The Digital Health Guy Gets the Expert Opinion:
Dr. Ray Costantini, Co-Founder and CEO, Bright.md
For many people, a trip to see a physician is a lot like a trip to the Department of Motor Vehicles. In both cases, they are going to wait a long time, fill out a lot of forms, and be frustrated because they forgot a piece of documentation. And of course, they know they will be grumpy because they lost a half day of work.
As you might have noticed, computers have improved the end-user experience at most DMVs. Yet for many patients, a trip to see a doctor is still an experience that has not improved much at all. Waits are long and frustrating, the amount of time spent with the doctor is too short.
Yet a number of young entrepreneurs are developing technologies and systems that will soon change all that.
Ray Costantini is co-founder and CEO of Bright.md, a company that was founded to provide automation support to assist with primary care provider workflows and help them provide more thorough and evidence-based diagnosis and treatment.
Bright.md is developing a new range of innovative technologies that include its #SmartExam, which the company describes as, “your virtual physician, cuts the cost of visits by 80% – while providing high-quality care your patients will love.”
To use SmartExam, patients go online and use its simple interface to provide information on their medical histories, current ailments, as well as information on their insurance, preferred pharmacies, and more. In their offices, physicians receive an immediate alert that a patient report has been filed. All information is automatically entered into that physician’s system. He or she can immediately issue prescription orders, schedule an appointment and take other appropriate steps – all in a matter of a few minutes. That is only one example of the systems that Bright.md is building to improve the care experience, both for patients and their care providers.
Bright.md was named the 2015 OEN Launch Stage Company of the year, a 2016 Gartner Cool Vendor in Healthcare Delivery, and the HiMSS Venture+ 2016 Audience Choice winner. The company also received the 2017 Healthcare Innovation Award and was chosen as one of the most admired health care companies in the Northwest.
Ray’s unique pedigree and background have equipped him to have a highly informed perspective on what his happening in health care. He was first an entrepreneur: “My father and grandfather were entrepreneurs,” he tells us, “And I actually started my first company, which was in real estate, after I graduated from high school. Then I decided to go to medical school; at that time, my father gave me a look that pretty much said, `Why?’ But then I came back and became an entrepreneur again.”
Part of the Bright.md mission is to “delight” both patients and their providers while improving clinical outcomes, dramatically lowering health care costs, and developing opportunities for health care providers and businesses to discover opportunities for new revenues.
Those are lofty goals to achieve in today’s health care landscape. We thank Ray for contributing his insights to The Digital Health Revolution.
We know the readers of this blog will find this excerpt from my recent conversation with Ray to be very stimulating and, dare we say, revelatory?
Kevin Pereau: What was the thinking behind Bright.md?
Ray Costantini: There are a lot of layers to that question. I’m a big believer that the most important problems to solve are the ones that are so big and so ubiquitous that people have forgotten that they are there.
I think that Bright.md falls into the category of companies that are asking those questions. On the surface, we solve problems like: how do we help patients get pinged more quickly by their providers; how can we help them get care more quickly or conveniently; and, how can we make care more affordable?
And then, maybe one level up, there is the experience factor. How can we make the experience of health care if not more enjoyable, at least less unenjoyable? Health care is something that everybody needs, but nobody really wants it.
But at its core, the ubiquitous big, hairy, issue is that providers have what patients need, but it is just too difficult and inconvenient to deliver it, because they are spending so much time on menial stuff.
Today’s care providers are just too rushed, and our company was created in part to address that problem. The old country doctor model, where patients knew their clinician, who in turn had all the time in the world to provide care, was a beautiful one. But it isn’t going to work in today’s society. Today, physicians spend so much of their time dealing with an administrative burden. They’re filling out forms, online forms at this point, filling out paperwork and documentation, doing order entry, and creating billing files. Those activities are nowhere near the top of the list of most important things that they should be doing.
Kevin Pereau: And the net effect on the whole health care system is . . .
Ray Costantini: We’ve got a huge supply/demand mismatch. Taking our analysis up a step, we’ve got a problem with elastic supplier capacity. Under the current circumstances, we can’t really grow how many patients the provider can see. We can’t fix that problem by using traditional approaches.
In some ways, it’s like the agricultural work evolution over the last century, where we had an explosion of population and our farmers needed to be able to feed everyone. The challenge was, how do you feed a gigantic and growing population of people with farmers out there wielding shovels and picks? Instead of thinking farmers could meet the demand with those tools, we equipped them with a combine or a tractor. That made it easier for them to do more with the limited time and capacity that they had.
Today, we’re facing something similar in health care. As our population grows and ages, our demands on our health care system are growing as well, at an exponential rate. If we try to keep solving health care needs with picks and shovels, with the tools that we’ve always tried to use, we can never figure out how to work smarter.
The platform we have built at Bright.md is designed to help providers work smarter. It’s there to give them the support and tools that they need. That’s why we think of ourselves not as a health company or a care company, but as a care automation company.
Kevin Pereau: So, if you boil it all down?
Ray Costantini: One job is to make physicians’ lives better by empowering them with the tools they need to better serve their patients’ needs. And that’s where the concept of care automation comes in.
How can we gather the information that’s needed, how do we do that in a delightful, and highly functional, way? How do we synthesize that information and make it is as useful and actionable as possible? And how do we enable care providers to take action quickly and easily? We are in the process of figuring out those pieces.
Kevin Pereau: Can I ask you to explain what some of those “pieces” are?
Ray Costantini: Let me take a step back and discuss care delivery from the patient’s perspective. Care falls into one of two categories. You can either decide to dissect everything down to its smallest pieces, or you can look at categories. And I definitely fall into that second bucket – I’m a lumper rather than a splitter. And so, in my mind, there are two big buckets of care from a patient perspective. I would call them pull-based care and push-based care.
Pull-based care is care that patients actively want and demand – the category of care that patients are actively pulling to themselves. If I’ve got a headache, for instance, I am looking for immediate help for that, so I pull that care to me.
Push-based care is different. It is care that the providers need to push to the patient, because he or she might not even know to ask for it. One example is care for high blood pressure. Care providers need to push care for that problem to the consumers, who might not even know they are suffering from it. Do you know what high blood pressure feels like? It feels like nothing . . . nothing! And the same push-based model applies to other conditions, like high cholesterol and, for the most part, diabetes. Those are clearly push-based conditions, where caregivers need to help patients recognize that they have a need and to help them get care.
Both kinds of care are important. But in creating our company, we made the choice to start in the pull-based care model. That has been the best place to be able to provide care solutions, because patients were already asking for them. So, we built a whole set of tools that help automate the care of more than 370 different conditions. Our tools allow patients to request care from their own providers, or to use our SmartExam. From there, we built tools that allow patients to complete their medical data – in effect, to interview themselves. Our system aggregates patient data in a highly usable format so that providers can quickly and easily understand what is going on with patients, so they can order prescriptions, follow up and monitor what is taking place.
The goal is to build all the tools needed to support each of the tasks that providers need to perform, by aggregating them into a painless workflow. That makes life easier for everyone.
The individual tools are not always particularly interesting. Some are more innovative and exciting than others are, obviously. Some of them are more unique, like our ability to allow patients to effectively interview themselves, or our ability to convert multi-source data into an aggregated, chart-ready note. But the exciting part is how we put those pieces together to support the providers’ workflow, which in the end makes patients’ lives easier. That’s really what this is about.
In the end, the people in my company are the only ones who care deeply about the features we have built. Our real job is to think about the value that those features create. What really matters isn’t the tools that we build, it’s about how we can apply them to create value for patients and providers and for the health system overall.
Kevin Pereau: When did you start to think about health technology from that perspective – from the end-user’s perspective first?
Ray Costantini: Let me tell you one of my favorite stories. Here in my office, people are tired of hearing me tell this one, but here we go. The story is about something that happened when I was in medical school and was doing my first surgical rotation.
It was at a VA hospital. The surgeon who was supervising the rotation was a tough, rough physician and teacher. He was a stereotypical surgeon in that way. He was fond of hitting the med students with all kinds of tough questions. I was prepped. I knew he was going to give me hard questions too. Then the time came when I was stitching up a patient after doing my very first surgery. Just as I was closing up, he said to me, “What are the two most important parts of any patient surgery, no matter what kind of surgery it is?”
I didn’t have any idea. I had never encountered that question in any textbooks. After he let me think for a few seconds, he said, “The two most important things are the scar and the bill, because those are the only two things the patient sees, so you better make them both look good.”
It was a tongue-in-cheek observation perhaps, but that experience has stayed with me. Patients don’t know what happens inside of them during surgery. They assume that their surgery was done well. They only measure success and satisfaction on the things that they can see, and that is also true whether you are discussing a software company, an insurance company, or any other kind of enterprise. What matters most to consumers are the pieces that they experience. If what they see is satisfactory, they assume that the rest of what you have done for them has worked right – unless they can prove otherwise.
Kevin Pereau: Looking ahead, how do you think contributions by a company like yours will change how end-users perceive the care they are getting? Or addressing a larger issue, how will the world of health care change through the application of technology?
Ray Costantini: It’s hardly a profound observation, but I think health care is changing faster now than ever before. And I think that there’s a terrible misconception out there, when people say that everyone in health care is tech-averse. I think that’s absolutely false.
Did you know that physicians were the leaders in starting to use smartphones? They were the first group to exceed 90% penetration. Physicians use new technology every single day, they love their newest tech toys.
In the past, the primary quantifiable goal of many players in health care was not to keep people healthy, but to fill hospital beds. That is certainly changing. If you look at the billboards on the roads near where I live, you will see that the messaging is changing. It is less, “come to see us when you are sick,” and more, “we are here to help you stay healthy.”
And as we move from the fee-for-service world into a value-based care world, that’s a fundamental realignment of interests, because health care is discovering and addressing what patients want from them. And that, I believe, is huge.
Dr. Ray Costantini is Co-Founder and CEO of Bright.md, a company that was founded to provide automation support to assist with primary care provider workflows and help them provide more thorough and evidence-based diagnosis and treatment. Follow him on Twitter: @RayC_MD and