Health Innovators
Health Innovators

Episode · 2 years ago

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


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 ofits kind video program about health innovators, early adoptors and influencers and their storiesabout 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 IQ listeners. On today's episode we have Dr Robert Groveswith us. He is the executive vice president and Chief Medical Officer for BannaEtna, and I can assure you that we are going to have a veryinteresting dialog today about what it's like to innovate within a health system that hasat least twenty eight hospitals. Last time I checked, a crossing or spanningover six states and one of the largest employers that we have in the UnitedStates. So welcome to the show, doctor grows. Thank you, roxy, and glad to be here. I'm looking forward to the conversation. Solet's just kind of get started, like I do on every episode, byhaving you introduce yourself. You know what what do you do, and justtell us a little bit about your background. Sure, yeah, I'm on trainingis in Pulmonary Pal care medicine and I practice pulmonary critical care for Gosh, all told, probably twenty five years and in two thousand and thirteen gaveup the direct patient care part of that. But you know, at the startof my career I was a traditional pulmonary critical care guy, seeing thein patients and both the hospital setting and in the outpatient setting. And thenin well, my careers had some interesting twists and turns and about six yearsinto it I stopped and tried my hand at a startup company. We weretrying to do a voice to data technology and did that for a few yearsand then wound up joining banner health in two thousand and five, initially toroll out tell I see you, which say and describe in more detail aswe get into this. And and then my way through the organization a varietyof roles, became interested in population health and and at one point became thevice president of of Health Management for banner and then that evolved into chief medicalofficer roles in the banner Health Network, which is the value based contracting arm, and then that turned in to the role that I have today in ajoint venture between banner, which is a seven billion dollar integrated healthcare delivery systemthat started as a hospital system. Yeah, no, which everybody knows the namethat. And of course, now we have a third partner in themix. So that was recently acquired by CBS. So I find myself aninteresting position, poised between these these two giants. Right, right, yes, and that's one of the things that I think makes this conversation so exciting, because in my experience it's a very different world trying to innovate within sucha gigantic, multilayered organization versus a startup that's trying to been build, itbrind bring a healthcare innovation to market. So kind of before we get intothe specifics around, you know, the the healthcare delivery system that you're livingin these days, help me understand your perspective on what is it like,just describing the healthcare ecosystem through the lens of innovation as a whole. Yeah, what? How would you describe what's happening today? Yeah, you know, healthcare could be described, and this is how my colleagues who have spenttime in the military have described it, as a target rich environment. Thereis lots of opportunity for improvement and healthcare...

...and technology has to play a bigrole in that there is just too much information to manage and too much complexityto manage, even with teams of people. I mean no, health care isa team sport that's been around for a while, but it is becomingalmost impossible to manage without the intelligent application of technolog alogies. That the challengehas been that many of the technologies that have been developed for health care havedeveloped along the, I'll call them, at least in the United States,natural sylums, seem to be isolated from other parts of the system. Sowhen you take on when one as an entrepreneur, takes on healthcare, Ithink the first thing that you have to decide is what problem are you goingto try to solve, and once you figure that out, then you canstart thinking about what technologies or what strategies might be different or innovative to allowyou to break into that market and provide something that nobody else has. Hmmm, so how is innovation affecting the system in the network that you live in? Yeah, well, you know, the way I think about it isthat here is so badly broken that I think we need transformative innovations, notincremental innovation. Incremental innovation is innovative and it's okay. And you know,we get a little bit better at the Mrs, we get a little bitbetter at an interaction among a team. You know, process of management,Lean type strategies, all those are okay for fine tuning what we do.UHHUH. In the space that I'm in, what I'm looking for is strategies thatthe opportunity to transformers because, let's face it, we've been talking aboutinnovation and healthcare a couple of decades now and the costs continue to go upand we haven't really put a dent in that. I think there are acouple of reasons for that and that that has to do with why I'm inthe position I'm in, and one we've touched on a couple of times.It's just complexity, you know it. It is really, really difficult toget one's arms around the entire beast at the other reason I think that thathappens is there's a tendency for shortsightedness in the commercial market and to the innovationreally has to take place. And what I mean by that is in thecommercial market, of course, the the primary customer from an insurer perspective,is business right. It's not necessarily all big business, but that drives alot of it. And there's those one hundred to three hundred employee businesses andthen there's all the small businesses, and those are the guys that are buyingthe products to deliver to their employees and they tend to to see results ina year or two. You know, they want to hate quickly and Ithink a lot of insurers end up promising things that simply can't be livered inthat time frame. Hm, you know what I have gotten in the habitof doing with buyers, typically businesses, to say look, if you continueto do what you've always done in that way, then we're going to continueto see exactly what's happened over the last couple of decades. Cost or continueto go up. What needs to happen? I say it as we need patientsand patients. We need the time to develop the strategies, to developthe technologies, implement them, test them, iterate, improve them to get tothat point where we actually have a...

...transformational product that really can bring costdown in a big way. So it's a pick your partners kind of thing. It's Uh Huh, you know, align yourself with the company that youtruly believe is trying to do something different and then support them. Doesn't meanyou you look the other way, for for bad outcomes, but you supportthem and you continue to iterate and you watch that foundation being built and prettysoon you'll see the building go up and Burge. Over the last year anda half that I've been with the others, the final thing I'll say about thatrocks use. Complexity is the name of the game. You have toget comfortable with that. Used to think that I personally you how to fixhere, I mean, and when I look at it now, I am, you know, ridiculous, because it is simply too massive for any oneperson to know how to quote, fix it. Believe is that if weget the incentives right, then there are lots and lots of smart people outthere who will, on balance, actually fix this beast and give us somethingthat's more beneficial and far less costly than what we have today. There's plentyof room, I think at least fifty percent of what we do is waste. Yeah, Yep. So are we there yet with the you know,reimbursement models and incentive alignment? And, if not, how far do wehave to go? Well, I get the the one piece that's hard forindividual people or companies to manage really is the government piece. Right. Imean approximately half of the money that flows through healthcare now flows through either Medicaidor Medicare or veterans affairs. Those, those pocketbooks, are the ones thatare funding healthcare. Now, although cms has been toying with major reform,we haven't yet gotten to the point where fee for certain the end of feefor service is insight and I do believe that until that happens we're still goingto struggle because, you know, it's not because healthcare providers are any betterany worse than anybody else. It's that at the margin, when the incentiveis you know, if you want to make more, you do more thanat the margin, when there is honest debate about whether you could do anotherekg or have another office visit on the more typically, individuals will do moreif that incentive is there and can fix reduced costs by increasing volume. Aslong as that's there, it's hard to encourage true innovation. Now you getpunished for doing the right thing. Since, yeah, yeah, absolutely. Ihad a conversation with a client just this week's WHO's not a health system, but we were talking about value base care and outcomes and kind of shiftingto that, because there's immense opportunity. They're engaging with patients all day everyday, so there's immense opportunities to start collecting more data and report that back. And there's a cost associated with that. There's an extra lay of cost,and so the conversation was how we monetizing that, but right now we'renot getting compensated for it. So we're not doing even though it could behelpful and moving the needle as if you know, for the industry as awhole. Yeah, and I do. It's not that I don't think there'sanything we can do about that right, because I think there is. BecauseI think there's been enough dialog of about the need for value based care.And you know, one of the points that I make over and over againis it's common to hear it's unsustainable and...

...what we don't hear is that weare currently in crisis. It's not a crisis that's coming. We are currentlyin crisis and the evidence for that, and you know, it's like boilingfraud, right. You know, frog jumped into bulling water, jump outif you go slowly. Well, we are boiling the healthcare frog in.The evidence for that is that people are putting off needed care. There arepeople who are dying because of the cost of healthcare, and I would arguethat we have sucked up. We, being the healthcare industry, writ largeevery bit of improves middle class productivity. For at least the last two decades, hmm come has been hampered by what did Berkshire head? Could the tapewormon American business. And so the crisis is now. It's not coming itand in the fact that life expectancy has gone down for the last three yearsrunning, and I think that's directly related to economics, and economics is directlyrelated to the cost of healthcare. So we're in crisis now. It's nota future crisis. We're watching it happen. That's what the OPIOID epidemic is about, that's what the the crisis in behavioral health is about. These thingsare all tied together, and so it's no longer longer gee, we gotto fix this because in the future there's going to be a problem. Theproblems now. Yeah, yeah, absolutely so. How so, with thatcontext, in mind. How how are you creating innovative programs in this verycomplex, entrenched and tradition and old ways of doing things? How are youconceptualizing and launching and gaining adoption of innovative programs? Yeah, yeah, that'sa that's a great question, and the short answer that I'll give you isrecognizing opportunities and grabbing them before they disappear. Uh Huh. And that even goesback to the EICEEU. It was like, Oh, yeah, giveus an example. Yeah, I mean we've got a board of directors atBanner Health at the Times two thousand and five. So this is early inthe process that. And we've got a C suite, the you know,CEO, CEO, everybody see that is fully behind into this this project,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 ICEEU. So, you know, we've got everybody on board and let's seize the moment andreally roll this out and do it aggressively, and so that's what we did backinto five. So what does telly I see you. Let me justdescribe that to you very quickly. Imagine a bunker, if you will,a room that has board certified intensivists, critical care and nurses and administrative supportall sitting at multi screen computers that are connected audio visually in real time toevery intensive care unit bed at banner four hundred plus of seven states. Imaginethat scenario and then imagine a software algorithm that is constantly doing surveillance on thosestreams of data that are coming from the bedside, adverse trends, and sowe that's what tell you. I see is essentially, and we had fourduties. The way we described it to our colleagues is, number one,respond request for help from the bedside virtually instantly, and that's literally true.Can Be there with a board certified intensivist and audio visually connected to the roomin the blink of an eye. Okay. Thing is to identify those adverse trendsand then intervene before they become adverse.

Comes the proud us do that,because compters are much better at identifying those sorts of trends. If Iwalk by a room and the blood pressure is, you know, one andthirty at one point and maybe late in the day I walk by again andit's ninety. Both of those are kind of normal, so I might notnotice, but a computer would notice if that had been sliding all day longand it can send me in alert. So what battling those docks to dois to focus their efforts where they mattered. That we're going wrong. And thenthe third thing we did was helped along with the computer algorithms, withrote tasks. You know, everybody needs X or everybody needs why, andwith rare exception, we ought to do this for every patient we see,making sure those eyes are dotted and teas or crossed like deep vein thrombosis preventionor you know, stress alls for prevention. Those detail things that missed if inthe flurry of activity around, critically, I'll folks, unless there's a systemfor making sure that gets done. And then the fourth, obviously,is to measure what we do and improve. What made that work was the unwaveringcommitment of the Board of directors in the sea sweet, because there waslots of initially we had changing towels over the camera, treading to report meto the State Board. Interesting things took play. Yeah, I mean itwas exciting times. Right, right, what's ahead? I said right exactly. You know, that's really early. Yeah, yeah, it was it. And we didn't have rioting in the streets. I did have certain hecklerswho followed me around to every hospital presentation. Ultimately, and and here's where thepatients part came in, with the board to it took four years getgeneral acceptance. It took four years to prove that our Ali on this andit was expensive, but they stayed the course in today it is the largestand best eis use in the country. Mortality is some twenty percent lower thanpredicted. Linked to stay is somewhat around the same amount lower than predicted andit answers the question. Yes, better quality can cost less and significantly less. So that's an example of patients and patients and that taken advantage of anopportunity. There are a lot of places where it didn't do so well.The board was split or there wasn't that strong commitment, or the hospital startpushing back and saying this is a lot of money, I could use itover here, over here, and it took all of those things being inplace. So I give you another example. The in my current role, wehad a window of opportunity where the company was considering, Gee, whatare we going to do about telehealth? And we seize that opportunity and said, okay, let's figure out if we can, you know, as theJV, as the innovation engine, if we can slide something in here,you know, before everybody gets too focused on one of the big players,and get something going. And so we went through a process, which isquick by a large company standards, of about eight weeks of request for information, of comprehensive request for proposals near that field, down from fifteen companies toabout seven or eight, and then narrow that down further, two three thatwe visited on site and looked at what they were doing and we came upwith a great option. And I know you know about these guys. BeCould, I think, here recently, and that's ninety point six so andthat was a partnering opportunity that took advantage of and now we've got that rollingout, in fact, I think next...

...month, if I'm not mistaken.So that's another you know, it's an opportunity that windows close now. Idon't think we could do that today because of CBS acquisition and their relationship withcertain telehealth players and banners relationship with telehealth players and banners interest in building itsown. I mean, all of these interests are challenging to navigate, andso slipping that in is an example of taking advantage of an opportunity. SoI'm really curious. You know, a lot of our listeners or health innovatorswho are trying to sell their solutions, their wares too, folks like youand so any it could be those fifteen companies that were in the running couldbe listening today. And so what made ninety eight point six when that businessand stand out from some of these other innovators? Because I think that that'sjust some lessons learned that our audience can be able to take with them.Yeah, yeah, and guys, there are a couple of things I couldsay, actually quite a bit about that. But but let me start with Ihave not encountered any other company that came in the door saying, Hey, we think primary care ought to be available to everyone and we want toreduce the barriers to accessing primary care, and so we're going to try andoffer our services at, and I quote, a ridiculously low cost. Uh Huh, doesn't happen, right. I did not heed. Nobody else saidthat. They said, well, we charge the traditional rate and this,we do that, and it's like, yeah, I know, that's whateverybody says and that that was the that's an attention getter. Got, Yep, the the only part of it. I think that the other big pieceof it is you have that Aha moment when you say wow, yeah,everybody kind of does communicate the a text and yeah, I do like thefact that I don't have to be interrupted. And you know, and then forthat, what was palpable about their culture and how much time and attentionthey spend on taking care of the caregivers. You know, twenty percent of theirdoctor's time is devoted to making the system better. They built this andright, right. So you know, those things that they stand out,they really do. They get your attention. I think that's great. I thinkit's just great wisdom for our listeners. So so I want to kind ofdig deep a little bit into this. Is when you're developing these innovative programs, how are you involving or are you involving providers and patients into thatinnovation process? Are they ideating solutions to some of these most critical problems thatyou've got strategic initiatives wrapped around help me understand what that landscape looks like.Yeah, they certainly help identify the problem. You know, for example, priorauthorization. Nobody loves prior authors you know, patients hated, doctors hated, we hate it. It's just a pain to and you know often whenI say that, doctors will say, why don't you just stop doing it? Well, the answers is really pretty straightforward. It said we don't practiceevidence space medicine as a whole, health care and physicians, you know there'stoo much knowledge. You don't have knowledge management to degree you needed at thepoint of care, and so you tend to practice way you've always practiced.And that leads to why held variation in practice across the country, across countiesand even within the same group. And they can doing it right. Youknow, exactly possible. And so what... know, and the interest,obviously of the insurer, is to prevent over and over diagnosis. You knowthey're that's their job and you know the job of the doctors to make surethe patient gets what they need. And that's where that that's where the twomeet in prior and but if we could get the information to the dock inreal time at the time that they're seeing the patient, so that they knewif I want to get this MRI, the literature, and by the way, it's not the insurance company typically. Now say typically, because all thesethings are open to interpretation and insurance companies tend to lean to one way andanother. But the literature says, if I want to get this MRI,should try this, this and this first, and have I done that? Andif I haven't, it's going to get denied. So I might aswell either one go ahead and do that or go directly to appear to peerright now, instead of sending off a request, waiting for a week ortwo until somebody looks at it and then finding out that it's been denied andthen, yeah, this whole process is is is flawed. Yep, andnextive. That's what we're working on today. So so who identify that? Forus, it's all the people raising their hands saying I got a problemwith this, I got a problem with this, and it's patients, it'sdocs, it's insurers and a lot of money wasted on that process. Talkingtoday to a variety. In fact, we're anybody out there that's a solutionfor this. We're just in the process of identifying companies who can help ussolve this problem, and it's not easy. Right, you've got to the abilityto look at a chart in a variety of Mrs and that probably isgoing to require some ai and then you've got to have the ability to lookat expected clinical practices on the other end. It match the two and, youknow, be ideal if it could simply read the chart. Yeah,right, this ain't going to, you know, pass. And here's whatyou need to do. And, by the way, there's one of theirkey issue there. One of the things that's very frustrating is a physician isto have a conversation with the patient, build a trust, order an MRIand then have an insurance company deny and the first thing the doc thinks is, look, I'm the doctor, I know what's best. You will adMRI and the patient, you know, gets all huffy because the doctor knowswhat they're doing and the insurance company must be to blame. And that's notalways the case. I mean, so it's the doc isn't doing evidence basedmedicine, but they've already committed and they've already committed in a in an environmentof trust, and it's hard to back down from that. H help.Different of that is if you know up front. It's like you know,yeah, we could get an MRI, but let's try this first and onceyou know if the doctors committing to that, that's a much easier conversation with patient. You maintain trust, etc. So that's an example of how weare toying with focus group strategies to say, you know, how can we makethis better for you? The other thing that people complain about that we'veidentified as a huge bear is the EOB. You know at the expert benefits,that letter that you chet for the interns company that says this is nota bell, and it's like what the heck is it? Then you know, you try to figure out what's going on and you know we saved youthis much. From what you know. It makes no sense that we dothat. Nobody understands what it is. Why isn't it like a credit cardstatement? So you know, I mean like tronic decipherable. You'd be amazedat how difficult it is being it's part of it. As the claims lagright, there's that two to three months time that it takes for claims tobe processed and cleared. And, by the way, I've asked questions aboutthat and, Gosh, it's there are... many things in healthcare that's well, that's how we do it, you know. So duty for innovation.What if you had instant claims at judication? Wouldn't that be cool? So thereare lots of opportunities for innovation. It's, you know, the sky'sthe limit. And and a lot of this stuff it's kind of like,you know, Steve Jobs. A lot of stuff you don't have to askanybody. Just look at your own experience. What sucks about healthcare. Well,do you have a solution? Right, exactly. Some of it's not rocketscience, right, it's your discovery of the problem. So so whenyou're rolling out these innovations, you know we have I have a lot ofconversations around adoption and and so we might get some innovations out there that reallysolve of a viable problem, an important problem, but there really is justsome slow adoption by patients or providers. So help us understand. What aresome of the strategies that you've deployed to help with patient or provider adoption?Is there anything that stands out to you? Yeah, I you know, Ithink first of all you got to have a champion and whatever it isthat trying to folks to adopt, you know who is the key influencer?Hm, Huh, categoria. Is it nurses? Is it restored therapist?Is it doctors? Is it administrators? And then in that group you're goingto need a champion and if you don't have that, then it probably isbest to focus somewhere else where you do have that and then let those,you know, later adopters come on board once they see the proof of concept. So that's number one. Without a champion, it can be really,really tough to break into anything in health here. M I think the secondpart, and this is you know, it's something that I think is intuitive, but I ran into in a book I P picked up recently that someof you may have read called loon shots, and don't know if that rings abell for you, and it's. The author name is Safi. Thecall be Ahca L. I have not. I'm writing it down. Okay,loon shots. Yeah, he goes through some fascinating stories. So youknow about Nokia, about Panam and and what their trajectory was and why,after being radical and highly successful innovators, at some point they fall off.And even goes through a fascinating story of both the discovery and eventual implementation ofradar in World War II, which probably changed the outcome of the war,as did other like Einstein's discovery and the Manhattan probably set. But my pointis that most great ideas that you that make it to implementation get killed aboutthree times. You Watch this and it's and so what's needed actually, inaddition to a champion, is somebody within the company that is offering the innovationwho has the patients and the will and the resources to stay the course.You know, you've got to have a champion on both sides. Is kindof what it comes down to, Huh? And and the implementation requires and interaction. And what I mean by that he separates, but call separates outthe world into the causing the soldiers in the artists and the soldiers are thefolks that are using lean process to deliver what we know works reliably time atit critically important part of the process. But you introduce change those folks andit freaks them out. We got a pross. We got this down.What is this? And and if you can get them to take whatever itis your offering, they will look at... and they will say, Ican't use it, it's you know, it's this, it's that. Orwith radar it's too heavy. When I'm not flying with this in my airplaners, too hard to look at. Those are valuable cut those are he callsthem false failures, failures because even though those soldiers may say, I can'tuse this, it's garbage, what they mean is in its current form notas useful to me as it needs to be in order for me to adoptit. And iterative process there has to be. He likens it to phaseshifts. You know when when water goes from liquid to salad. That's aface shift. And he says you have to you have to hold it atthirty two degrees where you've got some ice. Those are the soldiers that and you'vegot water, and those need to exchange on a regular basis, toiterate until that innovative product is maximally useful and then it will get implemented.So it's champions on both sides and that concept of having a nursery for thatinnovation where it can have the opportunity to grow even as people try to killit. So so, Robert. I mean I think that that is hugeand I want to kind of sit with this for a little bit, becausehealth innovators, or even folks like yourself, sometimes have the belief where they haveto have the perfect solution and when they put in order to and ifI'm a health innovator, in order to present it to someone like you,I've got to have all the answers everything. I got to know what features andfunctionality you need. I've got to know what problem it's solving, I'vegot to know the business model. I've got to know all of these differentthings in order to be credible and order to, you know, get investmentin order to get buyers, and and so there's this kind of two parallelpaths of I got to have some semblance of what that's going to look liketo raise capital or to get buy in internal to organizations like you. Ialso have to have some semblance of that how I'm going to package that businessmodel in order to get pilot customers. But at the same time, toyour point, I need to make sure that I'm not so absolute in thosethings because I need to build, test, iterate, build, test, iterate, and and I think that. I think that as an industry,both you know, leaders like yourself and health innovators, that it's kind oflike it's just cut. It's very complex to navigate both of those areas andmake peace with it. Yeah, you know, and it's interesting and Ieven think that innovators may need to help at it, because there's educate,there's there's irrational expectations on both sides. Run, if you go to aprosument department, well, you know, it's almost like they expect you tohave thought of everything and fixed it before you bring it to me. Youknow it, and so that's an irrational expectation. And on the you know, and so it creates that expectation on the innovation side. And so Ithink here's what I would look for. I would look for someone who hasthought deeply about, you know, all of those potential issues, who ishonest about the ones that they haven't yet quite solved and are looking for interestor support and who are willing to offer a product that is not fossilized.It's like yeah, we could, we could tweet that. Yeah, wecan tweak this. I'll give you an example of that. In our currentrelationships. There's there's a company called hole on. It's just like the KenWilbur Term Hlo on, and they are a smart pipe. It's what theycall themselves. And and so smart pipe, smart pipe. Yeah, they information. The story goes by directionally.

In other words, we can takeinformation from database and put it in front of docks so they can close caregaps and whatever else. Oh and, by the way, we can doit Mr Agnostically, doesn't matter what your Emr is. Oh and, bythe way, we can put it in the workflow, so we're not askedseparate system, etc. Okay, cool. The implementation, in the implementation ofit has been a little more challenging and you know, folks get frustratedand well, it doesn't work. In the answer is, Oh, yes, it does, it does work. It's not perfected yet. The pipefrom database to physician works beautifully and that's that. Got Pad Technology for that. What we're all interested in, though, is, wow, if you couldhave a system that could pull information out of any MR and send itback to my database. That way cool. And and so you know, we'reall interested in net but that's not an easy task and it takes someiterations and some we've watched it work. Is it staable yet? Probably notmassively, the entire chart extraction, but pieces of it. Yeah, andand I can see a day when we get to the point where that's highlyvaluable. Now from a business perspective, hold on rightfully has to ask howmuch time and effort we put into this. With the on rule out there,may be solving this for everybody by mandate. Right, right. Thereare a lot of things that go into that. But my point is thatit ain't perfect yet is valuable and I can see where it's going. Imean the you know, it's kind of like the first automobile or two outthere. It's like what am I going to do with this? I meanI have to hand crank it, it's unreliable, there's no place to getit serviced. You know, I'll take a horse. Thank you. Well, but somebody could see the day when there were, you know, highwaysand and refueling stations and all that stuff, that that arguably made our lives muchbetter. So so it's early and everybody has to do that equation ofhow much risk, and I willing to accept and the innovator needs to beflexible in okay, if they're going to help me develop this and they're goingto put sweat equity into it, what do they get in return? Sobeing flexible on how you arrange it. and Oh, everybody's interested in whetheryou'll take risk or not. Now, that may not be appropriate for veryearly and a layers, but if some stage, if you're confident enough todo that, that's huge. Hmmm. So, yeah, what's so what'sthe ideal? Because I know are lit some of our listeners are in thatvery situation right now and they're making decisions around that. They're making decisions onwhat are the terms of their pilot with an entity like yours. So wherethere's this balance? You know, I talked about this phenomenon of death bypilot. Right, getting purgatory, pilot, purgatory, right, getting stuck inan organization like yours, where I get really excited. I can telleverybody, man, I've got a deal, I've got an engagement with Anna Etna. It gives me so much credibility. Quite frankly, it strikes my eak, strikes my ego, strokes my ego and and but then, youknow, am I going to be engaged for two years, four years,with no revenue coming in as we build, test and iterate? You know,how do I structure that relationship to where it works for everyone? Yeah, that's the I think. Yeah, I think you have to be willingto accept a no sometimes. MMM. Why do I say that? Well, because it is critically important. You...

...know, we're happy to we're happyto do pilots all day long, free stuff. Sure, most throw itout there. But if we don't define what success is, if we don'tdefine what we're measuring and make sure that what we're measuring is important to theorganization, and if we don't put a time limit on when we're going tomeasure that and what it means and where we go when that happens, it'spurgatory. It really is. Enforcing all of those issues is uncomfortable and it'slike, Oh my God, I'm going to lose the account. It's betterto lose the account then to give away free stuff and go nowhere and gotsome stuff. That's in Pilotte purgatory right now. And and I keep askinga question. How do we know the Pallet answer that question. There's.Yeah, exactly, how do we know when it's a success and how dowe know when it's over? Right, Oh my God, what does thatsuccess tell us about the next stage in our relationship? You know, what'swhat does the contracts supposed to look like? Now, okay, we hit thenumber you said we were supposed to hit, and when we hit thatnumber, you promised that we were going to get at least into your contract. And then here's what it was going to be. Structural. Yeah,you need to be talking about absolutely. I couldn't agree more. Absolutely.So what advice do you have kind of as we wrap up here? Whatadvice do you have for, you know, systems like yourself that are trying toinnovate within you know? How? How were we working together as acommunity to move the needle? What do we need to do? Yeah,you know, my advice to systems like like banner or Etna or CBS,frankly, is in order to nurture innovation, whether that's by partnership or internal development, you really need to separate out a section of the company, andI am going to protect this enclave of innovation. Now, that doesn't meanthey're you know, they've got free Willynilly, license to do whatever or whenever.But they have to have sufficient autonomy. M They are not held to taskby the lean machine. Right, yeah, that's different function, right, and God bless them, they got to do that. There is nothingthat I'm more passionate about than driving variation out of care delivery in healthcare.And that's a lean strategy. But that's not an innovations trash right, it'sso having that and this is loon goes into this, loom shots goes intothis, to separating that group out, giving them some protection. And nowthat doesn't mean you ignore your lean team. You got to. You got toget both some love, right, and and from some both some respect. But they have to have some fishing autonomy that they don't get cut thefirst time the budget gets you know. Yeah, absolutely, separate budgets,separate processes and systems, you know, just it's like two separate organizations,separate cultures. Right, exactly. The culture of efficiency and productivity is notgoing to be conducive to where are you innovation? Yeah, absolutely, andnow I don't mean that. It's really nearly chaos over on the artist side, right, right, about the term artist, you have one has towork 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 methat I have to do it in I... the Pentameter, that constraint.But you know, some of the greatest poetry ever written is written in Iam the pentameter because that constraint existed and the requirement was that here's your vehicleto express this thought. And so it leads to creativity, if you will, rather than stifling it. So good. I like to think of innovation inthe context of the sea suits as it really is corporate poetry. Right. It figuring out how to accomplish meaningful work, meaningful innovation, within theconstraints that you uniquely have around whatever that topic is. HMM, you know, that's the challenge. It's not always possible. Sometimes the Muse ain't there. But you know, the other other way of saying this is, Ithink Mark Twain was the one who said that I didn't have time to writeyou a short letter, so I wrote you along one. That's another wayof saying the same thing. Right, it's creativity is not chaos. Itis structured right. It is structured in a way that allows you to tothink creatively 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 but are in the trenches today? Yeah, it goes back to some advice that I got a long timeago, and that is that almost everything starts with relationships. Human relationships rightscome from. That's where opportunity comes from, that's where that's where the future ofhealth care is going to come from. If you are a health care innovator, get to know your space, get to know what other innovations areout there in your space, get to know folks that are, you know, on the lean team, that are making sure those processes iterate like clockwork. Expand Your network, expand your connections, and through that process you'll have moreideas, you'll have more opportunities and, happily, more failures, because themore failures you have, the closer you are to getting that one meaningfulsuccess that could drive your entire groom absolutely awesome. So that's great wisdom.Thank you so much for sharing with our audience today. It's been a greatdiscussion. I know that our listeners are going to get immense value from hearingthis episode well. Thank you, Roxy. That time went very quickly. Thatwas love. Thanks. What's the difference between launching and commercializing a healthcarein avation? Many people will latch a new product, few will commercialize it. To learn the difference between launch and commercialization and to watch past episodes ofthe show, head to our video show page at Dr Roxycom. Thanks somuch for watching and listening to the show. You can subscribe to the latest episodeson your favorite podcast APP like apple podcasts and spotify, or subscribe tothe video episodes on our youtube channel. No matter the platform, just searchcoiq with Dr Roxy. Until next time, LET'S RAISE OUR COIQ.

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