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 kind video program about health innovators, early adoptors 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 IQ listeners. On today's episode we have Dr Robert Groves with us. He is the executive vice president and Chief Medical Officer for Banna Etna, and I can assure you that we are going to have a very interesting dialog today about what it's like to innovate within a health system that has at least twenty eight hospitals. Last time I checked, a crossing or spanning over six states and one of the largest employers that we have in the United States. So welcome to the show, doctor grows. Thank you, roxy, and glad to be here. I'm looking forward to the conversation. So let's just kind of get started, like I do on every episode, by having you introduce yourself. You know what what do you do, and just tell us a little bit about your background. Sure, yeah, I'm on training is 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 gave up the direct patient care part of that. But you know, at the start of my career I was a traditional pulmonary critical care guy, seeing the in patients and both the hospital setting and in the outpatient setting. And then in well, my careers had some interesting twists and turns and about six years into it I stopped and tried my hand at a startup company. We were trying to do a voice to data technology and did that for a few years and then wound up joining banner health in two thousand and five, initially to roll out tell I see you, which say and describe in more detail as we get into this. And and then my way through the organization a variety of roles, became interested in population health and and at one point became the vice president of of Health Management for banner and then that evolved into chief medical officer 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 a joint venture between banner, which is a seven billion dollar integrated healthcare delivery system that started as a hospital system. Yeah, no, which everybody knows the name that. And of course, now we have a third partner in the mix. So that was recently acquired by CBS. So I find myself an interesting 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 such a gigantic, multilayered organization versus a startup that's trying to been build, it brind bring a healthcare innovation to market. So kind of before we get into the specifics around, you know, the the healthcare delivery system that you're living in 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 spent time in the military have described it, as a target rich environment. There is lots of opportunity for improvement and healthcare...

...and technology has to play a big role in that there is just too much information to manage and too much complexity to manage, even with teams of people. I mean no, health care is a team sport that's been around for a while, but it is becoming almost impossible to manage without the intelligent application of technolog alogies. That the challenge has been that many of the technologies that have been developed for health care have developed along the, I'll call them, at least in the United States, natural sylums, seem to be isolated from other parts of the system. So when you take on when one as an entrepreneur, takes on healthcare, I think the first thing that you have to decide is what problem are you going to try to solve, and once you figure that out, then you can start thinking about what technologies or what strategies might be different or innovative to allow you 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 is that here is so badly broken that I think we need transformative innovations, not incremental 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 bit better 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 that the opportunity to transformers because, let's face it, we've been talking about innovation and healthcare a couple of decades now and the costs continue to go up and we haven't really put a dent in that. I think there are a couple of reasons for that and that that has to do with why I'm in the 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 to get one's arms around the entire beast at the other reason I think that that happens is there's a tendency for shortsightedness in the commercial market and to the innovation really has to take place. And what I mean by that is in the commercial market, of course, the the primary customer from an insurer perspective, is business right. It's not necessarily all big business, but that drives a lot of it. And there's those one hundred to three hundred employee businesses and then there's all the small businesses, and those are the guys that are buying the products to deliver to their employees and they tend to to see results in a year or two. You know, they want to hate quickly and I think a lot of insurers end up promising things that simply can't be livered in that time frame. Hm, you know what I have gotten in the habit of doing with buyers, typically businesses, to say look, if you continue to do what you've always done in that way, then we're going to continue to see exactly what's happened over the last couple of decades. Cost or continue to go up. What needs to happen? I say it as we need patients and patients. We need the time to develop the strategies, to develop the technologies, implement them, test them, iterate, improve them to get to that point where we actually have a...

...transformational product that really can bring cost down 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 you truly believe is trying to do something different and then support them. Doesn't mean you you look the other way, for for bad outcomes, but you support them and you continue to iterate and you watch that foundation being built and pretty soon you'll see the building go up and Burge. Over the last year and a half that I've been with the others, the final thing I'll say about that rocks use. Complexity is the name of the game. You have to get comfortable with that. Used to think that I personally you how to fix here, I mean, and when I look at it now, I am, you know, ridiculous, because it is simply too massive for any one person to know how to quote, fix it. Believe is that if we get the incentives right, then there are lots and lots of smart people out there who will, on balance, actually fix this beast and give us something that's more beneficial and far less costly than what we have today. There's plenty of 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 we have to go? Well, I get the the one piece that's hard for individual people or companies to manage really is the government piece. Right. I mean approximately half of the money that flows through healthcare now flows through either Medicaid or Medicare or veterans affairs. Those, those pocketbooks, are the ones that are 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 fee for service is insight and I do believe that until that happens we're still going to struggle because, you know, it's not because healthcare providers are any better any worse than anybody else. It's that at the margin, when the incentive is you know, if you want to make more, you do more than at the margin, when there is honest debate about whether you could do another ekg or have another office visit on the more typically, individuals will do more if that incentive is there and can fix reduced costs by increasing volume. As long as that's there, it's hard to encourage true innovation. Now you get punished for doing the right thing. Since, yeah, yeah, absolutely. I had 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 shifting to that, because there's immense opportunity. They're engaging with patients all day every day, 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're not getting compensated for it. So we're not doing even though it could be helpful and moving the needle as if you know, for the industry as a whole. Yeah, and I do. It's not that I don't think there's anything we can do about that right, because I think there is. Because I 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 again is it's common to hear it's unsustainable and...

...what we don't hear is that we are currently in crisis. It's not a crisis that's coming. We are currently in crisis and the evidence for that, and you know, it's like boiling fraud, right. You know, frog jumped into bulling water, jump out if you go slowly. Well, we are boiling the healthcare frog in. The evidence for that is that people are putting off needed care. There are people who are dying because of the cost of healthcare, and I would argue that we have sucked up. We, being the healthcare industry, writ large every 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 tapeworm on American business. And so the crisis is now. It's not coming it and in the fact that life expectancy has gone down for the last three years running, and I think that's directly related to economics, and economics is directly related to the cost of healthcare. So we're in crisis now. It's not a 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 things are all tied together, and so it's no longer longer gee, we got to fix this because in the future there's going to be a problem. The problems now. Yeah, yeah, absolutely so. How so, with that context, in mind. How how are you creating innovative programs in this very complex, entrenched and tradition and old ways of doing things? How are you conceptualizing and launching and gaining adoption of innovative programs? Yeah, yeah, that's a that's a great question, and the short answer that I'll give you is recognizing opportunities and grabbing them before they disappear. Uh Huh. And that even goes back to the EICEEU. It was like, Oh, yeah, give us an example. Yeah, I mean we've got a board of directors at Banner Health at the Times two thousand and five. So this is early in the 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 that went 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 and really roll this out and do it aggressively, and so that's what we did back into five. So what does telly I see you. Let me just describe that to you very quickly. Imagine a bunker, if you will, a room that has board certified intensivists, critical care and nurses and administrative support all sitting at multi screen computers that are connected audio visually in real time to every intensive care unit bed at banner four hundred plus of seven states. Imagine that scenario and then imagine a software algorithm that is constantly doing surveillance on those streams of data that are coming from the bedside, adverse trends, and so we that's what tell you. I see is essentially, and we had four duties. 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 room in the blink of an eye. Okay. Thing is to identify those adverse trends and then intervene before they become adverse.

Comes the proud us do that, because compters are much better at identifying those sorts of trends. If I walk by a room and the blood pressure is, you know, one and thirty at one point and maybe late in the day I walk by again and it's ninety. Both of those are kind of normal, so I might not notice, but a computer would notice if that had been sliding all day long and it can send me in alert. So what battling those docks to do is to focus their efforts where they mattered. That we're going wrong. And then the third thing we did was helped along with the computer algorithms, with rote tasks. You know, everybody needs X or everybody needs why, and with 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 prevention or you know, stress alls for prevention. Those detail things that missed if in the flurry of activity around, critically, I'll folks, unless there's a system for making sure that gets done. And then the fourth, obviously, is to measure what we do and improve. What made that work was the unwavering commitment of the Board of directors in the sea sweet, because there was lots of initially we had changing towels over the camera, treading to report me to the State Board. Interesting things took play. Yeah, I mean it was 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 hecklers who followed me around to every hospital presentation. Ultimately, and and here's where the patients part came in, with the board to it took four years get general acceptance. It took four years to prove that our Ali on this and it was expensive, but they stayed the course in today it is the largest and best eis use in the country. Mortality is some twenty percent lower than predicted. Linked to stay is somewhat around the same amount lower than predicted and it 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 an opportunity. 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 start pushing back and saying this is a lot of money, I could use it over here, over here, and it took all of those things being in place. So I give you another example. The in my current role, we had a window of opportunity where the company was considering, Gee, what are we going to do about telehealth? And we seize that opportunity and said, okay, let's figure out if we can, you know, as the JV, 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 is quick 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 to about seven or eight, and then narrow that down further, two three that we visited on site and looked at what they were doing and we came up with a great option. And I know you know about these guys. Be Could, I think, here recently, and that's ninety point six so and that was a partnering opportunity that took advantage of and now we've got that rolling out, 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. I don't think we could do that today because of CBS acquisition and their relationship with certain telehealth players and banners relationship with telehealth players and banners interest in building its own. I mean, all of these interests are challenging to navigate, and so slipping that in is an example of taking advantage of an opportunity. So I'm really curious. You know, a lot of our listeners or health innovators who are trying to sell their solutions, their wares too, folks like you and so any it could be those fifteen companies that were in the running could be listening today. And so what made ninety eight point six when that business and stand out from some of these other innovators? Because I think that that's just some lessons learned that our audience can be able to take with them. Yeah, yeah, and guys, there are a couple of things I could say, actually quite a bit about that. But but let me start with I have 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 to reduce the barriers to accessing primary care, and so we're going to try and offer our services at, and I quote, a ridiculously low cost. Uh Huh, doesn't happen, right. I did not heed. Nobody else said that. They said, well, we charge the traditional rate and this, we do that, and it's like, yeah, I know, that's what everybody 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 piece of 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 the fact that I don't have to be interrupted. And you know, and then for that, what was palpable about their culture and 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 the system better. They built this and right, right. So you know, those things that they stand out, they really do. They get your attention. I think that's great. I think it's just great wisdom for our listeners. So so I want to kind of dig 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 that innovation process? Are they ideating solutions to some of these most critical problems that you'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, prior authorization. Nobody loves prior authors you know, patients hated, doctors hated, we hate it. It's just a pain to and you know often when I 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 practice evidence space medicine as a whole, health care and physicians, you know there's too much knowledge. You don't have knowledge management to degree you needed at the point 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 counties and even within the same group. And they can doing it right. You know, exactly possible. And so what...

...you know, and the interest, obviously of the insurer, is to prevent over and over diagnosis. You know they're that's their job and you know the job of the doctors to make sure the patient gets what they need. And that's where that that's where the two meet in prior and but if we could get the information to the dock in real time at the time that they're seeing the patient, so that they knew if I want to get this MRI, the literature, and by the way, it's not the insurance company typically. Now say typically, because all these things are open to interpretation and insurance companies tend to lean to one way and another. But the literature says, if I want to get this MRI, should try this, this and this first, and have I done that? And if I haven't, it's going to get denied. So I might as well either one go ahead and do that or go directly to appear to peer right now, instead of sending off a request, waiting for a week or two until somebody looks at it and then finding out that it's been denied and then, yeah, this whole process is is is flawed. Yep, and nextive. That's what we're working on today. So so who identify that? For us, it's all the people raising their hands saying I got a problem with this, I got a problem with this, and it's patients, it's docs, it's insurers and a lot of money wasted on that process. Talking today to a variety. In fact, we're anybody out there that's a solution for this. We're just in the process of identifying companies who can help us solve this problem, and it's not easy. Right, you've got to the ability to look at a chart in a variety of Mrs and that probably is going to require some ai and then you've got to have the ability to look at expected clinical practices on the other end. It match the two and, you know, be ideal if it could simply read the chart. Yeah, right, this ain't going to, you know, pass. And here's what you need to do. And, by the way, there's one of their key issue there. One of the things that's very frustrating is a physician is to have a conversation with the patient, build a trust, order an MRI and 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 ad MRI and the patient, you know, gets all huffy because the doctor knows what they're doing and the insurance company must be to blame. And that's not always the case. I mean, so it's the doc isn't doing evidence based medicine, but they've already committed and they've already committed in a in an environment of 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 once you 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 we are toying with focus group strategies to say, you know, how can we make this better for you? The other thing that people complain about that we've identified 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 not a 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 you this much. From what you know. It makes no sense that we do that. Nobody understands what it is. Why isn't it like a credit card statement? So you know, I mean like tronic decipherable. You'd be amazed at how difficult it is being it's part of it. As the claims lag right, there's that two to three months time that it takes for claims to be processed and cleared. And, by the way, I've asked questions about that and, Gosh, it's there are...

...so 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 there are lots of opportunities for innovation. It's, you know, the sky's the 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 ask anybody. Just look at your own experience. What sucks about healthcare. Well, do you have a solution? Right, exactly. Some of it's not rocket science, right, it's your discovery of the problem. So so when you're rolling out these innovations, you know we have I have a lot of conversations around adoption and and so we might get some innovations out there that really solve of a viable problem, an important problem, but there really is just some slow adoption by patients or providers. So help us understand. What are some 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, I think first of all you got to have a champion and whatever it is that 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 going to need a champion and if you don't have that, then it probably is best 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 second part, 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 some of you may have read called loon shots, and don't know if that rings a bell for you, and it's. The author name is Safi. The call be Ahca L. I have not. I'm writing it down. Okay, loon shots. Yeah, he goes through some fascinating stories. So you know 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 of radar 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 point is that most great ideas that you that make it to implementation get killed about three times. You Watch this and it's and so what's needed actually, in addition to a champion, is somebody within the company that is offering the innovation who 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 kind of what it comes down to, Huh? And and the implementation requires and interaction. And what I mean by that he separates, but call separates out the world into the causing the soldiers in the artists and the soldiers are the folks that are using lean process to deliver what we know works reliably time at it critically important part of the process. But you introduce change those folks and it freaks them out. We got a pross. We got this down. What is this? And and if you can get them to take whatever it is your offering, they will look at...

...it and they will say, I can't use it, it's you know, it's this, it's that. Or with 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 calls them false failures, failures because even though those soldiers may say, I can't use this, it's garbage, what they mean is in its current form not as useful to me as it needs to be in order for me to adopt it. And iterative process there has to be. He likens it to phase shifts. You know when when water goes from liquid to salad. That's a face shift. And he says you have to you have to hold it at thirty two degrees where you've got some ice. Those are the soldiers that and you've got water, and those need to exchange on a regular basis, to iterate 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 that innovation where it can have the opportunity to grow even as people try to kill it. So so, Robert. I mean I think that that is huge and I want to kind of sit with this for a little bit, because health innovators, or even folks like yourself, sometimes have the belief where they have to have the perfect solution and when they put in order to and if I'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 and functionality you need. I've got to know what problem it's solving, I've got to know the business model. I've got to know all of these different things in order to be credible and order to, you know, get investment in order to get buyers, and and so there's this kind of two parallel paths of I got to have some semblance of what that's going to look like to raise capital or to get buy in internal to organizations like you. I also have to have some semblance of that how I'm going to package that business model in order to get pilot customers. But at the same time, to your point, I need to make sure that I'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, both you know, leaders like yourself and health innovators, that it's kind of like it's just cut. It's very complex to navigate both of those areas and make peace with it. Yeah, you know, and it's interesting and I even 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 a prosument department, well, you know, it's almost like they expect you to have thought of everything and fixed it before you bring it to me. You know 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 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 are looking for interest or support and who are willing to offer a product that is not fossilized. It's like yeah, we could, we could tweet that. Yeah, we can tweak this. I'll give you an example of that. In our current relationships. There's there's a company called hole on. It's just like the Ken Wilbur Term Hlo on, and they are a smart pipe. It's what they call themselves. And and so smart pipe, smart pipe. Yeah, they information. The story goes by directionally.

In other words, we can take information from database and put it in front of docks so they can close care gaps and whatever else. Oh and, by the way, we can do it Mr Agnostically, doesn't matter what your Emr is. Oh and, by the way, we can put it in the workflow, so we're not asked separate system, etc. Okay, cool. The implementation, in the implementation of it has been a little more challenging and you know, folks get frustrated and well, it doesn't work. In the answer is, Oh, yes, it does, it does work. It's not perfected yet. The pipe from 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 could have a system that could pull information out of any MR and send it back to my database. That way cool. And and so you know, we're all interested in net but that's not an easy task and it takes some iterations and some we've watched it work. Is it staable yet? Probably not massively, 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, hold on rightfully has to ask how much time and effort we put into this. With the on rule out there, may be solving this for everybody by mandate. Right, right. There are a lot of things that go into that. But my point is that it ain't perfect yet is valuable and I can see where it's going. I mean the you know, it's kind of like the first automobile or two out there. It's like what am I going to do with this? I mean I have to hand crank it, it's unreliable, there's no place to get it serviced. You know, I'll take a horse. Thank you. Well, but somebody could see the day when there were, you know, highways and and refueling stations and all that stuff, that that arguably made our lives much better. So so it's early and everybody has to do that equation of how much risk, and I willing to accept and the innovator needs to be flexible in okay, if they're going to help me develop this and they're going to put sweat equity into it, what do they get in return? So being flexible on how you arrange it. and Oh, everybody's interested in whether you'll take risk or not. Now, that may not be appropriate for very early and a layers, but if some stage, if you're confident enough to do that, that's huge. Hmmm. So, yeah, what's so what's the ideal? Because I know are lit some of our listeners are in that very situation right now and they're making decisions around that. They're making decisions on what are the terms of their pilot with an entity like yours. So where there's this balance? You know, I talked about this phenomenon of death by pilot. Right, getting purgatory, pilot, purgatory, right, getting stuck in an organization like yours, where I get really excited. I can tell everybody, 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, you know, 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 willing to accept a no sometimes. MMM. Why do I say that? Well, because it is critically important. You...

...know, we're happy to we're happy to do pilots all day long, free stuff. Sure, most throw it out there. But if we don't define what success is, if we don't define what we're measuring and make sure that what we're measuring is important to the organization, and if we don't put a time limit on when we're going to measure that and what it means and where we go when that happens, it's purgatory. It really is. Enforcing all of those issues is uncomfortable and it's like, Oh my God, I'm going to lose the account. It's better to lose the account then to give away free stuff and go nowhere and got some stuff. That's in Pilotte purgatory right now. And and I keep asking a 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 do we know when it's over? Right, Oh my God, what does that success tell us about the next stage in our relationship? You know, what's what does the contracts supposed to look like? Now, okay, we hit the number you said we were supposed to hit, and when we hit that number, 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? What advice do you have for, you know, systems like yourself that are trying to innovate within you know? How? How were we working together as a community 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, and I am going to protect this enclave of innovation. Now, that doesn't mean they'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 task by the lean machine. Right, yeah, that's different function, right, and God bless them, they got to do that. There is nothing that 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's so having that and this is loon goes into this, loom shots goes into this, to separating that group out, giving them some protection. And now that doesn't mean you ignore your lean team. You got to. You got to get 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 the first 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 not going to be conducive to where are you innovation? Yeah, absolutely, and now 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 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 do it in I...

...am the Pentameter, that constraint. But you know, some of the greatest poetry ever written is written in I am the pentameter because that constraint existed and the requirement was that here's your vehicle to express this thought. And so it leads to creativity, if you will, rather than stifling it. So good. I like to think of innovation in the context of the sea suits as it really is corporate poetry. Right. It figuring out how to accomplish meaningful work, meaningful innovation, within the constraints 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, I think Mark Twain was the one who said that I didn't have time to write you a short letter, so I wrote you along one. That's another way of saying the same thing. Right, it's creativity is not chaos. It is structured right. It is structured in a way that allows you to to think 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 time ago, and that is that almost everything starts with relationships. Human relationships rights come from. That's where opportunity comes from, that's where that's where the future of health care is going to come from. If you are a health care innovator, get to know your space, get to know what other innovations are out 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 more ideas, you'll have more opportunities and, happily, more failures, because the more failures you have, the closer you are to getting that one meaningful success 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 great discussion. I know that our listeners are going to get immense value from hearing this episode well. Thank you, Roxy. That time went very quickly. That was love. Thanks. What's the difference between launching and commercializing a healthcare in 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 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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