Health Innovators
Health Innovators

Episode · 2 years ago

Gaining Payer Adoption of Your Healthcare Innovation w/ Dr. Robert Groves

ABOUT THIS EPISODE

Are you targeting a health system for your innovation? Then don’t miss this episode!

How does innovation affect the payer landscape and how do payer systems prioritize innovations and their resources? We got the inside track on how payers look at and engage healthcare innovators and how these priorities impact all stakeholders in the continuum of care.

On this episode of CoIQ with Dr. Roxie, we’re tackling the question of internal development and overdevelopment of innovation versus external innovation solutions in the payer landscape. 

Dr. Robert Groves, executive vice president and chief medical officer at Banner-Aetna will guide us through the pathways of proof points, case validations, the willingness to accept risk, and the knowledge of the path to “yes” that can transform innovations into active healthcare solutions. 

 

Dr. Groves is a career critical care doctor who has seen it all— from start-ups to established clinical protocols. Through his experiences, he has developed a special focus on which payer products and services require internal development and which are best supported through external innovations, like yours.

You’ll be blown away on the answers and how to get there.

Tune in to discover strategic insights on how to increase adoption among health systems and maximize commercial success.

 

Welcome to Coiq and first of its kindvideo program about health, innovators earlier doctors and influencers, andthey ar stories about writing the roller poster of health careandnovation. I'm your host, Dor Roxy, founder of legacy, DNA marketing groupand it's time to raise our COIQ welcome back to Youyq listeners ontoday's episode. We have Dr Robert borwas with us. He is the executivevice president and chief medical officer for Bana Etna, and I can assureyou that we are going to have a very interesting dialogue today about whatit's like to innovate within a health system that has at least twenty eighthospitals. Last time I checked crossing or spanning over six states and one ofthe largest employers that we have in the United States so welcome to theshow Dr Gros. Thank you ox inm glad to be here. I'm looking forward to theconversation. So, let's just kind of get started like I do on every episodeby having you introduced yourself, you know a what do you do and just tell us a little bit about yourbackground sure yeah. My training is in Pulnary vecal care, medicine and I practice pumonary critical care forGosh a'll, told probably twenty five years and in two thousand and thirteen gave upthe direct patient care. Part of that. But you know at the start of my career,I was a traditional plulmonary, critical Parguy Sein, sing patients and both the hospital setting and in theoutpatient setting and then in well the you know my careers had someinteresting twists and turns, and about six years into it. I I stopped and tried my hand to tostartup company we 're trying to do a voice to data technology and did thatfor a few years and then wound up joining banner health in two thousandand five initially to roll out tella ICU, which calm and describeing moredetail as we get into this and and then my way through the organization. Avariety of roles became interested in population, health and and at one point became the vice presson ofhealth management for Baner, and then that evolved into chief medical officerroles ind the banner health network, which is the value based contractingarm, and then that turned in to the role that I have today in a jointventure between banner, which is a seven billion dollar integratedhealthcare delivery system that started as a hospital system, Yeah Etna, whicheverybody knows the name Atta. And of course, now we have a third partner inthe mix. So H, TAT was recently acquired by CVs. So I find myself in aninteresting position poised between these. These two giants right right,yes, and that's one of the things that I think makes this conversation soexciting because in my experience it's a very different world trying toinnovate within such a gigantic multilayered organization versus astartup, that's trying to Ben Build it Ben, bring a health carrenovation tomarket so so kind of before we get into the specifics around. You know the thehealther delivery system that you're living in these days help me understandyour perspective on what is it like just describing the health careegosystem through the lens of innovation as a whole hhow? Would youdescribe what's happening today? Yeah, you know, healthcare could be described, and thisis how mmy colleagues, who have spent time with the military have describedas a target rich environment therere is lots of opportunity for improvement andhealthcare, and...

...you know technology has to play a bigrole on that. There is just too much information to manage and too muchcomplexity to manage. Even with teams of people I mean no health care is ateam. Sport that's been around for a while, but it is becoming almost impossible to manage without theintelligent application of technologyes, that the challenge has been that manyof the technologies that have been developed for health care havedeveloped along the Alcoldum, at least in the United States. Natural Silos seem to be isolated from other parts ofthe system. So when you take on when one as entrepreneur takes on healthcare, I think the first thing that you have to decide is: What problem areyou going to try to solve and once you figure that out, then you can start thinking about whattechnologies or what strategies might be different or innovative to allow youknow to break into that market and provide something that nobody else hasmm. So how is innovation affecting the system in the network that you live inyeah? Well, you know the way I think about itis that care is so badly broken that I think we need transformative innovations, notincremental innovation, incremental innovation is getaitive and it's okayand you know we get a little bit better at the Mrs, we get a little bit better at an interaction among a team. You knowprocess of management, Lean type strategies, all F, those ere okay forfind Tuny. What we do think in the space that I'm in what I'm looking foris strategies that have the opportunity to Transformis, because, let's face it,we've been talking about innovation, an healthcare couple of decades now, andthe costs continue to go up, and we haven't really put a dent in that. Ithink there are a couple of reasons for that and that that has to do with whyI'm in the position, I'm in in one we touched on a couple of times-is just complexity. You know it. It is really really difficult to get one'sarms around the entire beast. An the other reason. I think that that happensis there's a tendency for shortsihtedness in the commercialmarket and to the innovation really has to take place and- and what I mean bythat is in the commercial market. Of course, e. The primary customer from an insurer perspective isbusiness right, it's not necessarily all big business, butthat drifts a lot of it and there's those you K, ow, one hundred to threehundred employee businesses and h n there's allthe small businesses and those are the guys that are buying the products todeliver to their employees. They tend to to see results in a year or two. Youknow they want to hate quickly and I think a lot of insurers end up promising things thatsimply can't be elivered in that time fright. You know what I have gotten in thehabit of doing with buyers, typically businesses to say. Look if you continueto do what you've always done in that way, then then we're going to continueto see exactly what's happened over the last couple of decades. Costs are goingto continue to go up what needs to happen. I say it as we need patienceand patience. We need the time to develop thestrategies to develop the technologies, implement them test them, iterate,improve them to eget. To that point,...

...where we actually have atransformational product that really can bring cost downin a big way. So it's a pick, your partners kind of thing. It's Uhuh, youknow align yourself with Ha company that you truly believe is trying to dosomething different and then support them doesn't mean you, you look the otherway for for bad out comes, but you support them andyou continue to iterate and you watch that foundation being built and prettysoon you'll see the building, goup and or Chi the last year and a half thatI've been with the other. The final thing I'll say about that rock e is complexity, is the name of the game.You have to get comfortable with that used. To think that I personally, youhad O fix co care, I mean, and when I look at it now, I am you knowridiculous, because it is simply too massive for anyone person to know howto quote fix. It believe is that if we get theincentives right, then there are lots and lots of smart people out there whowill, on balance, actually fix this beast and give us something. That's mor beneficial and far less costly thanHuke Havay there's plenty of room. I think at least fifty percent of what wedo is waste Yeah Yep. So so are we there? Yet, with the you know,reimbursement models and incentive alignment, and it's not. How far do wehave to go? Well, I can the the one piece that's hard for individual people or companies tomanage really is the government piece right. I mean approximately half of the money thatflows through health carand ne off flows through either Medicaid orMedicare or veteran's affairs. Those those pocket books are the onesthat are funding health care. Now, although cms has been touing with majorreform, we haven't yet gotten to the point where fever certain the end offever service is insighe, and I do believe that until thathappenswe're still going to struggle- because you know it's not because health careproviders are any better any worse than anybody else,it's that at the margin when the incentive is, you know, if you want tomake more, you do more than at the margin when there is honest debateabout whether you could do another ekg or have another office visit on the youknow. More typically, individuals will do more if that incentive is there andcan fix reduced costs by increasing viume. As long as that's there, it'shard to encourage true innovation, ow you getpunished for doing the right thing: Sintually, Yeah Yeah! Absolutely I hada conversation with a client just this week: Who's not a health system, but we weretalking about value, base, care and outcomes and kind of shifting to that,because there's immense opportunity, they're engaging with patients all dayevery day, so there's immense opportunities to start collecting moredata and report that back and there's a cost associated with thatthere's an extra lay of cost, and so the conversation was how we monetizingthat. But right now we're not getting compensated for it. So we're not GE, Jo, even though it could be helpful andmoving the Te edle, as you know, for the industry as a whole yeah- and I doit's not that I don't think there's anything we can do about that likebecause I think there is because I think there's been enough dialogueabout the need for value based care and o one of the points that I make overand over again, is you W...

...it's common to hear it's unsustainableand what we don't hear is that we are currently in Chries. It's not a crisisthats coming. We are currently in crisis and the evidence for that, andit's like foiling fraut Rightn. You know frog jumped into bully water jumpout. If you go slowly well, we are boiling the healthcare frog te evidence,for that is that people are putting off needed care. There are people who aredying because of the cost of healthcare, and I would argue that we have shuckedup, we being the healthcare industry ritlarge every bit of improvesmiddleclass productivity for at least the last two decades. Mcome has beenhampered by wanted Berkshire Ha becuse, the tapeworm, anAmerican business, and so the crisis is now it's not coming and an the factthat life expectancy has gone down for thelast three years. Runnyn, I think, that's directly related to economics and economics is directlyrelated to the cost of health care, so we're in crisis. Now it's not a futurePRICIS were watching it happen, that's what the opioad epidemic is about.That's what the the crisis and behavioral health is about. Thesethings are all tied together and, and so it's no longer gee. We got to fixthis because in the future, there's going to be a problem, the problems nowyeah yeah, absolutely so how so, with that context and mine, how? How are you creating innovativeprograms in this very complex intrenched in tradition and ALD ways ofdoing things? How are you conceptualizing and launching andgaining adoption of innovative programs? Yeah Yeah? That's a that's a greatquestion and the short answer that I'll give you isrecognizing opportunities and grabbing them before they disappear and, and that even goes back to theEICU. It was like. Oh Yeah, give us an example: Yeah I mean we've got a board ofdirectors at at Banner. Health at the time is two thousand and five. So thisis early in the process that and we've got a Csuite the you know, CEO Coo, everybody cee- that is fully buck. Ino This thisproject, and this was after a full evaluation. I was part of the team thatwent to Chicago to look at what advocate was doing with the ICU, and soyou know, we've got everybody on board and let's seize the moment and really rollthis out and do it raggressively, and so that's what we did back into Ave. sowhat ies tell I I s you. Let me just describe that to you very quickly. Imagine a bunker if you will a roomthat has board certified Intensivis, criticalcare, nurses and administrative support all sitting at multiscreen computersthat are connected audio visually in real time to every intensive car unitbed at banner four hundred plus of seven states. Imagine that scenario andthen imagine a a software algorithm that is constantly doing surveillance on those treams ofdata that are coming from the bebsite adverse trends. And so we that's whattellyic Ye is. Essentially, we had four duties. The way we described it to ourcolleagues is number one respond request for health in the bedsidevirtually instantly and thats literally true, can be there with a boardcertified intensivist. An audio visually connected to the room in theBlinko. ANA thing is to...

...identify those adverse trends and thenintervene before they become adverse icomes. The OUERTHE EUS do that,because computers are much better at identifying those sorts of trends. If Iwalk by a room and the blood pressure, is you know, Hondredand thirty, at onepoint and maybe late in the day I walkd by again andit's ninety both of those are kind of normal, so I might not notice, but acomputer would notice if thet had been sliding all day long and it can send mean alert. So what Bhattlin? Those dots to do is to focus their efforts wherethey mattered and tewer going wrong and then the third thing we did was help along with the computer alborithmswith wrote tasks. You know everybody needs X oreverybody needs why, and with rare exception. We ought to do this forevery patient. We see making sure those eyes are dotted and tees a cross likedeep ban, thron, Bosus prevention, or you know, tressalls- for prevention.Those detail things that messed, if in the flurry of activity aroundcritically, Gill, folks and Lops, there's a system for making sure thatgets done, and then the fourth obviously is to measure what we do andand improve what made that work was the unwaveringcommitment, the board of directors in the C sweet,because there was lots of English. Initially, we have tanking towels overthe camera. TREP report me to the stateboard interesting things to play.Yeah I mean it Wass, exciting times, right right. What's E, I think right,exactl Exay, I you know that's really early yeah, it EA. I was it and wedidn't have riding in the streets. I did have certain hecklers who followedme around to every hospital presentation. Ultimately, and here's where thepatient's part came in with the board to it, took four years get general acceptance. It took fouryears to prove that they Arai on this and it was expensive, but they stayedthe course in today. It is the largest and Besteius in the country.Mortality is some. Twenty percent lower than predicted link to stay is somehataround the same amount lower than predicted, and it answers Tho question.Yes, better quality can cost less and significantly less. So that's anexample of patience and patience and that taken advantage of an opportunity.There are a lot of places where it didn't do so. Well, the board was splitor there wasn't that strong commitment or the hospital start pushing back andsaying. This is a lot of money I could use over here over here and it took allof those things being in play. So I give you another Execaplle, the in my current role. We had a windowof opportunity where the company was considering Gee. Whatare we going to do about Tella helth and we seize that opportunity and said?Okay, let's figure out, if we can, you know ad the jv as the innovation engine.If we can slide something in here, you know before everybody gets too focusedon one of the big players and get something going, and so we went througha process which is quit by by large company standards of about eight weeks of you, K, request forinformation of you know comprehensive request for proposals, nearow that feeldown from fifteen companies to about seven or eight and then narrowthat down further to three that we visited on site and looked at what theywere doing and we came up with a great option, and I know you know about theseguys, Beca O. I think here recently and that's ninet point six so, and that wasa partnering opportunity that took advantage of, and now we've got thatrolling out. In fact, I think next...

...month, if I'm not mistaken, sotat'Sother, you know it's an opportunity that window is closed now.I don't think we could do that today because of CBS acquisition and theirrelationship with certain Tele health players and banners relationship withtell health players and banners interest in building its own. I meanall of these. Interests are challenging to navigateand so slipping. That, in is an example of taking advantage of an opportunity. So I'm really curious. You know. A lotof our listeners are health innovators, who are trying to sell their solutions,their wares to folks like you, and so any it could be. Those fifteencompanies that were in the running could be listening today, and so what made ninety eight point: Six winthat business and stand out from some of these other innovators, because Ithink that that's just some lessons learned that our audience can be ableto take with them yeah, yeah and Gosh. There are a couple of things I couldsay actually quite a bit about that, but but let me start with. I have not encountered any othercompany that came in the door. Saying Hey, we think premiar hare ought to be available toeveryone, and we want to reduce the barriers to accessing primary care, andso we're going to try and offer our services in or quote a ridiculously locause. UHHUH doesn't happen like I did not. Nobody else said that they saidwell, we charge the traditional rage and we do this d. We do that N, it'slike yeah. I know that's what everybody says and that that was the that's anintention together, atap the the only part of t, I think, tha, the other bigpiece of it is? U You have that Aha moment when you say wow yeah, everybodykind of does communicate the atteck and yeah. I do like the fact that I don'thave to be interrupted and you know and then that what was palpable about their cultureand how much time and attention they spend on taking care of the caregivers.You know twenty percent of their doctor's time is devoted to making thesystem better. They built this and right, and so you know those things hatthey stand out. They really do they get your attention. I think that's great. Ithink it's just great wisdom for our listeners, so so I want to kind of digdeep a little bit into this is when you're developing these innovativeprograms. How are you involving, or are youinvolving providers and patience into that innovation process? Are theyideating solutions to some of these most critical problems that you've gotstrategic iniiatives wrapped around ehelp me understand what that landscapelooks likeyeah. They certainly help identify theproblem. You know, for example, priorauthorization. Nobody loves priorofforthing. You know patients hated doctors hated Y. Now wehate it. It's just a pain to, and you know often when I say that back an wellsay: Why won't you just stop doing it? Well, the answers is really prettystraightforward. It said we don't practice evidence space medicine ashole, healthcare and physicians. You know, there's too much knowledge, youdon't have knowledge management to the degree you needed av te point of care,and so you tend to practice what you've always practice and that leads to wildvariation in practice across the country across chouties and even withinthe same group, and they can doing it right. You know...

...exactly ipossible, and so what you know ind the interestobviously of the insurer is to prevent over reen and over diagnoses. You knowtheyre, that's their job and you know the job of the doctors to makesure the patient gets what they need and that's where that that's, where the two mat in Priro and but if we can get the information tothe dock in real time at the time that they're seeing the patient so that theyknew. If I want to get this MRI the literature by the way, it's not theinsurance company, typically not Sak, typically, because all these things areopen to interpretation and insurance companies, ten to lean to one way and a the another. But theliterature says if I want to get this. SMRI should try this this and thisfirst and have I done that and if I haven't it's going to get denied, so Imight as well either one go ahead and do that or go directly to appear topear right now, instead of sending off request waiting for a week or two untilsomebody looks at it and then finding out that it's been denied and then yeah,this whole process is, is flawed? EAH! That's what we're working on today soso who identified that problem for us? It's all the people raising their hand,saying I got a problem with this. I got a problem with this and is patience. It's docks it'sinsures and a lot of money wasted on that procect. We're talking today to a variety in fact we're anybody out.There has a solution for this, we're just in the process of identifyingcompanies who can help us solve this problem, and it's not easy right. Yougot ta the ability to look at a chart in avariety of emrs and that probably is going to require some ai and then youvegot to have the ability to look at expected clinical practices on theother end and matched the two and you know be ideal. If hey could simply readthe chart, Ih right, this ain't gonna, you know pass andhere's what you need to do and by the way, there's one other key issue there.One of the things that's very frustrating as a physician is to have aconversation with the patient, build trust order in MRI and then have aninsurance company. Deni and the first thing thet dot thinks is look I'm thedoctor. I know. What's best you will Tatmri and the patient you know getsall Huffy, because the doctor knows what they're doing and the insurancecompany must be to play, and that's not always the case I mean so it's the dock isn't doing evidence based medicine,but they've already committed and they've already committed in anenvironment of trust and it's hard to back down from ther how different thatis. If you know up front, it's like you know, yeah we could get an MRI, butlet's try this first and once you know if the doctoriscommitting to that that's a much easier conversation with patient, you maintaintrust etcepeans. No, that's an example of how we are toying with focus groupstrategies to say you know: How can we make this better for you, the otherthing that people complain about we've identified as a huge bear is the EOB. You know the Excellenbenefitsthat letter that you car for the Insurance Company. That said thisis not a bill and it's like what the heck is it thene. You know you try to figure out what's going onand you know we saved you this much from what you know. It makes no sense that we do that.Nobody understands what it is. Why is it like a credit card statement,so you know I mean likconack decipherable you'd be amazed at how difficult it isman it's part of it. Is the claims lag right, there's that two to three monthstime that it takes for claims to be processed and cleared and by the wayI've asked questions about that and...

Gosh. It's there's so many things inhealthcare thats. Well, that's how we do it. You know so orunity forinnovation. What if you had instant claims at dudication? Wouldn't that becool, so there are lots of opportunities for Innovat it's. Youknow the Kyis the limit and and a lot of this stuff, it's kind of like youknow, Steve Jobs, a lot of the stuff. You don't have to ask anybody. Justlook at your own experience. WHAT SUCKS ABOUT HEALTHCARE? Well, do you have asolution right exactly some of it's not rocketscience right its right. The discovery of the problem, so so, when you're rolling out theseinivations, you know we have. I have a lot of conversations around adoptionand and so we might get some innovations out there that really solveof a viable prof an important problem, but there really is just some slowadoption by patients or providers so help us understand what are some of thestrategies that you've deployed to help with patient or provider adoption? Isthere anything that stands out to you yeah? You know, I think. First of all, you got to have a champion and whatever it is that trying folks to adopt you know if whois the key influencer Ategoria? Is it? Nurses is a restotro therapist? Is itdoctors as in administrators, and then in that group you're going to need a champion, and ifyou don't have that, then it probably is best to focus somewhere else whereyou do have that and then let those you know later adopters come on board oncethey see the proof of concept. So that's number one without a champion.It can be really really tough to break into anything in Healthr M. I think the second part- and this isyou- know, H it's something that I think is intuitive, but I ran into in a book.I picked recently that some of you may have read called loonshots. I don't know if that brings Ha bill for you and what's the author nameis Safi Bacall Bahcall? I have not I'm writing it down. Okay, loom shots yeah. He goes through some fascinatingstories, so you know about Nokia, about Panam an and what their trajectory was andwhy, after being radical and highly successful innovators at some point,they fall off and even goes through a fascinating story of both the discoveryand eventual implementation of radar and World War, two which probablychanged the outcome of the war as ti other like Einsteins discovery and the man had' price ter.But THY point is that most great ideas that you that make it to implementationget killed about three times. You Watch this and it's and so what's needed. ACTU, in additionto a champion, is somebody within the company that it s offering theinnovation who has the patience and the will and the resources to stay thecourse you know you got to have a champion on both sides is kind of whatit comes down to h in the implementation requires and interaction,and what I mean by the he separates of a call separates out the the world intothe because of the soldiers in the artits and the soldiers are the folksthat are using lean process to deliver what we know works reliably time infritically important part of the process, but you introduce change thosefolks and it freaks them. Outwe got a PRASS. We got this down. What is thisand and if you can get them to take...

...whatever it is your offering, they willlook at it and they will say I can't use it it s. You know it's this, it'sthat or it was ridor. It's too heavy. We I'm not flaying with this. In Myairplaners too hard to look at those are valuable. Those are. He calls thim fals failuresfailures because, even though those soldiers may say I can't use this, it'sgarbage what they mean is in its current form. This is not as useful tome as it needs to be in order for me to adopt it and some iterative processthere has to be, he likens it to phase shits. You know when, when water goesfrom liquid to salad, that's a Fa Hin, he says you have to. You have to holdit at thirty two degrees where you'v got some ice. Those are the soldiersthat and you've got water and those need to exchange on a regular basis toiterate until that Innovativ product is maxaly useful and then it will getimplemented. So it's champions on both sides and that concept of having anursery for that innovation, where it can have the opportunity to grow, evenas people try to kill it so so rober I mean. I think that that is huge, and Iwant to kind of sit with this for a little bit, because health, innovatorsor even folks, like yourself, sometimes have the belief where they have to havethe perfect solution and when they put in order to, and if I'm a healthinnovator in order to present it to someone like you, I've got to have allthe answers everything I got to know what features and functionality youneed. I've got to know what problem it's solving I've got to know thebusiness model. I've got to know all of these different things in order to becredible in order to you know, get investment in order to get buyers and-and so there's this kind of two parallel path of. I got to have somesemblance of what that's going to look like to raise capital or to get biininternal to organizations like you. I also have to have some semblance ofthat how I'm going to package that business model in order to get pilotcustomers, but at the same time, to your point, I need to make sure thatI'm not so absolute in those things, because I need to build test iterate,build test, iterate and- and I think that I think that as an industry, bothyou know, leaders like yourself and health innovators that it's kind oflike it's just it's very complex- to navigate both of those areas and makepeace with it. You know- and it's interesting and Ieven think that innovators may need to help because there's educate, there's,there's inrational expectations on both sides. Rightif, you go to a proturementdepartment. Well, you know it's almost like they expect you to have thought ofeverything and n fixed it before you bring it to me. You know, and so that's an irrational expectationand on the you know, and so it creates that expectation on the innovation side,and so I think, here's what I would look for. I would look for someone who has thought deeply about.You know all of those potential issues who is honest about the ones that they haven't yet quite solved and arelooking for interest or support and who are willing to offer a product that is notfossilized. It's like yeah. We could we COAN tweep that yeah we can tweak thisI'll. Give you an example of that in in our current relationships, tthere's a companycalled Holon, it's just like the kin, Wilburg termhlon and they are a smart pants, what they callthemselves and and so pipe Smark tipe yeah they aal information.

The story goes by directionally. Inother words, we can take information from your patabase and put it in frontof Docks, so they can close caregaps and whatever else Owen. By the way wecan do it. Mr Agnostically, doesn't matter whatyour Mr is. Oh, and by the way we can put it in the WORKFLOOP. So we're notat separate system et CEA, okay, cool the implementation in theimplementation of it has been a little more challenging and Y. U folks getfrustrated and well it doesn't work, and the answer is: Oh yes, it does. Itdoes work, it's not perfected, yet the pipe from database position worksbeautifully and that's and they've got pated technology for that. What we'reall interested in, though, is wow if you could have a system that could pullinformation out of any EMR and send it back to my database that way, Coo and-and so you know, we're all interestd in that, but that's not an easy task andit takes some iterations in some we've watched it work. Is it tailable yet probably notmassively like the entire chart extraction but pieces of it? Yeah and-and I can see a day when we get to the point where that's highly valuable now from a business perspective. Hol onrightfully has to ask how much time and effort we put into this with the enruleout there. Maybe solving this PM for everybody by man dades right right.There are a lot of things that go into that, but my point is that it ain'tperfect yet is valuable and I can see where it'sgoing. I mean the you know it's kind of like the first automobile or two out there. It's like what am Igoing to do with this. I mean I have to hand crank it. It's unreliable, there'sno place to get it serviced. You know I'll, take a horse. Thank you well, butsomebody could see the day when there were you know, highways and and Nrefuling stations and all that stuff that arguably made our lives muchbetter. So so it's early and everybody has to dothat equation of how much risk am I willing to accept and the innovatorneeds to be flexible in okay, if they're going to help me develop thisand they're going to put sweat equity into it, what do they get in return sobeing flexible on how you arrange it and oh everybody's interested inwhether you'll take risk or not? Now that may not be appropriate for veryearly innovators, but in some stage, if you're, confident enough to do that?That's Hute, so yeah what'! So, what's the ideal-because I know oursome of our listeners are in that very situation right nowand they're, making decisions around that they're making decisions on whatare the terms of their pilot with an entity like yours. Where there's thebalance, you know I talk about this phenomenon of death by pilot right,geting, purgatory pilot pargatory right getting stuck in an organization likeyours. Where I get really excited, I can tell everybody man, I've got a deal.I've got an engagement with Gana Etna. It gives me so much credibility. Quitefrankly, it strikes my e strikes, my ego sthokes, my ego and and but thenyou know, am I going to be engaged for two years, four years with no revenuecoming in as we build test and iterate, you know how do I structure thatrelationship to where it works for everyone? Yeah, that's th, I think yeah. I think you have to be willing toaccept a no sometimes. Why do I say that? Well, because it is criticallyimportant, you know we're happy to...

...we're Happyn to do pilots all day, long,free stuff, sure we'll put it out there, but if we don't define what success is, if we don't definewhat we're measuring and make sure that what we're measuring is important tothe organization and if we don't put a time limit onwhen we're going to measure that and what it means and where we go. Whenthat happens, its pervator, it really is enforcingall of those issues is uncomfortable and it's like, Oh, my God, I'm going tolose the account it's better to lose the account than to give away freestuff and go nowhere in got some the stuff. That's in pilot purgatory rightnow, and I keep asking he question: How do weknow nthat question ther', O yeah, exactlyhow do we know when it's a success, and how do we know when it's over right? Ohmy God! What does that success? Tell us about the next stage in ourrelationship. You know what is the contract supposed to look like now?Okay, we hit the number you said we were supposed to hit and when we hitthat number, you promised that we were going to get at least a to yearcontract and then here's what it was going to be strectur EAHYEAHO need tobe talking Abou. Absolutely, I couldn't agree more absolutely. So what advice do you have kind of aswe wrap up here? What advice do you have? For you know systems like yourself that are tryingto intivate within. You know how? How were we workingtogether as a community to move the needle? What do we need to do? Yeah? You know my advice to systemslike like banner or Etna or CVs frankly, is in order to nurture innovation, whether that's bypartnership or internal development. You really need to separate out a section of the company, and I am going to protect this enclave ofinnovation that now that doesn't mean theyre. You know, they've got free, Willi Nilly licenseto do whatever or whatever, but they have to have sufficient autonomy. They are not held to task by the leanmachine right, yeah, that's a different function right and God bless him. Theygot to do that. There is nothing that I'm morepassionate about than driving variation out of care, deliveryin health care and that's a lean strategy, but that's not aninnovation's Tras Itso having that- and this is loom,goes into this loom. Shots goes into this too separating that group outgiving them some protection. And now that doesn't mean you ignore your leanteam. You got you got to get both some love right and and show them some bothsome respect, but they have to have sufficiont autonomy that they don't getcut the first time the budget gets. You know, yeah, absolutely separate budgets,seperate processes and systems. You know just it's like two separateorganizations, separate cultures, right, eacttr of efficiency and productivityis not going to be conducive to innovation. Yeah a absolutely- and Idon't mean that it's really nearly chaos over on the artists side rightright about the term artist you have one has to work within constraints and,frankly, those constraints are what generate creativity. For example, if I am going to put a thought out there-...

...and somebody tells me that I have to doit in Iam- bic, pentameter- that's constraint, but you know some of thegreatest poetry ever written is written in. I am the contameter, because thatconstraint existed and the requirement was that here's your vehicle to expressthis thought, and so it leads to creativity if youwill, rather than stifling it so good. I like to think of innovation in thecontext of C sueets, as it really is corporate poetry right figuring out howto accomplish meaningful work, meaningful innovation within theconstraints that you uniquely have around whatever that topic is you know, that's the challenge. It'snot always possible. Sometimes the mews ain't there, but you know the otherother way of saying this is, I think, Mark Twain was the one who said that I didn't have time to write you a shortletter. So I wrote you a long une. That's another way of saying the samething right. It's creativity is not chaos, it isstructured rig. It is structured in a way that allows you to to thinkcreatively about how you might accomplish it within that constraint:Yep, Yep, absolutely, okay, so then kind of flipping the hat a little bit.What advice do you have for health innovators better in the trenches today ye? It goes back to some advice that I got a long time ago, and that is that almost everything starts with relationships. Human Relationships deas come from.That's where opportunity comes from, that's where that's where the future of health careis going to come from. If you are a healthcare innovator, get to know yourspace get to know what other innorvations areout there in your space get to now. Folks that are you know on the laneteam that are of making sure those processes iterate like clockwork, expand your network, expand yourconnections and through that process, you'll have more ideas, you'll have more opportunities and happily morefailures, because the more failures you have, the closer you are to gettingthat one meaningful success that could drive your entire ry. Absolutelyawesome! So that's great wisdom. Thank you. So much for sharing with ouraudience today it's been a great discussion. I know that our listenersare going to get immense value from hearing this episode. Well, thank you,roke. That time went very quickly. That was lot thanks. What's the difference between watchingand commercializing a health care Novation, many people will watch a newproduct. Few will commercialize it to learn the difference between watchand commercialization and to watch past episodes of the show head to our videoshow page at Dr Roxycom thanks so much for watching and listening to the showyou can subscribe to the latest episodes on your favorite podcast APPlike apple podcasts and spotify, or subscribe to the video episodes on ourYoutube Channel, no matter the platform just search Coyq with Dr Roxby untilnext time. LET'S RAISE OUR COIQ.

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