Health Innovators
Health Innovators

Episode · 3 years ago

How to Avoid Pilot Purgatory in Healthcare Innovation w/Dr. Joseph Kvedar, VP of Connected Health with Partners HealthCare


The commercialization process in healthcare is very complex, and it’s impacted by a multitude of factors and circumstances. Why is commercialization so much harder in the healthcare industry? What are the biggest mistakes innovators are making, and how do these mistakes make growth impossible? What do we need to be mindful of when trying to get into a delivery network or hospital system?


On this episode, I’m joined by Dr. Joseph Kvedar, VP of Connected Health with Partners HealthCare. Dr. Kvedar is a pioneer, early adopter, and influencer in the field of connected health. We talk about overcoming the commercialization difficulties in healthcare that so many innovators face.


3 Things We Learned

  • What makes it so challenging to commercialize an innovation in healthcare
  • Why having the most advanced/superior innovation is meaningless
  • How to successfully get into a delivery network or health hospital system


When healthcare innovations are still small, just starting to garner entry level interest, is when they are most vulnerable to facing issues that impede commercialization. Whether it’s losing a key team member, or encountering changes in the market, that randomness is inherent in bringing innovations to market. There are ways to mitigate this, however.


It’s critical to settle the “people issues” early on and understand your product-market fit. Raise only the right amount of money, and spend it thoughtfully. Line everything up to present the best business case possible.

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. On today's show, we're going to talk with one of healthcare's pioneers, early adopters and top influencers in the field of connected health and, frankly, somebody that I admire most in this industry. Dr Joseph Caveter, the vice president of connected health at partners healthcare, is going to share with US why some healthcare Devasians fail to commercialize and why some succeed. He's also going to share with us some of the biggest challenges health innovators will face in two thousand and nineteen and how to overcome them. Welcome to the show. I'm delighted to be with you, Roxy. Thanks for inviting me that so. I think that you've been leading the way in this field for for decades. So most of the people that are listening to the show are probably already know who you are, but just in case, we have a few people that don't. Maybe we can just start off the conversation by you sharing a little bit about your background and what you do. I'm delighted to do that. I don't think I'm so very popular that I introduced myself. For sure, I am a dermatologist by training, faculty or Professor Actually at Harvard Medical School, and really that's my roots as a clinician. But about twenty five years ago I got intrigued, frankly obsessed with a concept that why is it that we demand that healthcare happens when two people are together in the same room and that's the only way you can get healthcare? And actually today, as we speak, the adoption of any other type, which will get into terminology I'm sure, is still only about twelve percent among doctors, twelve to fifteen percent. So twenty five years later, we've made a dent. Ways to go and and so I still keep hammering away at that concept. And and so that took me to this land that we now called digital health. In the beginning we call it tele a medicine, and we just kept jinning up programs illustrate that concept. Some of it was interest of our parent institution. I was, I am a clinician at the Massachusett Central Hospital in Boston. So they wanted to do a lot of work overseas with second opinions. So we put that program together. We also got interested in chronic illness management because it's a big problem, and I should mention also, because we're talking about successive innovation, that one of the things I did early on was to launch beyond dermatology. And as much as I'm passionate and love my clinical work, it is a very small part of healthcare. I just felt like if I was going to make a difference in this new care model, that I really had to get beyond dermatology, which is why chronic illness management, online, second opinions, all of these other things that we do. And so that that was the start and then we went we went through some lean years for sure. I was taying mentioning to someone a yesterday that in about two thousand and five we got we thought we that tell a medicine was was no more. So we abandoned that name and we invented the connected health and we really did it because nobody wanted to talk about tell a medicine. Wow. So we've got, you know, we're going to we're going to create a new word so people will actually ask us what it means and we can talk to them. And and that was what we did. We said, connected health sounds novel, let's talk about that. And sure enough, Oh, what's that? How's that work? And it worked.

So it became a term of art in the industry and I think still is to a great extent, although very recently, probably surmounted by the term digital health, which is which is certainly all encompassing. So that leads us to the present, where I have a system level oversighted our delivery system for telehealth programs. I still have a strong foothold in our innovation group, which was recently rebranded as pivot lab, so they're helping its throw a lot of corporate partnerships create the future of digital health and I have the privilege of doing things external departners which I love, such as, and maybe we'll come back to this, but cochairing the Ama's committee on digital payment reform, working with a double AMC advising some number of companies. So it's it's a really fun job and you can tell I'm delighted to talk about it. And let's just talk a little bit about the conference because that's how we met and there's that right. So so, yeah, Fifteen, sixteen years ago now. I kind of lost track. My colleague Joe Trenello has this idea of bringing people together, convening, and it grew over the years. In Twenty Fifteen, two thousand and sixteen we combined it with the personal connected off the lines at hymns and they're connected off conference. So it's now hymns event. It occurs every October. I am privileged to be program chair, so it's my job to line up the content, which I do with a very, very capable group of people at my side. And I think again, as you were talking about innovation and the role of convening, it's amazing to me I was recently at a because another interest of mine is technology and aging, and I was recently at a meeting that the dean of Harvard Medical School convened a number of people in the in the area and just the rich tapestry that we build on movie when we meet New People a similar interests as very special. So these these events that we all go to now and there, and when we started the conference there were about probably four or five, four or five a week and everyone has to sort of split their time and choose wisely. But but the value is so much in the networking and the sharing of ideas and I think that's an innovation feeder as well. I like to say that you were doing it before it was cool. Well, people in the beginning, and again, this is this is you know, we're talking about success in innovation. But people thought I had lost my mind, truly they did, because I was in the lab right around here in the Harvard teaching hospitals. That's the path you you open a lab, you do basic research, you get promoted aster you become a chair and the Dean and that's thank and I just that wasn't for me. So they really thought I had kind of abandoned ship stuff. And in they on the early days it was a little bit of rough sailing, but we got by that. Yeah, and look at you now. So you know, a big part of the reason why I even started this show is this stat that I've been so passionate about and spent like the last six years kind of, I would say, being married to, is that over ninety five percent of healthcare innovations brought to market, fail to generate a profit or reach any acceptable level of customer acceptance. And and and so I would love to get your feedback, and I know the listeners would as well. Why do you think that some healthcare innovations fail and some succeed? Well, of course there are multiple, multiple reasons. I could tell...

...a story of a company that we launched out of our center in two thousand and ten called health rageous, and it was. It was an early play and remote monitoring for chronic illness, but but in the in the corporate corporate benefit space. HMM. And the reason I tell that story isn't to tell that the details of that company, but to illustrate one point, which is we were doing really well. We had four major health plans piloting the solution and they were giving really good feedback. And then all those affordable care act exchanges happen, MMMU, and every single one of those within a week said we're not going to continue working with you because we have to focus on the exchanges. So those kind of you know, when you're when you're small and you have entry level interest in what you're doing, you're so vulnerable to the way the wind blows or anything else right, the executive that's your champion leaves the company and nobody else seems to want to pick up the contract. And so that randomness is inherent in in bringing innovations to market. And sometimes there are quite legitimate reasons that companies fail, like from a product perspective, there's not a product get fit. Yeah, and there's a there's a founder. Often, and this isn't meant to be a slander, but it is. It is, I think, accurd. Often someone from technology or engineering who is passionate about a technology and feels like that's going to do the thing, and and so. And one rule I would say that we must all follow us that technology should never lead, it should always follow a business problem. So that's one thing that you see a lot of. I think we're talking about this the other day, how it's become fashionable to raise a lot of venture money. People seem to measure their entrepreneurial success by the amount of venture money they can raise. I suspect part of the reason for that is right now it's there's a lot of venture money out there, and so people can raise tens of millions of venture fun. But what you do with it? If of course, is critical and and if you don't have the mindset to use capital efficiently and thoughtfully, you can see companies go south very quickly that way as well. And then I think again, they're probably I'm forgetting or not mentioning ten times as many as I'm mentioning here. But the other, the other one that I see a lot of is, unfortunately, people problems. Hhhuh, it it. You spoke about being married to a concept. When you form a company you're married to your fellow executives, M and if, if it and because it's brutal. The the path is breathtaking building any business. I'm sure you feel that way building your business. But if you don't get along with those people or if there's early like you didn't have the conversation about equity that you should have with your that can ruin a company five five, five or six or ten months into it, when there's a real feeling and negative feeling or miss understanding, because those of the times when you can't stop and repair it because fly out tomorrow to see a customer that you didn't know you're going to fly out to see because they're either going to sign a contract or they having a problem, it just gets to be breathtaking.

So I think settling the people issues early on, understanding and really really being humble about product market fit. Mm were raising only the right amount of money, not the most can raise, and then spending it thoughtfully. The other thing, which is related to that, that I definitely see as people who don't bring on. Now, not every startup needs a CFO right away, but you need a control or you need someone who can keep the books, because sloppy use of finances is a big potential problem. So those are a few thoughts. Probably, as I said, there's ten times more that I didn't mention. No, I think that's great insight. You know, just kind of going back to one of the things that you said, I see it all the time with innovators, you know, the innovation and becomes their baby and they love their baby. So everyone else is going to love their baby. And you know, most people won't tell you the truth. They'll just say I love your baby. To nobody wants to tell you that you have an ugly baby, or unless unless you're you're the person there, e're they're asking you to pay money for it. Right right. Yeah, that's true. Absolutely one of my other favorite I I subscribe to a newsletter from an investment banker, and part of the reason is that it's an area of business that I don't fully understand, so I'm eager to learn. But he is a this guy is a very simple and that's one of the reasons I read is stuff is because it's huge. It's it's like plain English, and he always has what are you doing that people care enough about? What is the problem you're solving that people care enough about to pay you to solve? MMM, and will they pay you enough that you can make a profit? Absolutely simple questions. And and yet, and this is especially in this economy where people are building businesses based on aggregating and then monetizing later and all that kind of stuff very kind of opaque fairly quickly. Yeah, you know, that's so true. A lot of times there might be a real problem that the innovation can solve, but if it's the last on the priority list, you know, then it's really pointless. And so I see a lot of health innovators spending a lot of time arm twisting trying to convince the target audience that they have a problem that they need to solve. Yeah, another fun, fun thing I see with with startups, and maybe again if this is the direction you want to take it. Otherwise you can shut me up and move on. But that's when you ask them about competition and they'll say, well, no one's really doing what we're doing. Right, I say, but that's not what I asked, because people are solving the problem that you're trying to solve somehow. And in my own case, having put been been an advocate and evangelist for a New Care Model for twenty five years now, every single day I wind up in front of someone who's quite happy with the old care model, thank you very much. And even though I can logically tell them about what I'm want to do and why it makes sense, they don't need to change. They're solving that problem another way and it suits them just fine. So I think that's a big DOS reality that entrepreneurs need to take as well. As is the competition may not be someone who's who's got your tech innovation, but maybe maybe someone's doing it with pen and paper and they're doing just fine. They don't need your system absolutely, just a substitute of status quo. Right. Yeah, yeah, so you know what?...

I also see very often. is even so, even if someone has a product and innovation that is technically or functional at least superior to what's available in the market place, which is basically what you just brought up, it doesn't necessarily guarantee success. You know, could this cold commercialization process is very complex, especially in healthcare. What? What? What do you think makes it even more complex to commercialize and innovation and healthcare may be compared to other industries? Well, I reluctantly answer that question because I wish it wasn't so. It is. So I quite agree with you, but I feel bad about that. And again I think it discourages some very entrepreneur people from getting near healthcare because they feel like sales cycles are long, and they are. I mean, selling anything to my health system is a multi frankly year process in most cases and you have to get so many different people, whether it's the finance people, the clinical people, that, etcetera. It's better the regulatory people maybe go to throw in it, privacy and security at the list seems to go on and on, and so I think there there is that duality about what we do, that there's always a clinical voice. Hmmm, one of the things I don't carry, you know, and we don't always agree with our friends in the pay or industry and the pharmaceutical and cry, but we all are obligated not to hurt you, hm, you the patient. We are obligated to do the thing it doesn't hurt you. So we are inherently more or less risk averse or more risky. We're inherently more risk averse and I think that that, that's that runs through and through. That's why long sales cycles, that's why multiple eyeballs look at things. That's why you have to convince the Clinical Committee, not just the CFO, and on and on and on. So I think that's the main reason. It's just it's fragmented sales and and they're the other thing is that, unlike many other and I'm speaking most mostly about the provider side now, although I think certainly translates to pay. I'm not as sure about farm it. But no, you know the way we used to we used to the the the way we would phrase it, and I would say joke, but it's not a joke, is it? If there's a table full of people making a decision, one person can say no and the answers no, HMM, even if the rest of the table says yes. So it's that kind of sort of consensus driven decisionmaking process that makes it, I think, a challenge for people to make sales and, as I alluded to earlier, they're all trying to display something we do now. One of the things that I think you know, so that nobody starts crying and turning you off and doesn't want to hear it. One of the things I can say that I think is positive, and I have I have an example of it, is the bright people will look at it and in the first best business case is how to make someone money. HMM. So you bring in something that helps make them money. The second best and it can be second best by all long shot. It's it's not like right up there, because it's a harder thing to sell, is how to make them more efficient, save them money, and and most digital health innovations fall in that second category. And it's just hard because you're making the you're promising the sales target. Pay Me a dollar now and I'll save you ten next week, and the person writing the checks feels like they're going to lose their dollar and then may or may not see that ten and it's buried... the back. It's a little bit like the reason that companies like Phillips, Gee, etc. Our successful because if we buy at the Massachusetts Hospital another m magnetic residence imaging set up, there's a lot of people out there that need MRIs. We know we're going to generate revenue on that. It's a straightforward investment. But if someone comes in and says I am a software tweak that allows the medical technician to be more efficient, that's a much more thoughtful, nuanced conversation. Maybe we don't want to lay off medical technicians, maybe we have a there's a union problem. There's all kinds of reasons that might not be a good sale, whereas Oh, make me money, sure, sign me up right right. One of the companies that's a spin out of our delivery system that I think is has done a brilliant job in this, and I'll use that example, is a company called Medumo, and so what what they kind of started out with was, we know, reminding people to come in for appointments. That seems like a noble cause, right who we a lot of people forget appointments and so forth, but it didn't really catch on until they figured out the better use case, which is reminding people to come in for their screening call on Oscopy. And, if you think about it, a screening call on oscopy takes a lot of time. You got a prep for it. It's a big deal. And the on the other on the provider side, one of the worst days in a gastro in trilogist life is when people don't show up for the procedure because they booked the time, they booked all the staff, Huh, and there's no way to utilize it. It's very disruptive. So the guys at medumo found this interesting niche where you, as an individual don't want to go through all that prepping for nothing. HMM. We, as people providing the service, don't want you to be a no show. And they capitalize on both sides of that and they're doing quite well now their business model as we pay them. But again, we it's easy for us to justify paying them because every time someone shows up for a Colonos to be all those resources are used wisely. That's, I think, a good example of someone finding a sweet spot with a technology that in the beginning, because they of course a lot of them doing, and it's fun for me, but they came to me when it was just reminders and it was kind of a hole home show, Shrug your shoulders project. But but they eventually found this sweet spot. So how is that discovered? was was that discovered through dialog with prospective customers? Is it something that they just stumbled upon? You know, how did they move from more of Hey, we're going to go to market with this, right, and and then kind of that slight nuance what actually becomes a game changer? Yeah, well, I think they the they did have some unfair advantage and that they were the founders, were a physician residence training in our system. So they had multiple different views of ways that a hospital might or might not benefit from from this tool. And I honestly think it was there was some randomness to it because they had a lot of different conversations with their fellow trainees and so forth, and it fell into someone's head one day that Oh wow, and again it doesn't have to be calling Oscary, but but it's something that if you miss that appointment, it's a big hit to me. Right. So I can in my world as a dermatologist, could be most surgery where you're coming in for skin cancer, we've got all these resources lined up and...

...then you don't show. That's probably one of their next use cases is they'll roll something out for that. So they're going around the healthcare delivery apt bars picking out those times when, if you don't show for an appointment, it's a real pain for writerer and then therefore for us to pay. I don't know what it is per message, just not a lot. All of a sudden it makes sense. So if you had a health innovation company, innovator approaching you, what would you say are the top three or five things that you're looking for that they need to be mindful of is they're trying to get into a delivery network or health hospital system. So I'm going to try to answer that in a relatively generic way. I want to separate out my passion for connected health because I'm usually looking for like Meduma was, as I said, that the the initial conversation they had with me. I was I was lukewarm at best. Uh Huh. was text messaging is kind of a yesterday's technology and again they turned it into a successful thing. So good for them, but it should, as I said, it should be something that is going to either enhance our practice delivery or if it's on the efficiency side, and I happen to love efficiency, but but again it's heart. It's a harder sell. Well, the efficiency side it's to me it's got to enable and empower patients to do more of their own decisionmaking and inspire them to take better care of themselves, because we need that desperately. And so that's a little personal, but I do look for that. Like there's so many people out there that say we're going to and and this is going to sound awful because it's countercultural right now, but we're going to offer you roxy to show your medical record on your iphone. I mean for you, because you're educated and engage, that might be a good thing. But for a lot of people who like, why do I care? Right and what? What? I can't read the darned thing. It's written in a different language. I don't even know what anything of the numbers need. So I just talked to a guy yesterday who's done what he calls a health infographic view of the EHR, and I haven't really studied it in great detail, but to me that's kind of interesting. Right. If I could make what came out of the apple APP, that was your health record, something that you could look through and digest the high points and it would make sense to you. I think that's a breakthrough. Hmmm. For me that part is really important. And then, as I said, the numbers have to work. That's number three. It can't be one of my favorite examples. As I said, I like innovations that touch on aging and one of my favorites was a Japanese robotic pet called PARO parrows. It looks like a seal. You may have seen one. They cost six thousand dollars. No one's buying them. Yeah, you can't sell them. Hasbro came along and created something called a joy for all companion pet at a hundred bucks. It's not as sophisticated as Parrow, but they're settling like hot kicks because the price is right. So that equation about price is really important. And and then, you know, the sort of corollary to that one is that people come in because they think, well, our price is high, but we're going to deliver a lot on Roi. And, like I said, that's asking me to make an enormous leap of faith. Mm Huh. Which I may or may not believe in. So it's hard when you're when your stuff's expensive at out of the gate, and some technology these really are and and that's a harder hills to climb.

And then, finally, this is kind of going to be consistent with what I said earlier. To help you know, Pete, present as a group of people with integrity. Present as a group of people who are professional, have the sophistication understand that, for instance, if you're going to deploy and it system, we have to have some integration, we have to pass a security on it. We can't just throw stuff on our network. It's a little bit and and again, this is what how do I phrase this without sounding like an old timer? But be again, be respectful and thoughtful. There's a lot of young most of the time they're young entrepreneurs, who are just a little bit flip about stuff like that. MMMUM, and that's kind of a turnoff. Sure, Yep. So let's talk a little bit about the pilot phase of the innovation process. You touched on this just a little bit. You know, it can be a real challenge for health innovators. You know, obviously everyone needs the clinical evidence to you know, to be able to validate the safety and efficacy of their innovation. But a lot of companies get stuck in what I call pilot purgatory. I know is I say it's death by pilot. You know these health innovators that go out of business because it's one pilot after another. You know, describe your experience with that phenomenon and then maybe some some recommendations of how innovators can avoid pilot purgatory. Well, you haven't given me anything easy yet. So that's the way to spend an hour to think some of these things through with you. That that's a really tough on. I think one one first bit of advice is is don't over customize the solution for each new customer. MMMM right. So you come in and say well, we do blue papers, we fold them over a red paper and that's our product. And we say well, we kind of want green and you've never done green and you've got three other customersitors in blue and red. Just say no, just say no, we don't do green. If we ever do green, will come back. But have the guts to not over customized, and especially when you're in that early phase. We're getting early customers is so critical. It's a real risk and you can't be stubborn enough that you have this vision that you alluded to this earlier, that no one will buy. Well, no, I didn't mean that, but but if you have five pilots going in there, all pretty different, that's a problem. Absolutely. I think that that is something that we just can't stress enough because it's so easy to get caught up in the you know, the hospital system that has all the brand reputation, and so I feel compelled to just acquiesce to everything that they want because that's going to be my path to success, and it can be so much to where you don't have anything viable at the end. I think the other big, big, big, big piece of advice is to is to have, I guess, take a lesson from the Japanese. You know, the Japanese negotiate for years before they do anything, and they do that for a number of reasons. But but before you sign that precious pilot agreement, ask a lot of questions about I'm one of my favorite things to do with people just in generals to say, okay, let's pretend that X, what we're talking about, is wildly successful hhhuh. Then what? And sometimes you sometimes you're the person across the table actually doesn't have budget, doesn't have spending authority, can't really hire you, even if the pilot successful. So you do you got to do a little bit of sniffing. Does that that person the one who's going to implement...

...this system, as I alluded to early? Do they need a committee of five to say yes? Do they need to run it by the CFO? Did they need to run it by the board? What is the path? And you do that through this sort of socratic approach where you say, well, I know my pilot is going to be successful, and you kind of Joe, you know, ha ha, but but just let's pretend it is for a minute then, and I think the more granular you get about that and what a success mean, by the way, if so, well, it worked but it didn't save us any money, or it worked but ten people complained. If one patient complain, we can't do it. I mean you all, I wish told me that right, because you know that would have wasted my time. There's this whole other side of it which is about, and this is a hard one for for startups, whether you whether you give the technology away, whether you in of course, our group we have a clinical validation group and pivot labs and companies pay us to validate their technology. So it's a reverse pilot in that way. Yep, but I would say we're in the minority in that regard. But but again have that conversation about and and I guess the other, at least an academic center's, major pot hole you can run into is that you're across the table from someone whose goal and pretty much only goal is to publish a paper, usually and and they're they're important because you then get to take the paper around and say we validated our technology at Hopkins or Mayo or Cleveland or wherever you like. Yep, but again, those people are that their career path is about the paper. It's not about putting you into the system and scaling that pilot. So that's when you sort of say, okay, well, if we're successful, who might theoretically pay for this and how big could it get? And would that be your department share would it be would it be someone in another sector? Would it be hospital leadership? Depends on the APP or the technology. But I think that's really and not that you can avoid pilot purgatory that way. But I think with if you follow those two rules, you can lessen the chances of it. I think that's great wisdom. Thank you so much. I know our audience so appreciate peering that. So the last question I have for you before we open it up to live Qa is there is this explosion of innovation happening right so. You know, twenty years ago, ten years ago, if you had a new innovation, you know it might be more easy to get in front of people. But one of the things that I hear over and over people are asking me is how do I rise above the noise the target audience that I am going after, you know, a thousand, five, hundred, tenzero other innovators or trying to get in front of front of them as well. How do I rise above the noise? Any advice that you have for folks regarding that? Well, cannily, it's really more your expert teeth than mine. But but so so this is half baked compared to what you could offer. I mean it's I have made a career, frankly, out of learning from other industries and bringing those learnings into healthcare. Part of the reason that I started in this space to be in with because other people were held with hello, rendering services without having to be in a room together. What an idea. I think there's a healthcare equivalent to celebrity endorsements. HMM. There's a healthcare equivalent to getting buzz on social media. Right there. The same tools that you would use if you had a new perfume or if you got Kendall Jender to where your jewelry or whatever.

It's not exactly that, but but those are not off the table. Yeah, get get and Rayson Herowitz to invest in you. I mean, I know that's Oh, sure, thank you, but but but my point is showing a lot of money out there and and choose your VC's wisely and if they have that kind of star power, use it. Hm. So I think you know, one of my another company that I admire, and I'm actually in a discussion with this founder about doing more with them, is Lark and their chat bought company that has done a lot of work in chronic illness management. But but one thing I admire about Julie is the way that she has done exactly what you describe. So she's on instagram. You you've scrolled through your instagram feed, you see ads for Lark. She's she's got. You know, our slide deck has ten different awards that she won for being the best of something. Now she's darn good, but I'm sure there was some engineering behind at least some of those awards. Sure, yeah, absolutely. You know, you get someone again like yourself who knows how to create a bit of buzz. And and I would not we were talking about earlier about spending money wisely, I would not underestimate spending money on PR and marketing. It's really important. I and in a I'll tell you the reason, and it is because if you really have an innovation, if it's really truly different, people will be, as I said earlier, people will be solving that problem a normal way and they won't even think to invite you to the Party and, let's say, know about you. Yeah, yeah, absolutely, I think that has a lot to do. I think that is great, and in you I have marketing insights maybe that you not even aware of. Well, I've hung around folks like you for a while. I have good folks that's around me that I learned from. I'm a lifelong learner in any case. So so thank you so much for sharing your time in your wisdom with us today. How do people get in touch with you or stay connected with you? If they want to follow you? Well, you can certainly. I'm actually pretty good about responding to people. I'm on Linkedin, Joseph Cavitar, I think, at Jcovit, on twitter, instagram, though most of my poster about wine and not healthcare. My email jcovit partners dot org. You can find my blog, which is the sea health blog, and we do a podcast as well, called well connected. All of that stuff is on the website connected health partners dot org. Awesome. Thank you so much. Yeah, thank you. What's the difference between launching and commercializing a healthcare in avation? Many people will watch 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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