Meet Nico Arcino, Kaiser Permanente's Senior Director of Strategic Partnerships

Seeking true partners for better medicine at better prices

How do we create better quality, more personalized, and lower cost health care? That’s the goal of Nico Arcino. He’s the Senior Director of Strategic Partnerships, in Kaiser Permanente’s Chief Digital Office. His role is internal and external partnerships. Since Kaiser Permanente is a large health care organization, he’s tasked with bridging meaningful relationships both inside and outside as well as overall, bridging health care and technology together. He knows what doctors, nurses, technicians, and administrators want. And he looks outward to find it. But he’s not just looking for the next big answer in-a-box. He wants a true partner to support Kaiser Permanente’s mission of high-quality, affordable care.

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Highlights:

• Kaiser Permanente targets entrepreneurs whose values align
• Kaiser Permanente prefers to introduce solutions through innovation that are ready to scale
• IoT, AI, Machine Learning, blockchain, and digital health solutions are key emerging technologies that are top priority
• Kaiser Permanente goes outside of health care businesses to discover technologies that can be adapted to health care
• Design thinking is important to creating a successful healthcare product

KM: What does it mean for you to balance internal and external relationships?

NA: I think the internal relationships are the most important part of my job. I cultivate relationships built on trust. I want to understand what the issues are, and not just suggest technology for technology's sake. It’s important to say, "I think I have something that I learned from talking to somebody that might be of interest to you, let's have a conversation about it." From there, we could take it to a place where we're really having more of a business-oriented discussion of what can be designed.

What do you look for in a partner?

We look for the right kind of partner in terms of how our values align, what they can offer, and how will they make a difference. In particular, we look for something special that, combined with our integrated care model, could actually make that difference at scale. These things take time to work through and get right and to agree that we should partner. We must have alignment.

Do you build your own technology, do you buy technology, or license it? Or is the answer: All of the above?

It's not a build or buy discussion. It’s not about buying commercial product or licensing discussion. It’s about R&D. It’s about working with big and small tech companies and wondering what they have in their shop that they may not be thinking about they could apply to health care. Our work in strategic partnerships is to recognize that potential and then see if it can be applied to health care and make it work operationally and at scale for Kaiser Permanente

What are some of the pain points you’re trying to solve?

We live and breathe health care today. We know what our IT challenges are, we know what our health care challenges are. People have been trying to solve these things for a long time. If you think about telemedicine, is telemedicine finally ready? In some cases, yes, but there are still issues. Some are regulatory issues, some are technology issues. Where we haven't been able to penetrate successfully 100% of the time is a person's home, because network connections are so varied. Not everybody's a tech person. You can't just take this into a home and expect it to work the way you think it will all of the time. I think that's where a lot of startups have failed, especially in remote patient monitoring. Home health care is the hardest thing. It’s hard to go into someone's home and be able to be efficient and provide quality care when you're working with a patient’s ability to use the technology.

Have you found any success with coupling home care with technology?

Yes. In Southern California, there is a cardiac rehabilitation program that was analog before, and it was outsourced to a third-party vendor. Think of it as education and rehabilitation. Patients were entered into this program randomly and 50% of them graduated. The point of the program is - if you have a life event such as a heart attack, you end up needing cardiac rehab. So, it's about how do I eat differently, how do I exercise, what do I need to do to maintain my health, mobility, and wellness going forward. It’s a proven cardiac rehab program that saves lives. The problem is that paper and phone-based programs are tough to scale. So, while we have tens of thousands of members who need it, we are still only able to deploy to thousands. The other problem is getting people to complete the program, especially people that are located longer distances from our facilities. So, what we did was we took a wearable and mobile app and a clinician dashboard internally, and virtualized or digitized, and the data was sent automatically to the clinician or the care manager. Members started to get excited about it and thought of it as something Kaiser Permanente gave to me and they really care about me. So, we've improved our score from 50% to around 85% graduation rates for the program.

How did you put the pieces together for that Cardiac Rehab program? It doesn’t sound like a solution in-a-box.

I think this is where it was a true collaboration. So, we internally built the portal, or what's called the clinician dashboard. The partner we worked with created the app for both the watch and the smart phone. And we leveraged the combination of that, in terms of collecting, managing, storing, and sending the data. We were able to build it within a short amount of time. And that was involving everyone in the design sessions - patients, nurse managers, and doctors. So, all the different people really understood the workflow so we could really create a program that was designed for the actual need versus just throwing out a wearable and seeing if it sticks.  The design process was key to ensuring it fit well into the workflow.

What are your greatest obstacles in terms of implementation of such an undertaking?

The challenge is typically, the technology is ready, but the question is will the patient adopt it? That’s still the challenge. Patients still have issues with devices such as they don't know how to set them up, pair them, activate them, those kinds of things. There’s debate over consumer grade versus clinical grade. Does it just have to be something that alerts you? Does the doctor have to receive all the data? Those are a lot of the debates going on, but I think we are seeing the value of it now.

Those debates you can’t just have with any entrepreneur who is coming to you with an in-a-box solution, right? Obviously, there are a lot of track your heart rate and measure your blood pressure devices paired with apps. But the fact that you had to design your own demonstrates a real problem in the entrepreneurial community that they’re not coming to you first and saying, "How can we design it to truly fit your needs." It's almost like they design it to solve a problem, but it's not going to solve the problem because they're not coming to you and going, "Okay, well, how will this fit into your bigger picture?” What do you wish that entrepreneurs knew so that they could better find or create solutions to truly solve your problems, so you don't have to go and create your own?

It’s great just to be able to buy something that is going to work, right? I think what I would tell many startups is that doctors have been trained in a certain way by the school they go to and then if they come to Kaiser Permanente then they're trained on how we take care of patients. So, for an entrepreneur, to have this great idea in the startup and say, "I'm going to fix this problem for you, doctor," it’s just not enough. It can't just be this, “I have this great idea and it's going to change health care, because you have to come in knowing, one, the doctor will need to be convinced in terms of how's it going to help them. Two, will it really fit into the workflow and make them do another click that will do something for them? A lot of times I think entrepreneurs head down this path and they hire people that do know some of this stuff, but they still haven’t done the usability testing, the designing thinking in terms of how it’s going to affect the workflow, or change it operationally within health care, and that’s where it fails most of the time.

The biggest mistake that entrepreneurs make is they think that there's a one-size-fits-all solution. The direction health care is actually going is a more personalized system. That's why having someone like you within an organization and having partners you can work with is important versus an entrepreneur saying, "Hey, here's my solution in-a-box." So, you are asking for entrepreneurs to come to you with something that’s adaptable to your needs and can be easily integrated into your workflow?  

Absolutely. And I think that changes the conversation because they're willing to listen and say, “Here's how I think I might be able to help you based on that conversation." It doesn’t have to be a one-size-fits-all in terms of Kaiser Permanente. It could be something that brings meaningful change to a department or a region, which is still valuable. It doesn't have to solve every part of my company to be a good thing. In health care it can be a small, incremental change. But at scale, it could be tens of millions of dollars, 100-million dollars in savings to the overall system. So, it's not insignificant to be able to do something incrementally, whether it's process-driven, or operationally-driven, or even something on a bigger scale, such as clinically-based. But, the important thing to think about is giving doctors more time to spend with the patient versus spending time with technology. That’s always a big thing.  I love talking to entrepreneurs. But when we think about partnering and somebody comes to me, I’m going to ask- what do you have? Or what do you think would be valuable to our system? Before putting entrepreneurs in front of the physicians, I must make sure it’s a good fit. So, if I think it’s a fit, I help coach them.

What criteria do you use when you determine whether or not an entrepreneur is ready for Kaiser Permanente?

I look at the stage that they're in. A lot of times, startups are still in the early beginnings and it's not a right fit most of the time. I think the thinking is good, the conversation is good, but the ability to execute on that is usually not. In my position, I usually look for companies that have been down the path for a while. They've done the infrastructure to secure all the back-end components that are required before we could leverage them. I think that it’s a maturity beyond the minimum viable product, and more of a solid state to really provide scalability to a company of our size.  The other important criteria is their values and alignment. We look at their values, what are they trying to solve, and then look at our values and say, “Do they align?” And then, based on that we say, “You know, this really is good fit, and they're solving this problem, let's give it a shot.”

If you’re looking for more mature businesses, is it fair to say that you are not attempting to be on the cutting-edge? Earlier stage companies are testing with your competition each day. Does that matter if others are first to market with cutting-edge treatments?

As a technologist, I think that it’s a double-edged sword. We could decide to take more risks, and then it fails because it couldn’t scale, and that’s bad because it creates change in our process, and we have to remove it. I think we are a leader in our approach. But that said, we’re not always going to go after the newest thing out there. I’m really thoughtful when partnering because if they can’t scale on their own and find other customers then they’re going to go away and you’re going to lose that key technology anyway because they’re not going to make it anymore.

So, what are your priorities right now? I know you mentioned remote health is very important to you. But what are the key areas in which you are looking to be approached by potential partners?

Digital health is important. We are consistently looking for solutions that digitize, that include patient monitoring, IoT, AI, machine learning. All of those are huge right now and have been our focus. Blockchain is starting to come to a level of maturity, where I think we are investigating it in terms of how much of it will be relevant. But if you are in the health care space, and you have a great idea for health care, or are doing something great and you're ready to change health care in one of those spaces, and you have the potential to accelerate some aspect of our business, can change the way that we could be doing our business, and have a potential play to reduce the cost or improve the quality of care, and even provide more access to our members, then I want to talk to you and know more about it.

What is the wrong approach with you?

Arrogance. Sometimes an entrepreneur comes in with confidence and sometimes it’s arrogance. Sometimes you don't know what you don't know. And I think if you don't know the impact of your tech, what your technology can do to the workflow, then I think you're at a severe disadvantage. And that's the biggest mistake that I've seen with companies coming in, whether it's from the entire workflow from the doctor and ordering, the processing to the nurse to a patient's home. If you don't really understand that entire workflow, and you think you've solved it already because you've answered one aspect of it, that's where you're going to fail.

If they want to get your attention and are willing to learn the workflow or already have it in mind when they come to you, how would you prefer they approach you via email, phone, or whatever?

I think that that email could include, "Hey, I'm interested…Oh, I have an idea. And I'm interested in talking.” I'm always willing to share about the challenges and ideas of workflow and always willing to introduce people to others. But keep in mind, I’m not always going to allow you to get into our network and shadow people because that can be overly intrusive. But if the idea is a really good one, I’d be happy to introduce them to a nurse or doctor. But they have to do their homework ahead of time.

Product design is so important whether it’s privacy, security, or simply its purpose! Any final advice for entrepreneurs at the onset of bringing their idea to fruition?

I think design is critical. What is the psychology of the design and how can that design help to solve problems for people? We did something with our new clinics, and I had the opportunity to work on some of the technologies from the home to the clinic and rethinking, reimagining what a clinic experience can be for the doctors and patients. Patients typically go into a office building that’s pretty cold with bland colors and they probably feel terrible or something terrible has happened to a loved one and it just doesn’t feel personalized, especially when it comes to handling identification and money. It can be more friendly in clinic design as well as in terms of processes. We really took a design thinking approach to what the experience could potentially be from your house to the clinic, to seeing the doctor, and thought about what if we could change that. It really meant rethinking the entire workflow and how those technologies would actually work from the mobile device or your browser to making an appointment, to paying, to getting to the facility. And so, think about what you want to do and how you can make that experience better through design.