Digital Healthcare Innovations and Obstacles

Transcript

DAVID CARTY: If you’re like me, there’s not enough time in the day. And some days it even feels like that time is being stolen away from you somehow. But time efficiency is key for professionals like Dr. Liz Kwo, who is very regimented in how she approaches her day to day life.

LIZ KWO: I like to be productive. People always ask me how I’m so productive, writing books, managing a job, being on boards. And I think it’s because I get energy from these things. I get energy from all the various things I get to do. I’m very grateful. Of course, you know, we are in a different lifestyle where you can order food from Whole Foods or Amazon or, you know, you can order delivery. And I think that people should use that if they are able to. I do a few different things. One is that I try to sleep well. So I definitely get my full rest, but I also as some people do, you know, wake up not necessarily earlier than the kids, but at the same time so that I can then build in time to either once when I drop them off, I do a quick workout. I’d also sometimes work out in between meetings even for thirty minutes on the Peloton. I do things like meditation. It’s been very helpful for me to sort of ground myself even before a presentation. And I do outsource things. So I think about, you know, what do I need to do to make sure that I can provide for my family, eat healthy, think about all the different things that we have to do in life to be fulfilled. And when I was working in Europe, there were a few days where I just felt like people were planning their meetings around their vacations. And here, you plan your meetings only as much as you can, even on the weekends, even on weeknights. And in Europe, it’s just a little bit different. So I’ve learned to integrate different techniques around the world into my own lifestyle and habits.

CARTY: Portioning out her time carefully is one career hack that Dr. Kwo takes advantage of. But she applies that same discipline to other areas too, such as maintaining her professional network.

KWO: Making sure that I have time with friends. So I do sort of seven minute phone calls even with those that I call my own board of directors. They’re like my friends, but they’ve known me for a long time. And when I have career questions, family questions, marriage questions, they’re just people that I really trust. I am very, I would say deliberate in how I network and how I keep track of folks. I get a lot of requests all the time about picking my brain and doing things. So sometimes what I do is I aggregate all the folks that want to learn. So I try to maximize my time in mentorship. But, also, those that I have been mentored by, I make sure to make it more than just a transactional thing. I send them emails that I think about, articles that I’ve read, books that I really love. And I’m also very deliberate in conferences when I meet people. I try to make sure that it’s more than just, as we mentioned, a transaction. It’s very personal.

CARTY: It’s no wonder Dr. Kwo finds herself on several boards of directors, and she uses her status to try to influence boards to be inclusive.

KWO: Well, number one, I do think we’re starting to change the typical perspective of what a board member should be. In the past, it was a CFO, CEO, former. Compared to now, people are now opening their eyes. They’re saying, well, for this board role, we need someone who has a lot of commercial experience, in med tech. Or this one, it’s more on the research side. Or this one is more AI in the future of healthcare and tech. They may not all have the p and l or the operational experience, but they need to have the ability for their advice to be useful to the CEO. The second thing is actually having some experience, not only operationally, but also thinking about the board on a governance level. There are ways that board members sort of talk. Right? We’re not operators. We are when we’re in the boardroom, we’re sort of thinkers where we ask questions. We try to deliberate over what are big decisions, and you don’t get everything, all the information that you’d want. You only get it once a quarter. And so being able to be a board member with that strategic thinking and sort of high level thinking is really key. I think there is a way to at least get your foot in the door by first getting on one or two boards that are smaller. And then at some point, when you’re known for, as we talked about, the brand, what you stand for, what your experiences are, then you start to get known in the network, and then you can start to build your board portfolio.

CARTY: This is the Ready, Test, Go. podcast brought to you by Applause. I’m David Carty.

Today’s guest is efficiency enthusiast and digital health innovator, Dr. Liz Kwo. She is the chief commercial officer at Everly Health, a member of the Mass General Brigham Innovation Board, host of the DigitalMD podcast, and author of the book, DigitalMD, Revolutionizing the Future of Healthcare, which came out earlier this year. The American healthcare system is riddled with strains, and I don’t mean muscle strains. Compared to other wealthy nations, the United States ranks near the bottom in many health outcomes. And it’s for this reason that Dr. Kwo argues that the US healthcare system needs what she calls lifesaving treatment to alleviate it of its high financial and societal costs. Dr. Kwo prioritizes a digital-first approach to promote greater accessibility and personalization in our health care choices. Let’s check-in with Dr. Kwo and, hey, no wait time. In your book, Digital MD: Revolutionizing the Future of Healthcare, you advocate for digital-first health care as a win-win for all of the five p’s, which are pioneers, providers, patients, payers, and policymakers. While it’s proven that digital transformation in health care leads to more positive patient outcomes, you say, quote, positive change is happening only at a fraction of the pace possible, end quote. So what big obstacles remain in terms of digital innovation and adoption in health care?

KWO: Oh, there’s so many. Where do we start? I would say the first is that, especially for startups and earlier stage companies that really wanna make a change and make a difference, oftentimes, they have to understand who are the ultimate payers. Like, who is paying for this? I see a lot of innovators, especially entrepreneurs, who have either a personal story, something they’ve experienced. But when it comes down to it, I ask who’s gonna pay for it and at what price and why would they pay for it right now at this moment? They can’t always answer that. They say the payers or the employers, but why is the employer going to pay? So oftentimes, the payers, employers, what are they looking for? Like, number one, easy implementation, lack of abrasion with the person that they’re trying to the employee or the member that they’re trying to engage with. But number two, what’s the cost? Like, what’s the ROI? If you’re charging them ten dollars per member per month, are they gonna get thirty dollars back in cost savings for health care? Are they not going to go to an ER or have a length of stay in a hospital that’s very long? Or are they not gonna have to see a specialist? Or and then in addition, the third thing, of course, is all the convenience, affordable, accessible care. Digital health can do that. But I think the first two questions have to be answered. And then the third, of course, is, yes, we reduce wait times to see a specialist. We give them care now at this moment, but all the other first two questions have to be answered. I also think, you know, what are the areas? Of course, number one is regulation, with the five p’s. We’re now starting to see a lot of the FDA thinking about AI and how it’s used. One interesting area even for prior authorization for, let’s say, payers is with the AI and chat, the ability for these tools, the question is, can then we approve sort of orders and reviews of, let’s say, prior auth? But can we not deny? Because the black box area of AI is somewhat scary for a lot of people. And if you can’t certainly know why this AI has denied something, it can be difficult to really, allow. So the FDA is starting to look at all of these AI use cases and where things are legal and when things aren’t. I think that will have to be more regulated. I think the third key area is thinking about all the new technologies and how they actually support the ecosystem. So what we’re seeing with you know, we we’ll talk a little bit later, I think, about voice and other things, but we’re seeing so much emergence of use cases, but not all of them will actually be used because I think people assume there are use cases, but who’s paying for the use case? How is it being done? And what is the actual benefit in the long run is gonna be key.

CARTY: To pull on a thread there, you write in the book about how a massive wave of leading edge healthcare technologies is making it challenging for the FDA to assess the quality and safety of these emerging products. Combine this with consumer preferences toward D2C digital health alternatives and the expensive conventional healthcare, and you really have a wide base of consumer demand for these digital alternatives. But that places the onus on the organization, right, to be responsible and thoughtful with their products. So what should they be doing from a quality and a safety standpoint to ensure high quality care for consumers, especially in this industry?

KWO: Yes. I mean, there’s so many things. Number one is data integrity, which is cybersecurity and all the things that will be, people you know, no one really reads a fine print on apps that you download and things that are being utilized. So it is on the company, oftentimes, I believe. The second is making sure that the quality metrics, what they’re judging for. You know, we’ve seen a lot of really interesting companies, like mental health companies and others that are dispersing drugs or, you know, there’s a very interesting wild wild west right now. We’re starting to monitor these more closely now to say, can this medication, is this accurate? Is this medically necessary? But, also, is it actually following clinical guidelines? With digital health and the consumer side of asking for things, whether it’s Ozempic or other things that we’re seeing now with weight loss drugs, there’s a whole question of can consumers just pay for things and access things more than others? And so there will be some, I would say that are benefiting from going after the consumer bent, the consumer branded companies to gain things. I don’t think it’s a bad thing. You know, we have a lot of great companies that are now getting people what they need, whether it’s skin care or hair products or, like, you know, hair loss and other things where they’re directly able to benefit because they can now access a virtual care doctor and the medication and everything else. So I encourage that. I just think that we will need to be more focused on, as these different companies, you know, start to build and grow, how consumers are experiencing the quality. I will mention one thing that’s been interesting even at the company that I currently work for, Everly Health. We try to spend a lot of time working with the NCQA, which is a committee that focuses on preventive care and consumer quality. And when we work with the teams, we’re very focused on what is actually, this able to address. So we do right now something called FIT test, which is colon cancer screenings. And the goal is there’s a quality metric. Payers will reimburse for it. And so how do we make sure that we can get it into the right hands, into the right people so that they can be screened for colorectal cancer? Because we are seeing more and more people getting it earlier on in their early thirties and forties.

CARTY: Can you speak to the importance of the end user experience as it applies in a health tech setting and how payers and providers in particular can prioritize those experiences?

KWO: Yes. The end user so I would say there’s a whole engagement continuum. When you’re thinking about first, like, interactions, you know, there’s, like, push notifications right now on your text messaging or apps. They’re passive reminders, but then there’s, like, actively searching. So these are people that are starting to add information. Let’s say they’re coming to a site and inputting declarative language where they sometimes declare they have these symptoms or they’re looking for this. Versus AI can now also look at things that are not declarative just from your habits of when you go on Twitter or when you’re using certain things, they can tell what your sleep cycle is. Or when you’re actually searching for certain things, you might not declare that you’re looking for an STI, test kit, which is a sexually transmitted illness test kit. But now they assume that you may be more sexually active. And so there are interesting things that data is now being mined for. Even on Walmart, Mexico and Central America’s board, we see such interesting information about this for the end user. So meaning, when we, let’s say, even see people purchase, we see that when you purchase bird seed, we have a correlation to driving. People that purchase birdseed are less likely to get in car accidents. It’s sort of an interesting idea because perhaps they care for their car the way that they look after birds. So you see all these really interesting correlations among data. And so end users aren’t always aware of what they are actually entering in their information with. And so I think, as you’re thinking about this continuum, you know, we talked about passive information, then active, then you’re searching for certain things. And then at some point, there’s chatbots where you’re interacting, and then digital diagnostics where you’re actually really using things to test for yourself, and then hopefully digital treatment. So I see that continuum as an engagement of healthcare in the whole spectrum. And at some point, I do think everyone’s gonna be pushed towards sort of the early engagement that we talked about into testing, into the treatment, and then ultimately being in a cycle where the people can close the loop and get the care that they need with the end user in mind.

CARTY: You’ve just explained this concept of the digital engagement continuum, and that’s super helpful. From the pioneer or the innovator’s perspective, can you explain how important it is to help achieve that sort of proactive patient engagement with a digital product or service and how you can help facilitate customers moving from left to right along that continuum?

KWO: Absolutely. So I think the first thing is that in the past, people, I will say a lot of companies would start by creating digital health companies that didn’t always measure total amount of use and or they just sort of charge per member per month or per employee per month. Now there’s a lot more scrutiny. They wanna know, especially for the payers and employers, they wanna know how much they’re paying for, what is it getting them in return, and what are the, you know, cost drivers? How much are they saving for the different kinds of engagement tools? And because of that, I do think it’s been a really good awakening for digital health companies. As we think about that, especially for you mentioned pioneers, there are different ways to look at the technology. You know, everything from what we’re now looking at, you can either control the digital front door or you can come in on the back end of another platform that’s coming in. People are trying to be the platform, but I actually feel like there’s a lot of better ways to partner with other companies that already have a platform, and you just offer an extra service. There’s also a lot of not only technology as we talked about, but there’s different touch points of how people engage. So whether you come in from the provider, when you get discharged from a hospital or you go see your PCP, or a caregiver who’s looking for something and giving it to the end user, to the pharmacist now who you get your drugs from, to a pharmacy that’s online, to even things like advisors. There are now patient portals in engagement platforms. These are those that work with employers to try to broker and support these employees from getting the right care. They’re advocates. And then there’s the consumers that look for things. And so, for a pioneer, there are different ways to go about it. And they I oftentimes advise pioneers to sort of think about where are their engagement touchpoints that will get them the end user. Because not everyone thinks about that and that they can think about it from a various different type of ecosystem that they can get that, access to.

CARTY: This health tech space is getting fairly crowded, and you mentioned in the book how the regulatory environment is open to more health care innovators today than it had been in the past. And that’s great, but you still feel that the digital health industry is lagging in terms of addressing health equity concerns, for example, such as for low income or marginalized communities. How can these organizations do a better job of proactively addressing health equity concerns during product development?

KWO: Oh, I think it’s such an important point. We, as a society, definitely are building you know, we talked about from the consumer side. But there’s a lot of times for pioneers, they think about who’s willing to who’s willing to pay, and they start to build things based off willingness to pay. And, usually, it’s sort of the higher end folks that can pay and you can test with. But what ends up happening is they end up building for that rather than, let’s say, a Medicaid population. Because the way you build for Medicaid is very different depending on what their needs are. So good example in the digital health world is also cell phones. Patients oftentimes with prepaid phone cards don’t always have the same phone number, and they don’t always have smartphones. And we live in a different digital age when you are addressing that type of population. And so when people are thinking about addressing health equity, I think they need to think along those lines of what’s the digital format that you’re gonna engage with. The other thing too is how do you make sure that it is in the language that the person primarily speaks in, but also in the reading level. And so there’s sort of when you think about health equity, you have to build along those lines of how do you make it simple. And then third is also how do you build trust. There is sometimes a lack of trust among those that don’t always engage in the health care system, but need to or should because early diagnosis and prevention can actually lead to better outcomes. And so being able to build that trust early on with communities, with sort of local areas that have face to face advocates, that’s something that we, at least as providers. When I think about all of this, I still am a provider at my core. And when I think about how to engage patients to support them, you really have to build that trust. And it does sometimes start with actually the provider who’s in the community, who’s really building that relationship with the patient.

CARTY: And health tech companies sort of have a unique ability to build trust in maybe ways that traditional health care could not. Right? Because you can access those communities directly on their phones. Right?

KWO: Yes. It’s true. And I do think that, especially for phones, [the power is similar to] what sent people to the moon. Right? So it’s like that the processing power is so key, but how do people then actually use it in a way that allows them to feel like they’re getting the right care? I do see a lot of tech companies. We’ve seen all the Amazons and others who are now trying to create virtual care products that are priced very reasonably and are getting people the care that they need. I think we’re going to see more of that and more companies trying to get lower price points, get more volume, and get people access that they need. And as we talked about the continuum, they came in at all sides. Sometimes it’s chatbots just for mental health. Sometimes it’s a fertility, ovulation testing kit. Other times, it’s a musculoskeletal thing. They hurt their back, and now they just need physical therapy in the home, so it’s virtual. And they can, you know, use their phone to set it up with their body to see if they’re doing the right positions. We’re seeing all of that right now being very accessible. And for any of these health tech companies to power one member versus a million members, oftentimes, if it’s just an app, it’s the same cost. Right? And it’s just a bit more bandwidth. So, it’s gonna be a really interesting, next, I would say, future of where this kind of care is going.

CARTY: Voice technology in particular shows a lot of promise in this area. You write about a few examples related to elder care, accessibility, and mental health services in particular. What does the next wave of voice enabled health tech services and products look like, and what goes into validating those experiences?

KWO: Yes. Voice is something I’ve always been very interested in personally. Everything from voice detection of, let’s say, Alzheimer’s or dementia or other things that you’re seeing to, being able to so passively listen into what is happening in the background, especially if there’s a nine one one call, how this person is presenting. Perhaps they can know pretty quickly if this is a heart attack for various different reasons. We’re seeing a lot of that literature now come out. There’s also passive listening with the patient and a provider to sort of automate note taking, which will streamline. It’s more of an admin savings. It streamlines a lot of the physician’s or a nurse’s time. So they’re not constantly just, you know, inputting notes. And there’s also in the future, maybe even prior authorization. So a typical we talked about earlier, if you’re trying to get someone an MRI for their knee. And in the conversation with the patient and the doctor, they basically said, oh, so we’ve put you on physical therapy. Didn’t work for five weeks. Pain is still unrelenting. You have and you basically can check all the boxes in a voice recording, and then, hopefully, the AI can then just say check, check, check. This allows for an MRI to be approved. So it streamlines all these things that used to have to be faxes and back and forth. I also think we are now at a time where people have their Googles or Alexas at their homes. And so there’s now people interested in looking at, can you ask Alexa to help you find a provider? My old company that I worked for, also was pioneering this with a lot of provider groups, and thinking about how do you then proactively get Alexa to help you with your care, whether it’s also if you have a fall at home to signal somebody to help you. There’s there’s so many different interesting opportunities within voice. And I’ll mention another key area about voice too, which is thinking through what you can do to automate not only the workflow we talked about listening in the background, but also in getting people the care that they need through just a conversation. So, I think there’s gonna be a lot in the future within voice and AI and technology.

CARTY: We talk a lot about AI on this podcast. We are a technology podcast, so we have no say in the matter. You’re a proponent of AI in general stating that it benefits all stakeholders and has a variety of uses including in AI assisted surgery, and we’ve talked through a few other use cases on this episode already. We’re at a bit of an inflection point, it feels like, with generative AI and how organizations are using it across the business. Where do you see generative AI providing the most value and reliability in the healthcare ecosystem today, and what’s the level of risk that organizations take on when they deploy it?

KWO: Yes. I think, there’s a, you know, you may have a lot of information that I don’t even have, so I’d love to hear your perspective too. Generally in AI, it’s not just about automation. It’s about augmenting medical professionals’ ability to make informed decisions. So with AI, vast amounts of data can be analyzed and aiding identification of disease at their nascent stages. So we’re seeing that with acute kidney injury, being able to predict it, you know, forty eight hours ahead of time, even the VA with deep minds. There’s a lot of really interesting work on, AI even combing through medical records and thinking through adding that with genetic profile and other things, what you could actually, predict or at least assume would be the risk of someone’s, not only sort of health, but how do you change behavioral, how do you change the person’s behavior based off of what you now know? There is, of course, emerging ethical complexity because, especially as we’re thinking about AI algorithms, as people build them out, they sometimes can stem from skewed data or different sets, different things that are flawed in programming. So we wanna ensure that the algorithms are objective and unbiased. I also think, though, balancing AI with healthcare judgment, which we talked about with augmenting the professional, is really important. So assisting with tools as to not necessarily replace, but to support. So some of the things that we’re seeing right now with pathology and radiology in medicine is that you can still have a radiologist or pathologist review and double check. But there are things that the AI may be able to spot or see or compare to the last imaging, let’s say, of a chest CT scan. And looking at it there was a comparison. There you didn’t notice this, but this actually got a little bit bigger compared to last time. And so I think there’s a lot of great opportunities. When you said generative AI, I do think it could be a very interesting time to think about that, especially as we’re thinking about the summaries of what can happen from a discharge at a hospital. There’s also a lot of really interesting ways to explain a professional’s note into more layman terms, to think about that. And, also, I mean, we’re seeing a lot of interest in just making sure that people get a full suite of their medical records in a way that people can explain.

CARTY: Okay, Dr. Kwo. Lightning round questions for you here. First, what is your definition of digital quality?

KWO: I think it’s the ability to improve affordable accessible care, in a realm that allows the patient to be able to be in control and be able to engage and also feel encouraged and emboldened to leverage this care.

CARTY: What is one digital quality trend that you find promising?

KWO: I definitely think the voice changes, the voice biomarkers, the ways that we’re leveraging voice in digital health will be a big benefit for the future.

CARTY: What is your favorite app to use in your downtime?

KWO: I use Calm. It’s a really nice way to sort of sit and meditate and or listen to a really good reminder about being present.

CARTY: It’s an app that I probably should be using a lot more than I am, to be honest with you. And finally, what is something that you are hopeful for?

KWO: I’m hopeful for the future of people coming together and doing the not necessarily the right thing, but the thing that helps support the most people. Like, leveraging technology in the right way to support more and more people for happiness and joy and health and wellness.