Health Innovators
Health Innovators

Episode · 2 years ago

Dr. Grace Terrell On Implementing Commercialization Strategies & Tactics

ABOUT THIS EPISODE

When it comes to healthcare and innovation, the dysfunction of the system can seem hard to overcome without the right strategies. Why is it hard for some innovations to succeed? What are the key things you need to do in order to ensure your success? What are some of the biggest shifts in care delivery and benefits redesign?

On this episode, primary care physician and Envision Genomics CEO, Dr. Grace Terrell shares on her perspective on innovation as an early adopter of value-based care.


3 Things We Learned 

Innovators face a commercialization dilemma 

Many innovators find themselves at a crossroads as they try to commercialize. First, they can circumvent the current system and go direct-to-consumer, which means coming up with creative cash and subscription models, while handling the costs of educating the consumer market. On the other hand, they can go into the healthcare system, which means dealing with longer budget cycles and outdated payment models. This is a critical choice any healthcare innovator must make, and the decision affects every element of the business.


Why many innovations fail 

It’s tempting to focus on one part of the commercialization process - the product itself. Other key details must be considered; whether the product really meets the needs of the target market, how the product scales and who pays for it. 


The importance of being agile in innovation

Don’t become too fixated on one market segment or approach, be flexible enough to pivot when shifts are necessary. Many things in healthcare can change, especially in terms of policy and all healthcare innovators need to be in a position to move quickly. 

 

One of the biggest barriers to commercialization is how innovations are created. Healthcare innovators leave the industry to escape the dysfunction of the market, but end up creating products to sell back into that dysfunctional system. The problem is, it’s difficult to change healthcare outside of the system, or without involving many different people in the process. It takes a village to build a successful innovation and business, from investors, partners, willing payers and patients.

 

 

Welcome to Coiq and first of its kind video program about health innovators, earlier doctors and influencers and their stories about writing the roller coaster of healthcare innovation. I'm your host, Dr Roxy, founder of Legacy DNA marketing group, and it's time to raise our COIQ. Welcome back to the show coiq listeners. On today's episode I have with me Dr Grace Terrell. She is a primary care practitioner. She's also the president and CEO of envision Geno Mix. Welcome to the show. Thank you very much, happy to be here. So for our listeners who don't know who you are just yet, and just take a few minutes to let us know a little bit about your background and what you do. Sure. So, as you mentioned, on the Premier Care Physician on the general intern is by training and still see patients in that venue. And back in the late to mid S I founded with a group of other people in Organization Code cruisial healthcare. That was a multi specialty group that grew to about three hundred seventy five DOTS and C from North Caro on the that became one of the very first organizations. Now the what's now called the move to value movement. So we were able to lower the cost of care, improve the Quala the some of the very first medical home things. After that I found it as population health management company, coach Yes, which is now helping other organizations actually do some pretty innovative things within the here model redesign space, and for the last two years I've been the C envision genomics, which is a whole genome sequencing startup analytics company focused on really changing the way we take care of people with were and diagnosed, in this diagnosed diseases. So so what you're trying to say is that you're really bored and you have nothing to do. Yeah, what did they do? A little bit of policy work in Washington as well with PJACK, whichcific position focus technically, but it's commission that looks at redesigning Fayment models for physition care. And so, yeah, I think life is an adventure and just need to make it something totally fun, which is yeah, yeah, absolutely. I think your story is so particularly interesting because of the different Lens of healthcare innovation that I think that you've had the opportunity to put on, both being an early a doctor of Value Base Care also being an entrepreneur, being in nonprofit and for profit. So you know what it what advantages and disadvantages do you think you have come into the innovation process as a physician, being an insider into the healthcare ecosystem? So I guess an advantage I would have is that I practice regular, old control of medicine, you know, in a clinic, and have done so cross multiple venue since those first out of training in one thousand nine hundred and ninety three. So I've been in everything from a three person medical practice that included me and my mother in law and father in law, to a mostly speciality group to now a large health system that's an immigrated health system. And within that context of seeing the good, the bad and the ugly in the way healthcare is and has been practiced, and have always been somebody who, I think, can say, well, you know, there are things that we can do from this place in space that can just be so much better. And so it's really from that land that I think I'm able to think through, you know, what's out there in terms of technologies and...

...other ass it's people and culture to sort of redesign the way we think about taking care of people. So so just kind of paint a picture for us from your point of view. What is it like writing the roller coaster of healthcare in evasion? Well, I'm one of those people that sort of is tends to be on the bleeding edge. So what's one of the very first to be an electorrent health record back in the early two thousand were of the first to be what's patients in a medical home? So a lot of times when you're early and early adoptor or in the innovation space, there's a lot of uncertainty and when I look back now I sort of smile because people occasionally one that teach me electroy about things that I was actually, you know, in the early process of helping them to design and build about fifteen years ago. We didn't really know what we were doing. Ended up we make a lot of mistakes. You have to be willing to accept that and learn from them and in just continue to think about the fact that there's a lot of ability, I think, from most people in that are educated people to criticize, but the create, the creative process, which is so much more fun, is harder for people. We're just not used to doing it. And so what I have found in my career that's been most helpful is to take all those criticisms and just keep making things and building things, and that's really what I think innovation is all about. Have have you seen us be able to move the needle? I think he touched on something there's a lot of criticism about, you know, the old tradition, you know kind of the broken model, but at the same time there's there's a lot of people out there that are doing really phenomenal things. So how have you seen the needle move? So I will go back, way back when I was a kid, will growing up in rum North Carolina and watching my Grand Dad essentially have a terrible last couple of years of his life because of terrible cornery artery disease where, you know, he could hardly get from the house to the Bourne without stopping to take a Nitro glystroom and bypass graft was something that had just happened for heart surgery, but he didn't get it in time he died. To visit one of the first hard cases in the in the county, which was a friend of his who did get that shortly before he died and said something along the lines of they just cut it open like a chicken branch and but that was all better or something. Anyway, we went from that to the by the time I was in medical school at Duke in the s bypass operations were being done at big health centers and we're, you know, this big fancy deal, but people were getting better. And then by the time I, you know, was in training as an internal medicine resident rake forest, it was stants that were out there and you know, after that we got stabbens and bypass went to the community hospitals and stints were going all over the place and fixing things. and My my cousin, my dad, had a bypass operation in the s and the Community Hospital was home in two days. He's and then if bet a cousin who recently had cornary disease and he he was on in a day. Okay. So so if you take the long view, either like in colinary artery disease, or you look at the you know what happened within the HIV space, where when I was in med SICO, in one thousand nine hundred and eighty five, everything is dropping dad...

...to become a chronic disease. You do see remarkable progress on the science side or the medical side. But what what we haven't realized is that we're now doing the same thing on the Carol every side, and so there's a lot of remarkable things out there. If you were in the middle of having the bypass operation in nineteen one thousand nine hundred and eighty something, when it was still sort of early on, you wouldn't have imagined what it would be like twenty years later. So I there were drugs that would reduce the incidents and cornary disease and much better care, but it was it was a process that was going on. That's what's happening right now with carolivery, and it's because we're starting to think about things outside of just the technologies that used to be in the big hospital buildings, but what can be done in the digital world. What can be done with, you know, artificial intelligence? What can be done with genomics, with integration of information across mutable sources? And when you take that and you model it within the context of care delivery and payment model, redesign, benefits redesign, then we are making progress. I think that what we'll see over the next twenty years would just be some significant improvement more than we can actually see when we're them the battles, when a day to dagnations. Yeah, yeah, absolutely. So I think it's really good for us just to pause periodically and kind of go down memory that lame like that in really kind of, I guess I would say, celebrate some of the Innovation and progress that we've made, you know, not ignoring the fact that there's still a lot of progress that needs to be made, but it can be discouraging and so we need to encourage ourselves that yes, we are doing it, we can do it. Can we do more? Yes, and we're all working to towards that. So a lot of the conversations that I have with innovators like yourself is just you know, how difficult and complex it is to commercialize and innovation and healthcare. So, from your perspective, why do you think that some healthcare innovations succeed and some fail? Commercialization is all about the application of capital into a system that will allow something to scale and meet people's needs. A lot of innovation people have a one off solution and APP if you will, that they're trying to superimprose on top of a very complex healthcare delivery system that doesn't isn't able to sort of accommodate that within the payment delivering model. So I think the best way to think about any type of innovation is how does it meet somebody's needs? How are you going to scale in and WHO's going to pay for it? And so much of health care the person who's paying for it isn't necessarily the one who it meets their needs, and so a lot of people com up with solutions to fix a particular problem that we're not looking at it within the complexity of of the system. Those that are successful either have created a bypass around that, as you're now getting with the director consumer movement in ways, or they're working to to come up with a way of integrating into a system that actually makes it easier rather than harder, and that's not always easy in the innovation space. Yeah, I think that's a cross road. That is that innovators always face. Do I do I try to circumvent the current health care system? That is going to be a really long Ardoris road for me. For me in...

...go direct to consumer and kind of look at more creative pat cash models, subscription models, all of the different innovative business model options that we have today. But then there's there's all there's a cost associated, a much larger cost with educating and promoting to the consumer market. And then if you go into the health care system, it's how do you navigate that right? How do you navigate that to make sure that you don't just get bogged down with something that's really innovative but because of that payment mechanism, that payment models that are still somewhat outdated? How do I not just kind of find myself really right back where we are? Here's a good you know, if you're doing with health systems and you're sewing into a health system, they've got about an eighteen month budget cycle and so just the process of doing with large health care systems for what you need to do is a difficulty for many store ups have just lower amounts of cash and really can't sustain that, particularly because most of the nature capitalists are looking at a pretty quick internal investment. So part about capital markets really just not set up for at yet. If you're if you're talking about the pay or market, you're basically trying to get someone to pay for your your thing. You innovated. They have a very different set of way of thinking about things that have to do with clinical utility and evidence. That's a little bit behind the way most innovators think about solutions, and so they describe that a little bit more. Okay, sure, so, within my space, holding on sequencing, we know that if you do holding non sequence in on patients with rare and diagnosed misdiagnosed diseases and a certain criteria, children with developmental delaying seizures that are and determined calls, people that have certain things that you just can't figure out. If you get that, if you get holding on sequencing, you can sometimes save hundreds of thousands of dollars down market with respect to the cost of care. But they tend to do their analysis at the level of being here's one more fivezero tests, if you will, as apposed to seeing this five Tho test is going to say two other thousand dollars, and getting them to actually see that clinical utility is just a slow process. So that this part of that would be one example of that. Yep. So what phase of the commercialization process are you at now? Do you have paying customers? Are you still in kind of the pre launched? Help US understand that you're right at the level where we've got a process with a product that is ready to go to market, which is code of comb which is a data analytic tool. They can make a diagnosis from the genetics information in about an hour for things that used to take days Um, and so it requires certain license, in which we have, and we were this is just sort of the nature of startups. We were ready to launch last year, had capital lined up and the the capital source was being led by someone who who died, and expectedly at age sixty three, of unlikely event. So this is the type of thing that happens in the start of world. We've still talked about the wild ride of entrepreneur shap right. I mean...

...you just left for take that. I can't predict that went. It was a good friend and that wonderful mentorities. It's very hard for me to have a pretty party form for myself and the real life there. He loves, his loves and is his family. You know, is very much suffered from that for war than I have. But but then thee list, that was just one of those things and that's just storing up. So Hey, you talk to me. You know, a year ago I would have said by this point we would have had expectation we'd be about three, three million dollars in the positive respect revenue. So in the started world, things happened. Those are black swarms and things like that happened. So we are in the middle of right now of re designing things around a emerger process with another company that has complimentary business model, and that that happens, I think you're will be seeing some interesting things for the next few months the year, so stay tuned. All right, that's great. So I think you kind of touched on this. You know, I was going to ask you, or I am asking you, what did some of the biggest challenges that you faced as an entrepreneur? Certainly having something like you just described happen is a huge challenge. You know, I like to have really candid conversations about what it's like to be a healthcare entrepreneur because if we share those realities, I think it's just very encouraging, like hey, I'm not in this alone right man, it's happening to you too. I don't take it so personal. And then if we share strategies of how we overcome that, you know, then together we can kind of move to need a little bit. So just kind of speak to maybe some of the other challenges that you faced and what have you put in you know ways that you've overcome them? I'll give it. There was one outside my current company. But you talked about the research for capital. So my most especially medical group, players one very early own so that there was going to be a move to value and they look with a strategy to to do that. It would require capital and partners as well as willing payers, and we went down that path and had some of the some results in terms of ruining the cost of care about twenty percent in a very vulnerable, high cost population of patients. That's been published, by the way, in the general population health. But the players were slow in the politics changed what looked like was going to happen. After medicats pension legislation got sort of confounded by the Supreme Court decisions. It really changed the trajectory of the market. So we continue to have results, but we lad with respect to our ability to to to to move as fast as we thought the market was going to fast. So we ended up seeking out partners for what we were doing. Those partners included lab cool and wait for his badness, which at the time was an independent academic medical center in our community and ultimately we spent off the company called chess and that additional capital and the ability of that those resources has allowed chance to be successful. It's now managing, I believe, that a hundred thousand lives in value based contracts. Has Been Successful in multiple men care, advantage and next Gen, a CEO's. And when wait first just announced that it was going to going to merge with ASTRIAN and Charlotte, were...

...just one of the largest health systems in the southeast, in their press release they mentioned chance has been one of the resources and masses that they were bring into the table for what they were planning. So if you look back in two thousand and thirteen when we were making these very hard decisions about we're going to do this line, we don't have money, who sort of be our partners? But where we are now and the fact that you know, it's like that bypass story. We couldn't have couldn't have seen me. We would be all right. It was a very, very hard road and the value that the shareholders of punstone will have then, and she had over the next ten years should be multi phone relative to the lunch, wit and tears and horn work get into it in the late two thousand and ten to two thousand and thirteen. But it's taken longer than we thought. It took partners. So what's what's that conversation like with the board, with the shareholders, with the investors, of we're going, we're going to get there, but not yet. We're going to get there but not yet. Sometimes it's a very hard conversation. You know, people are impatient, people were scared, they don't see the future and sometimes you're wrong about the markets going on health fast it's going to go. But we thought all along that it was going to be about some very basic truths, which was there was a lot of exist expense and health care that could be improved by redesigning models of care, that we're much more patient centric, that took care to the age where there was a graded information and in positions that we're managing this with a team of people that could greatly benefit from integrated information on everything from pharmacy to a Care Mon of redesign, and we were very convisit that was the case in the market was going to need that because of all the trends that we're all aware of and to help your calls. And so that was a truth that you know. We had some more reproof points that ended up being good evidence of that, and so is the rest of the market came along with the way we were thinking about it. Then we continue to have all lose access and there's players now who will not do certain types of contracts in this in this way without our are being involved in our market because they know that we know what we're doing. So that experiences made a difference. WHODO's right. Yeah, it's kind of whin. Yeah, so as you kind of went to market, you know, both in your previous experience in your current experience, are you, you know, having any type of like targeting or segmentation strategy where you're really separating the innovators, in the early adopters and identifying and finding those in presenting your offering to them, versus presenting that to the mainstream market that's not ready yet? That deep a different absolutely. So we do the context of holding nome, sequencing and rare disease. One day, you and I and our children are granchildren. We all have very unexperience of holding ome secreencing at some point in our lives to be in a secure, safe, stored environment and it can be act says, by any type of physician or patient when it's needed to basically inform about medical risk, possible disease, possible side effects from drugs. But that's not where we are right now. So where we are right now is that this technology is out there as getting cheaper and the people who need it the most, for those who are not very well...

...serve our current healthcare market, which are those with, mostly children, with rare disease that are being this diagnosed and under diagnosed. So they end of the children's hospitals, the people that will benefit from this now or at children's hospitals, and so we the dialog is with those that understand is the children's hospital market. They know they don't have the resources to do this. We're making it less expensive for them so that they can order this testing and we're serving as a source of expertise so that they can actually get it to the people that that need it the most. Ultimately, the whole system will have this as a technology, but right now there's a probably five percent of the population is just extremely poorly served by our current health care delivery system, which is focused on pronct diseases and those with rare diseases. Need a very different strategic approach show the places that they go or the places that we need to be marketing and targeting. Right now, M so is, as we think about the commercialization process and all of the decisions that are made when you're developing that early adoption strategy, targeting, communication, branding, messaging, business model development, what are what are some of the strategies that you've deployed that would be valuable to share with our audience? So I think one strategy that you have to deploy, that we've done, is to not be everything everybody, but selling Adis there. You've got limited resources, limited capabilities, and so going towards those that move the most and make it as easy as possible for them to provide that service. Sometimes you have to choose not to have somebody to be a customer because it's going to require too much resource and it's not really where you're waning in whip set of this. Sometimes you have to pivot. So you may think that you've got a product that's going to serve one segment and in that segment that in your wall. When that happens, you have to you have to move and you have to do it in a way that makes sense. So what example of this would be when we were developing chess, my population health management company, and two thousand twelve thirteen, this is before spring court decision in Medicaid expansion. So we had developed the model for the dual eligibles, because we solve them as being somebody that, moving forwardble care actors Medicaid expansion happened, would be high costs and that you could put some real inovation around giving the better care and it would be better for them and loward calls. When expansion didn't happen, we just had to do something very different with that and really winning another directions, which Medicare expansion and Medicare showed sayings next Acos, not because we didn't want to serve that market, but because there was no way to pay for it. If you look at some of the policies coming out in Washington right now, particularly with some of the focus on the waivers, there will that market will open up soon, but it wasn't there in two thousand and twelve just because of some policy changes yeah, yeah, absolutely. So I talked to some innovators who are either physicians that are first time turn entrepreneur or maybe an executive or a leader within a big healthcare organization that have left because they've ID identified a problem that they want to solve on their own. And one of the things that's really interesting is for the innovators that are doing it for the first time, there seems to be a lot more you know, naivete I'm going to do this...

...on my own, I've got all the answers, I understand the problem, I understand the solution, I understand my commercialization strategy and so forth, and whereas you know, other folks like yourself who have like I've done this, I've done this. You know, there's lessons that you seem to take with you of like, we tried this and it didn't work, or, you know, all of the different things. So what advice do you have for those listeners, those health innovators who are, you know, may have the healthcare background, may not, but they're they're doing this for the first time and they're really, really passionate about the problems that they're solving and the technology that they're innovating what advice do you have for them? Don't be arrogant, let's stay passionate and listen. Listen, listen to two people about what their real concerns are, because sometimes you have a you're solving a problem that they don't think that they have. And sometimes there is any reasons why doesn't were in that other people involved them. Most solutions are not one person's work, although that's sort of the way you we tend to think about things in our code for our individualist culture, but is a focus, a team base. So many physicians, many entrepreneurs, may not have the types of business skills that are needed to basically manage a larger team, to basically understand everything from business development, marketing and sale. Some of them don't even know there's are three different things right right, just that fundamental that those are three separate things. The founders are not always the best ones to to lead businesses to the next place in space and sometimes passion can get in the way of execution. I am very fortunate that I've been in a multiple different types of situations where I've been in medical practice, that I'm see you for now twenty years that we grew from four or five people around the table to organization and had, you know, two thousand Polis and had lots of people helping me. But that's a very, very different place in space in terms of managing something of that size and complexity and building it and growing it than in the situation was a start up and chance the complete that was in between, which essentially had this spent off out of a big company. We call this gunk works. Initially that became separate company. Sort of been between that. So I am not a on the dock right. So I have a lot of skills from because I've been these other things, but it's always within the context of realising that I'm a generalist and that there requires a team of people, just like it does in the ore, just like it as everywhere else, to basically build building, to build businesses and to something that can be important and meaningful. So a lot of folks that are at storing up me and they don't get that perspective because they've been frustrated with the system that they find dysfunctioning than work. So then they leave to solve a problem and they want to sell it back to that dysfunctional system. So have your hand around being part of something and understanding your placement Goo system. I think tenzero of those stories, if not a hundred thousand of those stories, right, right. So you...

...touched on something, you know, evolving different people in the process. So I love what you just described because you're talking about building business, business building right, right, and in that it takes a village. Right, it all starts with the people. Even when you're building a product, you know, we're evolving other stakeholders in that product development process. What are some of the strategies and tactics that you've deployed at possibly involved all vain patients and providers in the development of the solution or even the development of the go to market strategy. So I won't give you an example right now in the place in space I am with glements, but I'll go back to what we were doing when we were building out some of the things that she has in I mean this this is the type of thing that doesn't sound like an Inno nation. It that't sound like that, you know, a kind of Hoodie or black total make or something in on stage. But we we were thinking about redesigning models of care around patients. We developed a committee of patients that we work from all walks of life that we're part of our just like one of the other committees at commers that we had finance committee and operations and all these, we had a pension committee and they told us what their actual experience was and they're very as opposed to, you know, what we thought we were providing. Yeah, and from that we learned a lot and we understood what some of the difficulties were. One thing that I'm doing right now that I am finding just so much fun as I'm working doing some independent work for the primary care tell medicine provider, and I'm learning so much from these patients that have zero access to primary care or desperate to find solutions for the problems that the technology can easily provide outside of the traditional health care system. Sometimes don't know the limits of that, but I'm learning more about the healthcare market and anyways that I didn't know then I had in twenty years sitting in my practice or doing some of the things that we do in our extensive this transitional care credit Corston see patients, because these are the people that never came into my office and they're using a technology now. I've said about twenty five hundred patients food and ipand just like this since February. Sometimes they're in their car, sometimes they're at work, sometimes yeah home, sometimes they're in bed, sick their uplding, floating pictures of their boys and Ivy from me, a tillment poison ibby and it's it's even in space. I'm getting patient satisfaction data back. But these are patients that they call them because there they can't get a refield the doctor's office or close or they can't afford to going to see their doctor, but they can afford the copay for this type of thing. So sometimes just getting outside of what you usually do and get another perspective, you know, I think can make a great deal of difference. It's just fascinating for someone that's been so entrenched and so many different facets that really can be that honest. Of I'm still learning, right, because we are, no matter what how much we know, we're always learning something new. It was just so much done. I'm just sort of this is why I couldn't never specialize and quint essential generalists like I can't imagine just knowing one thing really, really well. I'm just going to do a lot of things not so well, but a lot of right, right, right. Yeah, so some of the challenges with like patient and provider Co creation, some of the conversations that I've had around this, especially for a startup, is that, you know, I completely buy into involving them in the process. It's not something I'm opposed to. I'm eager to do that. But when I reach out to...

...those folks, they're excited about what I'm doing. They're just really not excited about contributing their time for free. And and then the innovators, you know, are straight for their bootstraft right, and in their strap for cash, and so, as they're making decisions of what they're doing with the limited funds that they have, allocating funds to pay those patients, sort of pay those providers for that feedback so they can cocreate with them, becomes a real challenge. How how have you address that? You know, where you just finding people that you had relationships with or people that were saying, you know, I'm willing to give you some of my time for free. What did that look like? In the Zoopho I gain for the patients a lot of terms. These were people that written complaints they were passionate about a bad experience. If they had, yeah, invited them to solve that. So we may not be the typical people that he was. Like I just had a really bad experience with organization and sort of like great, when you become on verse of our Patient Committee and help us get better and see that that ended up because it was meeting a need that they had. It was an emotional need. They were unhappy people that wanted tore something so true in within the context of of other types of audiences. Everybody's got MOMS and dad's and children and cousins twice removed, and you can reach out sometimes to friends and family, not just for capital, which is the way a lot of people think about right right here, in terms of product feedback. So you have to be you know, sometimes you're your family is the only one who's going to tell you something negative and critical about you. So it can be that way for your friends and family. Let them invest in your company, not was financially, but invest in your company with feedback. So that's just something that they go all innovators are to realize this, that the friends and family round is not just about money. And so sure the village it takes sometimes to build something absolutely well, Dr Turrell, I thank you so much for your time in these just incredible wisdom that you shared with our audience today. It's been such a delightful conversation. How can our audience, our listeners and viewers get a hold of you if they want to talk more about what you're doing or have some questions with their own commercialization process? Sure so, you can reach me by email with gt rol at envision genomenkscom. You can find me on twitter at grace to twenty two, and I'm on Linkedin. So I would be happy to have conversations with people who we need those meetings and if it would be helpful, awesome. Thank you so much for your time today. All right, what's the difference between launching and commercializing a healthcare in avation? Many people will launch a new product, few will commercialize it. To learn the difference between latch and commercialization and to watch past episodes of the show, head to our video show page at Dr Roxycom. Thanks so much for watching and listening to the show. You can subscribe to the latest episodes on your favorite podcast APP like apple podcasts and spotify, or subscribe to the video episodes on our youtube channel. No matter the platform, just search coiq with Dr Roxy. Until next time, LET'S RAISE OUR COIQ.

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