Are Telemedicine and Virtual Care Here to Stay?

Are Telemedicine and Virtual Care Here to Stay?

Aditi U Joshi

Meet Aditi U. Joshi, MD, MSc, chair of the telehealth committee for the American College of Emergency Physicians and former senior advisor of acute care telehealth at Thomas Jefferson University Hospital.

podcast available

Dr. Joshi has worked in telehealth for over eight years, most recently leading Thomas Jefferson University Hospital’s on-demand telehealth program. She holds an assistant professorship in the Department of Emergency Medicine at Thomas Jefferson. Dr. Joshi is a champion of health innovation and has a passion for training students and residents about how technology is fundamentally transforming how we interact and care for patients.

An early adopter of telehealth

MDisrupt: How did your passion for health innovation and specifically telehealth evolve?

Aditi Joshi: I graduated residency in 2009 and started my career in a busy emergency department. After a few years, I had symptoms of burnout and decided to try something different. I found an advertisement for Doctor on Demand and decided to apply. This was in 2013 when they were just beginning. I was one of their first doctors and eventually became the assistant medical director. During my time there, I helped develop best-practice protocols to ensure patients were getting a quality visit.

In 2015, Thomas Jefferson University started a huge enterprise-wide telehealth program that piqued my interest. I eventually joined Jefferson in the department of emergency medicine and was the medical director of our telehealth program. My role here has been interesting because, as an academic center, there’s room to try new things. This is also encouraged by our CEO, Dr. Steve Klasko, who has a commitment to health innovation, creating home-based health care, and improving health equity. The team here has expanded and achieved a number of things like a direct-to-consumer program, a triage program in our emergency department, and telehealth education. We also have a telehealth fellowship for post-residency training.

MDisrupt: What is the difference between telehealth and telemedicine?

Aditi Joshi: Telemedicine is the actual service between the patient and the provider. Simply, it’s direct care or a medical encounter. The term telehealth is much broader because it’s not only the services but also includes preventive maintenance, follow-up, and the regulatory portions of telehealth. It’s a more relevant, all-encompassing term. In the future we’re going to realize that telemedicine, or telehealth, is just going to be part of healthcare and the “tele” is going to go away. We may call it virtual care, but eventually, it is just going to be healthcare.

Bringing telehealth to more people

MDisrupt: What are some of the challenges and solutions of adoption in telehealth?

Aditi Joshi: Reimbursement tends to be the biggest reason that clinics and hospitals have shied away from telehealth. It was viewed as an added amount of work without being able to charge for it. With the Emergency Care Act, telehealth got reimbursed to a much broader degree. In respect to that, telehealth visits cost less for both patients and payers. Of course, the caveat is sometimes we need to send patients to a higher level of care because not everything can be done via telehealth. When I first started out, there wasn’t much engagement by either clinicians or patients in telehealth. Patients would pay out of pocket for these types of visits—a limiting factor for many people. As more payers have adopted telemedicine, whether it’s a contract with companies that supply direct-to-consumer telemedicine or a hospital system, it has continued to evolve.

A second challenge is cost. The setup costs to cover technology can be prohibitive for small practices or hospitals that can’t buy the necessary software and hardware. With the realization that telehealth needs to be integrated into the future of healthcare, it’s important to consider the cost to establish these services.

Internet connectivity and access to phones and smart devices is a third major challenge. During the pandemic, there were a number of people in Philadelphia who could not access our platform due to connectivity and technology access. Given the dire emergency situation, my colleagues applied for a grant to do targeted outpatient testing via a mobile van. There’s a second round of grants that focuses on access and expansion of devices and internet connectivity. It’s probably the first time the government has really put that much money into this type of health innovation.

In the future, we’re going to have to figure out how we access rural areas. Today it’s being done with local community interventions such as setting up kiosks or enabling people to access the internet by coming to libraries and community centers.

How innovators can make a difference

MDisrupt: Many in our audience are digital health innovators who have access to capital, technologies, and engineers to build solutions. What could we do better and what are we not doing enough of?

Aditi Joshi:  It has been a beautiful thing to see how many people are committed to trying to improve healthcare with all of the digital health solutions that are out there.

When it comes to innovating in healthcare, it can be very complicated, so at the very least you have to understand the healthcare system and how it works.

The biggest complaint from clinicians is that health innovators don’t understand hospital workflows and so they create solutions that make it harder for us to get our jobs done. Physicians are overburdened, so adding something that isn’t useful or efficient or that can’t be reimbursed ends up being a problem. Some ways to get around this are really understanding what your solution is and ensuring that what you’re creating is solving a problem in the first place. I will say that speaking to clinicians early on is a really good idea—with the caveat that we don’t always know the right solution. It’s great to get people who are outside of medicine to innovate, but it’s important to have someone onboard, like a chief medical officer or an advisor, who understands how clinicians practice and how patients respond or use the solution.

MDisrupt: What advice would you give a founder who is interested in telehealth solutions and improving patient care?

Aditi Joshi: First and foremost, understand what you’re trying to solve and get the right team around you—people who work in a similar fashion and have similar goals. I usually give this advice to residents or medical students, but it also works for anybody who is starting a company or has an innovation.

When I started out in telehealth, I really enjoyed it. I kept saying yes to things. I said “yes” to being the assistant medical director, at Doctor on Demand. I said “yes” to Jefferson. And here at Jefferson, every time there was a new program where people came to us and said they want to try this telehealth solution, our department would say “yes” and then we would do it. It didn’t always work! We have a lot of programs we never brought to fruition, but every time we went through the thought process and the workflow it became easier and easier. Now if a health innovator were to ask me, “Can you set up a process to do this type of program?” I would say, “Absolutely!” I can do that because I’ve had practice through trial and error.

Telehealth, ten years out

MDisrupt: What will an interaction with the health system look like in ten years?

Aditi Joshi: I love this question because this is my favorite thing to work on. At the American College of Emergency Physicians, where I’m chair of telehealth, we have a task force looking into how we are going to define emergency medicine for the next five to 10 years because of telehealth.

First, there’s going to be a lot of home-based healthcare for patients with both acute and chronic disease. We’ll be able to use the emergency medical system for acute care and deliver a lot of what we can do in the emergency department at people’s homes. We can also employ more cross-consults which will allow patients to access specialists. We’ll be able to observe patients at home and take better care of them.

There’s also going to be better health literacy once we figure out how to make it palatable. We need to uncomplicate the terms we sometimes use in medicine, so patients can have more control over what they’re doing and what they understand for their health care. The future is going to rely on more individual practice and giving patients the ability to understand and improve their health along with us will be essential.

Medical education is going to change significantly for medical students, residents, and care providers. We’ll also have to continue to understand how smartphones are optimized to work in the healthcare space. They are part of our daily life and we need to make them part of our healthcare, too.

At MDisrupt we believe that the most impactful health products should make it to market quickly. We help make this happen by connecting digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Our expert consultants span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.

Real-world Innovations to Reduce Maternal and Child Health Disparities

Real-world Innovations to Reduce Maternal and Child Health Disparities

Sarah England, PhD

Meet Sarah England, PhD, the
Alan A. and Edith L. Wolfe professor of medicine and vice-chair of research at Washington University School of Medicine’s Department of Obstetrics and Gynecology.

podcast available

Dr. England has devoted her academic research career to maternal and child health, with the goal of reducing disparities and poor outcomes across affected communities. She has been a champion of simple and elegant solutions that, at scale, are poised to make a big impact. Partnering with digital health leaders on innovative solutions can have a global reach and feed into a system where the benefit can be felt across generations.

Maternal and child health disparities today

MDisrupt: Can you describe the current state of health disparities for maternal and child health in the US?

Sarah England: Women of color are not faring well in terms of maternal health outcomes compared to white women. Pregnancy-related death is defined as the death of a woman during pregnancy or within one year of the end of pregnancy; a complication of that pregnancy; or a chain of events initiated by the pregnancy. The statistics are staggering. Black, American Indian, and Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women, according to the Centers for Disease Control and Prevention.

It’s a significant issue and it’s about time that we address it. Many people think it’s due to socioeconomic status, but this is not true. Black women with at least a college degree are still 5.2 times more likely to face these consequences compared to their white counterparts.

Building momentum for change

MDisrupt: How are maternal and child disparities being addressed by the health system and government entities?

Sarah England: Most pregnancy-related deaths are preventable and many of the causes of death can be addressed. Women of color face higher rates of stress associated with situational experiences of racial discrimination in the health system. A well-known example is Serena Williams. She knew that she had a complication from her pregnancy and was not believed by the medical professionals that were caring for her. This happens to Black women more commonly than it does to white women. This is something that we can really address by listening to women during their pregnancy.

And healthcare professionals have to be more cognizant of listening to women of color. Medical schools are developing curricula bringing more attention to issues of this nature. The federal government, especially funding agencies, are realizing that we need to address health disparities more than we have in the past. So the tides are changing. We are realizing that this is not good for the future: In order to reduce the trends in maternal and child health, we have to be much more aware of how we treat patients, how we study them epidemiologically and have a greater focus on those that are carrying the burden of disease.

In summary, we must implement standardized protocols in quality improvement initiatives, especially among facilities that serve disproportionately affected communities We need to identify and address implicit bias in healthcare that would improve patient-provider interactions, health communication, and health outcomes, and there needs to be a greater focus by funding agencies to address racial disparities.

A call to action for digital health leaders

MDisrupt: Many in the MDisrupt audience are entrepreneurs who have access to capital, technology, and engineers to build solutions. How can we help?

Sarah England: There is no shortage of good ideas, but often existing ideas remain stuck in “innovation bottlenecks” as they struggle for attention, funding, or the means of implementation. Healthtech founders can help lift us out of the bottleneck and bridge that gap from academia to commercial.

Fortunately, many digital health entrepreneurs are not only highly innovative but also have a desire to make a social impact. And solutions can be pretty simple. For example, we know that the twelve weeks after childbirth (fourth trimester) is a key window of opportunity to provide healthcare to mothers and babies. However, we often do not focus on the immediate post-pregnancy period. My colleagues and I have talked about getting a mobile unit that could go to underserved or remote areas and check in on new mothers. We could provide women access to services to help their emotional well-being, provide contraception and talk to them about birth spacing, ensure they are getting enough sleep, provide help with medications, and prevent substance abuse, and make sure they have physically recovered from childbirth. This relatively easy solution could make exceptional strides in maternal and child health, especially during this critical fourth trimester period.

Building better and more effective information-gathering systems that connect across all parts of our country is also an area where tech solutions are vital. Many people in remote and underserved communities are routinely left behind. And not all states collect information on race, ethnicity, income, and health insurance status because there are no national standards for data collection and reporting of maternal mortality statistics. Such data are critical for recognizing and understanding disparities, and without them, there has been insufficient accountability for maternal mortality.

Motivating for change

MDisrupt: How do you motivate healthtech entrepreneurs to innovate in maternal and child health?

Sarah England: Investors are interested in companies with broad portfolios and a message around social good. It’s a great time to go into maternal child health for this reason because improving maternal health improves child health and ultimately family health. It’s a feed-forward system that has long-term gains.

Another aspect around innovation is this concept of academia and companies working together to solve big problems. When I started my career, it was really important to be independent and have your own ideas and solutions. Now it’s really gone to “team science” and working with others to move your ideas forward. Also, women are pursuing technological fields. Oftentimes, they have children and raise awareness of this issue and push for robust solutions. There is going to be great innovation in this space in the years to come.

Passion-forward

MDisrupt: What advice can you give to women on their career and personal journeys?

Sarah England: It’s about following your passion. My original career path was cardiovascular sciences, not women’s health. Then I read a paper about preterm birth and felt compelled to connect with people in the field and find out more. I ended up going into a neonatal intensive care unit (NICU) with a friend of mine who was an NICU nurse. I saw a baby who had been born at six months and was being kept alive by multiple machines. It was heart-wrenching. I talked to the mother of the child and she blamed herself, even though the medical professionals didn’t know why she delivered the baby early. It made me realize that we don’t have all the answers, and you need innovative, creative minds in this space. So my advice is to follow opportunities because they may end up changing your course in life and opening up a chance to follow your interests and passions.

For women interested in connecting with other women in health, there’s a group that I’m part of called the Women’s Health Collaborative. The goal of this group is to support women in the field by networking and finding others to connect with who can help you move your ideas forward. You just have to be fearless and be ok not knowing everything. It’s very rewarding when you get to where you want to be.

Parting wisdom

MDisrupt: What parting wisdom can you give digital health entrepreneurs?

Sarah England: First and foremost, we need to raise awareness that maternal health is key for child health, and often the health of the entire family. Addressing maternal health issues has long-lasting health benefits across many generations. Second, you can partner with reproductive health researchers and clinicians. For example, we are partnering with engineers to develop devices needed for the care of women during pregnancy. We are very interested in partnering with other innovators with a sincere desire to improve maternal/child health.

At MDisrupt we believe that the most impactful health products should make it to market quickly. We help make this happen by connecting digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Our expert consultants span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.

Where is DTC Healthcare Headed? Lessons from 23andMe’s SPAC IPO

Where is DTC Healthcare Headed? Lessons from 23andMe’s SPAC IPO

ruby.gadelrab

MDisrupt CEO and founder Ruby Gadelrab shares her insights in a recent Clubhouse MedTech interview with Henry Peck. Ruby has worked on the commercial side of biotech, healthcare, and digital health for 24 years. She founded MDisrupt to connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.   

Henry Peck: Let’s talk about 23andMe. What role did you play there and what were the key challenges you were trying to solve for the business?

Ruby Gadelrab: First, some disclaimers—I left 23andMe four years ago. So I’m not speaking on behalf of the company. The opinions are my own as an industry observer.

I was hired at 23andMe just after the FDA had told them they had to temporarily stop selling health products to consumers. My role was to help them figure out some of the non-consumer business models. These included:

  • 23andMe for medical professionals. How do we educate and engage medical professionals on genetics and the reports that 23andMe were providing?
  • 23andMe for educators. Could a genetic test be used to teach university and medical students about genetics, statistics, and ancestry better than a textbook could?
  • 23andMe for research. How could the 23andMe experience be used in a research setting to improve recruitment in population health studies? For example, by giving people interesting data about their ancestry and eventually their health, can we improve recruitment and longer term engagement?

How 23andMe broke new ground

Henry Peck: In your opinion, what makes 23andMe’s product offering so successful and “sticky”?

Ruby Gadelrab: Let’s break this question down into two parts—why is it successful and sticky to consumers, and then secondly why does it have huge potential as a business.

Let’s start with consumer experience. Every aspect of our lives has been digitized through technology. Healthcare is undergoing that same revolution. 23andMe was the first company to work closely with the FDA to create a product that consumers could buy directly themselves that gave them personalized insights from their genetics about their health and ancestry. Over 10 million people bought the product and clearly, ancestry was one of the killer apps, but consumers also had an interest and hunger for health information and trait information.

23andMe made that information really easy and engaging for consumers to understand and interact with. They made the information digestible at an eighth grade literacy level and they explained complex genetics concepts simply enough for people to understand.

23andMe gave consumers the ability to participate in research for causes and diseases that they really care about. During the time I was at 23andMe over 80% of consumers were consenting to research.

Business value

Henry Peck: So what does that mean in terms of value to the business?

Ruby Gadelrab: 23andMe has one of the largest genetic databases in the world, with over 10 million people genotyped and consented to research. An individual genome isn’t really that useful unless it’s paired with phenotype and/or clinical information and aggregated with millions of other genomes so that we can see the patterns and discover new genes that are important for diagnostics and therapeutics.

What’s unique about 23andMe is that the database is recontactable and engaged and the company has the ability to collect additional phenotype data—I believe they currently have over 30K phenotypic surveys completed daily. Effectively, they have built a crowdsourced research platform where you can quickly make novel discoveries which can be applied to building new generations of therapeutics and diagnostics.The value they add to research is clearly recognized by pharma. Drug development is a long and expensive process. That’s because:

  • It takes 7-10 years to bring a drug to market.
  • 90% of drug candidates fail.
  • $2.6B is the average cost of getting a drug successfully to market.
  • It’s incredibly difficult to recruit patients into clinical trials and engage them for the life of the trial.

How do we create efficiencies in this process? The theory is, with the combination of genotype/phenotype data and a recontactable database, can you accelerate the pace of novel drug discovery? Find new drug targets and bring them to market faster? 23andMe has a partnership with GSK where they currently have over 30 therapeutic programs in the areas of oncology, cardiovascular disease, immunology, neurology, and metabolic disease, so clearly pharma sees the potential of such an asset.

4 keys to health product success

Henry Peck: Let’s talk about 23andMe’s recent announcement. How do you think this next step will change the company and their business? Any bold predictions for the future of 23andMe?

Ruby Gadelrab: Despite the numbers, the genetics industry is still in its infancy. And it’s still not a routine part of our healthcare system. Our healthcare system as it stands today is neither about health nor about care—it’s actually a reactive sick care system.

One of the few silver linings of the COVID-19 pandemic is that It showcased the huge gaps in our healthcare system that are ready to be addressed by those who are daring enough to try and disrupt it. Effectively, the pandemic pushed the fast forward button on digital health adoption. And one of the biggest gaps that was revealed is the problem of access.
Everyone from within the health system and outside of it recognizes that it has to change—we have to:

  • Improve access to health information and health services
  • Build solutions that can predict and prevent disease before people ever get sick and deliver the right interventions to the highest risk populations at the right time
  • Have a more holistic view of individuals’ genetics, lifestyle and behavioral data as well as social determinants of health in order to figure out what the right interventions are and who needs them most urgently
  • Develop tools for individuals to have all their health data consolidated in one place.

At MDisrupt we see many digital health companies trying to address some of these challenges. We work with them to identify which problems they are trying to solve that matter to the current healthcare system. So generally for a health product to be successful and gain widespread adoption it has to improve one or more of these four areas:

  • Health outcomes
  • Experience—for patients and for physicians
  • Access to healthcare products or services
  • Reducing healthcare costs.     

When I think about how companies like 23andMe have played a role in this (beyond therapeutics, which we already talked about), here’s what comes to mind:

  • 23andMe has built a platform that provides easier access for consumers to gain insights about their health.
  • They have built an experience for consumers to engage in conversations about their health often before they are patients—and this experience is more engaging than what we currently see from our health systems.
  • The previous generation of genetic tests focused on inherited rare diseases that affect 1% of the population.
  • The next generation of genetic tests will focus on common chronic diseases that affect many of us, such as diabetes, cardiovascular disease, hypertension, and obesity. 23andMe’s genotype/phenotype database gives them the power to develop this new class of tests known as polygenic risk scores.

One caveat to this is that these types of tests are difficult to get to market as hey require huge datasets, the studies are complex because many of the diseases are impacted by lifestyle and behavioral factors, and how these products will get through regulatory is still to be seen.

Why building health products is a marathon and not a sprint

Henry Peck: 23andMe has been one of the flagship companies in direct to consumer (DTC) healthcare. Talk to me more about this space.

Ruby Gadelrab: Building health products is hard, it’s expensive and it takes time. You have to be in it for the long term. It’s hard for a number of reasons.
In healthcare, the user, the influencer, the payer, and the consumer of the product are often completely different stakeholders with completely different incentives, so that’s a really tough challenge.

It’s a really highly regulated space and the regulation is not just per country, it’s potentially per state as well. When you’re thinking about building a health product, you have to think about the regulatory process countrywide and statewide. Your regulatory strategy also deeply impacts your commercial strategy—the type of product you would build for a DTC market is potentially different to what you would build if you want the healthcare system to adopt it.

Unlike tech, in health, you cannot test and iterate quickly. You need to do the studies to generate the evidence that your product is safe, is effective, is clinically useful, and that its economics work, and these studies can take many, many years.

When you start the commercialization process, you have to find your earliest adopters in the healthcare world, which involves building specialized sales teams and deploying expensive KOL (Key Opinion Leader) programs,
Finally, you have to get your product reimbursed and engage the medical community.

Digital health innovators: Don’t skip these steps

Henry Peck: What are the key challenges in DTC? What do you absolutely HAVE to get right in DTC?

Ruby Gadelrab: These three areas are critical:

Regulatory and Evidence Generation
For ANY health product the two things that are most critical are regulatory and evidence generation. No one should skimp on those. If you really want to disrupt healthcare this is the key differentiator. Quite frankly, there is a lot of nonsense out there disguised as health products and your studies and regulatory strategy is what will differentiate you from the nonsense and stop you getting in trouble. The advice I give all digital health companies is to hire a CMO (Chief Medical Officer) even if part time, because they will help you with the evidence generation and staying on the right side of regulatory.

Understand User Acquisition
People underestimate the cost of user acquisition. It’s very expensive to acquire consumers for health products, especially when most people are used to health products being covered by insurance. To be clear, I am a firm believer that there is a self-pay market for access and convenience, but it’s a subset of the market. I see this a lot where companies start out DTC, then realize how hard and expensive it is, and then want to pivot to B2B2C—where they want to work with health systems, employers, providers etc. So, back to my earlier point—to do that you need to make sure you have the right regulatory strategy and have done the evidence generation to allow you to make that pivot.

Bring Healthcare Providers into the Experience
Many DTC companies are improving the access to and experience of health products—and we love this democratization of health products. HOWEVER, part of the consumer experience has to be bringing healthcare providers into the fold. Think about the scenario where a consumer orders a test at home or uses an app or wearable to track their health data and that consumer takes that report to their physicians who has never seen it, has no idea why they ordered it and they ask the consumer, “What is this crazy thing you ordered off the internet?” That ruins the consumer experience.

The way around this is to engage healthcare professionals early on in your product development, so they can help you build products that are clinically useful even if they are for a consumer market. They will be your advocates later. Then, when your product is on the market, provide education for healthcare providers who may see your consumers. Educate them on your product with data and studies. This will massively help with the consumer experience and you won’t spend ridiculous amounts of money calming the naysayers.

Innovators to watch 

Henry Peck: Who are some of the leaders and “up and comers” in the space, in your opinion?

Ruby Gadelrab: It’s companies creating DTC health products that are taking an evidence-based approach that democratize access and improve the experience of healthcare products and services responsibly. And they are even better if they can demonstrate that they can improve health outcomes and reduce healthcare costs.

  • At-home lab testing. I think Everlywell and Modern Fertility are fascinating in that they massively improve the access to and the experience of a traditionally cumbersome process.
  • Liquid biopsy for early cancer detection, particularly patient-initiated (not DTC, but easy access). There are so many digital health companies innovating in this area: Grail, Exact Sciences, Guardant Health, Freenome, just to name a few.
  • Femtech. Women’s health has been neglected for far too long. Everyone thinks Femtech is just about fertility but it goes beyond that into hormone testing, sleep, diet, menopause, endometriosis, and so much more.
  • Apps and wearables that help with at-home patient monitoring. I like OneDrop. It’s a diabetes product that uses a data-driven approach to measure blood glucose levels with coaching and data.
  • Mental and behavioral health apps that combine technology with coaching experts.

Henry Peck: What types of technologies/businesses can we expect to see with the rise of DTC?

Ruby Gadelrab: Some products are DTC and some products are easy-access, where a physician network behind the scenes orders the product. Telehealth is the key technology that can power this. Telehealth and virtual care are big areas by themselves but they also power some of these products that appear to be DTC.

Health data analytics companies are generating huge amounts of data. How do we make sense of it all into something that’s clinically useful?

I think there is also potential for a company to create a space for providers and consumers to learn about digital health products and the evidence behind them. This is one of the things we are working on at MDisrupt.

At MDisrupt we believe that the most impactful health products should make it to market quickly. We help make this happen by connecting digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Our expert consultants span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product talk to us.

The Future of the Healthcare System

The Future of the Healthcare System

Chet Robson

Meet Chet Robson, DO, chief clinical officer at Walgreens.

podcast available

Beginning as a family practice physician, Robson went on to C-suite positions at health systems and one of the largest health retailers. He was an early adopter of electronic medical records (EMR), educating himself and helping colleagues understand how to use and implement them. He later earned his MBA at Dartmouth in health care delivery science with a focus on how healthcare can be delivered to different populations. At Walgreens, he delivers healthcare directly to the consumer on a national scale—in everyone’s neighborhood.

Listen to the full interview here.

MDisrupt: How do you envision healthcare delivery in the US changing?

Chet Robson: Health care is becoming more home- and consumer-driven. Examples of this include telemedicine for care delivery, oral oncology medications that can be taken at home, home testing (COVID-19 testing, cholesterol and genetic tests), mental health coaching, and health tracking through apps. Hospitals are having to become parts of a system that reach beyond the hospital walls; integrating with retail pharmacies, companies like Uber, and more.

From the pharmacy standpoint, it’s a very similar theme—meeting consumers where they live and making it easy for them to get medications and other health care services. Several retail healthcare venues now have primary care doctors’ offices inside of their pharmacies—an elegant integration of delivery models supplementing the norms of the traditional health care system.

The final piece is the payment models to help facilitate care. It’s not simply about how we pay for a particular diagnosis and treatment , but how we pay for the prevention, the treatment, and the aftercare for the best outcome.

Recently with COVID-19, there’s been a huge evolution of home delivery, medication, and medical goods.

MDisrupt: As a health retailer, how do you evaluate innovative technology for introduction into the retail pharmacy market?

Chet Robson: This is always an exciting challenge because there are so many great ideas at different stages of development. Given this, we have a very formalized approach that we go through. The first thing we evaluate when a company brings something new to us is identifying what problem the technology is trying to solve. We’ve seen things where it’s great technology and an interesting scientific venture, but it doesn’t really solve a problem. Then we dive into the fundamentals around the basic medical science, clinical efficacy, real-world evidence data, multi-population studies, outcomes, and feedback that affects patients around use, price, insurance coverage, and ordering. We really want to understand if the technology actually improves the problem that needs improving.

From a business standpoint, we evaluate if there is a sustainable business model and synergistic fit with our current strategy. There are many times we’ll see products that are really very good, interesting, but it might not really be the exact right fit for what our current strategy is or what we’re trying to achieve.

MDisrupt: Adverse drug reactions are the fourth leading cause of death in the US, but pharmacogenomics is still not a standard of care. How do we reconcile that and where is it going?

Chet Robson: I share that frustration with you because I’m a big believer in pharmacogenomics. It could really become a valuable tool, but we are still along the pathway to integrating it into the standard model of care. First, it’s “newer” science to the general public, regulatory bodies, and legal organizations so there are hurdles around education and defining how to use the information in patient care. Second, we have to become very specific about the benefits, impact, and use cases for pharmacogenomics. Third, there are operational challenges around getting the information into a prescriber’s workflow so that the health care provider, at the point of writing the prescription, has access to drug interaction information. It has to be simple and straightforward. Lastly, the information has to be available to anyone who’s going to interact with it. This includes the healthcare provider and the pharmacist, so they can support each other to ensure that drug interactions are identified and acted on appropriately.

MDisrupt: Do you have an example of a country or health system that’s been successful in implementing a PGx program?

Chet Robson: We’ve implemented a very successful program through Walgreens Boots Alliance and our independent pharmacies in the Netherlands. The health system in the Netherlands is a single payer system, so both the physician and the pharmacists have access to a common EMR. This is critical because the physician or pharmacist can look up a patient’s drug interaction information. The physician can request a pharmacogenomics test, the patient’s results get added to the system, the pharmacist sees the results, and then walks the patient through the information. If there’s an actionable medication, the pharmacist can then connect with the physician to request a change of medication. It’s worked extremely well and we’ve had really good uptake. Even throughout the pandemic we’ve seen the number of pharmacogenomics tests going up greatly because there is a good deal of interest from the patients. The other interesting piece is that the physicians look at the pharmacies now as part of the whole ecosystem. It’s still early and we’ve not even completed a year, but the initial results have been strong.

MDisrupt: What’s the future for pharmacogenomics?

Chet Robson: PGx is beginning to be a part of a bigger picture of understanding a robust genetic overview of an individual. Currently we have an understanding of phenotype through biometric testing, lab testing, and imaging, but we tend not to have a very good genetic view. To be able to fully manage a patient’s health, you have to understand that entire equation including the social determinants of health.

The FDA a year or so ago really pulled back on the pharmacogenomics information that could be released to patients. Currently, they’ve begun to make major strides moving forward by looking much more deeply at the research and working with the Clinical Pharmacogenetics Implementation Consortium (CPIC) and other organizations. A major hurdle to overcome is the FDA becoming more comfortable with what PGx offers. Payors are also doing a lot of different testing in various different forms with pharmacy benefit managers (PBMs), sometimes with their insured populations, and sometimes with particular disease states.

As you begin to make PGx an actionable, value-based test, we’re going to need to become much more refined in our risk stratification of how we use the test. It’s an important piece of the total comprehensive view of the patient.

MDisrupt: What does the pharmacy of the future look like?

Chet Robson: There’s only about four ways to manage health and disease. First, maintain health by exercise and good nutrition. The second is to prevent illness through immunizations, routine testing, continuous health monitoring. Third is medication delivery and education. And fourth are interventions like surgery and radiation. Pharmacists can play an integral role in the first three ways by providing medication and treatment expertise.

Part of the pharmacy of the future is helping pharmacists become integrated in delivering health services rather than simply delivering prescriptions. This can include mail or home delivery, telemedicine, followup care, and clinical services. Pharmacies are already in everybody’s neighborhood and it creates a network of places where people can easily access the health resources they need. Lastly, in the virtual world of health apps tied to medication and health management, digital pharmacy services can play an important part in medication management, providing immunization information, or answering questions around the clock via Ask A Pharmacist chat. Having that virtual, always-ready connection is definitely going to play a critical role in the pharmacy of the future.

The pharmacy of the future is really an expansion of what we do now. It’s about allowing the pharmacist to use their full skills rather than just operational ones, thus allowing people to connect virtually and in-person to their local pharmacy. It’s about an interconnected healthcare ecosystem that meets people where they live and experience health care. A health care system that operates in the continuum of people’s lives—living, working, and virtually.

At MDisrupt we believe the most impactful health products should make it to market quickly. We connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

If you are building a pharmacogenomics or other health product, MDisrupt can help. Talk to us.

Six Things Healthtech Founders Should Know When Building Health Products

Six Things Healthtech Founders Should Know When Building Health Products

Healthtech is a fast-growing industry in which technology (wearables, apps, cellphones, databases and software) is used to solve problems in healthcare around improving access, productivity, delivery and quality of care as well as potentially reducing costs. According to Rock Health, despite a global pandemic, in the first half of 2020, $5.4 billion was invested in healthtech in the U.S. alone.

However, building health products is hard and very different from building tech products. Many innovators from the tech world are flocking to the world of healthcare and attempting to disrupt it through their innovations. There are well-established steps for building health products that scale. What are the key things that healthtech entrepreneurs should know as they navigate this complex industry?

1. Understand healthcare’s many stakeholders.

Within the healthcare ecosystem, there are many stakeholders; often, the user, influencer and payer are not the same people. When building a health product, it’s important to understand from the beginning who the stakeholders are and what they value. You should map out who will use it, who will pay for it and who will make the decisions to implement it because this will have a direct influence on what you build, what features it will have and what the value proposition will be. Some key stakeholders include:

  • Providers: The doctors, nurses, pharmacists, dentists, radiologists, surgeons and other practitioners who are licensed to deliver care to the patient.
  • Health System: An organization or a group of organizations that is responsible for delivering primary and secondary care to a target population.
  • Payers: A company that pays for medical services. Insurance companies are the most common type of payer. In the U.S., these fall into one of three categories: commercial, private and government.
  • Employers: The largest purchaser of health insurance, covering more than 55% of Americans.
  • Patients: The ultimate consumers of healthtech and healthcare products and services.

2. Solve a real problem.

Many of today’s healthtech products started as a technology discovery that was then applied to healthcare to try to solve a problem. Often, this is merely a perceived problem because the founder’s limited experience of the healthcare ecosystem means that they haven’t understood their target audience and the audience’s clinical workflows, intent or guidelines they follow.

The way many healthcare stakeholders think about this is that they look for solutions that generally solve one of these problems:

  • Does it improve patient health outcomes?
  • Does it reduce healthcare costs?
  • Does it improve the patient and physician experience?

It’s important that your product solves real problems in healthcare, and the best way to do this is to consult health industry experts and deeply understand your audience.

3. Generate evidence to convince skeptical audiences.

Evidence generation is one of the most critical steps in building health products. Firstly, people’s lives are at stake, so it’s important to demonstrate your product is both safe and effective.

Secondly, you have to convince doctors to use it. Doctors can be the world’s most skeptical audience, partly because they are scientists at heart and partly because they took an oath to “do no harm” and they genuinely care about doing the best for their patients. In addition, medicine is one of the most litigious industries.

Data, publications and recommendations from medical societies will likely convince doctors to routinely adopt your product in their practices.

4. Ensure that the economics work.

Evidence generation is important not only for providers, but also to convince payers to reimburse your product. Payers and employers will need to be convinced of the financial advantage of utilizing your technology. They will want to know:

• How much does it cost compared to what they are currently doing?

• How much will it cost to implement the solution in its entirety (switching costs, training costs, etc.)?

• How much will it save the healthcare system and over what time frame?

• Does the cost of the solution plus the implementation provide a compelling ROI over a reasonable amount of time?

This is where the skills of a trained health economist come in. Health economists are trained to do health economics and outcomes research. They help compile the dossier with models that you will need to present to payers.

Like all other types of business, even if you have the best product to solve the biggest problems, if the economics don’t work and you can’t convince someone to pay for it, it’s nearly impossible to scale.

5. It’s a marathon, not a sprint.

Most entrepreneurs who build health products and expect them to scale in a healthcare setting have to be in it for the long haul. It can take 10-15 years to get widespread adoption of a health product, including the time to complete all the studies necessary to generate the evidence to convince providers to adopt it and payers to pay for it. This is very different from the tech world, where products can scale and exit within five years.

Often, good healthtech companies run out of money and time before they can fully scale. For example, clinical studies from a healthtech company called Lantern were just recently published, two years after the business folded and sold its IP.

6. Pick the right investors.

To the point above, it’s important that healthtech founders choose their investors wisely — the ones that understand the time and money it will take to successfully build and scale a health product and have realistic expectations. The studies and regulatory processes may take years, and revenue and exit expectations should be adjusted accordingly.

There is no doubt that healthcare is ripe for disruption through technology, and there is no shortage of talented entrepreneurs to catalyze this disruption.

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First published in Forbes Business Council.
Ruby Gadelrab Forbes Councils Member

ruby.gadelrab

Ruby Gadelrab, CEO + Founder, MDisrupt

Ruby Gadelrab is a seasoned health executive with a track record in successfully commercializing healthcare and healthtech products. Her expertise lies in developing high-impact B2B and B2C marketing, branding, and commercial strategies. Ruby served on the executive team at 23andMe as vice president of commercial marketing and has worked for many leading companies in the biotech and genetic spaces. Before founding MDisrupt, Ruby consulted for, advised, and mentored more than 25 companies in the healthtech space.

At MDisrupt we believe that the most impactful health products should make it market quickly. We do this by uniting digital health companies with experts from the healthcare industry to help them accelerate their time to market responsibly.

Our expert consultants span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.

3 Leadership Roles Doctors Can Play In Healthtech Companies

3 Leadership Roles Doctors Can Play In Healthtech Companies

Healthtech is defined as the application of technology to solve problems in healthcare—think wearables, apps, cellphones, connected devices,  software, databases, etc.  It can also include medical devices, personalized medicine, and even at-home testing solutions.  

The healthtech industry (also known as digital health) is growing rapidly.  According to Rock Health, despite the global COVID-19 pandemic the first half of 2020 saw a record investment of $5.4B in the sector in the US alone. Healthtech products are designed to solve problems in healthcare related to

  • improving patient outcomes 
  • reducing healthcare spend 
  • increasing access to care, and 
  • improving the patient and physician experience. 

Many companies in the industry are started by nonmedical founders— technologists, scientists or business leaders who see the $4 trillion healthcare industry as ripe for disruption. But doctors, too, are playing many critical roles in this industry. Increasingly, mid-career physicians are reducing or ending their clinical practice to join or found healthtech companies themselves.  

What leadership roles can physicians play in healthtech and how are they contributing?

Physician CEO/Founder

Doctors have a clear understanding of problems they have witnessed and experienced within the healthcare system. And they often have a good understanding of how the healthcare system works and who its important stakeholders are. This can make doctors very well-suited to creating health products and solutions that will not only solve real challenges in healthcare but will also be valued and adopted by other healthcare professionals.  

Some examples of physicians who founded health companies include: 

  • Kartik Modha, MD, a UK-based GP who founded myhealthspecalist. He recognized patients’ struggles to find private physicians recommended by other doctors and built a search and recommendation platform to address this. 
  • Suzanne Sysko Clough, MD, co-founded Welldoc a digital health delivery platform for chronic disease management through lifestyle interventions and behavioral coaching.  
  • Moira Schieke, MD, a clinical radiologist, founded Cubisimi to digitize radiology practices and create a new category of precision imaging.   
  • Nate Gross, MD, co-founded Doximity, the world’s largest medical network for physicians, and then went on to co-found Rock Health, a VC fund focused on digital health. 
  •  Andrew Beck, MD, is a molecular genetic pathologist who co-founded and leads PathAI. The company seeks to use AI and machine learning to modernize pathology and improve diagnostic accuracy and treatment efficacy for diseases like cancer.  
  •  Jeremy Friese, MD, MBA,  founded and leads Verata Health, a  company that has created an AI-powered Frictionless Prior Authorization™ platform to optimize both the patient and physician experience.
  • Oliver Kharraz, MD, founder and CEO of ZocDoc, a platform that solves access to care through telemedicine.

Often physicians who found companies need to augment their executive teams with both technologists and product leaders who understand how to turn the insight into a product. They also need to include commercial leaders who can ensure the commercial viability of their solutions and then help them develop  market access strategies. 

Chief Medical Officer (CMO) 

As mentioned above, many innovators who start healthtech companies do not have medical backgrounds. That’s why the Chief Medical Officer role can be one of the most critical hires for the success of a healthtech company. This role is a key executive position and is essential for companies that expect their product to be adopted and paid for by stakeholders within the healthcare system. The responsibilities of the CMO are broad and can include: 

  • Develop and communicate the clinical strategy
  • Represent the voice of healthcare and patients inside a company
  • Enable the company to find product-market fit and solve real (not perceived) problems in healthcare 
  • Ensure the company meets regulatory requirements
  • Design studies to generate the evidence required to prove the products are safe, useful and cost effective
  • Develop the product’s global value and reimbursement dossier 
  • Ensure that patient care and safety are a consistent company priority
  • Communicate with medical advisors, key opinion leaders and medical societies 
  • Educate payers and other stakeholders in presentations on clinical utility 
  • Ensure that the company is designing its products responsibly and ethically. 

If you want to look at the career paths of some incredible physicians who have left clinical practice to become chief medical officers in health companies, here are some great examples: 

While the chief medical officer role is critical for companies creating health products, many early-stage health startups often can’t afford to hire one full time. This is where new versions of this role are emerging; they include:

  • Part-time Chief Medical Officer – This is where a chief medical officer can work for a company just a few days a month so the company gets the benefit of their expertise without the full salary costs. Federico Monzon, MD, one of our senior CMO consultants at MDisrupt, currently works with three separate healthtech companies in this capacity, dividing his time between them. 
  • Interim Chief Medical Officer – Hiring a CMO is a big decision and it’s important to choose the right one. You want a person with the skills and knowledge you need for your health innovation but also one who can fit in culturally with the rest of your team. It’s important not to go for long periods without any medical oversight at all. Companies whose CMO leaves suddenly may also require an interim CMO.  In this case, a physician works with a company for a few months, filling the key responsibilities while the search for the long-term CMO is underway. 
  • Virtual Chief Medical Officer – This is a very new way of engaging a CMO for companies that need flexibility—think of it as a CMO on demand. The virtual CMO isn’t usually there physically (who is these days since the global pandemic?) but they work with companies to solve some key clinical issues, particularly early on. The time commitment can be anything from 2-10 hours a month as needed. It’s a perfect role for physicians who are still in clinical practice but want to experience working with healthtech companies in a lighter capacity.

These roles allow healthtech startups to have an executive-level medical voice at the table in a way that they can afford. They also allow physicians to add value to health companies, and try working with the founders and ensuring alignment with product strategy and company  culture before making a full commitment to join. 

Head of Medical Affairs 

Medical affairs professionals often (but not always) report to the chief medical officer and are the medical face of the company.  Many physicians take medical affairs roles, but non-MD clinicians, including nurse practitioners, physician assistants, genetic counsellors, and PhD scientists do so as well.  The primary role of medical affairs is to educate, communicate, and engage the clinicians who will be adopting the product the company is developing. Medical affairs roles are ideally suited for clinicals who love to make sense out of data, develop content, and teach.

 Their responsibilities can include: 

  • Building, managing and engaging Key Opinion Leader (KOL) programs 
  • Overseeing clinical trials 
  • Executing publication plans
  • Developing education programs for healthcare providers 
  • Educating sales and marketing teams 
  • Developing content for patient education 
  • Coordinating data and communications at scientific conferences 
  • Gathering and sharing market intelligence
  • Providing clinical and technical support to the clinical users of the product.

Some notable physicians who have had successful careers in medical affairs include: 

The medical affairs professionals are critical to the commercial success of a health product. They work hand in hand with the sales, marketing and product development groups within an organization. The key to adoption of health products is educating the providers who will be using them; this is the primary function of this role. 

Adding Physician Leaders to Health Companies May Enable a Faster Path to Market. 

These roles discussed above are just three examples of leadership roles that physicians can play. There are many more that we will outline in future blogs. 

At MDisrupt, we believe that the most impactful health products should make it to patients faster. From reviewing and advising hundreds of companies, our insight is that healthtech companies that hire and engage healthcare experts early and often are the most likely to be successful. We currently have 31 physicians in our network who are looking for opportunities to advise and consult for healthtech companies.

If you are a healthtech company that requires a CMO or Medical Affairs leader (full time, part time, interim or virtual) please click here. 

If you are a physician who would like to join our network to become a CMO or Medical Affairs lead for a healthtech company, please click here.

ruby.gadelrab

Ruby Gadelrab, CEO + Founder, MDisrupt

Ruby Gadelrab is a seasoned health executive with a track record in successfully commercializing healthcare and healthtech products. Her expertise lies in developing high-impact B2B and B2C marketing, branding, and commercial strategies. Ruby served on the executive team at 23andMe as vice president of commercial marketing and has worked for many leading companies in the biotech and genetic spaces. Before founding MDisrupt, Ruby consulted for, advised, and mentored more than 25 companies in the healthtech space.