Health Innovators
Health Innovators

Episode · 3 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 its kind video program about health innovators, early a doctors and influencers and their stories about writing the roller coaster of healthcare innovation. I'm your host, Dr Roxy, founder of Legacy DNA marketing group, and it's time to raise our COIQ. Welcome back to IQ listeners. On today's show I have Sarah Si song with me and she's been noted by fierce health as one of the most influential women shaping healthcare. I T welcome to the show, Sarah. Thanks so much, glad to be here. So, for those of our listeners who might not know who you are just yet, take a few minutes just tell them a little bit about your background and what you do. Excellent. So right now I am now working for a venture capital firms. We're capital partner space in Boston Massachusetts. In my role here I am helping invest in health, in early stage startups, health, TAC tech enabled services. We have seventeen companies in our first portfolio. We are about to start investing out of our second funds, which will be about two hundred and fifty million. So I am on the lookout all the sport things that are new, innovative and digital health. Great Entrepreneurs, great companies that are really transforming the business of healthcare. But I got into this by working on the proper minds of health start systems across the US, and so I share a little bit about that as well. So began my work as the US Navy back in two thousand and three, after red school started, a Lieutenant J G overseeing primary care operations. That I was at Kaiser for eight years and worked on a lot of different technology compliance projects, one of them being Kaiser's first large scale Telemedis and program and then Boston for the last six years I was the CO founder and health launched the first part of that general digital program so we launched video visits, that an opinions. So that was from two thousand and eleven until just last summer. So I come from a place of piloting things and seeing what 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 I know about your background, all the way from, you know, concept to full scale implementation. So I think we're going to have a really exciting dialog today. So total excited that it's very fortunate. Yeah, so tell me how you got into tell a health we completely for to it is so at the going. You know, I don't think it was certainly not a direct connection. But when I was in the navy and I one of the things I was excited about with the fact that it barely turned twenty four and they put me in charge of overseeing a primary care clinics, to be a third team clinics across in Diego, and one of the projects that I was assigned to was implementing video conferencing systems all across these clinics. So or just having to be half a million dollars a polycomedy of conferencing software and laugh you all of the equipment city on my floor. So you know, one of the things I did there was implement that one of some one of the clinics was in that desert a hundred miles east of San Diego. One of them was San Clementy Island, thirty miles off the coast San Diego. But that was the direct connection. I really found that I like doing projects more than the daytoday operations when I was in the navy. So looked for consulting style jobs and moved to northern California and worked for Kaiser for eight years and I worked in three different groups with any Kaiser. I worked at the health time hospital and then I work for the medical group and then in the end I worked for the National Group as well, which is called the federation. But when I was working for the medical group we had vp who came to us and said, you know, we have that are in northern California where we have the severe problem with Dirm welight times. You know, we can't get patients in for nine months to a year for these serve conditions. Obviously has too long to wait and he's sure I didn't give up the season. He just said, can you solve the problems of this drama stuff? And so we approached the problem and you know, obviously telemedicine was one of the things that we came to is as IDs, but the only telement is and being done back in two thousand and eight was at UC Davis and they were doing all video based Tele of medicine. And for us the problem was the amount of Dermatolog 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 to test, 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 it be 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 it gives them feedback, send a prescription or referral as needed. How? So all of that happened in the course of a patient visit. That was just a fifteen minute patient visit in the office, and so over the course of piloting we figured out how to actually do that. So we were able to have patients who are coming in, you know, could be for five different things, but if a germ condition was one of them, we would take the 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 and basically it's through the course of, you know, getting buy in from the clinics, 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 thousand of these what we called Derham e consults and months and you know, through the course of seeing how much this impacted drm access. So patients satisfaction was virtually a hundred percent. I think the PCPS that was some extra work for them, but we also made it very easy for them in a lot of ways and so all stakeholders ended up being a lot happier and I think we were actually surprised at the PCP statisfaction. We found that pcps were often referring things to derm and they know through the course of getting dirm feedback, so it 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 treat it. So they felt very empowered. Think there are up. There's also a situation where a PCP said to a patient, you know, I know exactly what this is, that the patient didn't believe her PCP and wanted to refer all the germ. So we were able to take a photo send it to Durham. The drm confirmed with the PCP fought and in that case that really strengthened that that patient PC relationship. So through the course of seeing how this 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 providing medical care from a distance via technology, and that covers a lot. Yeah, yeah, so what's fascinating to me is that you were one of the pioneers in this. So, you know, tell a medicine, tell a health is so much more common today then when it was when you first got started. You know some really curious you know it was. It was really radical when you were doing it. So when when I'm really curious about is, you know, what were the challenges, unique challenges for you, you think, because you were so early. It's a great question. I think people are concerned about privacy. From an organizational level, I think that that wasn't one of the things that was a challenge for a that that was ever something patients or or pcps asked about. I think it's something that when I talk to health systems, they asked about, but I think one of them was just really even how to describe it. Hm. You know, how do you? You say you're doing a visit over Tele Medicine, you say you're doing it video, a visit, you're taking a photo of just how you describe the interaction, and I'll give you a couple of examples of this. So we're doing a focus group to figure out what to call this and 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 group and we were going around thanking. You know, what do you think of when you think of telemedicine? What do you think of when you think of tell a health and this one woman, who is probably in her late s and she was a nun, so she was in our full garb, said, you know, we've been talking about this. Are you saying tell a marketing and she literally like thought. We've been talking about tell a marketing whole time. 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 I think the other thing is so and this is how they describe it, because part of the thing is you need to get by inform patients, and we often really found that. You know, when the physician says to the patients, Hey, you know, we have this program I'm supposed to use and I'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 a bit. But if you have a PCP who says, you know, we have a fabulous new program I could give you a referraral to derm for an in 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 for your consult go to the waiting room, wait for fifteen minutes. We'll have our as once back, I'll call you back into the office. I'll share the diagnosis the prescription that the dermantels is recommends. You can go pick it up before you leave today. You know, there's this much more empowering so there was. There was a lots of getting the position by and in order to really pitch the program so I kind of back to it. We need to know how to describe it. Yeah, and what the that's takes were to even 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 know that whole positioning in 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 the early adopters, you want to be able to communicate that it's unlike anything they'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't seen before, so without, you know, watering down the revolutionary aspect 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 other thoughts, one is just what is are you solving a problem or are you looking 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 thousand and eight, so when I started it at mass general and two thousand and eleven, two thousand and twelve, there were a lot of people that actually knew it. Tell him that is in once at least within the position community, and we're excited to use it. But one of the problems I found is that we were off and trying to find a used for the technology that they've been solved problems. So I think this is so the poor things I'll talk about, I don't think are any different from today, but they were things that I found were really the big barriers from the beginning. So one one. Are you solving a problem or you're looking for use? At the technology and the places where we were solving a problem is obviously it worked well, and YEP, not the other way down. So I think we all 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 still to this day, is, you know, physicians aren't going to do something if they can't get paid for it. You know, they may do it one or two times, but they're not going to do it as part of their everyday clinical workslow. Yeah, so how to pilot something that was innovative that pairs weren't paying for and get positions to use it at scale? What was really a challenge, and I think this is something that continued to be a barrier where we're making a lot of progress. But at last general we ended up creating a fund. That was almost we created a mechanism to pay ourselves. So the positions when they would do tell us, tell edics and visits, whether it was video, second opinions or other things, we came up away as basically deciding how much their time was worth and how much that visit would get paid to them. That was essentially an equivalent of what a fee for service in persons as it would be for them. So that was, you know, we were able to, at least an early day, solve the problem with physician payment, but I think as we got a lot of traction, we got to the point where people could do this a hundred percent of their practice. We actually found the psychiatry all of a sudden we were afraid that we weren't going to have adoption. Psychiatry Boor butet out of the water and and basically they we had to go back and tell the department to 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, I think then the problem we have. But how do you say, well, use this sometimes, but don't use it all the time? And I think it's it's just it doesn't work if it's not something you can think of for every patient, and that's really stuck with me. With everything else they've worked on, I think saying on the regulation, you know, is really challenging. Can I do this visit with a patient and another state, or can say is can I do a first visit? Can I prescribe that? Occasions are just there's so many questions around the regulatory environment that I think oftentimes physicians tend to not do it at all because they're concerned about probably it's safe from their perspectives, their licenses. They're their key to be able to hang out a shingle and and show red services. Part of what I liked in my role at both Kaiser and mass general is being able to help provide a framework and share, you know, I'm not a lawyer, that I was able to share here's the law and here's what we are allowed to do, and and I think that getting that I'm comfortable with. That was huge. And then the fourth challenge, would say, I think it's probably still the I guess one of the most important is, you know, you have to have leadership by it and vocal endorsement at the highest levels. And I found that through the course of various work I was...

...doing, I was hearing from our leadership that this was most important. Telemedicine and digital is the future. It was something that we had to provide for our patients. Are Physicians had to do and I would go. So that was the message I preached, that's what 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 YEP and 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 and you know they were bought in, they were excited, but they were taking here. I absolutely agree and I want to do this too, but at the end of the day, our CEO had a list of ten goals for me for this year and digital health and telehealth aren't anywhere on there. And we'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 not something I can really tell my team to focus on. So I think part of it was figuring out how to work with leaderships so that this was really it wasn't coming from Sarah, because that wasn't the powerful message. It was coming from the leaderships. I think there are a number of organizations that have really highlighted from from the very top how important digital is, and I think Cleveland Clinic has access anywhere, any time. That of the Mayo Clinic has the goal to touch two hundred million lives by two thousand and twenty and you know, those are things that they're very much enabling through digital and needs to go to their patient website, accid Toro phosition via video and second opinions is right there on the front page. So really a lot of the work I was 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 I love it. So it kind of want to start with the first one. You know, you kind of talked about, you know, starting with a problem versus 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 more success. So you know when the organization is really starting off with more of technology, you know, what did you have to do to really change that? Was it to you know, kind of reverse engineer and find the problem? Was It, you know, getting patients or providers involved to kind of 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 help our listeners understand how you overcame that, because I think that that's something that folks run into really often. They get really, really excited about the technology and 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 these questions in the band. Apologies if I'm I'm pausing and thinking for a couple that is so, I no, no, think. Yeah, so, you know, I think the way it first hit me was, you know, when I was a kind of there, I was doing a very structured program that 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 program and getting traction, and there was no definition around what we should focus on, what our products were, who I would work with, and so in my first couple years of MGS I spent a lot of time going around trying to find people that were excited about working with technology, using technology, and I think it very naturally I ended up getting a lot of people were excited about 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 meet those people, but then very quickly realize that there were a lot of those people and more people than I could manage, and so it actually turned into one of those things where, in order to manage the volume of Indoct interests, I really had to say to my leadership and within the small team we had of these. I'm a team of wonder. You know, there are couple of partial stees are helping out in the early couple years, how we prioritize among these ten things sitting on our desk, and I think one of the things we started to say is let's let's come up with some sort of 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 what your 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 we came up with his framework. It was called Kerk. So prioritization, impact, readiness and complexity, and so we started to look at these initiatives and when we said noticing, so I think part of the reason we had to do this all to us because we'd say...

...notice something. You know, there's clearly there's no problem that they're solving. There's no, there's no market that's willing 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 is not at all aligned with what we're trying to do. But I think establishing this framework was also way of getting my direct bosses and also the hospital leadership on board with this. is how we learning about so that's the next time that thing came through the VP that you was looking at. It said yet know that that actually it's not a priority of the organization, or that's a really great program but you're probably going to have one consult a year and that's just not not high enough. So we thought it on things in terms of prioritizations with organizational strategy, and the two things are thinking about were population health management. How is it helping manage costs, increased value, impact, quality, or was it something that was helping sort of expand our network within the math 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 it worth putting together these huge contracts and spending a hundred hours of staff time to put all this in plate, or it were? It's spending that time on something where we have, you know, one console the day or, you know, a hundred confolts a week. And and so it really helped us shift towards things that were higher volume and that's really what gave us the early learnings 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 to do a program that involved video and imaging and it was across state lines and you 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 to put all the pieces together. So that was one of the things we thought about, because I think for people to think about with their programs. And the 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 of project manager to help, if they have positions. You know, all of all of that readiness. This factor, if they had a client who is willing to pay, all really helps. You know, when we had a single physition or a single administrator who had an idea for something but had not yet checked the markets and engaged interests there, and it leaves things in a very different space. So it was ultimately around that. Getting back to your trying to solve a problem, we're trying to solve problems that would be able to 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's great. So let's kind of move on to the number two that you talked about, physician payments. So obviously that's going to be really critical for for motivating them and getting them inspired and engaged help. The understand in our list is understand a little bit more of you know, what was this creative fund that you came up with? M Yeah, so I can talk about that and in some ways number two and three, on the reimbursement and regulatory like are also 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 in terms of position adoption, and I can talk about fun piece of it as well. But so I think solving the phosition adoption problem is it's something else big. I think we look at the you know, the typical highth cycle chart all the time and typically we're seeing that it's a few few providers of the Pos with the money, and I think this is something that became obvious as really early. So I mentioned the fact that the havial health and psychiatry was 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 money and when physitions fill for in person visits a fine acpt code, they write the visit note, they submit that to the insurance, the insurance review basically send 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 mechanism where position we spent a lot of time thinking about what was the right level of payment, but basically came up with something that was a dummy cpt kit system. So instead of putting the actual code, they would put vir or Vaz something. So anyway, they came up with a code and they would click 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 system to not send the bill out to the payers and instead to send it to this internal group that was looking at these visits and they would initiate a payment out of this internal plot we have. So I think, you know, it ended up, once we had buy in from leadership, that they were willing to us the problems. They directed...

...the finance to help us put this in place. Is Then, yeah, worked really easily and it's I think that the big thing is, even if there are more efficient system doing what the positions do every day all the time is always 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 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. I don't know how to what extent they were, but it was something that I think we were one of the early pioneers of, and and that's a number of other systems did it in the years after us. I think most states at this point are reimbursing. So I think we do at envy h while not there anymore, they're they're that fun still still does exist and it exists to pay for the visits to pairs do not cover, since pairs are covering quite 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 found was 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 this seems we need to advocate for more of this money. You know, we said, well, let's also big down into who are the actual positions they're doing 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 apartment of several hundred clinicians, we actually found that ninety percent of the money that had been stead was being done by six positions. Out of hundreds, there were six people that were driving ninety percent of the US elivation. So it was I think it also highlighted us just to this the spell curve. You know, 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 get the broad adoption, and so that was something that really became our focus in the years ahead, was how this why was it only need six? Why wasn't at the others? And and I thought it was unique to Mgcause I've talked 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 or so. And I think one example that I use a lot that continues to tell them me and would love, you know, I really should reconnect to these two women to delve into this more. But we had a woman who is a female cardiologist of a certain age, of a certain ethnicity, solid particular type of patient here or ten different descriptive details around her, and she had so many visits that she was doing over video that she had enough that she 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 so it's again kind of work cardiology was concerned, 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. Those ten descriptors also fit her, her colleague, to an absolute tea. They saw the exact same patients and that woman had tried video visits, didn't like it and didn't use it at all. But I think when you try to say that something around that a certain age would e gener like, what is it? Because of the right clinical 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 that are in. There's there's some trick to this adoption that we've not hit solved. So I get that. One of an example that I think don't be quick to jump to conclusions around. So one of the things I'm adopting are not yeah, so one of the things that I talk to clients about regarding that is this early adoption strategy and kind of the bell curve that you're talking about and how the aligns with the diffusion of innovation model. And so one 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're going to have a much greater adoption success than we would if we were going after the mainstream market. What I find happens most often is the health innovators that we work with. They just kind of see the market as kind of like a whole segment like you're talking about, and they're banging on the door and trying to convince the mainstream market to buy in and they're just so much more risk averse than the early adopters that their or or trying to get laggards to buy into it, and so it becomes so discouraging for them and sometimes they've run out of money before they actually get to market because they're, you know, 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 that there were these few earlier doctors. Some of the goal that we created ourselves were around having brought adoption across the...

...entire department and like having the entire department through it. And I think there are, you know, their arguments for both sides, but you know where I come down as is on the side of this isn't something that needs to be for everyone. Pat I'm in the opinion that there could be some people that are really good at for in person and that's what they love, and there are some people that maybe you want to mix and some people had almost you know, I think having a mix is good, but some people who maybe want to do mostly virtual and I think the idea that this is something you should have everyone doing at the same levels is just doesn't really match human behavior, at least with how we practice medicine right now. So, and I think that was just highlighted with my kaiser experience. There's one of the early dermatologies that we use. He was just not a good people person. He did not interface all the PCPS The 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 people that, you know, we're just lovely. They you know, we're very careful about developing the relationships and, you know, being really a consultant to the PCP and not. It was. It was a lot around communication and style and and I think they thing was true at energy. So they're there people for whatever reason. Maybe it's Tech Savva, style, communication, everything else, but they're my I'm of the opinion that, you know, maybe it will be not the entire bell curdle to really maybe it will be more beyond 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 than we need to. I like to use the cell phone because I think it's so pervasive that it's really easy for us to like kind of use that as an analogy. You know, you had groups of people when the iphone first came out that we're paying seven hundred dollars and at that time that was like just absurd amount of money and they were standing in line overnight, right for days to get to be the first person to have this iphone. And today you still have folks that have a flip phone and and and they're just they are not going to let that flip phone go until they don't make it anymore and someone takes it from them. Very true, hmm. And that's been much more like letting, letting the market drive, I think. You know, healthcare is one of the things where you know to some degree the hospitals aren't really following. You know, it's healthcare so different than the rest of the tech market in that you know I am going to patients often want their physicians 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 just go and I get what I want. All right. But it's very true that there's that same, that same adoption curve. But sure health turns you the first complicated because then on you know the positions want to buy in at their broader department organization and the patients aren't going to want to do it until the positions doesn't. And I actually have an example of that. We had a snow storm a few years ago in Boston and we got, you know, what a great opportunity to convert a lot of in person visits are virtual, to get people blown yeah, right. And so some folks on my staff. You know, we're given a list of the patients who have this 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 lines of, you know, so snow storm. I'm sure it is. This is the 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 it wasn't matter. I'm just based the storm or not, and you would you like to have a video that that was your doctor instead. And so I got a report back from a couple people on my team that we've had no uptakes, that, you know, out of thirty patients ask none had said yes, and I'm said you out, can I get on the phone and track them with them? And I very quickly realize that if I said and actually there was a I think I'm Boston will right up around. Because so I 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 that the storm tomorrow. Dr Walky asked me to give you a call and he would like us, like you to have a videos it with him tomorrow instead of the in person, or there's no reason to mess it. It'll just these death like your face to face. But you know that toosop you wanted to make sure that was okay with you and that knowing that it was coming from him directly is opposed to feeling like a Roboehl. I had a hundred percent of patients say yes since I circled back with the rest of the team and modified how how the question was being asked. And you know, just a little things like that, you don't know unless you're on the front line actually happy. So I mean if that I hadn't been for that experience and me getting involved and having a patients directly and messaging it differently, it could have been that we came out of the storm saying wow, even with a storm, patients don't want to do this right, right how we talk to them, and you know, so knowing it came from their physicians made all the 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 people just don't want this technology, even when they're stuck in their home and in that could be a complete wrong assumption, right because there's so many variables that play. 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 a pilot. So you know you've done several different pilots and so for the those of 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 best practices, are must haves that you would recommend that they stay mindful of in in 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 got what 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 maybe don't want to start with don't you something that you think is scalable beyond the first? But it's bigger than what you're doing right now. So you have to 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 departmental buying. 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. So I feel like I hear everyone's talking about these things called programs and they're actually pilots, as they're calling the program yeah, all we that to the audience is in there there's stakeholders, but I agree they really pilot. So pilot something that you think is is scalable beyond what it is you're doing initially in a big way. And I think you know the traction that we got in video visits at math general was one of those things. The problems that came to us, and this within the first couple of years, was the problem of a psychiatrist, Janet WISNIAC, who had patients coming in from all over Boston 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 required her to not to modify that the ghostes and the medication themselves over the course 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 the time a kid is pulled out as their regular environments, they're pulled out of their school and they're brought in the car and the car they find their way up to the eighth floor of the building and then they're waiting in the waiting room for an hour. You know, by the time they actually get into the office. With the position, she's not able to see them at their their regular self because they're extremely like any of us would be irritated. I'm irritated even thinking about like all of that process. Right. I think one of the things he would think is like she can't possibly assess them much like not even to think about the convenience or any other piece. Know, we're really 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 patients to come in there for the parents to take time off. So we solved this problem of being able to do a follow up video visit for patients with autism, but very quickly. I mean we did that knowing that this is something that could be used so broadly and astically. A very, very simple example, 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 the next thing be? You have any offensive that use and you know maybe it ultimately won't be anything beyond that. But I think if you you don't want to start down the path where you think this is going to be the only sort of pilot approach. Yeah, that was that was number one start. So things to keep in mind. So the scale ability. I think definitely that the champions. I think this has been well talked about in documented but just you know, as as the administrator and as the business and technology champion of this, you know ultimately I could convince the first couple positions, but I wasn't going to convince it an entire departments are really spring out. Who the internal champions was. was was really a win win in for many of the positions that I worked with, the cross emergency medicine, cardiology and neurology, psychiatry. There were so many of...

...them. This became something they were really excited about and this became their things and they're now building careers doing research and telemedicine. But for them, the chance to do the champion was, for me, really important because it gave me a person through whom I could evangelized to the rest of the department and for them it also gave them an opportunity 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 and figuring out what actually motivates them. And then the third one is really figure out what you're resourcing strategy is. You know, it takes a lot of work. I spent so much time thinking about you know, what was the right way to actually implement a pilot? Do you implement a pilot entirely with staff of the telemedicine group or whatever innovation group you're in, or it entirely out of the department, or is the combination of the two? And I ended up creating this graph that showed basically how there was no way, I think our leadership really wanted this to be a hundred percent on the department to implements 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 test called 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't know how to add more than new physition. So they're just any number of things that we could very quickly teach them, but they couldn't do it from day one. 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 time and then then when we were at full like full scale, well, never in up being at at whatever point where it is at full scale and implementation execution with enough. You know, there's there's always going to be time where you need to call someone to ask or technical support. There's there's always going to be some sort of base wine infrastructure supporting these programs. You know that probably will move to Ip, it'll move to existing places, but until it really becomes mainstream, that will fill it in the Tele Medicine, visual and ANA groups. But they really convincing your leadership that your departments can't do this on their own is really important if you want to be successful, because then you're not going to have again and kind of back to you won't have adoption and 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 the right way again. So yeah, yeah, that's I love the graph because it's so clear as to what you're talking about and how we have that extreme lot of better. Yeah, I'm sure so. So I'm curious. You know, you've got all this experience for working in these large, bohemous organizations and 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 so what do you think the differences are between trying to innovate within in a large existing organization and trying to innovate as a startup. What do you have very differently? 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 entrepreneurship than their many stages of company creation, at the earliest seed stages and a stages where a company has gotten just a little bit of money but it's still really testing. I'd say perhaps of both. Common is one thing when compan is the fact that they're trying to figure it out. You know, companies that 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 customer base, but it's through the course of actually trying it, trying to get customer contract, having a customer use the the product, that they iterate and evolved. And I think the successful companies iterated involved the unsuccessful company go iterate and go away. That it's it's been surprising for me to see there are companies that aren't getting traction and are don't use that as a sort of a an 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 are trying to figure out the right spot for this for their particular products. What's the 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 by the time you get into an organization that you do need to have a certain level of Polish and buying and other customers. I know it mass general. We we did do some things where we were the first, but as we looked at technology broadly, we were very often looking to see, okay, have you ever have used this with other providers and health systems? What was their 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 startups you don't need that. We see people actually talk to someone earlier today who has 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 much earlier and conceptual and I think one of the differences for me and figure out how 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 are ones that comes to mind right now. Yeah, yeah, so let's and I completely agree. I think that we could talk. You know, we could 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 do that on different episodes. But I do have just a couple more questions for you, kind of just switching gears and putting on maybe more like the flare capital hat in your current role. You know, a lot of our audiences is there's these health innovators that are pitching to people like you and and so you know, what advice do you have for them that are in the trenches right now? You know, we we hear a I hear a lot in the industry about everybody talking about innovation, but you know, is anybody really investing in innovation? And if they're investing, is anybody really adopting innovation. So just kind of talk about that a little bit from the from the investment firm standpoint. What what do you find? I do think that that in all theories and I think that would be a very big clubs and plant topics, you know, venture and investment for entrepreneurs and yeah, to give a talk 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 and an all time high. Two Thousand and eighteen saw the most money ever put into digital health. So I think that says there's a lot of interest from the market. I think at the same time, the money is becoming more and 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 coming up 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's the business model? What's the competitive marketplace? You know what? Oftentimes, in order to be successful you need to start small. But what is the Vision Division for the big business that you're building. That's good to say out frosts, because then if an investor doesn't see that this is going to be a return on the investment, you know, ultimately we have people investing money in our funds that we are then investing in companies and Shure we're very much about proving patient care and and proving the healthcare landscape. But if we go back 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't go marching over mission as one of those things right. A lot of the type so that you really have to be very clear on what the problem you're solving is and of that product is. And at been surprised to how many entrepreneurs haven't really thought through all those points that you know. I find if you come and saying, you know, I haven't brought this all through and here's what I'm thinking about, but if you come in saying here's my products and you haven't thought through those points, that as a different story. And there are so many accelerators and different cities now. So that's just because the math 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 refine that messaging, thinking through that, actually partnering them with Clients. But I think 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 a lot of different projects. There's never there's never a single this this world appeals well 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 in us, since I'm working with them to make sure I understand their strategy and supporting the partners working with our portfolio companies and that that really feels to my operator 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 hired to do, is to scout first startups and entrepreneurs and look for the next big 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 paid for and so there are more and more collusions in that space. A synchronous is not yet being paid for. So I think there's a real opportunity, HMM, to get the next big thing, I think, penitentially, behavioral health such a huge problem. So yeah, breathing, it's syncrenous, sell health, behavioral health and then what's called sent text. On the behavioral health side 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 and just seeing I is such a it's going to be a fifty billion dollar industry by by two thousand and twenty five. So women are the decision makers for the family. You know, if we go through itself, we had women go 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 and interest and what's called the stem tech market. So that's the probably underspending the most times to see about right now. So any ideas of it's entrepreneurs anytimes. So yeah, so how can people? So first of all, let me say thanks so much for sharing your wisdom with our audience today and with me. I really appreciate you taking the time today. And for those of our listeners who have some questions for you or have something that they want to pitch you, how did they get a hold of you? What's the best way? Absolutely no. Thank you. For anyone who got to the end of this podcast. Thank you for listening. And Yeah, happy to share my emails to my twitter handles at the song, Sarah. Email is Sarah at we're CAPITALCOM and I think that's also on my linkedin. So linkedin is that. There is the song and he's out suping me on Linkedin, but probably email is the most direct. But any of those three forms. And Yeah, happy 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 launching and commercializing a healthcare in avation? Many people will launch a new product, few will commercialize it. To learn the 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 for watching and listening to the show. You can subscribe to the latest episodes on your favorite podcast APP like apple podcasts and spotify, or subscribe to the video episodes on our youtube channel. No matter the platform, just search coiq with Dr Roxy. Until next time, LET'S RAISE OUR COIQ.

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