Health Innovators
Health Innovators

Episode · 2 years ago

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


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 CIQ and first of itskind video program about health innovators, early a doctors and influencers and their storiesabout writing the roller coaster of healthcare innovation. I'm your host, Dr Roxy,founder of Legacy DNA marketing group, and it's time to raise our COIQ. Welcome back to IQ listeners. On today's show I have Sarah Si songwith me and she's been noted by fierce health as one of the most influentialwomen shaping healthcare. I T welcome to the show, Sarah. Thanks somuch, glad to be here. So, for those of our listeners who mightnot know who you are just yet, take a few minutes just tell thema little bit about your background and what you do. Excellent. Soright now I am now working for a venture capital firms. We're capital partnerspace in Boston Massachusetts. In my role here I am helping invest in health, in early stage startups, health, TAC tech enabled services. We haveseventeen companies in our first portfolio. We are about to start investing out ofour second funds, which will be about two hundred and fifty million. SoI am on the lookout all the sport things that are new, innovative anddigital health. Great Entrepreneurs, great companies that are really transforming the business ofhealthcare. But I got into this by working on the proper minds of healthstart systems across the US, and so I share a little bit about thatas well. So began my work as the US Navy back in two thousandand three, after red school started, a Lieutenant J G overseeing primary careoperations. That I was at Kaiser for eight years and worked on a lotof different technology compliance projects, one of them being Kaiser's first large scale Telemedisand program and then Boston for the last six years I was the CO founderand health launched the first part of that general digital program so we launched videovisits, that an opinions. So that was from two thousand and eleven untiljust last summer. So I come from a place of piloting things and seeingwhat sticks to the wall and then executing and scaling at a large scale.Yeah, you've you've been involved in some pretty pioneering projects in from what Iknow about your background, all the way from, you know, concept tofull scale implementation. So I think we're going to have a really exciting dialogtoday. So total excited that it's very fortunate. Yeah, so tell mehow you got into tell a health we completely for to it is so atthe going. You know, I don't think it was certainly not a directconnection. But when I was in the navy and I one of the thingsI was excited about with the fact that it barely turned twenty four and theyput me in charge of overseeing a primary care clinics, to be a thirdteam clinics across in Diego, and one of the projects that I was assignedto was implementing video conferencing systems all across these clinics. So or just havingto be half a million dollars a polycomedy of conferencing software and laugh you allof the equipment city on my floor. So you know, one of thethings I did there was implement that one of some one of the clinics wasin that desert a hundred miles east of San Diego. One of them wasSan Clementy Island, thirty miles off the coast San Diego. But that wasthe direct connection. I really found that I like doing projects more than thedaytoday operations when I was in the navy. So looked for consulting style jobs andmoved to northern California and worked for Kaiser for eight years and I workedin three different groups with any Kaiser. I worked at the health time hospitaland then I work for the medical group and then in the end I workedfor the National Group as well, which is called the federation. But whenI was working for the medical group we had vp who came to us andsaid, you know, we have that are in northern California where we havethe severe problem with Dirm welight times. You know, we can't get patientsin for nine months to a year for these serve conditions. Obviously has toolong to wait and he's sure I didn't give up the season. He justsaid, can you solve the problems of this drama stuff? And so weapproached the problem and you know, obviously telemedicine was one of the things thatwe came to is as IDs, but the only telement is and being doneback in two thousand and eight was at UC Davis and they were doing allvideo based Tele of medicine. And for us the problem was the amount ofDermatolog as time available to see these patients. And so that the too fabulous Germatologists. I worked with Elizabeth CASS and Eileen Crowley said, you know,there's we can see in five seconds and a photo what what it is,what this germ condition is. So any in many ways, we decided totest, pilot and innovate around an idea of taking photos as germ conditions,which there are a couple other things and... it's a very common thing.But we tried to Girth Innovation Center and we basically mocked up how would itbe that a PCP who is seeing a patient and clinic could take a photo, send it to a remote dermatologist, have that remote und dermatologist you itgives them feedback, send a prescription or referral as needed. How? Soall of that happened in the course of a patient visit. That was justa fifteen minute patient visit in the office, and so over the course of pilotingwe figured out how to actually do that. So we were able tohave patients who are coming in, you know, could be for five differentthings, but if a germ condition was one of them, we would takethe photo. We hired a full time dermatologist who is based in San Francisco, who is doing the readings and we had a rotating schedule of dermatologists andbasically it's through the course of, you know, getting buy in from theclinics, getting buy in from the PCPS, getting buy in from the patients,we were able to get to the point where we were doing three thousandof these what we called Derham e consults and months and you know, throughthe course of seeing how much this impacted drm access. So patients satisfaction wasvirtually a hundred percent. I think the PCPS that was some extra work forthem, but we also made it very easy for them in a lot ofways and so all stakeholders ended up being a lot happier and I think wewere actually surprised at the PCP statisfaction. We found that pcps were often referringthings to derm and they know through the course of getting dirm feedback, soit maybe they seas derives those three times and once they've seen it three times, then they know what to look for and then they know how to treatit. So they felt very empowered. Think there are up. There's alsoa situation where a PCP said to a patient, you know, I knowexactly what this is, that the patient didn't believe her PCP and wanted torefer all the germ. So we were able to take a photo send itto Durham. The drm confirmed with the PCP fought and in that case thatreally strengthened that that patient PC relationship. So through the course of seeing howthis was impacting patient satisfaction, PCP satisfaction, the total cost of care quality,I got really excited about the long wave thing. coupally excited about pelemedicine. It's just an overall area where we could be making really big yeah,through a lot of parent type than ventions. Its basically tell a medicine is providingmedical care from a distance via technology, and that covers a lot. Yeah, yeah, so what's fascinating to me is that you were one ofthe pioneers in this. So, you know, tell a medicine, tella health is so much more common today then when it was when you firstgot started. You know some really curious you know it was. It wasreally radical when you were doing it. So when when I'm really curious aboutis, you know, what were the challenges, unique challenges for you,you think, because you were so early. It's a great question. I thinkpeople are concerned about privacy. From an organizational level, I think thatthat wasn't one of the things that was a challenge for a that that wasever something patients or or pcps asked about. I think it's something that when Italk to health systems, they asked about, but I think one ofthem was just really even how to describe it. Hm. You know,how do you? You say you're doing a visit over Tele Medicine, yousay you're doing it video, a visit, you're taking a photo of just howyou describe the interaction, and I'll give you a couple of examples ofthis. So we're doing a focus group to figure out what to call thisand we had a group of it was was coming to be more elderly people. They were. It was a patient of family, my visory council groupand we were going around thanking. You know, what do you think ofwhen you think of telemedicine? What do you think of when you think oftell a health and this one woman, who is probably in her late sand she was a nun, so she was in our full garb, said, you know, we've been talking about this. Are you saying tell amarketing and she literally like thought. We've been talking about tell a marketing wholetime. So you like tell a medicine was clearly not a term that resonated, and so what ended up going to other other things instead. So Ithink the other thing is so and this is how they describe it, becausepart of the thing is you need to get by inform patients, and weoften really found that. You know, when the physician says to the patients, Hey, you know, we have this program I'm supposed to use andI'll get some derm feedback, but I don't know like I'll do a photo. Do you want to do it or not? That some found very convincing. Right, right, and and that was what was happening in quite abit. But if you have a PCP who says, you know, wehave a fabulous new program I could give you a referraral to derm for anin person visit, but you won't be... 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 the dermatologists. To waiting foryour consult go to the waiting room, wait for fifteen minutes. We'll haveour as once back, I'll call you back into the office. I'll sharethe diagnosis the prescription that the dermantels is recommends. You can go pick itup before you leave today. You know, there's this much more empowering so therewas. There was a lots of getting the position by and in orderto really pitch the program so I kind of back to it. We needto know how to describe it. Yeah, and what the that's takes were toeven get the patients say it, say us in the first place.Yeah, and that's you know, that's something that's really common. You knowthat whole positioning in in kind of what category do we fit into, isreally challenging for, you know, breakthrough or radical innovations, because, youknow, if you're pursuing the early adopters, you want to be able to communicatethat it's unlike anything they've seen before. But at the same time, howdo you do how do you describe and get someone to understand something thatthey haven't seen before, so without, you know, watering down the revolutionaryaspect of it? So it's definitely something that I see that's really common.Yes, and I have some other thoughts in that too. And Yeah,and how far you want to go on that another. So for other otherthoughts, one is just what is are you solving a problem or are youlooking for use of technology? This is more when I came from yeah,I consider Cape the early, early days, because I was black in two thousandand eight, so when I started it at mass general and two thousandand eleven, two thousand and twelve, there were a lot of people thatactually knew it. Tell him that is in once at least within the positioncommunity, and we're excited to use it. But one of the problems I foundis that we were off and trying to find a used for the technologythat they've been solved problems. So I think this is so the poor thingsI'll talk about, I don't think are any different from today, but theywere things that I found were really the big barriers from the beginning. Soone one. Are you solving a problem or you're looking for use? Atthe technology and the places where we were solving a problem is obviously it workedwell, and YEP, not the other way down. So I think weall have things that you're smiling and nodding. So we all have those champles.Yeah, the other thing which again is I think, quite common stillto this day, is, you know, physicians aren't going to do something ifthey can't get paid for it. You know, they may do itone or two times, but they're not going to do it as part oftheir everyday clinical workslow. Yeah, so how to pilot something that was innovativethat pairs weren't paying for and get positions to use it at scale? Whatwas really a challenge, and I think this is something that continued to bea barrier where we're making a lot of progress. But at last general weended up creating a fund. That was almost we created a mechanism to payourselves. So the positions when they would do tell us, tell edics andvisits, whether it was video, second opinions or other things, we cameup away as basically deciding how much their time was worth and how much thatvisit would get paid to them. That was essentially an equivalent of what afee for service in persons as it would be for them. So that was, you know, we were able to, at least an early day, solvethe problem with physician payment, but I think as we got a lotof traction, we got to the point where people could do this a hundredpercent of their practice. We actually found the psychiatry all of a sudden wewere afraid that we weren't going to have adoption. Psychiatry Boor butet out ofthe water and and basically they we had to go back and tell the departmentto stop because there and you know, it would a good problem to have, but I think it is a highlights the fact that you know, Ithink then the problem we have. But how do you say, well,use this sometimes, but don't use it all the time? And I thinkit's it's just it doesn't work if it's not something you can think of forevery patient, and that's really stuck with me. With everything else they've workedon, I think saying on the regulation, you know, is really challenging.Can I do this visit with a patient and another state, or cansay is can I do a first visit? Can I prescribe that? Occasions arejust there's so many questions around the regulatory environment that I think oftentimes physicianstend to not do it at all because they're concerned about probably it's safe fromtheir perspectives, their licenses. They're their key to be able to hang outa shingle and and show red services. Part of what I liked in myrole at both Kaiser and mass general is being able to help provide a frameworkand share, you know, I'm not a lawyer, that I was ableto share here's the law and here's what we are allowed to do, andand I think that getting that I'm comfortable with. That was huge. Andthen the fourth challenge, would say, I think it's probably still the Iguess one of the most important is, you know, you have to haveleadership by it and vocal endorsement at the highest levels. And I found thatthrough the course of various work I was...

...doing, I was hearing from ourleadership that this was most important. Telemedicine and digital is the future. Itwas something that we had to provide for our patients. Are Physicians had todo and I would go. So that was the message I preached, that'swhat I evangelize, it's what I believe and that's what I convinced people.Yeah, so what I convince my team love of our leadership of and YEPand others. The challenge I found, which was really surprising to me,is I would go and I would talk to the chief of the departments andyou know they were bought in, they were excited, but they were takinghere. I absolutely agree and I want to do this too, but atthe end of the day, our CEO had a list of ten goals forme for this year and digital health and telehealth aren't anywhere on there. Andwe've got so much to do or being told to cut budgets or, yeah, managing staff. If it's not on the top prioritials, then it's notsomething I can really tell my team to focus on. So I think partof it was figuring out how to work with leaderships so that this was reallyit wasn't coming from Sarah, because that wasn't the powerful message. It wascoming from the leaderships. I think there are a number of organizations that havereally highlighted from from the very top how important digital is, and I thinkCleveland Clinic has access anywhere, any time. That of the Mayo Clinic has thegoal to touch two hundred million lives by two thousand and twenty and youknow, those are things that they're very much enabling through digital and needs togo to their patient website, accid Toro phosition via video and second opinions isright there on the front page. So really a lot of the work Iwas trying to get this to be something that leadership is saying and alignments in. So it's really fascinating because those four things actually hit not all the questions, but every one of those are on my list as questions. So Ilove it. So it kind of want to start with the first one.You know, you kind of talked about, you know, starting with a problemversus starting with technology and trying to find a use case. You know, talk about you know, how did you overcome that when you know obviously, when you start off with the problem, you're going to have a lot moresuccess. So you know when the organization is really starting off with moreof technology, you know, what did you have to do to really changethat? Was it to you know, kind of reverse engineer and find theproblem? Was It, you know, getting patients or providers involved to kindof help educate and identify what was the most important problem to be solved?Was it one of those leadership, you know challenges? Just kind of helpour listeners understand how you overcame that, because I think that that's something thatfolks run into really often. They get really, really excited about the technologyand then kind of look at trying to solve the problem later. Yep,that's a great questions and for the listeners benefit, I got none of thesequestions in the band. Apologies if I'm I'm pausing and thinking for a couplethat is so, I no, no, think. Yeah, so, youknow, I think the way it first hit me was, you know, when I was a kind of there, I was doing a very structured programthat was solving a very specific problem that was handed to me. Yeah, when I came to General I was instead handed the responsibility for building programand getting traction, and there was no definition around what we should focus on, what our products were, who I would work with, and so inmy first couple years of MGS I spent a lot of time going around tryingto find people that were excited about working with technology, using technology, andI think it very naturally I ended up getting a lot of people were excitedabout using the technology and using telemedicine but didn't have a problems to help,and so I think it was you know, I was at first excited to meetthose people, but then very quickly realize that there were a lot ofthose people and more people than I could manage, and so it actually turnedinto one of those things where, in order to manage the volume of Indoctinterests, I really had to say to my leadership and within the small teamwe had of these. I'm a team of wonder. You know, thereare couple of partial stees are helping out in the early couple years, howwe prioritize among these ten things sitting on our desk, and I think oneof the things we started to say is let's let's come up with some sortof framework for how we say yes to some things and know the other things. And that's I think, was really driven and you know, gets whatyour question of how we got people to think about this is solving a problem, but seem a little bit more deouciant and specific. So one of wecame up with his framework. It was called Kerk. So prioritization, impact, readiness and complexity, and so we started to look at these initiatives andwhen we said noticing, so I think part of the reason we had todo this all to us because we'd say...

...notice something. You know, there'sclearly there's no problem that they're solving. There's no, there's no market that'swilling to pay for this, and I would the person would email their chiefs, who would email their vp, and then my vp would email my bosses, and my bosses that day, Sarah, I heard you said no to this, you need to do this, and I say, but this isnot at all aligned with what we're trying to do. But I think establishingthis framework was also way of getting my direct bosses and also the hospital leadershipon board with this. is how we learning about so that's the next timethat thing came through the VP that you was looking at. It said yetknow that that actually it's not a priority of the organization, or that's areally great program but you're probably going to have one consult a year and that'sjust not not high enough. So we thought it on things in terms ofprioritizations with organizational strategy, and the two things are thinking about were population healthmanagement. How is it helping manage costs, increased value, impact, quality,or was it something that was helping sort of expand our network within themath generals? That was priority to impact really was around how big was this? We had some programs that, when they've worked, would save a life. But if they were only happening once or twice a year, was itworth putting together these huge contracts and spending a hundred hours of staff time toput all this in plate, or it were? It's spending that time onsomething where we have, you know, one console the day or, youknow, a hundred confolts a week. And and so it really helped usshift towards things that were higher volume and that's really what gave us the earlylearnings we needed to then be able to go and do those all volume programs. Complexity was was the third one. You know, if you wanted todo a program that involved video and imaging and it was across state lines andyou were going to be doing the patients and jury have to build Medicare,just the more complex it became, the more difficult it was for us toput all the pieces together. So that was one of the things we thoughtabout, because I think for people to think about with their programs. Andthe last was readiness. If you had a department who was ready to go, you know, someone they designs who as an Admin or some sort ofproject manager to help, if they have positions. You know, all ofall of that readiness. This factor, if they had a client who iswilling to pay, all really helps. You know, when we had asingle physition or a single administrator who had an idea for something but had notyet checked the markets and engaged interests there, and it leaves things in a verydifferent space. So it was ultimately around that. Getting back to yourtrying to solve a problem, we're trying to solve problems that would be ableto really make an impact in a way that you good for the organization,good for the customer and really move the needles. HMM. Yeah, that'sgreat. So let's kind of move on to the number two that you talkedabout, physician payments. So obviously that's going to be really critical for formotivating them and getting them inspired and engaged help. The understand in our listis understand a little bit more of you know, what was this creative fundthat you came up with? M Yeah, so I can talk about that andin some ways number two and three, on the reimbursement and regulatory like arealso part of this bigger theme of the position adoption in general. Yeah, I think a big one. So maybe maybe I'll talk about it interms of position adoption, and I can talk about fun piece of it aswell. But so I think solving the phosition adoption problem is it's something elsebig. I think we look at the you know, the typical highth cyclechart all the time and typically we're seeing that it's a few few providers ofthe Pos with the money, and I think this is something that became obviousas really early. So I mentioned the fact that the havial health and psychiatrywas blew our budget out of the water and I'll describe the the budget.So basically what we did is we we came up with a pot of moneyand when physitions fill for in person visits a fine acpt code, they writethe visit note, they submit that to the insurance, the insurance review basicallysend it back with the payment based on the patients eligibility and everything else.So far simplifying this. But what we did is we set up a mechanismwhere position we spent a lot of time thinking about what was the right levelof payment, but basically came up with something that was a dummy cpt kitsystem. So instead of putting the actual code, they would put vir orVaz something. So anyway, they came up with a code and they wouldclick submit in the same way that they did their regular visits. Yep,and instead of that, that code basically was a signal to our billing systemto not send the bill out to the payers and instead to send it tothis internal group that was looking at these visits and they would initiate a paymentout of this internal plot we have. So I think, you know,it ended up, once we had buy in from leadership, that they werewilling to us the problems. They directed...

...the finance to help us put thisin place. Is Then, yeah, worked really easily and it's I thinkthat the big thing is, even if there are more efficient system doing whatthe positions do every day all the time is always a better way to doit. So you know the fact that we were we weren't trying to reinventthe wheel in terms of the billing. We're just using the same mechanism.Yeah, different COPS, and so that that ended up being a good mechanism. We actually had talked to the Guisons, you're back in two thousand and eleven, I think, and heard they were doing something like this. Idon't know how to what extent they were, but it was something that I thinkwe were one of the early pioneers of, and and that's a numberof other systems did it in the years after us. I think most statesat this point are reimbursing. So I think we do at envy h whilenot there anymore, they're they're that fun still still does exist and it existsto pay for the visits to pairs do not cover, since pairs are coveringquite a bit now. But you know, the to the point of like,how do you solve this adoption problem? One of the things we also foundwas so on our blood budget was getting blown out of the water.We were excited and you wanted to think about you know, so maybe thisseems we need to advocate for more of this money. You know, wesaid, well, let's also big down into who are the actual positions they'redoing this activity and maybe that will tell us something about utilization and value.And we're breth the right place to use this. And out of an apartmentof several hundred clinicians, we actually found that ninety percent of the money thathad been stead was being done by six positions. Out of hundreds, therewere six people that were driving ninety percent of the US elivation. So itwas I think it also highlighted us just to this the spell curve. Youknow, it was something that six people are doing, not the whole department, and so it was great that those six were doing but how we getthe broad adoption, and so that was something that really became our focus inthe years ahead, was how this why was it only need six? Whywasn't at the others? And and I thought it was unique to Mgcause I'vetalked to other health systems. You know, this is not unique to US whatsoever. And as we rolled out some new departments, we found likewise,it was the same a neurology as the same cardiology, as the statement orso. And I think one example that I use a lot that continues totell them me and would love, you know, I really should reconnect tothese two women to delve into this more. But we had a woman who isa female cardiologist of a certain age, of a certain ethnicity, solid particulartype of patient here or ten different descriptive details around her, and shehad so many visits that she was doing over video that she had enough thatshe could do an entire clinic. So she was doing like ten patients,ten to fifteen patients a week at home, not in the office, and soit's again kind of work cardiology was concerned, she was blowing it outof the water. Yeah, and there was a she had a female counterpartliterally sat right next door to her. Those ten descriptors also fit her,her colleague, to an absolute tea. They saw the exact same patients andthat woman had tried video visits, didn't like it and didn't use it atall. But I think when you try to say that something around that acertain age would e gener like, what is it? Because of the rightclinical condition. I don't think there's an easy way to say, you know, Oh, it's just an age factor, it's just the type of patients thatare in. There's there's some trick to this adoption that we've not hitsolved. So I get that. One of an example that I think don'tbe quick to jump to conclusions around. So one of the things I'm adoptingare not yeah, so one of the things that I talk to clients aboutregarding that is this early adoption strategy and kind of the bell curve that you'retalking about and how the aligns with the diffusion of innovation model. And soone of the things that I see happen all the time is, you know, they've got a small subset of the population that are innovators and early adopters, and if we can identify who those are in the population, then we'regoing to have a much greater adoption success than we would if we were goingafter the mainstream market. What I find happens most often is the health innovatorsthat we work with. They just kind of see the market as kind oflike a whole segment like you're talking about, and they're banging on the door andtrying to convince the mainstream market to buy in and they're just so muchmore risk averse than the early adopters that their or or trying to get laggardsto buy into it, and so it becomes so discouraging for them and sometimesthey've run out of money before they actually get to market because they're, youknow, trying to convert, you know, the wrong segment of the population.So I think having that early adoption lens is really, really important.Yeah, and it's one thing that point, I think, as we saw thatthere were these few earlier doctors. Some of the goal that we createdourselves were around having brought adoption across the...

...entire department and like having the entiredepartment through it. And I think there are, you know, their argumentsfor both sides, but you know where I come down as is on theside of this isn't something that needs to be for everyone. Pat I'm inthe opinion that there could be some people that are really good at for inperson and that's what they love, and there are some people that maybe youwant to mix and some people had almost you know, I think having amix is good, but some people who maybe want to do mostly virtual andI think the idea that this is something you should have everyone doing at thesame levels is just doesn't really match human behavior, at least with how wepractice medicine right now. So, and I think that was just highlighted withmy kaiser experience. There's one of the early dermatologies that we use. Hewas just not a good people person. He did not interface all the PCPSThe way he interacted. It did not go well when people interacted with him. They did not want to do this ever again. There were other peoplethat, you know, we're just lovely. They you know, we're very carefulabout developing the relationships and, you know, being really a consultant tothe PCP and not. It was. It was a lot around communication andstyle and and I think they thing was true at energy. So they're therepeople for whatever reason. Maybe it's Tech Savva, style, communication, everythingelse, but they're my I'm of the opinion that, you know, maybeit will be not the entire bell curdle to really maybe it will be morebeyond that, just earlier doctors, but that's a good place to starting.I don't think any reason to try to force four things beyond that sooner thanwe need to. I like to use the cell phone because I think it'sso pervasive that it's really easy for us to like kind of use that asan analogy. You know, you had groups of people when the iphone firstcame out that we're paying seven hundred dollars and at that time that was likejust absurd amount of money and they were standing in line overnight, right fordays to get to be the first person to have this iphone. And todayyou still have folks that have a flip phone and and and they're just theyare not going to let that flip phone go until they don't make it anymoreand someone takes it from them. Very true, hmm. And that's beenmuch more like letting, letting the market drive, I think. You know, healthcare is one of the things where you know to some degree the hospitalsaren't really following. You know, it's healthcare so different than the rest ofthe tech market in that you know I am going to patients often want theirphysicians to tell them what to do. So I'm like the cell phones,you know, where it's something you know, no one's recommending anything. I justgo and I get what I want. All right. But it's very truethat there's that same, that same adoption curve. But sure health turnsyou the first complicated because then on you know the positions want to buy inat their broader department organization and the patients aren't going to want to do ituntil the positions doesn't. And I actually have an example of that. Wehad a snow storm a few years ago in Boston and we got, youknow, what a great opportunity to convert a lot of in person visits arevirtual, to get people blown yeah, right. And so some folks onmy staff. You know, we're given a list of the patients who havethis is the next day and we're calling up the patients and you know,I don't know the exact script, that they were saying something along the linesof, you know, so snow storm. I'm sure it is. This isthe other one of those days in Boston where you're actually the roads,you're legally closed and you're not allowed to be on the road. So itwasn't matter. I'm just based the storm or not, and you would youlike to have a video that that was your doctor instead. And so Igot a report back from a couple people on my team that we've had nouptakes, that, you know, out of thirty patients ask none had saidyes, and I'm said you out, can I get on the phone andtrack them with them? And I very quickly realize that if I said andactually there was a I think I'm Boston will right up around. Because soI was working Jason Walks to the cardiologist and math general and I said,you know, had an spared song calling from math general. You know thatthe storm tomorrow. Dr Walky asked me to give you a call and hewould like us, like you to have a videos it with him tomorrow insteadof the in person, or there's no reason to mess it. It'll justthese death like your face to face. But you know that toosop you wantedto make sure that was okay with you and that knowing that it was comingfrom him directly is opposed to feeling like a Roboehl. I had a hundredpercent of patients say yes since I circled back with the rest of the teamand modified how how the question was being asked. And you know, justa little things like that, you don't know unless you're on the front lineactually happy. So I mean if that I hadn't been for that experience andme getting involved and having a patients directly and messaging it differently, it couldhave been that we came out of the storm saying wow, even with astorm, patients don't want to do this right, right how we talk tothem, and you know, so knowing it came from their physicians made allthe difference in them wanting to do it.

I think that's such a powerful insight, that the language in the messaging can make such a huge difference.And, like you said, you know you can walk away thinking that peoplejust don't want this technology, even when they're stuck in their home and inthat could be a complete wrong assumption, right because there's so many variables thatplay. That's just such a profound example. Thanks for sharing that with us.So a couple of things that I also want to talk about is apilot. So you know you've done several different pilots and so for the thoseof our people that are listening in our audience, many of them or either, you know, in a pilot right now or they're develop you know,developing all of the guidelines and negotiating their pilot. So what are some bestpractices, are must haves that you would recommend that they stay mindful of inin the pilot, kind of like de Pilot Agreement, pilot development process,in order to make sure that when that pilot is over, that they've gotwhat they need to, you know, kind of implement it more full scale. I'll start with three things and maybe they'll go beyond but I think one, you know, being mindful of that partization framework. Hmmm, don't maybedon't want to start with don't you something that you think is scalable beyond thefirst? But it's bigger than what you're doing right now. So you haveto start small. I know there's a big move away from calling things pilots, even things that are pilots. People are saying don't call it a pilot, called a program because that creates a certain amount of sort of organizational departmentalbuying. You the fact that this isn't something, that it's not ready yet. Right, not ready yet, like programs aren't ready at too. SoI feel like I hear everyone's talking about these things called programs and they're actuallypilots, as they're calling the program yeah, all we that to the audience isin there there's stakeholders, but I agree they really pilot. So pilotsomething that you think is is scalable beyond what it is you're doing initially ina big way. And I think you know the traction that we got invideo visits at math general was one of those things. The problems that cameto us, and this within the first couple of years, was the problemof a psychiatrist, Janet WISNIAC, who had patients coming in from all overBoston for treatments for autism, H G and buy pollar and other things,but through the course of giving the medication, they were often on treatments that requiredher to not to modify that the ghostes and the medication themselves over thecourse of multiple weeks. So these patients were sometimes coming in twice a week, but coming in weekly, twice a week, very, very frequently,and you know, especially around the autistick population where she started. By thetime a kid is pulled out as their regular environments, they're pulled out oftheir school and they're brought in the car and the car they find their wayup to the eighth floor of the building and then they're waiting in the waitingroom for an hour. You know, by the time they actually get intothe office. With the position, she's not able to see them at theirtheir regular self because they're extremely like any of us would be irritated. I'mirritated even thinking about like all of that process. Right. I think oneof the things he would think is like she can't possibly assess them much likenot even to think about the convenience or any other piece. Know, we'rereally solving the problems time we let her see the patients exactly as they are. We were solving the problems to. It was very inconvenient for the patientsto come in there for the parents to take time off. So we solvedthis problem of being able to do a follow up video visit for patients withautism, but very quickly. I mean we did that knowing that this issomething that could be used so broadly and astically. A very, very simpleexample, but I think it's applying that logic to any intervention. You know, if you're if you're going to do something, where, where will thenext thing be? You have any offensive that use and you know maybe itultimately won't be anything beyond that. But I think if you you don't wantto start down the path where you think this is going to be the onlysort of pilot approach. Yeah, that was that was number one start.So things to keep in mind. So the scale ability. I think definitelythat the champions. I think this has been well talked about in documented butjust you know, as as the administrator and as the business and technology championof this, you know ultimately I could convince the first couple positions, butI wasn't going to convince it an entire departments are really spring out. Whothe internal champions was. was was really a win win in for many ofthe positions that I worked with, the cross emergency medicine, cardiology and neurology, psychiatry. There were so many of...

...them. This became something they werereally excited about and this became their things and they're now building careers doing researchand telemedicine. But for them, the chance to do the champion was,for me, really important because it gave me a person through whom I couldevangelized to the rest of the department and for them it also gave them anopportunity to really differentiate themselves and the internal leaders, both within the apartment,within the organization nationally in some cases. So but finding those those champions andfiguring out what actually motivates them. And then the third one is really figureout what you're resourcing strategy is. You know, it takes a lot ofwork. I spent so much time thinking about you know, what was theright way to actually implement a pilot? Do you implement a pilot entirely withstaff of the telemedicine group or whatever innovation group you're in, or it entirelyout of the department, or is the combination of the two? And Iended up creating this graph that showed basically how there was no way, Ithink our leadership really wanted this to be a hundred percent on the department toimplements some day one, and I really ended up think, you know,there's no way they can do that because they don't. They don't know how, you until we teach them. They don't know how to do a testcalled a test call to test the patients video. They don't know how to, you know, double check why the technology is not working. They don'tknow how to add more than new physition. So they're just any number of thingsthat we could very quickly teach them, but they couldn't do it from dayone. So I had this kind of a graphic like, you know, where our involvement kind of went from up tout down and their involvement not. Why? THEM AT ZERO? Those pretty low and yeah, over timeand then then when we were at full like full scale, well, neverin up being at at whatever point where it is at full scale and implementationexecution with enough. You know, there's there's always going to be time whereyou need to call someone to ask or technical support. There's there's always goingto be some sort of base wine infrastructure supporting these programs. You know thatprobably will move to Ip, it'll move to existing places, but until itreally becomes mainstream, that will fill it in the Tele Medicine, visual andANA groups. But they really convincing your leadership that your departments can't do thison their own is really important if you want to be successful, because thenyou're not going to have again and kind of back to you won't have adoptionand then they're going to say it's a failure, but it's not actually failure, it's just the fact that you didn't sort of implement and resource at theright way again. So yeah, yeah, that's I love the graph because it'sso clear as to what you're talking about and how we have that extremelot of better. Yeah, I'm sure so. So I'm curious. Youknow, you've got all this experience for working in these large, bohemous organizationsand trying to innovate internally and you know most recently you're in this role,you know, working for an investment firm that are working with health innovators.You know that, I'm assuming very often are early stage startups. And sowhat do you think the differences are between trying to innovate within in a largeexisting organization and trying to innovate as a startup. What do you have verydifferently? That's kind of common, and what do you see like, Gosh, this is really different? That's a big question. So what's different?I guess you know, I've learned a lot about venture and investing and entrepreneurshipthan their many stages of company creation, at the earliest seed stages and astages where a company has gotten just a little bit of money but it's stillreally testing. I'd say perhaps of both. Common is one thing when compan isthe fact that they're trying to figure it out. You know, companiesthat were looking at are trying to figure out. So maybe they've developed technology, they have come idea for how something's going to work with a particular customerbase, but it's through the course of actually trying it, trying to getcustomer contract, having a customer use the the product, that they iterate andevolved. And I think the successful companies iterated involved the unsuccessful company go iterateand go away. That it's it's been surprising for me to see there arecompanies that aren't getting traction and are don't use that as a sort of aan indicator to move into different areas in Sidink. Very similarly the health system, you need solutions that are further along. But you know, in many ways, even though they're using products that are further along way to internally aretrying to figure out the right spot for this for their particular products. What'sthe right even technism for the right users?...

What's the right volume? You know, what's the great strategy. Even on the differences, I think bythe time you get into an organization that you do need to have a certainlevel of Polish and buying and other customers. I know it mass general. Wewe did do some things where we were the first, but as welooked at technology broadly, we were very often looking to see, okay,have you ever have used this with other providers and health systems? What wastheir very heavy have you actually worked with an Academics Medical Center? Because,even though you're very different, show and we're really for that traction with startupsyou don't need that. We see people actually talk to someone earlier today whohas an idea for something. It's literally an idea, nothing even on papers. Yeah, and that's okay. So the fact that it can be muchearlier and conceptual and I think one of the differences for me and figure outhow to how to work and think about that as base. So yeah,that I could be that would be a good pullong podcast. Yeah, right, right, and we're but now they're money. But I think there's areones that comes to mind right now. Yeah, yeah, so let's andI completely agree. I think that we could talk. You know, wecould probably have three episodes because you've you've been involved in so many different angles. I think there's so much to talk about. What we'll have to dothat on different episodes. But I do have just a couple more questions foryou, kind of just switching gears and putting on maybe more like the flarecapital hat in your current role. You know, a lot of our audiencesis there's these health innovators that are pitching to people like you and and soyou know, what advice do you have for them that are in the trenchesright now? You know, we we hear a I hear a lot inthe industry about everybody talking about innovation, but you know, is anybody reallyinvesting in innovation? And if they're investing, is anybody really adopting innovation. Sojust kind of talk about that a little bit from the from the investmentfirm standpoint. What what do you find? I do think that that in alltheories and I think that would be a very big clubs and plant topics, you know, venture and investment for entrepreneurs and yeah, to give atalk at the American Tele Medicine Conference and New Orleans last month about this,and so I put some thoughts together and so to a lot, a lot. To stay on it. I think one one in digital health investments andan all time high. Two Thousand and eighteen saw the most money ever putinto digital health. So I think that says there's a lot of interest fromthe market. I think at the same time, the money is becoming moreand more concentrated in later round and so people are looking for more mature solution. So how do you approach against? The short answer, since we're comingup to the end, is yeah, you've got you've got to have,even if the seed staves, and idea to what your product is. What'sthe business model? What's the competitive marketplace? You know what? Oftentimes, inorder to be successful you need to start small. But what is theVision Division for the big business that you're building. That's good to say outfrosts, because then if an investor doesn't see that this is going to bea return on the investment, you know, ultimately we have people investing money inour funds that we are then investing in companies and Shure we're very muchabout proving patient care and and proving the healthcare landscape. But if we goback to our investors and don't make money, at the end of the day,we're not going to get that next round investment and we don't we won'tgo marching over mission as one of those things right. A lot of thetype so that you really have to be very clear on what the problem you'resolving is and of that product is. And at been surprised to how manyentrepreneurs haven't really thought through all those points that you know. I find ifyou come and saying, you know, I haven't brought this all through andhere's what I'm thinking about, but if you come in saying here's my productsand you haven't thought through those points, that as a different story. Andthere are so many accelerators and different cities now. So that's just because themath challenge, help sex programs, help bring a text stars their country,programs in virtually every city can be really useful and helping refine helping entrepreneurs refinethat messaging, thinking through that, actually partnering them with Clients. But Ithink really having your pitch down is would be the number one thing. Yeah, that's great. So what project are you working on today? So alot of different projects. There's never there's never a single this this world appealswell to my desire to be doing a lot of things in different spaces.We, I'll just say briefly, we...

...have our limited partners who invest inus, since I'm working with them to make sure I understand their strategy andsupporting the partners working with our portfolio companies and that that really feels to myoperator side and doing a day to day operations. We have internal initiatives.I'm constantly and then really my day job and the biggest thing I've been hiredto do, is to scout first startups and entrepreneurs and look for the nextbig idea and the thing I'm most excited. Well, I'll share all for that. I have a couple areas even in one is asynchronous tell the medicine. So I think syncretous problem medicine is huge, but it's now being paidfor and so there are more and more collusions in that space. A synchronousis not yet being paid for. So I think there's a real opportunity,HMM, to get the next big thing, I think, penitentially, behavioral healthsuch a huge problem. So yeah, breathing, it's syncrenous, sell health, behavioral health and then what's called sent text. On the behavioral healthside there's just such a huge problem. Again, video won't solve anything.We don't have enough psychiatres or therapists. And then you know women's health andjust seeing I is such a it's going to be a fifty billion dollar industryby by two thousand and twenty five. So women are the decision makers forthe family. You know, if we go through itself, we had womengo through many cycles of life between for totally pregnancy, post part of,menopause, everything in between. And there's there's a lot of growing investment andinterest and what's called the stem tech market. So that's the probably underspending the mosttimes to see about right now. So any ideas of it's entrepreneurs anytimes. So yeah, so how can people? So first of all, let mesay thanks so much for sharing your wisdom with our audience today and withme. I really appreciate you taking the time today. And for those ofour listeners who have some questions for you or have something that they want topitch you, how did they get a hold of you? What's the bestway? Absolutely no. Thank you. For anyone who got to the endof this podcast. Thank you for listening. And Yeah, happy to share myemails to my twitter handles at the song, Sarah. Email is Sarahat we're CAPITALCOM and I think that's also on my linkedin. So linkedin isthat. There is the song and he's out suping me on Linkedin, butprobably email is the most direct. But any of those three forms. AndYeah, happy to have you share that when you when you put this outthere. Awesome. Thank you so much, Sarah. All right, thank youso much. What's the difference between launching and commercializing a healthcare in avation? Many people will launch a new product, few will commercialize it. To learnthe difference between latch and commercialization and to watch past episodes of the show, head to our video show page at Dr Roxycom. Thanks so much forwatching and listening to the show. You can subscribe to the latest episodes onyour favorite podcast APP like apple podcasts and spotify, or subscribe to the videoepisodes on our youtube channel. No matter the platform, just search coiq withDr Roxy. Until next time, LET'S RAISE OUR COIQ.

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