The Evolving Internet of Health Things

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  • Techonomy16 conference in Half Moon Bay, California, Wednesday, November 9, 2016. (Photo by Paul Sakuma Photography) www.paulsakuma.com

  • Techonomy16 conference in Half Moon Bay, California, Wednesday, November 9, 2016. (Photo by Paul Sakuma Photography) www.paulsakuma.com

  • Techonomy16 conference in Half Moon Bay, California, Wednesday, November 9, 2016. (Photo by Paul Sakuma Photography) www.paulsakuma.com

Panelists

Sumbul Ahmad Desai
Vice Chair of Strategy and Innovation, Department of Medicine at Stanford Medicine

Rick Valencia
President, Qualcomm

Moderator

David Kirkpatrick
Founder and CEO, Techonomy


Personalized, digitized healthcare is evolving at warp speed. We not gather health data from not just wearables, but implantables and ingestibles. New tools and technology will interact with ambient devices to assess and even diagnose us. What is the nature of this evolving ecosystem surrounding the person? Does it have limits?

Kirkpatrick: Techonomy chose as a theme for this year what we call man, machines and the network. And we’ve never really had a theme before for an entire year, but this time we chose one, and it turned out to be very fortunate, because we were really were aiming to signal was that the internet of things and the interconnectivity of the planet, and the integration of the planet with people, and not just IOT, but the way that then dovetails with progress and artificial intelligence and other capabilities really is likely to create a new landscape for the planet. And so this next session is really going to be diving down into the IOT and health as a force. We’re not going to talk just about connectivity, because it very quickly takes you into systemic thinking, when you really start to look at what connectivity means in any system, but in this one as much as any.

Let me start by introducing my panelists. Sumbul Desai of Stanford Medicine is—you sort of head a strategy. Give me the quick list of things you’re in charge of there, because it’s a long list.

Desai: Mainly innovation, digital health, digital strategy when it comes to some aspects of the school.

Kirkpatrick: But you’ve also set up some clinics.

Desai: Yes. I run a few of the ambulatory clinics, where we’ve integrated technology. Basically my job in a nutshell is getting us into new areas of business, and then getting it scaled, and then handing it off. So I kind of started our foray into really growing our primary care business, our employer business, and now digital health technology, telemedicine.

Kirkpatrick: And I just want to say, what I find quite interesting about Sumbul, she studied computer science, was a journalist at ABC News, then went to medical school—then went to Disney, did strategy at Disney and then went to medical school.

Desai: Yes, that’s right.

Kirkpatrick: And now she does strategy and all this other stuff. So she has a very holistic, I think, grounding for thinking about probably anything. And you’ve put your focus on health care, so thank you for—

Valencia: probably glad you’re not in journalism today. [LAUGHTER]

Desai: Yes, I am. Let me tell you. [LAUGHS]

Kirkpatrick: You’re glad you’re not. Is that what you’re saying?

Desai: Well, it would have been a rough night last night. [LAUGHTER]

Kirkpatrick: There are many different kinds of journalists, but the media in general is in a new place.

Desai: Yes.

Kirkpatrick: So Rick.

Valencia: Yes.

Kirkpatrick: You run Qualcomm Life.

Valencia: I do.

Kirkpatrick: You are a long time entrepreneur, and a big believer in society and entrepreneurship in society, and in health care in particular. Tell us a little bit about Qualcomm Life and yourself as we get started.

Valencia: Sure. I am indeed a lifelong entrepreneur. Qualcomm is the first big company I’ve ever worked for. I sold a company a few years prior to going to Qualcomm, about six years ago. I came on board kind of as an entrepreneur in residence for a period of time, helping Qualcomm shape some of their service business efforts, none of which really got off the ground back then. But at one point I was asked to see if I could focus on a fledgling effort that we had a small team of evangelists promoting, which was wireless health.

And I had the opportunity at that time to meet Eric Topol. Eric was coming into the office on a frequent basis meeting with Paul Jacobs, our chairman, and we’d get together. And I have to say, it was one of my early inspiration, because when I was first asked to focus on this and see if I could help make a business out of it, my first response was I’m not a healthcare guy. I’m a tech guy. But having listened to Eric and have him share some of his vision, what I really enjoy doing is building things, and I enjoy building things in messy environments. Not quite as messy as it looks like it might get to be [LAUGHTER], but I mean I like disruption. I like industries that are going through transformations like healthcare is. And so that’s what got me inspired. And it’s been five years now. And there weren’t many people betting that I would last at Qualcomm for five years, but I’m having a great time.

Kirkpatrick: Eric’s role—we’re not going to talk about you all day by the way. [LAUGHTER] I hope not, but not for your sake. But you know, it shows when someone really has conviction, they can have a lot of influence, because Jeroen too has been highly influenced in taking that job and thinking about what he’s doing at Philips. So someone who really bounds the table and has articulate views can make a big difference.

Valencia: You know, Jeroen is one of them as well. In the last few years I got to meet Jeroen. He came into our office and shared his vision. It was about three years ago. And I thought, “Philips has this vision? Really?” And the audacity of the vision that he had and then what he’s carried out and the way he’s transforming that company is pretty phenomenal.

Kirkpatrick: Well let’s go straight to the IOT topic here. Sumbul, talk to me about how you think about this question of connectivity broadly in healthcare, and what some of the implication of it are in your view.

Desai: So I think from a physician’s standpoint, as well as a health provider standpoint, I think one of the goals that we really want to have is how do we get people engaged in their health, right, in their healthcare. I think the IOT, if we do it correctly, is a great vehicle of doing that. And I think one of our biggest challenges currently is we make interacting with every aspect of us so difficult. And for me the thing I’m most excited about with the internet of things is how do we leverage that to decrease the friction to make things easier.

And in the clinic that we’ve set up, which is called Clickwell Care, and it’s a virtual primary care clinic, really the goal for us to have clinical care as being a part of it, but really focus on the person’s full life, because I think what we’re missing currently from a health systems perspective is we are always just focused on the clinical care delivery piece, but not thinking about that person as a whole person. So how do we get into their consumer habits? How do we decrease the friction in terms of how they purchase healthy groceries? How do they get healthier foods delivered to their house? How do they actually get their pharmacy and medications delivered so that they’ll actually take it? And I think for us, what I’m really excited about is how do we think about the internet of things and enabling we as providers to actually be successful with engaging people in healthier behavior and decreasing friction.

Kirkpatrick: So for you, Fitbit and Apple Watch, which I left in my room, are not really the key thing to focus on when you think about IOT and health. Because that’s often where the conversation starts, and you barely even mentioned them.

Desai: Yes, and it’s funny, because one of the things that I’ve learned over the past few years in trying to scale and implement is—and this may go against some things that we talk about—it’s not about the technology. It’s actually about the service, and the care delivery model, and how people interact with healthcare. The technology is an enabler. And I think any time we focused—at least at Stanford we were focused solely on the technology, we failed. We didn’t get a lot of uptake.

And you know candidly, not to bring it back to the election, but I think that’s like a really eye opening thing about look at where we are as a nation in certain aspects. We at Stanford live in the luxury of living in the valley and we have a pretty advanced patient group. But even in that organization, we rolled out video visits—this is the most simple example—we rolled out video visits in 2013, and nobody used it. And when we actually thought about how do we develop a care model where video visits is a part of it, where we made the bricks and clicks model, where we allowed for people to come in in person and still actually maintained some of the relationship that they felt needs to be in person, but then allow for the technology to help with follow up, and wellness coaching, and other aspects, we got far better uptake. So now we do about 50% virtual and 50% in person, which is a pretty impressive number in a system where we only had 1-2% of video visit uptake not even two years ago.

And so I think that thinking about how does the technology enable our delivery, and not just focused on the little gadgets, I think is really important.

Kirkpatrick: You need to tell us what Qualcomm Life is doing.

Valencia: I would double down on that fact that it’s not about the technology. In fact, think about this, this is obviously become the remote control of most of our lives [the smart phone]. A lot of what we do on a day in and day out basis, we do through this. We’re always looking at it. But we don’t really think about our phones anymore as technology. Think about it, they only time your really think about this being technology is when you can’t get the network, when something crashes, when you have to reboot your phone or your computer. So it’s only bad things that you think about when you think about tech. So what we’re doing at Qualcomm is we’re trying to create the infrastructure and the underpinning of this internet of things and healthcare. And we’ve been at is as mentioned for about five years. We built out a platform in the home called 2net. And what we do there, we integrate with multiple medical devices, and fitness sort of wellness type devices, and we make it really, really simple for patients or consumers using these devices to get those devices connected and to get the data flowing back to their caregivers.

We then acquired a company about a year ago that was doing a similar type of solution, but in the hospital environment. So a company by the name of Capsule Technology, where they were integrating a lot of the devices in the hospital setting, particularly in high acuity, a lot of Philips devices in fact. And what we’re doing now is we’re bringing those together, because our view is as we move more towards value based care and outcomes based payment, it’s really going to be less and less about creating operational efficiency, to connect these monitors into the EMR to get the data there so that people don’t have to data enter. It’s going to be more about monitoring that patient wherever they are as they move through that journey, whether they’re in high acuity, moving down to a step down facility, to the home, there’s going to be a need to monitor those patients with serious chronic conditions or that have been recently discharged from the hospital.

And so we’re trying to create that connective tissue, if you will, between the patients and their care givers in a way that you’re not having to plug your patient in and out or discharge them into different settings. They don’t get discharged, they stay connected through the continuum from the hospital to the home.

Kirkpatrick: So in a way what you’re really trying to build is to be an ecosystem facilitator in a way.

Valencia: Exactly.

Kirkpatrick: For an IOT-centric healthcare system.

Valencia: Exactly right.

Kirkpatrick: But talk about why Qualcomm. And how much is the fact that you really dominate global radios in mobile devices, what made it possible and/or inevitable that you’re doing this?

Valencia: I think it was possible early on, and it feels inevitable now. It feels like we’ve made good progress, and as I articulate this not only to other folks, but to my own executive management, who is focused on buying a $47 billion chip set company right now, it needs to be crystalized in their mind as well. But this is the domain, in my view, of a tech company.

This is not the domain of one of the existing healthcare companies to fill. Why? Because this technology evolved so fast compared to the evolution of health technology, of medical devices particularly. This phone, and the technology in this phone is going to be obsolete in a couple of years. Or I might lose it. I’m going to get another one, I’m sure of it, in a couple of years.

The network, the 3G network is going to be shut down, AT&T announced, by 2020. So if you’ve configured anything to that network, you’re going to have a problem there. No one in the world, no company in the world knows better, the future of the technology in this device, or in the network, than Qualcomm. Qualcomm is working now to help develop the next generation network. And that’s on its way as we speak, the 5G network.

So what we do, a big part of the role we play, is we mediate between those two development cycles, and those two worlds. So we both help companies design the technology that goes in their devices to enable them to connect, and we also help create that infrastructure that the data flows over securely, and in a medial grade was.

And by the way, I want to quickly go back to your comment about Apple and Fitbit. I think they’re very relevant. I think they’re very relevant, both now because of what they’ve done to raise awareness around self-monitoring, but I also think they’re very relevant because there’s a big shift underway with those companies, with Fossil, with Timex, to embrace this whole movement. And what better way to be able to interact with your health than something you’re constantly wearing that can not only be a display but can be a sensor as well? And so I think you’re going to see a lot of interesting moves from those folks in the coming months and years.

Kirkpatrick: And I should mention, we have James Park, the CEO of Fitbit on stage at Techonomy tomorrow morning, so we’ll continue that conversation very concretely.

Anything you’ve heard that you would comment on, or should I ask you another question?

Desai: No, I do agree that Apple Watch and Fitbit, I think there’s a lot that they’re doing in this space, and I think they’re starting to think through really how do they become more engaged in the overall encompassing way of engaging patients. And I think they are very relevant; I agree. And I think they really have the potential of leveraging our phone to keep us engaged, and engage in health in a way that we haven’t done before. And I think that’s where they’re very interesting and exciting. And I think there’s a lot of opportunity that’s going to come from that.

Valencia: By the way, on that point really quickly of inevitability, about what we’re doing here, is again we’re acting as Switzerland. We’re connecting everybody. And if a company like Apple can agree that that’s important, then I think it is an inevitability that someone like Qualcomm, likely Qualcomm, hopefully Qualcomm, needs to play that role. And indeed they have.

Kirkpatrick: I’d like to throw up another tech company name an get your reaction to it, and that’s Amazon in this context, because one thing they have done surprising well in a very short time is position themselves with this new control device in the home for the internet of things, and other interactions. Do you believe that they have concrete designs on healthcare? What would you envision happening? I’d love you both to comment on that.

Desai: I know they do. [LAUGHS]

Valencia: They do.

Desai: They do. Yes, we have a relationship with them, and they absolutely do. And I think Amazon Echo is one of those devices that if you think about what they’ve done with the simplicity of that product to make it easy to use, I think there’s a lot of potential. And that’s exactly the type of thing, when we’re talking about the internet of things, in terms of how it’s really going to change the way we interact with health, I think that device is a great example of the potential—just think about the data potential on that. Think about the fact that there’s something in the house that can provide nudges in a really unique way. And they are absolutely thinking about healthcare. And I think the ability for them to do logistics the way they think about it, their ability to deliver products, I think they are very well positioned if anything, I think they’re one of the more interesting tech companies out there that are thinking about health.

Valencia: Yes, completely agree. And of course, both with the Echo in the home, and also AWS in the back, and I think they’ve got grand ambitions. What’s going to be interesting to see, with all the tech companies, is just how far they’re willing to go, because there’s a number of roles they can play that don’t necessarily take them into the regulated world, that don’t necessarily take them into HIPAA. And so that’s really, I think what’s going to be very interesting to watch over the next few years, including with companies like Apple and Google. How far are they willing to go in embracing that requirement, the regulatory environment, and the HIPAA laws, when right now they are primarily very, very big consumer companies that sell things to the masses. And healthcare is not quite the same way, and certainly the regulated world when dealing with real patients, and clinical grade type of data and solutions. It’s a bit of a different animal.

Desai: Just one point on that. I think they are all starting to realize that they are going to need to get a little deeper in order to actually figure out what the what is, even in the consumer space.

Valencia: Yes.

Desai: Because I think they’re still kind of on the fringe, and until you get a little bit deeper into some of the messiness of healthcare, the product is still not quite elucidated and clear. And I think they need to do that to get there, and I think they’re all listening and understand that. And so I do think that they are starting to think about how they want to go in that direction.

Kirkpatrick: I’m not going to drop that, but I just want to remind you all, this is a conversation, this whole room thing that we’re going to be doing all morning. So start thinking about how you want to dive in. I have one or two more things I want to mention and ask them, and then I want to hear from you guys.

But please directly address this point that I made about regulation and—if there’s one thing you can predict in a Trump administration, it’s that the regulatory environment is going to be more relaxed across the board. I would—if anybody in the room disagrees—does anybody in the room disagree with that? Okay. So let’s say for now that’s probably a given. That probably means that some of the obstacles that have been holding back some pretty cool stuff might not be as much a problem, right?

Desai: Well—go ahead.

Valencia: Might not.

Desai: [LAUGHS]

Valencia: The bureaucracy runs the world, not necessarily the politician, so whether or not there will be a dramatic change any time soon, I’m not so sure. It certainly shouldn’t get worse at this point. And frankly, the way that we’ve looked at it from the very beginning, it’s just table stakes. If you’re going to be in this business, you have to embrace it and deal with it. And that’s exactly what we’ve done. And certainly in different parts of the regulatory world with the FDA, it’s very, very complicated, very, very time consuming. I have to say, my view of their involvement with digital health generally speaking has been surprisingly positive and encouraging of the space. And we don’t see that as a major barrier. Frankly, the barriers are many, but they have a lot more to do with behavior change, with engagement, not just from patients, but from the provider organizations.

Desai: Yes, I would agree with that, and I would add that I think the business model and reimbursement piece, which I do think the government will have some impact on. It may not move favorably. I think that’s actually a big barrier, because the reason—the technology is not the issue. Interoperability, everybody can technically do it. It’s health systems, and the providers, and all the various entities agreeing from a business perspective whether that’s what should happen, and then also the reimbursement of the business model. The reason we haven’t dove in deeper, I mean, is at certain points, like we’re willing to cover the costs to an extent, but that’s because we’re a financially healthy health system. But at certain points for systems are not at that position, it becomes very difficult. And just the reimbursement for some of the basics I think still need to evolve. And I think that’s where the regulatory piece is going to be very important to see what happens over the next four years.

Kirkpatrick: Okay. Yes, please. Identify yourself.

John Madison: I just wanted to mention, to Rick’s point, so through the Qualcomm Tricorder XPRIZE, and for the workshops that I’ve conducted with the FDA, they are hungry for new ways of regulating that are lower friction. So they’re frequently lambasted for getting in the way, but there’s no federal agency that is more interested in reinventing themselves to reduce friction than the FDA. They are very, very serious about it.

Valencia: My chief medical officer is the chairman of the CTA’s digital health group, and we brought that whole group out to visit with the FDA and had some exhibit booths and had talks throughout the day. And they brought not only the senior leadership, including the director. They brought a lot of the rank and file folks that sat through the sessions all day and were very engaged. So again, it’s still a challenge, I mean no two ways about it, but—

Kirkpatrick: That is extremely encouraging, and also that was a very exemplary audience interaction, because by no means do you have to ask questions. You’re all in this conversation. So who else has something to say?

Klitzman: I’m Robert Klitzman from Columbia University. That was great. Especially given last night, I’m struck by the disparities between those who see themselves as the haves and the have nots, and Trump will probably also try to get rid of Obama Care, and may well succeed. So I’m wondering about reaching not just the well-educated, the worried well, but reaching people who have less education, less resources, and how tech might work given those challenges, or how you look at those challenges.

Kirkpatrick: Great question.

Desai: And I actually think that that is the biggest challenge. And I think last night was a great reminder of that. As I was thinking about this morning, you know, we on the coasts have an opinion that, hey, everybody can use video visits, and phone, and so forth. And a lot of times when large companies, like even Teladoc, when they’re citing their numbers, they’re still 90% phone calls that people are interacting with when they’re interacting with their doctors when they’re doing virtual care.

So I think we really need to be thoughtful about—and even in our population. So we have about 3,000 patients in this clinic. We allow for phone, video, and in person. And we let the patient pick. And interestingly the demographic is 18–45 year olds. So we initially thought we’d have crazy uptake a video visits. We still see most people wanting to interact in person for the first visit. And that’s completely driven by their choice.

And so I think what we as a health system where we are still struggling, and I think that has not quite been figured out is how do we get to those populations. And I think education is really one of the easiest ways. And that’s also where, again, going back to the internet of things, I think where if things are within your phone, like text messaging, and leveraging your calendar more effectively to really change behavior and engage with healthcare, I think that’s really kind of some of the secret sauce that we’re not doing. I think we need to be a little bit more thinking simplified about how we do this as opposed to necessarily thinking about some of the sexy gadgets out there.

And that’s always a little bit of my big challenge. I mean, we still use fax machines and paper insurance cards. We need to be realistic about where we’re at. You know?

Valencia: Yes, healthcare is keeping the fax industry in business. [LAUGHTER]

Desai: We are. That’s very true.

Valencia: Yes, I think the answer is that fundamentally it has to be built into the system. It’s not about the interesting gadgets. There are some really great ones out there that you’re going to get some consumer uptake on, but it is going to be the people on the edges. The people in the middle won last night. And I think the message is what do we do for everybody.

And in healthcare what we’re trying to accomplish is building out that infrastructure so that it, very much like the financial services industry, it is just what it is. It’s not an option or an interesting gadget, the industry is digital, it is connected. Patients stay connected wherever they are. They’ve come to expect always on healthcare, and always interacting healthcare. That’s where we really see that going.

Desai: And what we’re doing is really focusing on education for that group. And so we’re spending a lot of time thinking about what kind of education will actually resonate with those populations to get them to try to use things differently, and that there’s a ton of work that we’re trying to do to put into that to be able to realize a little bit of that change.

Bach: David Bach Platypus Institute. I’ve got two what I think are interconnected questions. You’ll tell me if you agree. The first one is as you think about the future, to what extent are you thinking about using digital technology to make the current system and current paradigm more efficient? And to what extent are you think about basically breaking the paradigm apart and moving toward a health optimization versus disease oriented topic?

And then the second question, which I believe is interconnected, is it was asserted that healthcare was more complicated than banking, which sort of make intuitive sense. But I’m wondering why is that true, and what are the real rate-limiting steps, the real rate-limiting steps, given the technological we don’t have a problem, that stand between us and actually realizing this vision of an interconnected healthcare system?

Kirkpatrick: Luckily we’re going to be coming at those two questions all day, but please take a shot at it.

Desai: For your first question, that is my internal struggle, [LAUGHS] is whether we—so part of my job is thinking about how do we create novel ways within an existing old system, and can that then break apart what we’re doing and completely re-haul? Right? And we run into a lot of challenges in terms of scale and fighting against the system that we’re in.

Again, just to give you a simple example of that, we have call centers that schedule our appointments, and we are trying to engage people to use video visits. I have educated our call center multiple times on what the different things you could offer to a patient are. They still tend to go to their habit of offering in person visits. So I’m not just trying to educate my patients, I’m trying to educate the people who are actually scheduling. And so that’s just the very practical reality which drives me nuts day-to-day, right.

And so there’s that within a system. I sometimes think re-hauling the whole system is the way you need to go. And that’s sometimes where I think tech companies have a really interesting edge if they were willing to get in deeper and do something innovative, because I feel like then you start with a blank slate. But the challenge is can you get people to do that, and there’s a lot of risk for them to potentially do that. And will patients come? That’s the other part of it, because patients do value the names or the relationships that they may have with existing folks. And then it that also just going after a niche of patients as opposed to at scale? So that’s kind of that aspect.

And then for the second question, I do think—well, I think maybe Rick chime in on the first one, and then I can get to the second.

Valencia: Well, here I might diverge from where Eric might think disruption will come from. Honestly, I think it’s going to come both directions. But I think disruption, change, dramatic change, transformational change, needs to come from within. And when I say that, I don’t mean we expect the existing health system to wake up one day and change itself. I mean that us technologists, us change agents need to get inside and work from the inside out, as well as developing new technologies. That’s the primary reason we did the acquisition of Capsule Technology. We now have 2,000 hospital customers all around the world, and we are in the hospital, we understand that world a whole lot better. So I really do think that it’s going to be a combination of the consumer revolution if you will, but also working from inside.

And by the way, if you think about any industry that has embraced technology, digital technology, it typically starts out with optimizing the current system. From that flows data, that data gets analyzed, and before too long it’s changing the system itself, the data. It becomes more of a data driven process. And I think healthcare is no exception.

And by the way, healthcare is very, very special in a number of instances, but in a lot of instances, it’s not very special at all. It’s very routine. It’s very mundane. And that’s where most of the costs are in the system. And that’s where we need to focus.

Desai: And just in terms of barriers, I think what’s challenging about health, and when I sit down with entrepreneurs, it’s like who’s your customer. That’s very clear in consumer oriented businesses, right, but in our business your customer is the patient, your customer is sometimes the family, your customer is sometimes the provider. And a lot of times the provider’s resistance to change their behavior, which Rick touched on, as well at the patient’s resistance for behavior change, that’s a challenge. And then you’ve got the healthcare administrators, and then you’ve got the payer system, and then there are employers.

I think sometimes figuring out who you’re selling to and what you’re selling to has been really challenging to companies. And getting everybody to kind of work together, I think it’s there, but there’s a lot of systems in between each one of those points that needs to—or the data needs to flow, and the interactions need to flow. That’s been a big challenge I think sometimes.

Kirkpatrick: Okay, I saw a hand back there, and this will have to be the last one in this round.

Chang: My name is Henry Chang. I’m with 3M Connect, leading kind of our IOT efforts. Quick question for you. So you touched upon reimbursement, and a lot of times incentives that are driving the various stakeholders drives kind of ultimate alignment. And so as you think about the reorganizational design, the opportunities in terms of what you can do, you have to think about behavior change, you have to think through organizational change, and how you actually provide that service delivery. What kind of change do you really see in terms of incentives that need to be in place in order to kind of align the organization, because right now reimbursement is not there? There may be other types of things here that really kind of drive behavior, and most likely from an incentive-based structure, that’s probably the only and first way to tackle this full world problem.

Desai: I think that’s where independent practices versus health systems, I think health systems have a little bit of a benefit when they own physicians actually. Because there are health systems where they don’t own the physicians groups, and that becomes more challenging as well. But in a system like ours where we actually have the physicians groups.

I do think incentives, it’s funny like in our group, one of the things that’s driven, you know honestly, it’s money, and salary, and time. And I think those are the incentives that we’re trying to drive with our physicians to change their behavior. And we do, even simple things like Press Ganey, I mean we’ve now drilled it to the point where there’s a lot of transparency. And I was giving a talk in Boston recently, and honestly we’ve used a little bit of the public shaming method that we’ve gotten used to when we train to get physicians to behave differently.

So those things, along with incentives around your bonuses and your salary structure. The other thing that we’ve done to be able to drive innovation in certain areas, and I think this is where Kaiser has had a leg up on us for many years, is we actually eliminated the RVU piece for primary care. So it’s completely salaried physicians.

Kirkpatrick: I’m sorry, for the acronym.

Desai: So it’s revenue—it’s basically, we don’t drive physicians to have to be getting billed—

Kirkpatrick: What does RVU stand for?

Desai: So it’s relative value units

Valencia: It’s kind of like billable hours for a lawyer.

Desai: So what we do is we don’t actually allow our physicians to do that in primary care. What we do is we salary them. And we’ve had a much better uptake with them being able to try new things, because it actually allows them more time as opposed to having to turning out patients to be able to get to a certain salary number. So that’s been very, very helpful actually with us.

Valencia: I’ll say we have a number of relationships with a number of companies that are employing incentives, and incentives work. Financial incentives work. They just work.

Q: Just a quick comment.

I was in DC when they announced the CPT billing codes for doing video visits, and there was a round of applause in the room, and as someone who was currently at OMC I walked out of the room in despair, because what they basically did was retro to create dollars for clicks. And to your point, in a world where we’re trying to use whatever technology we have to get the best possible outcome, paying so much for a video visit, so much for a telephone call, so much for a text message, so much for an email is just regressive.

Kirkpatrick: Thank you. And I’ll hear more from you and Kaiser in the near future. Thank you both. This is a great conversation. I hope you’ll be here and we can continue it in various ways over the next few hours.

[END]

 

Transcription by RA Fisher Ink

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