Health Innovators
Health Innovators

Episode · 2 years ago

How to Launch a Breakthrough Innovation From Concept to Mass Adoption w/Sarah Sossong

ABOUT THIS EPISODE

When it comes to commercializing breakthrough innovations, how you position yourself in the category and the ability to find the right partners are key. How can you fund new innovations and overcome physician adoption challenges? How do you get the top healthcare leaders to support the innovation? What are some of the elements that can become barriers to market success?

 On this episode, I’m joined by health tech investor, digital health innovator, and health systems operator, Sarah Sossong. She is one of Fierce Health’s “influential women reshaping health IT”, and she pioneered large-scale innovations from concept to mass adoption and national recognition. On this show, Sarah shares her insights and advice to healthcare innovators.

 

3 Things We Learned

  • Language and messaging are key in the mass adoption of innovations
  • Focusing more on the technology and not the problem you’re trying to solve affects your innovation
  • How to make it easier for a physician to adopt your innovation

There are many barriers to the adoption of innovation, and many of them can be mitigated by laying the right groundwork, and taking the right steps. Leadership buy-in, leveraging internal champions, and starting with a problem not a technology are some of the ways you can ensure the success of your innovation. Whatever you do, think long-term. Don’t just think about what you’re doing right now, think about the parts of the innovation that are the most scalable beyond the present moment or the pilot phase.

 

Welcome to Coiq and first of its kindvideo program about health, innovators earlier doctors and influencers andtheiar stories about writing the roller coaster of healthcare andnovation. I'myour host, Dor, roxy, founder of Legacy, DNA marketing group and it's time toraise our COIQ welcome back to you, Yq listeners ontoday's show. I have Sarac to song with me and she's, been noted by fiercehealth as one of the most influential women shaping healthcare. It welcome tothe show Sarah thanks for much glad to be here so forthose of our listeners who might not know who you are just yet take a fewminutes. Just tell them a little bit about your background and what you do excellent. So right now I am nowworking for venture capital, firm, Paer capital partners based in BostonMassachusetts. In my role here, I am helping. Invest in health is in earlystage, startup health, PAT techanable services. We have seventeen companiesin our fors sport folio has we are about to start inmessing out of oursecond fund at which will be about two hundred and fifty million. So I am onthe lookout all this forof things that are you innovative and digitalhealth, greater entreprenories, great companies that are really transformingthe business os health care. But I got into this by working on the frontlines and help tersystems across the US and so I'll share a little bit about that as well. So began my work at the US, maybe back intwo thousand and three after Grad School Tar, the Lieutenan, Jg overseingprimary care operations that I was at Kaigier for eight years and we're gon aa lot of different technology compliance projects, one of the Mi Baincasers, firs, large scale, televisisin program and then Boston for the lastsix years. I was at that cofounder in and healt launched the first part of NAT general vigitalprogram, so we launched video VI, it second opinions, so tha was from twothousand and eleven until Tis last summer. So I come from a place oftiloving things and seeing what sticks to the wall and then executing andscaling it at a large scale. Yeah you've you've been involved in somepretty pioneering projects and from what I know about yourbackground. All the way from you know concept to full scale implementation.So I think we're going to have a really exciting dialogue today, so OIHATF Ery, fortunate yeah, so tellme how you got into tella health, no completely fortuitous. So going youknow, I don't think it was certainly not a direct connection. But when I wasin the navy, I want of things I was excited about was back that it barelyturned twenty four and they put me in charge of overseing a primary tarclinics to be o thirteen clinics across India going one of the projects that I wantassigned to was inplementing video comferenting systems, our grash, theseclinics so or just happene to be half a million dollars, a polly COMVIDEOconferencing opper and ye all of hs Oll, the equipment, citting Onmyn Bord soYoah n. One of the things I did there was implement that one of them one ofthe clinics, a in that seven hundred miles east of San Diego one of them-was San Comanty, island, thirty miles off the Cok San Diego, but that wasn'tthe direct connection yeah. I really found that I like doing projects morethan he day to day operations when I was in the navy, so look for consultingstyle jobs and moved to Northern California and worked for Kaizer foreight years, and I worked in three different groups: Wot enkider. I workfor the healthtime hospital and then I workd for the medical group and then inthe end I worked for the National Group of Ell, which was called the federation.But when I was working for the medical group we had vp who came to us and said you know wehave this area in northern California, where we have a severe problem of Durn,wait times yeah. We can't get patients in for nine months throee year Fo. Heserve conditions at obviously had to on to wait. He sure I didn't give upseition. He just said: can you solve the problem of the Dermaceff, and so weapproached the problem and you know obviously TeleMedicine was one of the things that we came to as an idea, but the only TilemHahad been being done back to two thousand and eight was at UC Davis andthey were doing all videobased, Tello, medicine and bres. The problem was theamount of Dermatalisis time available to see these patients and so that thetwo bad ulof Germatologis I worked with Eliaeth, CASS and Ilen Krawley said youknow. Therwe can see in five seconds and a photo. What what itis, what the germ condition is so any in many ways we decided to test pilotand innovate around an idea of taking photos, O Teri conditions, which thereare a couple other things in nowit's, a...

...very common thing, but we ta ToregardInnovation Center and we basically mocked up. How would it bethat a PCP who is sing a pation ind clinic could take a photo, send it to aremote dermetologist had that remote afte t German Tolle tovew it give tothe back. Send e prescription or Referallo needed Hawcool of thathappened in the fource of the patient business. That was just the fifteenminutpation visit in the office and so over the course of hiliting. We figuredout how I tid actually do that, so we wereable to have. Patients who are coming in, you know could be for fivedifferent things, but it's a a Duram condition with one of them we wuld taketa photo. We hired a fulltime GER entologist to is based in San Francisco, who is doing the readings and we had arotating schedule of Germatologist and basically it through the course of you know getting by Infrom the clinicsgetting byin from the pcps getting biens fom the patients. We were able toget to the point where we were doing threesand of these, what we calld DermeConsop, O Mon- and you know, through the course of seeing how much thisimpacted der masses. So pecient as satisfaction as virtually a hundredpercent, I think the PCP that was am extra workfor them, but we also made it very easy for them in a lot of ways, and so all te collers ended up being a lothappier and I think we were actually surprised at the PCP satisfaction. Wefound that pcps were often referring things to durm and they you knowthrough e course, of getting durm feedback. So maybe they ceased youreyes Os three times and once they've seen it three times, then they know hitto look for and then they know how to treat it. So they felt very empowered think there were als. There was also asituation where a BC PIEC at to a Patien. You know I know exactly whatthis is, but the patient idnt believe her pcpam wanted to work for all thegerms, so we were able to take a photo. Then it SI durin. The Duran confirmwith a fus Po thought, and then that case it really strengthend that patientCP relationship so through the course of seeing how this was impactingpatient satisfaction, PCP satisfaction, the total cost of per quality. I gotreally excited about that long. We thing COUPL, I said agout pall,medicine, it just an overall area where we could be making really big YEA Thorg.A lot of different types of ban aroutions is UST. It's yeah. Basically,hello. Medicine is for ading medical paire from adistance T, BEA technologyand that's covored. A lot yeah yeah, so what's fascinating to me is that youwere one of the pioneers in this. So you know Tela, medicine, Tela health isso much more common today than when it was when you first got started. Youknow SOM, really curious. You know it was. It was really radical when youwere doing it. So what I'm really curious about? Is You know what werethe challenges? Unique Challenges for you? You think, because you were soearly t's, a great question. I think people are concerned aboutprivacy from an organizational level. Thinkthat that wasn't one of the things that was a challenge, Trak Thatha, was ever something sacinter orpcps asked about. I think it's something that when I talk to healthsystems they ask about, but I think one of them was just reallyeven how to describe it m. You know, how do you do you say you're doing aVISITO, Vertello medicine? Do you say you're doing it, video visit if you're,taking a photo like a just, how you describe the interaction and I'll giveyou a couple F examples of it. So we are doing a focus group to figure out what to call this and wehad a group of it. Was it was kind of to be more elderly people? They were.It was a patient of family, Vijorin, council group and we were going aroundtaying. You know what do you think of when you think of Tell emedicine whatdo you think of when you think a tella health and this one woman who isprobably in her lates and she was a nun, so she was an ourt full guard said youknow, we've been talking about this. Are you sing telemarketing and heliterallylike thought we'd been talking about telemarketmedic, clearly, not aterm that resonated and so ended up going to other other thingsinstead. So I think the other thing is so and but ust how they describe itbecause part of the thing is he meed to get by inforpations, and we afte reallyfound that you know when the Pysitian says to the pecens Hey. You know wehave is program, I'm supposed to use and I'll get some derm feed back, but Idon't know like I'll: Do a photo yea, do you want to do it or not that itdoesn't sound, very convincing right, righ and- and that was what wouldhappenin quite a bit. But if you have a PUCP Ho says yeah, we have a fabulousnew program. I could give you a referral to Durm for an Inperson visit,but you won't be able to get in for six...

...months. But if you don't mind I'll,have my ma come in right now take a photo I'll, send it to thedermatologist Eto waiting for R, your consules go to the waiting room. Waitfor fifteen minutes will have her son back I'll call you back into the officeiher the the diagnosis, the prescription, that the German Talli isrecommend. You can go ticke it ut the fre lead today. You know this is muchmore empowering, so there was there was lots of getting that the position byand in order to really pitch the program. So I kind of back Toi weneeded to know how to deprive it yeah and what the net a for to, even if thepatient, Ta et Fay us in the first place. Yeah- and that's you know, that'ssomething- that's really common! You know that whole positioning and in kind of what category do we fit into,is really challenging, for you know, breakthrough or radical innovations, because you know if you're pursuing theearlier doctors you want to be able to communicate that it's, unlike anythingthey've seen before, but at the same time, how do you do?How do you describe and get someone to understand something that they haven'tseen before? So without you know, wadering down the revolutionary aspectof it. So it's definitely something that I'e seen. That's really commonyeah an I some other thought Tom that too that Yeu man how far you Weni wantto go on that another. So the four other other tocts one is just. What is?Are you solving a problem or are you looking for use of technology? This ismore when I came from yeah. I consider KP the early early days, because I wasback in two thousand and eight so when I started it at Mas Genral in in twothousand and eleven two thousand and twelve, there were a lot of people thatactually knew its tellof medicine Wans at least wwit in the position communityand we're excited to use it. But one of the problems I found is that we wereoften trying to find a use for the technology that e Ben Sollo problems.So I think, is so the Fort Things I'll all talk about. I don't think ther'reany different from today, but they were things that I found were really the bigbarriers from the beginning. So on Wan, are you solving a problem or youlooking for use, tat the technology and the places where we were solving aproblem and obviously ye worked well and Yeh Stop the other way down. So Ithink we all have things. Thatyo smiling a D nodting, so we all havethose Shas yeah. The other thing, which again, is, Ithink, quite common still to this day, is you know, Positians aren't going todo something if they can't get paid for it. You know they may do it one or twotimes hat they're not going to do it as part of their everyday cinical, worktoyeah, so how to pilot something that was innovative,that pairents weren't paying for and get positions to, use it a scalewhat was really challengeing. I think this is something that Ha ycompene to be a barrier where we're making a lot of progress, but at thatgeneral we ended up creating a fund that was almost we created amaghanismto pay ourselves. So the positions when they would do tell u telemedicinevisits whether it was video second opinions orother things. We became up a way of basically deciding how much their timewas worth and how much that visit would get paid to them. That was essentiallyan equivalent of what fe fir service in person that it would be for them. Sothat was you know. We were able to at least an early DA solve the problemwith tosition taent, but I think, as we got a lot of traction, we got to thepoint where Yeu people could do this a hundred percent of their practice. Weactually found the psychiatry all of a sudden. We were afraid that we weren'tgoing to have adoptions PSYCHIA Trup we or dudgit out of the water and and basically we had to go back andtell the department to stop because Itanditwas a good problem to have, butitis highlight the fact that you know. I think then the problem we help. Buthow do you say well use this somehows, but don't use it all the time and Ithink it it just. It doesn't work if it's not something you can think of forevery pationt and that's really stuff with me. Whith everything else. They'veworked done, Itin saying on the regulation. You kN Hi is reallychallenging. Yo O. Can I do this visit with a patient in another state orcansis? Can I do a first visit? Can I prescribe medications there justthere's so many questions around the regulartory environment, but I thinkoftentime positions tene to not do it at all, because they're concerned e,thets, probably safe from their perspective, their licenses, yeahthertheir key to Bey, able to hang out a shin go on. I hadand show I ad thereis, is no partyf. What I like in my role, aboth Kims ar NAT general, isbeing able to help provide a freemork and share. You knowI'm not a lawyer, but I was able to share yeah here's the law, and here iswhat we are allowed to do and- and I think that getting that uncomfortablewith that was huge and then the fourth challenge US Sak. I think it's probablyStilloh the biggest one and the most important is you know. Ye has haveleadership by it and vocal endorsement at the highest level and Y. U Kno! Ifound that through the course of...

...varians work I was going. I was hearingfrom our leadership that this was umost important, ou, Telle, medicine anddigital is the future. It was something t we had to provide for our patients.Our phositians had to do, and I would go to that was the message. I preach thatwhat I evangelize is what I believe and that's what I convince People Yeth Wat.I canvid my team out of our leadership, OP and YEP and others the Talen adFounda, which was really surprising to me as I would go, and I would talk tothe chief of the departments and you know they were bought in. They wereexcited, but they would say rint tar. I absolutely agree- and I I want to dothis too, but at the end of the day our CEO have a list of ten goal for mefor this year and digital health and telahealth anywhere on there and we'vegot so much to do we're being told to cup budgets or yeah managing stuff. Ifit's not on the top priortials that it's not something. I can really tellmy tam to focus on so think. Part of it was figure out how to work theleadership so that this was really it wasn't coming from Sarah, because thatwasn't the powerful message it was coming from the leadership S. I thinktherrethereare number of organizations that have really highlighted from fromthe very top how important digital is- and I think cleveand clinic- has yeahaccess anywhere anytime, as I bem Mal clinic has ye. The goal is touch twohundred million lives by two thousand and twenty, and you know those arethings that they're very much enabling, through digital and Nees, to be go totheir patient websites. Yeah access to a position, an ve, a video and secondopinions- is right there on the front page. So really a lot of the work I didwas trying to get this to be something that leadership this saying andAlendment Tin. So it's really fascinating, becausethose four things actually hit, not all the questions, but every one ofthose are on my list as questions though I love it. So I kind of want tostart with the first one. You know you kind of talked about you know, startingwith a problem versus starting with technology and trying to find a usecase. You know talk about, you know. How did you overcome thatwhen you know, obviously, when you start off with the problem, you'regoing to have a lot more success, so you know when the organization isreally starting off with more of technology. You know what did you haveto do to really change that d? Was it to you know, kind of reverse engineerand find the problem? Was it you know getting patients or providers involvedto kind of help, educate and identify what was the most important problem tobe solved? Was it one of those leadership? You know challenges justkind of help. Our listeners understand how you overcame that, because I thinkthat that's something that folks run into really often they getreally really excited about the technology and then kind of look attrying to solve the problem later. Yep that not t a great question and Fo voisers Bat, a Boit iget and oneof these questions, an a deat Iaapol, you tha Im, I'm pausing and thinkingfor a couple minutes o' Gono, no Tind Yeah, so you K O. I think the way itfirst hit me was. You know when I was at kider. I wasdoing a very structured program that was solling a very specific problemthat was handed to me yeah. When I came to past general, I was instead handed the their sum belief for building ofprogram and getting traction, and there was no definition around what we shouldfocus on what our products Wer, who I would work with, and so in my firstcouple years hat I'm Jagei. I spent a lot of time going around trying to findpeople that were excited about working with technology usingtechnology, and so I think it very naturally I ended up getting a lot ofpeople that were excited about using the technology and using telle medicine,but didn't have a problem Athelp, and so I think it was you know. I was atfirst excited to meet those people, but then very quickly realize that therewere a lot of those people and more people than I could manage, and so it actually turned into one ofthose things where, in order to manage the volume of endo interest, I reallyhad to say to my leadership and within the small team we had yeah of these I'ma tem of Ondor. You know there are a couple of partial sus at helping out inthe early couple years. How do you pratitize among these ten thingssitting on our deck, and I think one of the things westarted today was we wet? Let's come up with some sort of framework for how wesay yes to some things and know to other things, and that's, I think, wasreally driven and you n get hat your question and howwe got people to think about. This is solving a problem, but dea a little bitmore deosicate and specific. So wone. We came up with his framework that Wacalled Kerk, so piatization inpact readiness and my complexity, and so westarted to Loke at these initiatives and when we said noticing,...

...so I think, art of the reason we had todo thit dog to I, because we would I'd say no, its something Yeow, there'sclearly, there's no problem that they're solving there's no Y, there'sno market, that's willing to pay for this, and I would the person wouldemail their chiefs, who would email their vp and then mi the P and email. Ibosses and my boxes, Wut say tar. I heard you said no to this. You need todo this and I say, but thit is not at all aline, but what we're trying to doso, I think establishing the framework was alte way of getting my direct boxesand also the OSPITAL leadership. ONM Board with this is how we wer he aboutYous, O tin. So the next time that thing came through Yo, the VP that yowelooking at it said Yeah. No, that that, actually it's not a priorty of theorganization or that's a really great program, but you're probably going tohave one consolt to year and that's just not not high Oug, so we thoughtBou things in terms of ciretization with organizational strategies. The twothings Aere thinking about where population health management. How is thelping manage cot increase value in fact, quality? Or was it something that was helpingsertof extand our network within the mash general system that was prior? Theimpact really was around. How big was this yea? We had some programs thatwhen they workd would save a life, but if they were only happening once ontwice a year, was it worth putting together these huge contracts andspendinge a hundred hours of back time to put all this in place, or it weresending that time on something where we have. You know one conpole a day or youknow a hundred consults a week, and, and so it really helps us shift towardsthings that were higher volume and and that's really what gave us the early learnings we needed to thenbe able to go and do these coller dolume programs complexity was ass. Thethird one you if you wanted to do a program that involved video and imaging-and it was across tate mines and Youre- can to be during your patiente andyou're gonna have to fill Medicare just the more complex it became th. The moredifficulu live bres to put all the pieces together, sowow. That was one ofthe things we thought about Anis. I think good for people to think about with their programs, andthe last was readiness. If you had a a department who is ready to go, you knowsomeone Theyad, a signd Wois, an adman or some sort of project manager to helpif they have positions. You know all Oll of that readiness this factor ifthey had a giant who was goling a pig all really helps. You know when we hada single position or a single administrator D who had an idea forsomething but had not yet check the markets when we gaged interest and itleaves things in a very different space, so it was openlay around the gettingback to. We were trying to solve a problem. We were trying to fondproblems that would be able to to really make an impact but Y in a waytit wul be good for the ormannation Ben for the costumer and really move theneedle mm yeah, that's great. So so, let's kind of move on to the number twothat you talked about physician payments, so obviously that's going tobe really critical for motivating them and getting theminspired and engaged help me understand and our listers understand a little bitmore of you know what was this creative fund that you came up with yeah, so I can tale about that ND insome way. Number two and three on the reversement and regulatory like arealso part of the bigger teeme of the position adoption in general yeah. I think a big one, maybe maybe I'lltalk about it in terms of position, adoption sand. I can talk about fun,piece of it as well, but so I think bobly missinitian adoption problem. Is it something else big? I think welooked at that yea. The typical hipcycle chart all the time andtycically we're seing that it's e few few providers as opposed to money- andI think this is something that became obvious as really early. So I mentionedthe fact that they had real health, ind psychiatry, Wis, a bluor budged out ofthe water and I'll decrad the budget. So basically what we did is we came upwith a pat of money and when a Positian SFILL for in person visits thefin a cptcode, they write the visit. No, they submit that to the Insurane of theInsurane yerviews, basically soin it back with the payments based on w thatpatient elatability and everything else o far as people fine with. But what wedid is we set up. Amecanism were a Pysitian wee. We spent a lot of timethinking about what was the right level of payment, but basically came up withsomething that was a dumbcptkit system. So, instead of putting the actual code,they would put you know Vir or Vid Somin. So anyway, they came up with acode and they would quick sammit in the same way that they did theirregularVisi Yeh, and instead of that, that co basically was a signal to our billingsystem to not send the bill out to the pairs and instead to send it to thisinternal group. That was looking at these visits and it would initiate apayment out of this internal Ting. We have so, I think you know it ended upunce. We had byimg from leadership that...

...they were willing to you at the promes.They directed the Finance Osol, but put this in place, is en yeah now workedvery easily and it. I think that the big thing is even if they are moreefficient, cystoms doing what the positions do every day. All the time isalways a better way to do it. So you know the fact that we were we weren't,trying to reinvent the wheel in terms of the building were just using theStan back to them, yeah different COMPNSO, that that ended up being agood mechanism. We actually had talked to the guy sender back in two thousandand eleven. I think and heard they were doing something like this. I don't knowto what extent they were, but it was something that I think we were one ofthe early pioneers, Om and and that' number of other system did it in the years after us. I think mostpaces. This point are reimbersing, so I think we do at MD shop while Im, notthere anymore theyrethey're, that fun thel still does exist and it exists topay for the business. The payrs do not cover since pairsare covering quite a bit now,but you know the to the point of like how do you SOLVThe pradoption problem? One of the things we also hve found when so on.Our blood budget was betting blown out of the water. We were excited and Yoknow wanted to think about. You know so maybe the pans we need to advocate formore of this money. Yeah we SAI Elo, looks also dig down into who are theactual position they're doing his activity, and maybe that will tell ussomething about utalization and value and were Werei. The right place t usethis and out of the Department of several hundred commissions, weactually found that ninety percent of the money tat is imset was being doneby six positions. Bot of hundreds, there were six people that were drivingYo have ninety percent of the EAS elevation. So it was, I think it Alto ighlighted usjust to this, the belker. You know it was something that six people are doingit not the whole department, and so it was great that those thicks were doing,but how we get the broad adoption, and so that was something that reallybecame arfocus in the years ahead was how this yeah. Why would it only be six?Why wasn't it the others and- and I thought it would unique toEMG, because I talked to other health systems. You know this is not uniquewhatsoever and, as we rolled out to newe departments, we found likewise, itwas the same Menerology, the same hardiologies wor statement Ortho, and Ithink one example that I use a lot that continues to Pell Tome and would loveyeah. Ireally should reconnect to these two women to Dell into this more, butwe had a woman who is a female cardiologist of a certain age of acertain ethmicity of Ye, follow particular type of patient Y or tendifferent, descriptive details around her, and she had so many visits thatshe was doing over video that she had enough that she could do an entireclinic. So she was doing like ten patients, ten to fifteen patients aweek at home, not in the office and so again kind of where cardiology wasconcerned. She was blowing it out of the water yeah and there was a she had.A female counterpart literally sat right next door to her. Thosetendescriptors also sit R, her colleague to an absolute two days, allthe exact same patient and that woman had tried video tit, didn't like it anddidn't use it at all. But I think when you try to say, there's somethingaround O at a certain ageas of agendea like what is it because it's the rightclinical condition, I don't think, there's an easy way to say you knowOhit's, just anage factor, it's just the type of Patiente that e in hoursthere's some TRICP to this adoption that we've not hit solve. So I givethat Bos an example that it don't be quick to to jump to conclusions aroundthem. So one of the things I dopting yeah, soone of the things that I talk to clients about regarding that is thisearly adoption strategy and kind of the bell carve that you're talking aboutand how that aligns with the difusion of innovation model, and so one of thethings that I see happen. All the time is, you know: they've got a smallsubset of the population that are innevators and earlier doctors, and ifwe can identify who those are in the population, then we're going to have amuch greater adoption success than we would if we were going after themainstream market. What I find happens most often is the health innovatorsthat we work with they just kind of see the market as kind of like a wholesegment like you're, talking about and they're banging on the door and tryingto convince the mainstream market to buy in and they're just so much morerisk a verse than the earlier doctors that they're or trying to get langards to buy intoit, and so it becomes so discouraging for them, and sometimes they run out of moneybefore they actually get to market. Because they're you know trying toconvert. You know the wrong segment of thepopulation, so I think, having that early adoption, lins is really reallyimportant. Yeah, yeah and Actualy one thing yeah fine. I think, as we saw,that there were these few earlier doctors, some of the goal thatwecreated ourself were around having...

...broad adoption across the entiredepartment like having the entire department to it, and, I think thereare,you know their arguments for both sides, but you Kn, where I come down, is on the side of t. This isn't something that needs tobe for everyone, hed, I'm on the opinion that there could be some peoplethat are really good aferin person and that's what they love, and there aresome people that maybe want to mix and n some people ID almost you know Ithink, having a mix is good, but some people who maybe want to do mostlyvirtual- and I think the idea that this is something you should have everyonedoing at the same levels as this doesn't really match human behavior, atleast with how we practice medicine right now so- and I think that was justhighlighted with my Mik taizer experience, the oneof the early Dervin houlds that we use. He was just not a good people person.He did not interfete all of the PTPS. The Way He interacted and did not goall and people interacted with him, they did not want to do them ever againand there were other people that you know were just hopflly. They, you know were very careful about developing herelationships and you know being really consolant to the PCP and not it was. It was a lot aroundcommunication and style and- and I think, they've sing with trude and MGto their their people, for whatever reason, maybe it's Texavy, tha stylecommunication, everything else but theyre. My I'm of the opinion that youknow it. Maybe it will be not the entire bell curve, ultimately, maybe bemore beyond the just earlier dacters, but that's a good place to startind. I don't think any reason to try toforce FORC things beyond that sooner than we need to. I like to use the cellphone, because I think it's so pervasive that it's really easy for usto like kind of use that, as an analogy, you know you had groups of people whenthe IPHOAM first came out that we're paying seven hundred dollars and atthat time that was like just absurd amount of money and they were standingin line overnight right for days to get to be the first person to have thisiphone, and today you still have folks that have a flipphone and they're just they are not going tolet that flip phone go until they don't make it anymore and someone takes itfrom them. HMAND I much more like letting lethingthe market drive. I think Yo Ow healp cares one of the things where you tosome degree in the hospitals, not really following you know it's health care to differentthan the rest of the tech market. In that you know, I am going to peaches often want their phosition totell them what to do so. I'm like that. It cell phones, yea Wherei, something yeah, no one'srecommending anything. I just go and I get what I want all right, but iin verytrue that there's that same that same adoptioncur, but not sure we health cares. He e were complicated because then on youknow the Positians want to buy an of their broader department organization.The patients aren't going to want to do it until position doesn't, and I actually havean example that we had a snowstorm a few years ago in Boston and we got youknow what a great opportunity to convert a lot: O inperson visits arvirtual to o get people Boh, yeah right, and so some folks on myself, you knowere, given a list of the patients to have the is the next day a we'recalling up the patients- and you know I don't know the exact script, but theywere saying something along the lines of you know so PA Snow Storm, I'm sureI is now. This is neither one of thes days in Boston whereyou're. Actually,the roads Yore legally closed and Youare not allowed to be on the road,so it Wasn' matter of Ocan base the storm or not, and you would you like tohave a video han? It was your doctor Insad, and so I got a report back fom acouple people on my team that we've had bill apig that you know out of thirtypatients. Ask None had said yes and I said yea can I get on the phone and trysome MOFTINE and I very quickly realized that, if I said actually as a,I think I Boston will breag up around because so Iwas aldut Dason Walk Toyouthe cardiologist, the Mat General Ani said you know Hili. I ther song callingfor Tat General Ho Ow about the storm tomorrow. Dr Waty asked me to give youa call and he would life as ould like you to have a video ovisit with evtomorrow, instead of Theinperson thereand, there's no reason the Messagitill just do tuff like your face to face, but you know Dattr Wa y wanted tomake sure that was okay with you and that, knowing that it was coming fromhim directly as opposed to feeling like a Robo Calk, I had a hundred percent ofpatient day. Yet since I circled back with the rest of the team and modifiedhow how the question was being asked- and you know just yo little things likethat- you don't know unless you're on the throat line. Actually talking so I mean it's exacthad't been through that experience and me getting involved in chatting. I patents directly andmessaging it differently. It could have been that we came out of the store andsayin wow even with the sore and the patients. Don't want to do this righright, O we talk to them and you know so, knowing it came from r theirposition made all the difference. Ind...

...them wanting to do it. I think thatsuch a powerful insight that the language and the messaging can makesuch a huge difference and, like you said you know, you can walk awaythinking that people just don't want this technology, even when they'restuck in their home and and that could be a complete wrong assumption right,because there's so many variables that play that's just such a profoundexample thanks for sharing that with us. So a couple of things that I also wantto talk about is a pilot, so you know you've done several different pilotsand so for those of our people that are listening in our audience, many of themor either. You know in a pilot right now or Theyrde you know, developing all the guidelines and negotiating their pilot.So what are some best practices are, must have that you would recommend thatthey stay mindful of in the pilot kind of like dpilot agreement pilotdevelopment process, in order to make sure that when that pilot is over, thatthey've got what they need to. You know kind of implement a more full scale M I'll start with three things in thatmaybe go beyond, but I think one you know being mindful of that paratizationframework mm, don't maybe that want o star adult you, something that you think isavailable beyond the first thit's bigger than what you're doingright now. So you have to start small. I know there's a big move away fromcalling things, pilots, even things that are pilots. People are saying,don't call the pilot called a program because that creates hat a certainamount of sort of organizational and departmental Biin to the fact that they diotsomething that it's not ready yet right, not ready. Yet like program aready ettoo, I feel like her everyone' talking about using called programs and thee.Actually, pilots, TAT, they're, calling the program Yep Yeah ealway AK to theaudience, an ther therdday colders, but I agree really pilot so pilot,something that you think is is scalable beyond what it is Oyou're doinginitially in a big way and Iti. You know theattraction that we got in video visit. TAT TAT general was one of those things.The problems that came to us Ni so tha within the first couple years, was theproblem of a a Psychiistis Janit, WASME AC, who potations coming in from allover Boston for treatment for autism, at Ach team andbicler and other things, but through the course of giving the medication,they were often on treatments that reqired her to Mo to modify the thedoses and the medication afsolved over the course of multiple week. So thesepatients are somehimes coming in chice a week, but coming in weekly twice aweek very, very frequently, and you know especially around the ofpisticfoculation, where she started by the time a kid is pulled out in their theirregular environment, they're pulled out of their school and they're brought inthe car hand, the part they find a way op to the eigth floor of the buildingand then they're waiting in the waiting room for an hour. You know by the timethey actually get into the office with the position she's not able to see themat their their regular self, because they're extremely like any of us,should be irritate, I'm Eritaieed, even thinking about. Like all of thatprocess right, I think one of the I he woas thinking like she can't possiblyacseps them much like not even to think about the convenience or any otherpiece, so we're really solving a problem. How we let her see the patient,exactly they are Yo, were solving the problem to it was very inconvenient forthe patients to come in Theyr for Thep parents to take time off. So we SALVthis problem of being able to do a follow video is it for patience withofkogen, but very quickly. I mean we did that, knowing that this issomething that could be used so broadly and Aicalbe ae very simple example, butI think to supply that logic to to any intervention. You know if you're, ifyou're going to do something where, where will an x say, be you have anyfensife Thatou and you know, maybe it ultimately won't be anything beyondthat. But I think if you you don't want to start down he path where you thinkthis is going to be the only sort of pilot approach yeah so that WASD thatwoasd member one ar bi sticke the minds so the scales only, I think, definitely t the champions. Ithink this has been well talked about it documented, but is you know, as asthe administrator and AES the business and technology champion of? Is You know?Ultimately, I could convince the first couple pobition, but I wasn't going toconvince it: an entire department, therlike te Hurin out who the internalchampions wor was Wa, really a win way. I think in for many of the positionsthat I worked with across ten Mergen, that is, men, curtiology nerologypsychiatry. There were so many of them.

This became something they were reallyexcited about and this became Bheir thing and they're now building careersand research and Televeisin, but you know for them. The chance to be thechampion was you for me really important, because it gave me a person through whom I couldhave angelized to the rest of the department and for them it also gave them anopportunity to really differentiate themselves and internal leaders o notboth within the apartment within the organzation nationally, in some cases,so, but finding those those champions and figuring out what actually motivatethem and then ithe. Third, one is reallyfigure out what your resourcing strategy is. You know it takes a lot of work, Ilece so much time. Thinking about youknow what was the right way to actually implumence the pilot. YOU IMPLEMENT Epilot entirely with staff of e Tela Medicine Group or whatever innovationgroup you're in or is it entirely ont the department or is I a combination ofthe tube and I ended up creating this wrath? That shows basically how there was no way. I think ourourleadership really wanted this to be a hundred percent on the departmentimplement theday one, and I really ended up saying you know tthere's noway they can do that because they don't they don't know how you until we teach them. They don'tknow how I cou do attackcallthat test call crontested patient video. Theydon't know how to you know double check why thetechnology's not working, they don't know how to onboard anexpedition. So the Sany number of things that we could very quickly teachthem, but they couldn't do it from day once s I had to in of this graphit, like you know whereour involvement kind of went from us to dam and their involvement, you not whatHa Zero Thotas pretby low and I pay over time and n gain when we were atfull like full scale. Well, we never enme updaing it whatever point wheresthat full skill and implementation execution with Enoug Yeah t e there'salways going to be time where? U Need to call someone to ask for technicalsupport. There's there's always going to be some sort of based lineinfrastructure. Supporting these programs, you O thatprobably will move to Itoyou in 'll move to existing places, but until itreally becomes mainstream and will still Liv in that Hallo medicinvisualinimation groups, but think really convincing your leadership that yourdepartments can't do thi on their own. Its really important. If you want to besuccessful because th you're not going to haveagain a ton of back to, you, won't have adoption and then they're going to sayI too failure, but it's not actually failur. Just the fact that you didn'tsort of implement he resource at the right lake, again home, yeah yeah.That's! I love the grafh because it's so clear as to what you're talkingabout and how do you have that exte yeah, I'm sure? So so I'm curious, you know, you've gotall this experience working in these large bahemit organizations and tryingto innovate internally, and you know most recently youre in this role. Youknow working for an investment firm that are working with health,innovators. You know that I'm assuming very often our early stage startups,and so what do you think the differences are between trying toinnovate within an a large existing organization and trying to innovate asa startup? What do you have verydiffrinferentlayhthats kind of common? And what do you see like Gosh? This isreally different to a big question. So, what's different, I don't you know.I learned a lot about venture and investing and 'mpronership in ther manystages of company creation at the earliest steed stages and a spageswhere a companyhas gotten just a little bit of money. But it's still reallytesting I', say to Commoni one thing: Whas compitendthe fact that they're trying to figure it out you know companies that were looking at aretrying to figure out you hav to maybe they've withall e Tin Technology. Theyhave some idea for how somethings going to work with particular customer base,but it's through the course of actually trying it trying to get comtumercontract having a customer yvuse the product that they iterate and evolve,and I think the successful companies Iterat ed involved the unsuccessfulcompanies, go't iterate and go away, but it it's ey surprising for me to seethere are companies that are getting traction and a don't use that as a through, but an indicator to movement and intodifferent areas and OI think very similarly, a the health system needtolutions that are further along, but yea in many ways, even though they'reusing products that are further long way to internally are trying to figureout the right box for for this for...

...their particular product. What's theright, even exaism for the right Usieris wit, the right volume, you know: What's what's The reahtstrategy iing on the the Differenceis, I think by the time you get into anorganization thou, you do need to have a certain next level of Polish and Buyin and other customers. I know atTAT general we we did do somethings where we were the first, but as we looked at technology proudly, wewere very often looking and see. Okay, have you ever have used Tis athotherproviders and health system? What was their Ver Havy? Have you actual becausean academic medical center, because, even though you're very differentshowing were really or for that traction with with startup? You don't need thata we see people actuallyy talk to someone earlier today. You had an ideafor something: it's literally an idea, nothing Yo get on paper, yeah, that'sokay, and so the fact that it can be much earlier and conceptual you n W. I think one of the differencesfor me and figure out how to how to work and and think about at those tatesso yeah I could be. That would be a good fullon, podcast yeah, very greatsamd, lar e, but now theyre many, but I think thore are ones thatcome to mind right now, yeah yeah, so hat and I completely agree. I thinkthat we could talk. You know we could probably have three episodes becauseyou've you've been involved in so many different angles. I think there's somuch to talk about what we'll have to do that on different episodes, but I dohave just a couple more questions for you kind of just switching gears andputting on maybe more like the flaire capital hat in your current role. You know a lot ofour audiences is these health, innovators that are pitching to peoplelike you and and so you know what advice do you have for them that are inthe trenches right now you know we we hear, I hear a lot inthe industry about everybody talking about innovation, but you know. IsAnybody really investing an innovation and, if they're investing, is anybodyreally adopting innovation? So just kind of talk about that? A little bitfrom the from the investment firm standpoint? What what do you? I do think that that in all Teri Ithink that would be a very good subtipuent topic. You know venture andy investment for entrepreneurs and yeaw to gave a tolk at the American tellmedicine conference and New Orleans. Last month at office and Su, I put somethoughts together and so a lot a lot tous day on it. I thinkone one is digital. Health Nvestment is and all time high a two thousand andeighteen Sol, the most money ever put inintidigital oulth. So I think thatsays there's a lot of interest from the market. I think the same time the themoney is becoming more and more concentratedand later round, and so people are looving for moremature. So I jos, so how do you approach Agueinst? The short answer,Sonc you're, coming up to the end is yeah. You've got you've got to have, even if the se Sam, an idea of te Wanyour product is: What's the business movel? What's the competitivemarketplace, you know what often time in order T bo Successullyoneed to start small. But what is the vision? Division for the day, businessthat you're building, that's good to say, UPSOK, because I is an investorGoeo see that this is going to be a return on theinvestment you know. Ultimately, we have people, invest in money, ind ourfund that we're that investing in companying them showing were very muchabout poving peach ant Caren, an proving the Health Tur landcape. But ifwe go back to our investors and don't make money at the end of the day, we'renot going to get that next, Jom defiitly, we don't, we won't go markingover mention. There's one othe thingi right lot of the ty tink. You really have tobe very clear on h what the problem you're solving is and what that productis, and it have just been surprised at how many antrepeers haven't reallythought through all those points you know itsfine. If you come in saying yougoy. I haven't topped this all through and here's what I'm thinking about. Butif you come in saying here's my product and you haven't ghought through thoseplict that thats the different story yeah, there are so many accelerators indifferent cities, nout of Masscust, because the matcal health teck program,Helpfu, Hav, textars, ther country programs in virtually every city Su andyou really ufil an helping refine, helping onpeeris refind. That messagingthinking through that actually partnering them with clients, but Imean really having your pitchdown is- will be the enumber one thing: YeahYeah, that's great! So what project are you working on today? So a lot of different projects?There've? Never there's! Never! ACA. This world appeals well to my desire tobe doing a lot of things, an in different spaces. We...

...oljou lay briefly. We have our limitedpartner to invest in as Sinsie I'm working with them to make sure Iunderstand their strategy and supporting the partner working with art,cortfolio companies and t that really feils to my operatorside. For during a day today, operations we have internal initiative,I'm constantly and then my my really my day, job and the biggest thing I'vebeen hired to do is tha bout first start up the lentrepreneurs and lookfor the next big ideaand. The thing I'm most excited well all share off for acouple areas: an Ventein one is eieengrness tale medicine, so I thinksacred, its pobbly medicine is huge, but it's now being paid for, and so thereare more and more pollution in that tace, a infricence is not yet beingpaid for so think, there's Ha real opportunity, hm toget, the next bigthing I think tendentially tehabral health Su'H, a huge problem, so yeahtreething its Tinger O stell health, teavria health and then what's calledsenintact son, the abor health side Ir's. Just such a huge problem again,video won't solve anything. We don't have enough psychiotros or therapist,and then you know wonmen help I'md. Just seeing I is such a it's going tobe a fifty billion dollar industry by by two thousand and twenty five. Sowomen are the decision makers for the family. You know. Is We go throughitself? We had women Gog through many cyfles of life between fortiallypregancy, post, part of metopon. You now everything in between, and there isthere's a lot of growing investment and interest in what's called the stedy Tamarket. So that's the probably that I spending the most time thinkin aboutright now, so any idea of yeah, Aha, so yeah. So how can people so, first of all, let me say thinks somuch for sharing your wisdom with our audience today and with me. I reallyappreciate you taking the time today and for those of our listeners who havesome questions for you or have something that they want to pitch you.How do they get a hold of you? What's the best way? Absolutely no! Thank youfor anyone who got to the end of this podcast. Thank you for listening and yeah happy to Chare my email fo, mytwitter handles at Toe Bong. Sarah Email is Sarah at wlar capitalcom and Ithink that's also on my Lintin Sowev been. Is it there thi song and Hes atto Payn me on Linkson, but probably you know is the most direct, but any of these three forms and yeahhappy to have you share that when you, when you put this out there awesome.Thank you so much. Sarah all right! Thank you! So much. What's the difference between watchingand commercializing a D health care novation many people will watch a newproduct. Few will commercialize it to learn the difference between watchand commercialization and to watch past episodes of the show head to our videoshow page at Dr Roxycom. Thank so much for watching and listening to the showyou can subscribe to the latest episodes on your favorite podcast APPlike apple podcast and spotify, or subscribe to the video episodes on ourYoutube Channel, no matter the platform just search Coyq with Dr Rockbin untilnext time. LET'S RAISE OUR COIQ.

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