Podcast: “Charting a New Course with Dr. Murray Zucker”
What’s at Stake in the Future of Healthcare?
What role will technology and digital solutions play in streamlining healthcare so that it is more impactful and efficient for patients, employers, healthcare providers, and government agencies? Brendon and Murray are joined by healthcare executives and thought leaders Kevin Pereau and Henry Loubet in this provocative round table, spanning mental health, artificial intelligence, best practices for sustained engagement in digital health, and more.
[00:00:11.950] – Brendon: Everyone knows that the behavioral health care system is broken, but we’re willing to bet you have no idea just how broken it really is. Of course, this is charting a new course, and we speak with really smart people here to ask one simple question what are we going to do about it? I’m Brendon Kelly, and with me, as always, is Dr. Murray Zucker. Hey, Murray, how are you today?
[00:00:30.490] – Murray: Hey, Brendon. Really good. Very excited about our recording today because we’ve got two health care leaders who are so known in the field, really rock stars in the field. They’ve been involved. They help shape health care, they’re influencers, they shape the future. So this is going to be really interesting, very exciting. And their backgrounds are so extensive and so important, I don’t want to not give credit where credit is due. So maybe I’ll ask each of you to just introduce yourself, maybe start with you, Kevin.
[00:01:05.030] – Kevin: Sure. I write books on healthcare. I have two out called The Digital Health Revolution and It Takes a Village. And I also have a boutique strategy and management consulting firm that focuses primarily on helping providers and payers get maximum value from their digital health investments.
[00:01:26.870] – Murray: Henry, how about you?
[00:01:28.510] – Henry: Sure. Hi. Thanks, Murray and everyone. Henry Boulet. Bohemia Health is my consulting company, however, and I do health care consulting for a number of different portfolio companies, but primarily my background has been in managed care, where I was formerly Western CEO of United Healthcare, president of Health Net, and a couple of other health plans along the way, and also been really involved on the employer side with a large insurance brokerage firm. So had a variety of experience as well on the provider side. So thanks for having me.
[00:02:06.290] – Brendon: Excellent. Thanks for being here, both of you. I assume that Murray pulled in some favors for this one, or some money. Probably changed hands because we’ve got a high caliber show here. And so, as a bit of background, we at HAP have actually ran a survey of employers and insurance companies back in December, and what we wanted to do today is really get in front of you guys and have you respond. So this was a survey we conducted with senior leaders to both honestly and anonymously, which I think is important, evaluate their organization’s priorities overall, but then in particular as they relate to digital health care strategies. So few questions came out of that, but three we want to really touch upon today. So, without further ado, if it’s okay with you guys, I’d love to jump right in and start the conversation. Sounds good. All right. We’ll have the drumroll in there. I hope Ross or someone else can do that. So here we go. First question of the survey was, what is the priority health issue to address with your digital health strategy? And then, so spoiler alert, it was mental health number one with a bullet for both insurers at 44% and employers at almost 80% to 79%.
So why don’t I ask you, Kevin, to kind of kick us off? Obviously, we know, no surprise, mental health is a huge priority for everybody. So aside from the obvious sort of pandemic impact that we’ve seen over the past few years, what do you think is really driving that?
[00:03:45.950] – Kevin: First off, I’m not surprised that it’s a priority and it’s been called out. If you’d ask that question ten years ago, then five years ago, then eight years ago, in any random order, you would have gotten different answers to that question. And I think when we first burst out of the gates with Digital Health, it was really all about getting people paid and paid faster. And it’s nice to see that over the course of our journey, we’ve evolved to really start to ask ourselves tough questions about what do people really need? Right? So I’m not surprised that they’re saying things like they need assistance and tools to better help people when they’re feeling depressed, feeling down, just mental health in general. It’s a notoriously difficult group to engage. It’s a notoriously difficult and challenging group to even target. I think Murray provided some great insights, in It Takes a Village. A couple of the key takeaways was that it’s tough to pull people out of the shadows. You need it to be anonymous, you need it to be personalized, you need it to be focused on addressing a key need that anybody has at any one given point in time, and it needs to be anonymous.
One of the other takeaways that I remembered was we have this image of who needs a mental health app or who needs a tool that you can literally stand on its head when you realize it’s really everybody. I mean, at a certain point in time, it’s not just someone that’s chronically depressed, which is really when I first started taking a look at this market segment, that was my assumption. It was, how do you get chronically depressed people to engage? Well, that’s going to be tough, but you realize over time, and Murray made me realize this when we were doing our interview, was that it can be anybody. It can be cyclical, it can be episodically driven. The death of a loved one, for example, in the fall, can drive somebody into poor eating habits and putting on weight and suddenly no energy to do the things that they usually have zest for in life. So I think the more that we come to realize that there’s a cause and effect here between mental and physical and that we all experience it, I think that that’s a good place for us to be, and it’s a good tool to be providing employees, especially.
[00:06:13.060] – Brendon: That’s a great start to this conversation, for sure. And I couldn’t agree more. I’d love to hear, Henry, your thoughts on this as well.
[00:06:20.980] – Henry: Sure. I’ve got a little different take. I mean, one of my frustrations as a healthland president and CEO for about 20 years and the thing that I really had trouble coming to grips with had to do with the mental health benefit itself. This is obviously Boba, for mental health parity that the inpatient benefit would be 30 visits, the outpatient benefit would be 20 visits, even though when it came to the medical side, there was no limitation. And we’d have very, very sick people hospitalized and their benefits would be cut off in 30 days and they’d be discharged from the hospital in some cases. And same thing on the outpatient side. So I think my thought to piggyback Kevin saying is that mental health and behavioral health for me has always been a very high priority in this juxtaposition between the medical side and the behavioral. Mental health side has always been paramount. And I’m so pleased to see some of the advances that have been made, companies like Happify and Ginger and others that are emerging. That’s my take on the emergence on the behavioral health side, which I think is so positive in the health plan world at least.
[00:07:38.760] – Brendon: Absolutely. I said to somebody the other day in a conversation that 100% of your people (was talking to a large employer) 100% of your people are already on their mental health care journey. So it’s not about that small amount of people that show up in the claims data. We know that people are dynamically all along this mental health spectrum at any given point in time. And Murray, I think you know a thing or two about this sort of stuff. So to get your thoughts as well.
[00:08:06.140] – Murray: I’m still learning, actually. I wasn’t surprised with the results. Actually, I was very pleased with the results that there’s that much recognition of the impact mental health has both for employers and health plans for the population in general. And taking it one step further, it’s not a national problem, it’s an international problem. And when we pose the question, so why is it becoming so recognized? Why is it now so important? Okay, you’ve got the pandemic that shine the light on it and all the consequences of depression, anxiety, post traumatic that goes with the pandemic. But I think societies have come along in recognizing it. So decreasing stigma is helping why it’s become front and center main problem. Also, when you look at let’s just take from a strictly hardcore, hard nose financial standpoint from the health plan perspective, if you look at dollars spent so it’s chronic medical illness is the big ticket item, right? And then there’s a severe horrendous things, heart transplants, liver transplants and all. But if you look at chronic medical illness just in terms of expense, not to mention the burden of people’s lives, quality of life and all that, but you then look at chronic medical illness under the microscope, you say, oh my God, about 50% of these illnesses have comorbid or coexisting depression or anxiety. And then the research shows, wow, if that’s the case in a person who has comorbid depression or anxiety, they don’t take their medicine, they don’t change their lifestyle. Their needs for insulin are higher than usual. They live shorter lives. They’re in the emergency room more. So from a strictly practical financial standpoint for the government and health plans and everybody: chronic medical illness really needs to be looked at in terms of its comorbid mental health issues. So that’s a financial thing.
From the employer perspective, I’m not surprised either, because these days retention of quality workers is a big deal, right? And the younger workers are all saying, hey, we need good mental health benefits because we’re under a lot of stress and they’re more sensitive to these issues. If you want to retain a good workforce, you need to up your benefits, but also you don’t want people out ill, so you don’t want them performing suboptimally at work. If you can provide mental health and wellness as well as disorder care, you’re going to have a healthier workforce. The other thing too, that’s so amazing is now we’re starting to realize that we thought, okay, so about 20% of people in the general population have depression rates. But it’s much higher. We found out through some studies that we interpret some data at happify, that actually there’s an additional 17% who are undiagnosed or unrecognized as being depressed. So that’s in the workforce, that’s at home, it’s all over the whole population. So it’s even greater than we thought. So when you get up to 40% of the population suffering, it’s almost normal to have a mental health issue, which is an interesting way to look at it. So anyway, I’m not surprised at the findings. And with this recognition and improvement of benefits and improvement in treatments and making it more scalable and available through digital, I’m hopeful.
[00:11:42.150] – Brendon: Yes, makes sense. And of course, the conversation has been expanded dramatically in the past few years now, I think obviously driven by the pandemic, which is silver lining, it’s put us front and center when it comes to focusing on mental health. And I hope that means more people are going to get the care they need. I found it interesting, a week or two ago, president Biden pledged more than, what, 6 billion in his budget to increase mental health support services. And then there was like $450,000,000 in there that was earmarked for researching new care models. Curious if you think that’s going to go into the digital health space, because to me that’s exactly what that says. But what do you guys think?
[00:12:25.290] – Kevin: I’ll go first, and I’ll let my esteemed colleagues here join in. It’s interesting. One of the interviews I did, when you write these books, you really meet some interesting people. And one of the more interesting and innovative thinkers that we ran into in this last book, It Takes a Village was Peter Lee, who runs Covered California. And for your listeners out there who aren’t familiar with Covered California, it’s where people who lose their employer benefits go for their next health plan. Highly subsidized. The guy is a genius when it comes to aggregating copays and gives and gets and benefits and subsidies from both state and federal government. But we kind of tiptoed into this as a subject matter, right?
We said that is really connecting with somebody when they’re most vulnerable. And why wouldn’t you, for example, consider this as a marketplace for reaching people who need help right now with a tool that can help them in a way that they’re embarrassed to ask for? Right. So I think one of the takeaways from how Peter was thinking about marketplaces in general was that it’s a great venue for reaching people in the Medicaid space, people that are vulnerable for whatever reason, whether it’s an expectant mother who’s just had a spouse who lost their employer benefits or a Medicaid patient. We all know someone that’s on it. We have family members who actually use Medicaid and could use tools like this. So it’s yet another way of getting resources and tools in front of people when they need it and in a way that allows them to consume it in a way that’s meeting them where they are, I guess, is where I was going.
[00:14:25.230] – Henry: Yeah. In terms of your question, Brendon, on funds under the Biden administration earmark for innovation and so forth, the long answer to that question of is it going to digital is yes. End of story. I try to be brief because usually my knowledge isn’t that strong, so it’s easier to be brief. But no. The good news is there’s so much private sector money going into digital health. This may be controversial. I would say too much. That there’s such an outflow of venture capital and private equity money to companies that in some cases are I can’t always understand what their overall value proposition is and what they’re proposing. So I know we’ll talk about that, but I think the focus on digital is great, but the need for clarity and doing things, quote, unquote, the right way, is really paramount to make sure that we’re doing things that really add value. So I’m glad that Biden administration has earmarked funds there, but I think it’s just got to be spent efficaciously.
[00:15:42.510] – Murray: and Henry, I think that if you look at the funding streams, okay, so in the Biden plan and like we mentioned, all the private equity money that’s going into it, the money kind of shows the way, and they’re really bright people who kind of see the future, and they put their bets on the future. So in a way, it’s exciting to see the confidence that the markets have in digital, and you try to understand so why? And it answers so many of the questions of scale. We just don’t have the workforce, especially in the mental health to deal with the extent of the problem. So digital can really scale that. That’s real important. And with scale, obviously, is the access.
Even if there are available therapists, people don’t know where to go, and they don’t know why they’re seeing who. So that’s another piece of the puzzle that is in disarray. And that I think that digital with digital assessment, digital triage can really give some efficiency into the system. The other thing, when I go to these conferences and give talks on this issue, people mentioned scale access and underserved, but rarely do people talk about quality. That what digital brings to the arena of quality. If you go into ten different therapist offices, you’re going to get ten different approaches. Maybe three out of the ten use best practice. The other seven are making up as they go along. And so there’s no fidelity, there’s no consistency, and there’s no measurement of outcome. So you bring digital into that sphere, and you’ve got consistency and you’ve got data, and you’ve got real outcomes that are really showing to be very strong. And then I mention the underserved, too, like you mentioned, Kevin. And I think one of the other things that we’re more aware of the mental health crisis is our increased awareness about inequity in lots of things in society and healthcare, especially our topic here. And with that inequity, you say, well, how are we going to serve this population? It’s so divergent, so many different approaches culturally and traditionally. And I think digital offers the hope that that can be addressed.
[00:18:08.510] – Brendon: Yeah. Murray, it’s funny because when you chat, when you were talking right there, I thought you’re describing pharmacotherapy, right? Like it’s the reason everybody wants a pill. It’s infinitely scalable, it’s consistent, there’s evidence behind it. And I think what a lot of people think about other therapeutic interventions when it comes to behavioral health in particular, there’s this idea of, like, I don’t want to go sit on the couch and just chat to somebody. Is that going to be of any use? Or my cousin went to somebody and they didn’t get anything out of it because it was some form of talk therapy.
And to your point, when people ask me, who should I go? What should I look for? Because I think you’ve drilled it into my head at this point, Murray, evidence based: look for somebody who’s actually doing the stuff that we know moves the needle on these things. And I think it’s such an important point, but it’s an interesting way you described it, because that is pharmacotherapy in my mind. That’s how you define it. And to see that being applied to the digital therapeutic space, that’s innovative, I think that’s promising. And maybe it’ll drive more innovation across the board with all these different interventions. I think that’s exciting.
[00:19:20.310] – Murray: So, Brendon, are you saying that someday the doctor will write a prescription, take this app, and call me in the morning.
[00:19:30.510] – Brendon: I’m saying that all three of you are going to become AI, and I’ll just be able to go onto an app and it’ll probably be the metaverse. It’ll be virtual reality. Right. I won’t have to talk to a real human ever again, but hopefully you’ll still get paid. We’ll have to license your likeness.
[00:19:50.070] – Murray: Well, don’t tell your likeness that!
[00:19:53.120] – Kevin: you know, Brendon, at a certain point, the conversation always pivots to how do you engage and sustain. And when you talk about evidence based, you personalize that toward the individual and you’ve got a guy that’s going to stay connected. Right?
[00:20:08.000] – Brendon: Yeah.
[00:20:10.110] – Kevin: I hate to say it, but it’s the what’s in it for me and the what’s in it for me right now. And if you can help me muscle through a particular troubling time, I’m coming back. Right. I’m going to use the tool again and again and again because you’re helping me. And I think a lot of times, innovators and health plans and even providers, they lose sight of that. Right. So take evidence based down to the micro level and you just achieved the Holy Grail of engagement challenges.
[00:20:42.450] – Brendon: Kevin, you just beautifully teed up our next survey question. So thank you. I’m going to stop talking and just let you run the show, I think. So that second survey question is, what is the biggest piece missing in your digital health strategy? Surprise, surprise. It’s around personalization. So 43% of insurers said it’s the ability to personalize the experience. 53% of employers said the ability to get employees engaged and retained. And I think those are two sides of the same coin, right? So, really interesting point in a critical point, because if they don’t use it, no one gets better, it doesn’t work. So that’s a hugely important point. Henry, why don’t we go to you on this one? I know you do a lot of work with provider marketing at Ehealth. So how does content that comes personalized from a doctor, for example, perform in the Medicare space as opposed to something that is generic?
[00:21:48.870] – Henry: Sure. And it ties back to the first question. Brendon, we didn’t discuss value based care. Some of the mantras of Ehealth, talking about Ehealth, is this drive towards value based care. I have some other comments later I’d like to make on that, but I think that’s what we’ve defined at Ehealth, where I work as a consultant and executive advisor around that theme, and we’ve entitled some of the employees, directors of value based care and the like. But to your point, what we’ve seen with Ehealth is that where historically, Ehealth has been what I call an e-broker or broker that brings in members into health plans as part of the overall marketing strategy, which is similar to what others do.
Ehealth took it to a new level from a personalization standpoint, and that is, the area that I work in, built a whole new provider channel. And that provider channel, instead of just talking generically about a health plan like Humana or Health Net or Anthem or any of the others, we actually tied it from a personalization standpoint to a medical group and even down further to a physician. And so one would select Sutter Health or UCLA or Optum, whatever those medical groups and or hospitals may be and that would be the choice they would make. And by doing that, one is we showed more profitability in terms of the value that we brought relative to the costs and expenditures. And second of all, we saw, I believe it was, about a ten x engagement rate improvement when they had this personalization where someone could really identify either with the physician group in hospital or even down to the individual physician themselves. And so, to me, it became really clear and again, granted, this is Medicare population, but this whole concept around personalization was so essential and critical to make what we do in the digital space effective.
[00:24:17.320] – Brendon: And Henry, you mentioned at the very start value based care, which is something I keep hearing come up more frequently, more recently. Would you define that for the audience just so we can all get sort of clear on exactly what we mean by that?
[00:24:34.450] – Henry: Yeah, almost self explanatory.
[00:24:36.940] – Brendon: I’m going to make you do it anyway.
[00:24:37.880] – Henry: Moving on to other questions.
[00:24:45.530] – Kevin: Good question. Next question. I can give you the pop culture version of that and that’s that healthy outcomes matter, right? I mean, you could really reduce value based care, Henry, I think, down to: hey, I think as doctors we should reward and remunerate along the lines of who got to the better outcome. I think that you can’t do that without data, right? And data is a wonderful thing, but only if there’s an actionable next step. And I think one of the big benefits of value based care is that it really aligns all the industry incumbents around the notion that healthy outcomes are important. And that really should be our holy Grail kind of highest level.
[00:25:30.810] – Henry: I like that, and it was going to be my answer.
[00:25:30.850] – Kevin: I didn’t mean to steal your thunder Henry…
[00:25:30.870] – – Henry: Which was going to be incredibly articulate.
[00:25:34.310] – Brendon: Yeah. Are you guys texting each other?
[00:25:36.200] – Kevin: Maybe. The answer that Henry wrote down for me when we were prepping for that.
[00:25:41.370] – Brendon: It’s going to be in the book.
[00:25:45.970] – Henry: But I bounced back quickly. I mean, Kevin had me in his first book and had me on the back cover, so he obviously shows great judgment and taste as an author and a writer.
But I would say that Kevin touched on it, in all sincerity, aligned incentives. Value based care in my mind, is around population health. It’s taking overall numbers of folks, 10,000 members for example, and paying medical groups or hospitals a set fee to take care of that population, hence the name population health. And that’s a real critical ingredient of what’s value based care. And I think it really speaks to what it brings to the fore and how important it is. Sometimes the term sort of gets misused.
One of the quick, real quick examples, and I don’t know how far it’s gone, but one of the things I was most impressed is, this on the pharmacy side, Brendon, Murray and Kevin, and that is that I remember Cigna, I believe it was, and I’m sure other health plans have done it. They would say, if you have diabetes, we’re not just going to pay for your insulin every time you have to refill your insulin. We want to show that your health is improved. And that what we’re doing from an intervention standpoint, isn’t just the medication itself, whatever that may be. It could be hypertension, could be high cholesterol, whatever that may be, but a combination of the medication. And this is where I think digital can be so powerful coupled with an intervention, and then pay that on a population basis so that if the person doesn’t get better and they don’t stay engaged and they don’t have adherence to the medication, that the health plan should be penalized for that, or the PBM should be penalized for that. To me, that’s a good example of value based care, at least one example.
[00:27:53.770] – Murray: Yeah, I’m glad you mentioned the word outcomes, because that at the end of the day, is one of the key elements of value based care. And when I look around, I see it’s understandable, and the model is there because you have evidence. You can do lab tests, you can check blood pressure, weight, things like that. On the mental health side, it seems to be a little stickier because mental health is a little squishy still.
What data do you use? And can digital itself provide data so that you can get a value based arrangement out of it? And then you mentioned the pharmacy, the PBM thing. I don’t know if this is true. Maybe it was rumor or I made it up while I was sleeping, but there’s some talk about pharmacy. The whole model of reimbursement for pharmacy is runaway costs and everything. And some people were talking that actually pharmaceutical companies will be reimbursed based on outcomes and value based care. Did I make that up or have you heard that?
[00:29:02.890] – Henry: I tried to touch on that. But yes. Whether it’s pharmacy company or combination, now, that so many of the health plans own or are owned by pharmacy companies CBS with Aetna, Signa with Express Scripts, united Healthcare with Optimum, the new PBM that Anthem has, I think now it’s a really exciting opportunity to make that happen, Murray, what you’re just mentioning, where those can truly be tied together, and that an employer. I know we wanted to talk some later about employers, but employer truly gets value for the dollars that they’re spending, which next to personnel cost, health benefits are the second highest cost driver that an employer has. So I think this is a real exciting opportunity. I don’t know if Kevin has any thoughts on that?
[00:29:59.950] – Kevin: I’m usually good for something provocative, guys, and I will just say this for me. I think the ultimate health outcome is eliminating the need for the drug, right? I mean, you take somebody that’s a person that has diabetes, the raging debate on the left and the right is free at the point of consumption, right? I kind of look at that and I say with the right tools, with the right maybe AI, we can recognize the triggers and recognize the drivers and do what Verda Health has done, which is basically help over 100,000 people reverse their type two diabetes and eliminate their need for insulin altogether.
I think that’s the beauty of these data driven business models, right? We’re on the cusp of, actually we’re in the midst of, what I call connected health actionable data. And you can achieve those outcomes if you help recognize the drivers. And I think one of the coolest things about the discussion I had with Murray was Happify helped you recognize the triggers, right? They help you recognize the root cause of what’s causing the behavior to go off rails. And in the case of somebody with diabetes, it’s not just always poor nutrition choices. Sometimes it’s like I mentioned earlier, something that’s episodic, right? The anniversary of a loved one passing away. We go into a funk, we jack up on sugars and we eat poorly and our energy craters and boom, before you know it, we’re going to see our doctor because our blood sugars are spiking, right? The A1C is off the charts and it’s not healthy for us. We’re ready for a readmission, if you will. But I think the beauty of actionable data and a framework around which you can harness that and connect it to an expected action for any individual is the real output that we’re aiming for.
[00:32:15.440] – Murray: That’s such an essential point. I mean, treating disease is one part okay, we’re really good at that on an individual level, perhaps, but really preventing it and then changing lifestyle and attitudes so that people don’t get diabetes. And I’m so glad you mentioned, well, I’m also glad you mentioned Happify, but really glad you mentioned AI, because a book you turned me on to actually Eric Topol, your friend with the book Deep Medicine, and I just love his byline that with innovation, automation, digital and big data, you can put the care back into healthcare. That’s such an important phrase.
I think to get personalized medicine, you really need AI because the data you need is way beyond any individual physician’s or therapist’s ability. But if you crunch the numbers, you look at the trends, you bear down on the person themselves, you can really do some amazing things. And just to make another pitch for Happify here, that in Happify, one of the ways we use AI is we have something called life graph variables and all the inputs from the person using our platform goes into essentially an electronic digital medical record. So it starts to learn about you personally, learns about your health, your attitudes. And then what it does is because of that, it gets analyzed and it can feed back to you in a personalized way, in a way that you can understand, that you can act on, and that you can build trust and have a relationship with. So I think AI is so crucial to this whole issue that we’re talking about personalization.
[00:34:06.290] – Brendon: So coming back to this whole point of personalization engagement, retention of folks using whatever it is we’re introducing. I think, back to the State of the Union, and populations like Medicaid were specifically called out, right? So what do we think personalization and engagement look like for groups that would fall under Medicaid or Medicare? Anybody can jump. Murray, you are just making a point, so I’m going to ask you to keep talking.
[00:34:40.030] – Murray: Oh, I’d love to. So I think it’s a real challenge. But again, the whole idea of what AI is capable of and then you use it in a platform that’s accessible, that gets personalized. I think when I look at the Medicaid population, so it’s very diverse, different backgrounds, education level, health care disparities, chronic illness, all these problems. And it’s enough to make you want to throw your hands up in the air and say, oh, just let me focus on the worried well, and then I’ll have really good data. But the real need is a large section of the population, and that’s really the fastest growing segment of healthcare, is really the public sector. Right. So we’ve got to crack that equation. And I think, again, if you just say one size fits all for people living in a certain part of the city underprivileged or so economically disadvantaged, and one size fits all in terms of health care, well, that may be true for everybody there needs their covid shots, but we all do. But it’s not true to get that person who has their own personal history, their own background, you got to get that person motivated and engaged. And I think AI is the way to do it.
[00:36:00.770] – Kevin: Yeah, I would concur I think Murray nailed it. I think it boils down to, can you help me solve a problem I have, and how do you know I have the problem? And it gets back to what’s the data sharing mechanism that shines a light on that particular individual? And you can’t drive engagement unless you’re solving a problem for me. And I’ll stop sharing data with you if you’re not solving a problem for me.
So I think the way you crack that code is it is with sustained engagement, is if you continue to add value for me, I’ll continue to lean in and share data. When you think about how digital health burst onto the scene and how it’s evolved, I think a lot of our assumptions were wrong, right? First we said people wouldn’t engage, and they did. We saw the first wave of digital health was really dominated by apps. There was an app for everything. And the next wave of digital health was all about the backward looking view. Sometimes you hear this called quantified self for the big data era, but it was all about the smartest people in the room looking backwards and saying: hey, I can tell you what just happened and why.
And I think where we’re at right now is probably the most we’re on the cusp of the most exciting time that we’ve ever seen in healthcare and that’s that now data has become actionable largely because of what Murray described with the dynamic of AI. You can basically have a platform that recognizes the triggers and says, there is another resource in our value chain that we can provide to you that will help you right now. Sometimes that’s content, sometimes that’s coaching, sometimes that’s a hand off to a real live person.
The one piece about actionable data that is kind of scalable and repeatable is you can apply that to any disease state and you can apply that to any condition. Once you get good at engaging, capturing, analyzing and reconnecting the data, you’ve really cracked the code and you’ll be adding value at the micro level as well as at the macro level. And I don’t see how you can do that without some of the things that Henry mentioned earlier with a value based care model that aligns all of the industry incumbents around the notion that: hey, healthier outcomes is really the way you lower cost in health care. I always used to say early on that we don’t have a doctor shortage, we have too many people doing bad things to themselves. And from a scientific perspective, that’s something we already touched on.
[00:38:48.120] – Henry: Murray touched on it, just to extrapolate a little bit, is the different strategies for populations: socioeconomic background, cultural background, all the things that we all know about. But it does require different strategies, different interventions, different practitioners, mid level practitioners, social workers in some cases, and obviously physicians and others. But I think that’s a real critical part. Companies like Consejo Sano and others that have really focused on being culturally sensitive. We use the term social determinants of health. But a lot of that is around the different strategies and the same thing for populations, the Medicare versus a straight medicaid, wholly different approaches towards the interventions that we’re talking about.
[00:39:43.570] – Murray: Yeah, Henry, I’m glad you mentioned that. And I learned that firsthand many years ago, actually, I was heading a medical clinic on an American Indian reservation and I was wondering why people weren’t doing what I told them they should do. And so I went to the director of the clinic, an Indian woman, very wise person, and I said, what’s going on here? I have great training. I’m really giving them all this education and it’s not changing their blood pressure or their diabetes. What’s going on? She said, well, you’re speaking to them like you’re at the university in your training, and these people have a very different perception. You’re making a diagnosis. But they also have a lot of faith in the faith healer diagnostician. If you walk out to a certain mesa when the moon is so and so, and then you’ll bump into this guy, and they’ll tell you why you’re having migraines, and you’ve got to learn how to put it in the context of their culture. And so that stuck with me throughout my career, that unless you’re speaking the language and the culture of the person you’re dealing with, you’re going to miss the point. And again, a plug for AI innovation and the digital approach, we can do that.
[00:40:58.750] – Brendon: Yeah, I think that’s exactly what’s really exciting about digital, right? Because you get that hyper personalization at the individual level. I remember you guys know, I’ve been sober 20 years now, and when I first got sober, I didn’t get sober on day one, right? Like a lot of people, I bounced in and out, and I succeeded when I found a sponsor who, I thought spoke my language, he was like me. We had similar experiences. I related to his background, and that was the guy who could kind of be my guide, because it was much easier for me to hear the message and kind of do the stuff I needed to do. And later on, I found that I sponsored a lot of young guys early on, and those were the people who sought me out. And I thought, gosh, if you could scale that: that one on one, finding the right person, the right tool for the right job, so to speak, that you get a lot better outcomes, a lot more impact at that individual level, and we wouldn’t lose as many people along the way, not just with substance use disorder, but with all sorts of things. If we could meet people where they are and kind of connect with them at that level. I think that’s what I find really inspiring and exciting about this space right now.
[00:42:16.450] – Murray: So I think we’ve really made a good case for the digital world. But one of the things that comes up now, the next question is, well, what about engagement and retention? Once they say, Oh, wow, this is great, and you guys really did this geared to me, it speaks to me personally. What are some of the elements that go into it to keep people engaged, to keep them on the platform so it doesn’t drop off after the novelty is gone? I think that’s a real challenge.
[00:42:46.630] – Kevin: I think, from my perspective, you need to keep solving a problem that’s important for me. Brendon, shout out to you, brother. I’m 22 years.
[00:42:56.050] – Brendon: Aww that’s awesome!
[00:42:56.690] – Kevin: I’m never going back. So at conferences, I find people like you to hang out with because it’s my safe space, right?
[00:43:04.470] – Brendon: Yes.
[00:43:06.490] – Kevin: I think that if you’re relevant and you want to stay relevant, you’re listening and leaning into what I need at any point in time. We all have goals for staying healthy. It’s not just one thing, right? I mean, we tend to think of health as sometimes through the lens of a chronic condition, but it’s really who we are. Like, all of our blood values, our weight or BMI or blood pressure, all that what, we do and how we feel. And I think those three things are those areas where there are resources that can help us on our journey. Whether it’s a nutrition goal, whether it’s an exercise goal, whether it’s a mindfulness goal. I would submit that the right answer is an AI platform that’s paying attention to what I find to be important and recognizes that I’ve got triggers that can cause me to go off rails and helps me with some corrective recommendations or resources or content. I’ll keep using that and I think that that solves the engagement goal and that sustains my interest as well.
Now, I think the bigger challenge, and we haven’t really probably talked about it yet, and I know we don’t want to leave this topic just yet, but how do you find guys like me, right? I mean, how do you reach people? I really view that as a big, major gap, and I hope that before we wrap up, we can at least talk about the gaps. We’re talking about the things that work and why. But we should also, for the interest of being fair and balanced, talk about what’s not working and how do you correct that?
[00:44:55.150] – Brendon: Yeah, that’s a great point, and it kind of leads into the final question, which is something that I hear all day long…
[00:45:04.040] – Kevin: You need to put me on the payroll, guys.
[00:45:05.260] – Brendon: I know. Why am I doing this? I keep asking myself, why am I here? I thought I was supposed to do this stuff. Kevin’s doing my job. So yeah, Kevin, if you’re hiring, I’m going to need a new job after you get me fired today.
But there is a point that comes up frequently, which is, yay, I’m talking to you. Guess what? There are too many point solutions on the market right now. I can’t tell one from the other. So they hire employee benefit consultants. Payers are constantly doing RFIs, trying to figure out who does what or who’s who in the zoo. As somebody mentioned earlier, VCs are investing so much money that tomorrow there’ll be 100 more companies that are doing similar things. So I think this has come up for insurers, it’s come up for employers.
In our survey, it came up universally across the two groups, and I think it’s a really important point. So as we think about this Payers, for example, investing so much in resources that don’t necessarily get used, and the same thing with employers, I think it’s an important point to bring up. And Kevin, I think you started down this path already, so why don’t we throw to you first and then Henry would love your input as well.
[00:46:19.320] – Kevin: I opened my big mouth. I’m not going to pull any punches here. This is a gap, right? And it frustrates me that after ten years, we still have this enormous gap. Honestly, I’m going to rip on the health plans a little bit here for just a second. You know, who’s always had access to members, you know who’s always known who’s got the chronic conditions or who’s leaning toward the chronic conditions? Health plans. And yet we’d be hard pressed as a group to come up with some solutions that they’ve scaled that can address our industry’s most pressing and acute needs. And period, over and out.
I keep waiting for the health plan to step up and say, Apple’s Health Kit is kind of an interesting idea. We’d like to become the Apple Health Kit of healthcare so that if you’re contributing data and you’re trying to manage a condition like diabetes and I’m sorry, I keep picking on people with diabetes, I don’t mean to. It’s just a low hanging, fruit, easy condition to sort of isolate and focus on. You’ve got Omada or you’ve got Verta or Solara. Name your tool, right? Contributing data to a platform that maybe a health plan is responsible for maintaining their AI layer or their AI engine recognizes that in some cases, Kevin is going to be flirting with A1Cs that are trending in the wrong direction, and it’s going to be nutrition driven. And if you’ve got a good AI design that has a next best action as the next logical step, you pair Kevin with Noom, you pair Kevin with Jenny Craig. And maybe if you’re a Medicare patient, you also send him home with some reimbursable meals to make sure that he’s eating right.
Now, if you’re somebody else and it’s driven by an episode of depression that’s cyclical, like we mentioned previously, you pair that member with Happify. I really am frustrated with health plans because they have been sitting on a ton of money. They really haven’t led the innovation wave whatsoever. They’ve been laggards with respect to how they use and adopt a lot of these technologies. You guys are an innovator. Over beers one night, you could probably tell me some stories about how frustrating it can be to sometimes even get on the radar of the right people at these health plans. But I think they’ve really so far swung on and missed this pitch. And there’s a wonderful opportunity, I think, for a health plan to come along and say, look, we don’t care where the data comes from. You know what? If it hits our platform, we’ll analyze it and help you with whatever conditions you’re trying to manage or goals you’re trying to attain.
So I think I’m going to watch these guys and you watch them. They’ll all struggle with, well, does that mean that we create a curated experience coming right out of the gate? Well, you can do open and you can do curated. They don’t have to be at odds with one another. If you’re on the East Coast and Omada is the tool of choice, great. We don’t care. If you’re on the West Coast and maybe that’s Verta health, that’s the tool of choice also great, we don’t care. But that data is going to land on our platform. We’re going to analyze what’s being contributed, and then we’re going to help you take the next best action.
You see Apple doing that a little bit now, and you see Point Solutions doing that, but it’s not in a scalable way. Like every morning, there’s an Israeli company called Lumen. I exhale into my Lumen. It helps me calibrate my diet based on what I ate the previous day. And it’ll tell me, Hey, Kevin, you’re leaning too heavy into carbs. If you want to get an optimal burn rate, you need to bring proteins into your diet today. But Brendon, the thing is, is they also look at what I’m logging on Noom. So not only are they contributing data, they’re harvesting data. And you get this wonderful exchange of, I’ve given you something, I’ve gotten something in return. And you know what? It’s all for the benefit of your member.
I really don’t have any insights to share as to who is doing what in this space yet. And if I did, I probably wouldn’t be able to share it with you. But I can tell you Optum’s Marketplace doesn’t do that. I mean, Optum’s Marketplace is all about, what do you need? You can buy it here. And I think it needs to be a little bit more sophisticated than that in a way that Murray was alluding to earlier, which is that AI level, and there’s room for AI on both the platform side and on the solution side, because I think that that’s going to be the thing that helps us to get to both personalization and the ability to scale in a meaningful way.
[00:51:35.290] – Murray: Well, Kevin, now that you’ve thrown my former employer under the bus, I was at Optum.
[00:51:41.790] – Kevin: You’ll never invite me back.
[00:51:44.270] – Murray: No. It’s interesting, I was at Optum for 18 years, and I walked away when I retired from Optum, I had the same impression, looking back, saying: “Wait a minute, sitting on all this data, and what are we doing with it? How come we’re not leading the charge?” And it was interesting because we did try something using predictive analytics to see who was about to have a Depressive episode, who was about to have this or that. And this is kind of primitive, it was a number of years ago, and then the project didn’t work because we’d call somebody and said, oh, you’re about to have a Depressive episode; they’d hang up the phone. So we have to be more sophisticated than we were back then. But you’re raising a very important point about the health plans are sitting on the data. They’ve got the funds, they’ve got access to resource, they can buy, merge, invest in, whatever. Henry, do you have any insights from your experience about health plans sitting on all this information while they’re not taking the lead in some of these outreach and changing towards population health?
[00:52:50.450] – Henry: Yeah, I was going to say as a recovering health plan CEO enrolled in the twelve step program, I’ll be happy to have some great insights, especially given Kevin and Brendon’s sharing earlier about their own lives. I have great insights into that. That’s why I left the health plan world. No, not exactly, but I think that it’s a great question. I wish I had the answer as to why it is. I think in my mind, health plans have grown so large and so bureaucratic in many cases that it’s very difficult to be nimble and to move and to change and to do the kinds of things that you’re saying. They just oftentimes have reasons why not to do things versus why to do things. And I think that’s kind of a key ingredient from an innovation standpoint is that many cases I think they’ve just gone too large. Companies like Oscar Emerge and some others to try to change the landscape. It’s an uphill climb, unfortunately, to build the health plan and all the infrastructure and the data systems and everything else that’s required, and especially to be on a national it’s a big country out there, and if you want to serve large employers in defense of health plans, you’ve got to build that.
And there’s a lot of resources that go into that. But I think historically, health plans have just not been the source of innovation. That’s why Oscar has evaluation that it does. So anyway, that’s my probably less than sophisticated response.
[00:54:42.500] – Kevin: I want to riff on something that Henry just said. I have very low expectations for health plans to innovate. I just do. But what I do have an expectation for them to do is work with the innovators. And that’s something that’s totally different. That’s a business model issue. And if they can, there’s out there somewhere at a health plan is somebody that’s thinking two to three steps out there and realizing that, you know what, we don’t have to invent everything, but we need to be able to work with everything that’s meaningful in our employers and their employees find to be useful for them. And I think the wonderful thing about digital is that if you look at the health plans business model, every fall they go through the sprint of trying to win the account, and then all year long they service the account.
Digital is something that they can sell and monetize all year long, right. And it doesn’t even have to be to their members. That’s the next thing in the evolutionary process. I’m really waiting for a marketplace to develop where companies like Happify can put their solutions in a health plan marketplace, on day one, you have instant access to 30 to 40 million members. And I think when health plans, God bless them, they go so slow when they realize that they can clear this hurdle, they now realize that they’ve got something that they can offer to people that aren’t necessarily their members. And I think the other thing is, they’re not the only people that I would expect to be providing routes to market. Covered California is a great example of another largely untapped route to market, and I think AARP is another. I think these marketplaces will emerge, but they wouldn’t have emerged without the data becoming actionable and the ability to reconnect and analyze and harvest as well as contribute to that. So I think Henry nailed it.
[00:56:44.970] – Murray: Yeah, it’s interesting. Now, that kind of ragged on health plans. I’m realizing half the calls I was on just today had to do with health plans, but not in the way we were just saying, but actually in some of their public sector RFPs, they’re being presented with, okay, their challenges, what can they do to innovate and serve this population? And they’ve got to get creative. They’ve got to get digital. On the other hand, because the Medicaid market is growing so quickly, and that’s where the government funds are going. That’s where the need is. We’re now finding that actually, the health plans seem to be responding. They’re reaching out to digital. They’re reaching out to innovators like Happify to be part of their RFPs, part of their solution. So I think that is an encouraging sign.
[00:57:36.260] – Kevin: I’m happy to stand corrected on that. Murray. It’s nice to hear that.
[00:57:40.130] – Murray: Well, I’m actually correcting myself because I was just throwing them out of the box. I realized what I’ve been doing.
[00:57:46.340] – Kevin: A lot of bad actors in healthcare, we’ll never run out of people to throw under the bus, but they’re the low hanging fruit, right?
[00:57:54.450] – Murray: That’s reassuring.
[00:57:56.770] – Henry: None of those bad actors are us.
[00:57:58.850] – Kevin: Well, not on the innovator side. My wife calls digital health: where all the cool kids hang out, right? This is where all the smart people in healthcare ultimately find themselves working, is on the digital side of things because we’re solving problems. Let’s face it. The beauty of an innovator is an innovator will look at something and go, I don’t accept no for an answer. I don’t accept that this is just not something that we cannot fix. And I love being in this segment of the industry because that’s who you’re surrounded with. You’re not surrounded with the we’ve never done it like that people, right? You’re literally working with people that say, I can fix that. Get out of the way. Give me some money, and here’s where I’ll get to in 24 months.
[00:58:43.030] – Brendon: All right, Kevin, that’s enough. Because now you’re stealing my thunder so wholeheartedly. That’s literally the thing I say at the beginning. “What are we going to do about it?” I don’t expect anyone to actually answer that question. So I guess this is the last episode. Okay. With that, I’m going to take this moment, it’s my moment, Kevin, don’t steal it from me to bring out the magic wand. And we’re going to skip right to it. Because, Kevin, you brought this on yourself, so I’m going to throw it to you first. I’m going to wave the magic wand. My six year old daughter gave me this for this exact purpose. I can fix anything in health care. Since you brought up our ability to fix things and you were leaning in this direction, I’m going to give it to you. Wave the wand. What are you going to fix and why?
[00:59:35.350] – Kevin: I think the thing that I would probably focus on first if I had your daughter’s magic wand, it would be aligning the industry incumbents with the biggest pain points around the notion that they are a conduit for reaching people with these problems. It’s something that they’ve never been good at. The flip side of that, Brendon, is when I go to see my doctor at One Medical, she is good at that. I mean, she looks at my data from a longitudinal view and she goes, look at your blood sugars. They spiked, but your weight dropped. How are you losing the weight? Well, I was juicing. That’s a bad thing for a guy in his sixty’s to be doing for an extended period of time because it’s like mainlining sugar. Right. The other thing I was doing was my wife was going on a destination wedding and she was taking some fat burning pills. And I thought, well, I want to look good in my bathing suit too. I’ll try that. My blood pressure went out of whack. She can’t help me unless she’s got a good look into me stepping on those scales every day and me taking my blood pressure every day. She doesn’t need to be overwhelmed by that with all of her patients. But boy, when they’re trending in the wrong direction, one Medical reaches out to me and says, we need to talk. So I think that the routes to market need to be better flushed out. And I think we can all learn something from the data driven approach that the One Medicals of the world are using. That would be my answer to that.
[01:01:11.270] – Brendon: That’s great. Yeah. It comes back to this whole hyper personalization. Right. So Henry, I’m going to hand it to you, okay.
[01:01:26.030] – Henry: I feel the power.
[01:01:27.220] – Brendon: Don’t go crazy with it now.
[01:01:30.770] – Kevin: Don’t use it for the winning lottery number.
[01:01:34.010] – Henry: I was going to say my remedy to all the world’s issues around health care is innovate, innovate, innovate; personalize, personalize, personalize. You’ve said it’s been part of your survey or whatever and how it gets done. Simple things which I wanted to bring up earlier, like texting, especially with culturally sensitive population, we have all these sophisticated, no disrespect to machine learning AI, big data, all these cerebral, really important things. But what’s going to be a reminder for people oftentimes, especially in culturally sensitive populations, is simple text reminder, for example, or provide that ability to do that and maybe take that to a whole different level than we’ve known before because that’s what we all do all the time. So why don’t we try to find ways and maybe those are being done. I’m sure they are; Kevin would know in a new and different way, as simplistic as it seems or whatever, because we’re talking about reminders adherence and any of the disease states that we’re talking about. So I would say that’s critical. There’s the whole focus on primary care and I think the more that we can do; one of the biggest innovations, clearly, as we know, during the pandemic is telehealth. And we’ve seen an incredible power unleashed and I don’t think it’s necessarily been done as well as it could be, but I think to Kevin’s point earlier, the measurement of what telehealth has brought and our ability to do less primary care in person for the worried well, everything else is really critical, but we have to measure that and see what the effectiveness is and how that can be used. But as we know, the numbers of visits and the number of companies doing telehealth has gone out the roof. So anyway, those would be the points, Brandon, that I would mention. Could I get one of those wands from your daughter?
[01:03:51.650] – Brendon: I can have it sent to you. Yeah, I’ll have to talk to my daughter. But.
[01:03:58.890] – Henry: Not sure how we would use that…
[01:04:00.180] – Kevin: But probably not to say healthcare problems.
[01:04:05.730] – Murray: You’ll have ads from Amazon popping up on your account.
[01:04:09.470] – Brendon: Yeah, that’s coming now. Murray, any closing thoughts from you today?
[01:04:15.180] – Murray: Well, one of the things that’s real clear: that it’s real fun to hang out with the cool kids, but what’s so nice about it? Just in our discussion we’ve identified problems and we’ve given some hope in terms of what directions might lead us to some answers and solutions. And the time is now. We’re really lucky to live at this point in history, in the evolution of health care. And so hopefully we’ll all be part of making things better for everyone.
[01:04:46.350] – Brendon: Well said, gentlemen. Thank you all again for joining. This has been a really insightful conversation and I imagine we’ll probably bring you back, especially you, Kevin, as you steal my job. But looking forward to chatting again, thank you all for joining and for sharing your insight. And of course, thank you at home for listening. This has been a really interesting conversation and of course we’ll probably end up doing a follow up, I imagine, because we’ve just started to unpack. But as Murray said, I think we’re actually getting somewhere to solving some problems, and that’s exciting. So please continue to listen and and join us again as we continue charting a new course.
“Charting a New Course,” highlights thought leaders and explores unique perspectives in the healthcare industry. You can listen to Charting a New Course with Dr. Murray Zucker HERE
Dr. Murray Zucker’s interview with Kevin appears in “It Takes a Village” and a preview of it can be found: HERE.
