create different artifacts for all three sets of customers.
Abridge has raised $27 million to date from investors like Union Square Ventures, Bessemer Venture Partners, and Wittington Ventures. For more information,  you can check out their website: https://www.abridge.com
Please make sure to check out the Society for HealthCare Innovation's (SHCI) website for more content. 

Dylan Beynon is the founder and CEO of Mindbloom, an at-home psychedelic therapy startup. Dylan has been named a top 25 consumer healthtech executive and one of the 100 most influential people in psychedelics. Mindbloom has facilitated 100,000+ psychedelic therapy sessions since launching in 2019, and is now the largest provider of ketamine therapy in the U.S.
Increasing access to Ketamine therapy was one of Dylan's main motivators for starting Mindloom. His family was among the 70% of those living paycheck to paycheck in America, for whom standard treatment would have been unaffordable. Mindbloom is now available in 35 states, accessible to 70% of the U.S. population, and has reduced the cost of treatment by as much as 72% (see linked study).
We spoke about the addiction fallacy related to Ketamine, and the comprehensive study Mindbloom published in the Journal of Affective Disorders demonstrating that their methodology delivers significantly better clinical outcomes than traditional in-person clinics, as well as SSRI’s, talk therapy, and legacy medications. This is a link to the study.
Dylan shared some surprising stats during our discussion:
With SSRI's (prozac and lexapro), 47% of people get a greater than 50% improvement in depression symptoms. Talk therapy is closer to 40%, roughly the same as a placebo. In peer reviewed clinical studies across 1250 participants, Mindbloom patients saw clinically significant improvement in symptoms 60% of the time.Mindlboom has shown through clinical research that their patients are also getting a side effect less than 5% of the time, as compared to the 30-50% of patients who experience moderate to severe side effects from SSRI’s.We moved from the discussion of efficacy to the topic of reimbursement. Ketamine is generally not reimbursed today for depression and anxiety, with the exception of J&J, which in 2019 got S-Ketamine approved for suicidality and treatment-resistant-depression. Unfortunately, it is still extremely expensive - approximately 13x the cost of generic ketamine.  

Dylan’s personal connections to depression and SAD are extensive. He lost both his mother and sister to fentanyl overdoses, despite trying every traditional treatment available to try to help them. 
While Dylan believed that his target customers would be early adopters before starting Mindbloom, he ultimately found that it was people who have struggled with anxiety or depression for a long time. Their average customer today is 41 years old, with more over the age of 57 than in their 20’s. We spoke of some of the other potential causes of the mental health crisis in the U.S. Among them, the poor metabolic health of the average American, which is getting worse.  Finally, we discussed Dylan’s learnings across three companies about how to build a successful company culture. We touched on the gap between good and great talent, and the false choice between being direct and honest, and being kind. Mindbloom won the Tony Shay award for transformational company cultures, which is a testament to the work environment Dylan and his team have created. 
Please make sure to check out the Society for HealthCare Innovation's (SHCI) website for more content. 
Additional links: Chemical imbalance of the brain theory may not be true. 

Dr. Groves is the Chief Medical officer of Banner Aetna, an independently licensed insurance company with a 50/50 ownership split between Banner and Aetna. "We have taken two elite athletes, put them together and said 'who is best at what, and let's leverage their respective strengths going forward.'"
Banner Aetna has  tried to be strategic about what services that are currently handled by the care delivery system or insurer should reside with the other.  By pushing care management (among other things) to the delivery system, they have been able to eliminate confusion for patients and duplication of efforts.
We also spoke about prior authorization. In the eyes of Dr. Groves, prior authorization is a way to check, "Is this really necessary based on medical literature?" now that the speed at which medical information doubles has gone from 50 years in the 1950's to weeks or months today. At Banner Aetna, half of all prior authorizations are now being done by Banner, which means that Banner doctors are speaking to their peers within the health system when discussing authorizations, and that those peers have access to the patient's record in real time, and can check for missing information. 
When it comes to attribution, Dr. Groves rejects the concept of "owning patients", and notes that Banner Aetna patients are often treated by physicians in the Banner Network that are aligned but not owned by Banner. Dr. Groves sees Banner Aetna's role as financing the services that a trusted physician feels his or her patients need, and helping to support the trusted relationship between a doctor and patient wherever it is occurring.

As we moved to a conversation about innovation in healthcare, Dr. Groves noted that technology should always be in service of the relationship between a clinician and patient. Trust, he noted, is what has suffered as technology has created a wall between patients and physicians. Dr. Groves is interested in technology that can streamline back office functions, make it easier for patients to find the right doctor, and assist patients in following through on commitments they have made to their physician to improve their health. 
We also touched on physician incentives. It has been Dr. Groves' experience over 30 years of managing physicians that whenever you attach reward and punishment to a metric, it immediately starts being distorted. "Intrinsic motivation is dampened by external rewards." 
Dr. Groves cited research by Brent James, which indicates that the ease of accomplishing a task is what drives most physician behavior. Physicians are inherently competitive, and thus sharing data with physicians so they can see where they stand in relation to their colleagues is also important.  Financial reward is a distant number 3 on the list of what influences physicians. Putting excessive weight on specific metrics results in an overemphasis on a limited set of metrics instead of the relationship and an evaluation of the whole patient. 
We concluded by discussing the concept of healthcare versus "rescue medicine." While Dr. Groves concedes that if he was in a car accident there is no place he would rather be treated than the U.S., we have a long way to go to improve the wholistic health of Americans. Whether it's subsidies for high fructose corn syrup, political influence within  the FDA approval process, regulation around PBM's, or pharmaceutical advertising, there are many places where Dr. Groves feels national policy contributes to the problem.

Dr. Groves can be found on Twitter and Linkedin.

Please make sure to check out the Society for HealthCare Innovation's (SHCI) website.

On episode 6 of season 3, I continued my conversation with Dr. Stephen Klasko, who was the president of Thomas Jefferson University and CEO of Jefferson Health from 2013-2021. Under his leadership, Jefferson expanded from 3 hospitals to 18, and saw its revenue grow from $1.8 to $9 billion. Dr. Klasko was #2 on Modern Healthcare’s “100 Most Influential Individuals”. He is also the co-author of 2020’s UnHealthcare: A Manifesto for Health Assurance with Silicon Valley investor Hemant Taneja, and is currently an executive in residence at General Catalyst. 
In the second half of this two-part episode, Dr. Klasko and I discussed some of the systemic issues in U.S. Healthcare.  We started with a discussion of behavioral health, and how we will need to think differently about clinician/patient interactions to get at the root of the problem, starting with acting more proactively.   
The antidote to much of what ails us, in Dr. Klasko's opinion, is healthcare at any address (i.e. Jefferson sent a nursing student  into the home of an asthma patient with 10 previous ED visits that resulted from asthma exacerbations. The nursing student discovered mold, and so Jefferson sent a handyman to fix it at a fraction of the cost of an inpatient admission). Nobody wakes up in the morning and says "I am going to telebank", and yet we talk about meeting people where they are (tele-health, homecare, etc.) as though it's novel.  Dr. Klasko's vision was that Jefferson would one day no longer be defined as a hospital system, but as a system that provided healthcare at any address. He asks, rhetorically, "Why would you want to be defined by the place where you've in essence failed to keep people healthy?"
 
Despite advocating un-scaling, in order to innovate, Dr. Klasko freely admits that he grew Jefferson from 3 hospitals to 18. Yet, these mergers allowed him to obtain huge geographic proximity - nobody was more than 10 or 15 minutes from a Jefferson facility. As a result of facilities owned by the hospitals they bought, Jefferson was also able to obtain massive primary care networks, further contributing to the vision of healthcare at any address. We spoke about Tandigm's partnership with Penn and IBC, and what it will take for that partnership to bear fruits for the clinicians and patients involved. Finally, we discussed mergers and acquisitions, and the future of our healthcare system. 
Dr. Klasko can be found on Twitter and Linkedin.

Please make sure to check out Society for HealthCare Innovation (SHCI) website (http://www.SHCI.org) for more information about our work. 

On episode 5 of season 3, the first of this two-part episode, I spoke with Dr. Stephen Klasko about his unlikely journey from OBGYN to the president of Thomas Jefferson University and CEO of Jefferson Health from 2013-2021. Under his leadership, Jefferson expanded from 3 hospitals to 18, and saw its revenue grow from $1.8 to $9 billion. Dr. Klasko was #2 on Modern Healthcare’s “100 Most Influential Individuals”. He is also the co-author of 2020’s UnHealthcare: A Manifesto for Health Assurance with Silicon Valley investor Hemant Taneja, and is currently an executive in residence at General Catalyst.

Dr. Klasko and I began the episode discussing the creation of the Jefferson Italy Center in Rome and partnership with Gemelli Hospital. Jefferson's presence in Italy highlighted one of the ironies of U.S. Healthcare - while we claim to be on the cutting edge of innovation when it comes to healthcare, we create serious barriers to entry. The CEO of Marriott Hotels in Italy can be a CEO in the U.S., but if you are the head of cardiovascular surgery at Shanghai university and you come to the U.S., we make you retake your residency. We also shun the use of alternative medicine, which is used to treat 2/3 of the world’s population, because it doesn’t fall into the familiar categories of surgery or drugs (Jefferson created the Marcus center for Integrative Health which is taking the best of care that happens around the world that is not just drugs and surgery).
Jefferson's uniquely international presence and perspective served the health system well during COVID. Their Italian hospital  served as the canary in the coal mine, and allowed Jefferson to have a clear picture of the damage that COVID would ultimately cause long before most of the U.S,.  Jefferson had also invested $50 million into Telehealth in 2014 and maintained the pandemic preparedness team it had stood up when Ebola (almost) hit.
 
We touched on the state-level licensure requirements and how much the emergency protocols reduced tensions around credentialing. The idea that someone might need a different debit card to pull money out in every state is ridiculous, and yet in healthcare, it is the status quo in credentialing because it often aligns with the vested interests of the incumbents.
Dr. Klasko blames the system in its entirety for the fact that while predominantly underserved people died because they didn't get care during the pandemic, insurers quadrupled their net operating income because people they thought would get care died.

You can find the full episode here:
Spotify: https://spoti.fi/3D26Ayq
Apple Podcasts: https://apple.co/3eZyovm
Dr. Klasko can be found on Twitter and Linkedin.

Please make sure to check out Society for HealthCare Innovation (SHCI) website (http://www.SHCI.org) for more information about our work. 

Yuri Sudhakar is the CEO and founder of Nudj Health, which integrates lifestyle medicine into provider care by using a combination of human engagement and technology.  Providers working with Nudj can prescribe lifestyle medicine. From there, Nudj steps in using technology, coaches, and more to help patients make the lifestyle changes that improve their physical and behavioral health.

80% of chronic disease can be reversed, treated or avoided with proper lifestyle choices. And over 40% of all premature death in this country is related to lifestyle choices. 
The idea for Nudj emerged while Yuri was working on the previous company he started, which was focused on aggregating data from implantable cardiac devices, pacemakers, defibrillators, and implantable loop recorders. 
As they began to engage with their patients and help them turn on  these remote monitoring devices, they began to learn a lot about them- more than just the data that was coming across the device. Specifically they started to learn about the mental health of these patients - many of them were anxious, depressed, or had some type of stress in their life, and that was driving the behavioral or lifestyle choices. 
The larger learning for Yuri and his team was that everything is connected. Doctors cannot just give patients material on their lifestyle choice and then treat their physical health with medications and procedures.  With Nudj, providers are seeing  depression (-45%), anxiety (-43%), and insomnia (-50%) scores dropping dramatically in conjunction with the physical markers that are indicators of improved health, like blood pressure scores, weight scores, lipid panel scores, etc.  
Yuri blames the reimbursement structure and lack of available resources for the lack of integration of lifestyle medicine into healthcare thus far. Just because something is obvious, Yuri notes, doesn’t meant it is easy to make it operational.  
One of the best things about Nudj for doctors is that there is no upfront cost - since they are the treating team, they bill for the services that they and Nudj provide, and pay Nudj for their contributions only after they themself have been paid. Yuri calls it "value as a service", and the idea is that Nudj works together with providers to create value, and when value is created, then and only then is there a financial exchange.