Corporate innovator: Parth Mehrotra, President and COO at Privia Health
Mehrotra oversees company efforts around growth, financial and operational efficiencyRead more...
While most entrepreneurs want to be the one to discover the next Amazon or Twitter, oftentimes major technological shifts are coming from the big companies, the players that have been on the scene for years, if not decades. Those companies have survived because they know how to pivot. They're the ones who either seed new ideas or acquire them and distribute them.
In this column, we talk to those companies and their innovators who are preparing them for what's coming.
In our latest interview, Ranjit Padmanabhan, co-founder and CTO of enterprise workflow management software company Autonom8, spoke to Dr. Archana Dubey, Chief Medical Officer at UnitedHealthcare.
Dr. Dubey is a physician executive and entrepreneur, who helps create, foster and grow transformative health solutions in the enterprise space, via GTM and partnerships, with key objectives of improving clinical outcomes and reducing total cost of care for employers and health plans, via value-based relationships.
In her role as Chief Clinical Officer at AliveCor, Dr. Dubey developed enterprise products for cardiovascular conditions to serve employers and payers. She also served as HP’s Chief Medical Officer consultant, supporting population health strategy for the health and wellness programs for the global HP population, inclusive of benefit design and vendor partnerships. She has also been on HP’s Scientific Advisory Board for their future clinical products. Prior to HP she has served HPE, Google, Qualcomm and Tesla in similar capacity.
As an entrepreneur and digital health evangelist, Dr. Dubey founded the Invent Health platform in 2017, which bridges together venture capital funds, health systems, and digital health solutions to help initiatives have a chance of survival and scale, from funding to adoption.
Dr. Dubey is trained in Internal Medicine and Family Medicine from Columbia University and USC respectively, and has practiced medicine at Stanford Health care and UC Davis for several years. At Stanford University, she served as a clinician and Stanford’s Director of Primary Care associates program that trained advanced practitioners. Currently she practices virtually. She is a board certified Family Physician, who has more than 25 years of experience as a physician, executive, entrepreneur, and board advisor.
Ranjit Padmanabhan: We'd like to start this off by learning a bit about you and your journey. Tell us about some of the important experiences that you've had that led you to UnitedHealthcare.
Archana Dubey: I have been a practicing physician for the last 25 years and my keen focus has been on making my patients' or, as we call it, the members' life better and closer to what the goals are when it comes to vitality and being the 100% version of themselves. Of course, by treating sickness, I was doing one patient at a time and I worked in that environment as a clinician at UC Davis and then Stanford for a decade and a half and then I pivoted to scale my ability from treating one patient at a time to several thousand people, using the lens of population health to help large employers make sense of how to utilize solutions and their health plans to better serve their population of employees and their dependents. As I was working toward serving nearly 300,000 members globally for a large employer in Silicon Valley, I also realized that some of the key partners in that journey are twofold. One is the third party administrator health plans, which is the health insurance as we know it, and then also the digital health partners, which are the vendor partners that are driving either point solutions or system level solutions for delivering that health and well being to the employee population. So, after serving the large self insured employers like Google, Qualcomm, Tesla, HP, HPE for the last 12 years, I decided to pivot again into getting closer to the vendor partnership space by joining a mature startup called Alivecor to build a cardiovascular solution in the cardio diagnostic AI space. Over two years, I'm proud to say that I was able to envision and, with an amazing team, build the product and sell the product to large employers and health plans. I felt like in the last two years I was able to serve an even larger population; we had 2.1 million users and counting that I was able to influence as the Chief Clinical Officer at Alivecor.
But my work was getting to complete because we had a healthy pipeline of prospects, and the product was complete, so what's next? And so I joined United Healthcare, which is the largest health plan in the country. They serve millions of lives; I would have to go on Google and check what the current number is but it's beyond 100 million lives that we serve in different lines of businesses, not only support on the health side but also support on the pharmacy benefit manager side. We also offer support on the behavioral health side, so there is a very holistic offering that United Healthcare offers and that is taking that ability and scaling my work to a much, much larger arena. That has been my goal as I transitioned from Alivecor earlier this year into United Healthcare in my role. So, that's been my journey, to make that patient's life better through increasing the impact.
RP: Thanks Archana, that’s a very deep and impressive background you have and thanks for the really thoughtful answer. Let's talk a bit about your current role at UHC. Could you tell us a little bit about that?
AD: My current role as the Chief Medical Officer is multifold. Since I'm very, very new here, I would share, in general, what a Chief Medical Officer's role is in a health plan because there are different flavors but they generally are very similar across all health plans.
Our role is to be an advocate for the member who is participating in the health plan. So, we advocate and influence their care through either using financial tools or quality metrics that we drive. For example, in my charter, I work with our health partners, which are the provider groups and hospitals, to make care more affordable and we work together to create a more affordable solution for that member, for that employer, or for that family on that plan. At the same time, we're really striving and holding the medical system accountable to meet quality outcomes. So, some of our health plans are incentivizing the medical groups to have better outcomes, for example, for diabetes, for hypertension, for better management of kidney disease. We do have in-house programs that support that but we also work very closely with the medical groups and hospitals to have patients and individuals get the right care at the right time at the right location. So, that is the two pronged approach.
Now, there are several levers that we use that allow us to deliver that affordable solution that drives high quality care. We use data, and I can proudly say, and it's well known public knowledge, that UnitedHealthcare has the most amount of data that allows them to see trends, that allows them to see how the provider groups are performing. This is not personal medical data, this is trends in the cost of care, in quality of care and, therefore, we can respond to it and have unique insights into which region, which hospital, which medical group can do better, and then we provide those insights to them so that we can partner in delivering those two goals for that patient or member. So, one is driving those two goals, second is looking at data and trends and responding to it with existing resources in partnership with the medical group, and third is innovation. So, innovation means digital tools that we can put in the hands of individuals and employers so that we can make sense of improving quality and affordability of care. One of the examples could be a transparency tool; for example, if someone is looking to go for physical therapy for a back issue, they can go on an app or a tool or application that could provide real-time information that somebody around the block is charging this much for their care versus if they drive, let's say, 20 minutes that the cost will be half of that. So, those are the things that allow that member now to function and perform at the level of a savvy customer. Our goal is for them to really ask for value as a savvy consumer or customer of healthcare.
RP: If I had to recap, its affordability, quality, and then you use data to continuously improve yourself and bring innovation into the mix. That's pretty amazing and all of us benefit from this.
So, let's take a step back and look at some of your prior work experiences. I wanted to ask about a particular experience at HP: you have a background as a Chief Medical Officer consultant at HP and before that you were the Global Medical Director, you were instrumental in learning how to bringing new technologies into HP, to keep healthcare costs down, and keep the employees healthy. What were a couple of your biggest learnings from that experience?
AD: Healthcare is personal and it's local also. Those are the learnings that I would impart for anybody who is looking to innovate in the digital health space.
Healthcare is personal and unless you understand what you're driving and striving for for that individual, and engage them and meet them where they need to be, you could build the best solution in your lab, nobody will engage. I'll give an example: member engagement is a huge learning that most employers have had as they were trying to create an alternate universe of health and well being, in parallel to the existing universe of hospitals and health plans, because employers are caring for their employees, their health benefits, and they are paying for it. So, what ends up happening is that if the health plans or the provider groups and hospitals do not move or innovate fast enough, the employers get a little bit impatient and they want to consider solutions that will drive health and well being faster into the hands of their members. For example, at one of the large employers that have served, as we were looking at data for our population, we looked at the claims data that was coming through for our population, we saw trends in diabetes. This was probably around seven or eight years ago and those trends allowed us to respond to it; we reached out to our health plans and asked them, “what are you doing to curb these trends in diabetes?” We did have those plans that were serving our members but the diabetes trend was going higher and higher and we wanted to respond to it. We asked them what kind of programs existed and when we saw the outcomes of those programs they were not moving the trend in the right direction. So, we partnered with a company called Livongo, which is a diabetes management program, so that our members could have a digital solution and also devices, which we were getting into their hands for free. This program, if somebody enrolled in it, there was no cost burden, it promised to really provide ample access to knowledge or health literacy, ample access to real time response from health coaching or digital coaching. These were all well meaning and responding to the right data and right tools at the right time, but it fell flat; the member engagement didn't improve. We saw low numbers of engagement across our population, not because Livongo wasn't doing well but because healthcare is personal. And so, we needed to pivot and figure out how to make Livongo happen for the individual who was having to manage their diabetes, so we started partnering with our pharmacy benefit manager. Imagine if somebody is refilling their diabetes medication, now that pharmacy benefit manager offers Livongo to them, that's when we saw the engagement start to rise. Their primary care physicians were informed about the presence of Livongo and their PCP started to mention that they have this solution in their hands, and that's when the engagement started rising. So, we needed to follow and promote the solution in a meaningful and thoughtful way, and that allowed us to really learn from this and scale this up to several other solutions and we were quite successful.
The second thing is that healthcare is also local, and we noticed that in the case of mental and behavioral health. We are living in a time where there's an ample mental health crisis. Most employers have responded to it, but in my time with the large employers, when we launched a mental health solution globally, we saw that the engagement in certain countries was rather low, even though the claims data or the provider data was showing that there was a higher level of mental health problems. The utilization was very low because, culturally, certain countries do not embrace mental health tools and solutions in the way that we do in the United States where there is no stigma around it but there are certain countries there is stigma around it. So, we needed to do an entirely different campaign in which we needed to bring in personal stories, have their own colleagues talk about success through the use of these solutions, talk about removing the stigma around it through wellness ambassadors, and bring in more excitement and positivity around those solutions, rather than something that was offered to somebody who's broken. That is how we needed to shift how we look at mental health in a positive light and embrace it ground up.
RP: Those were outstanding examples, very illustrative, and it shows that corporations can be compassionate as well. In this case, it looks like HP looked at the data and then started driving better health for their employees and, eventually, for everyone.
Let's switch gears a little bit: I wanted to ask about startups and partnerships. I'm assuming that during your tenure at HP you were approached by a lot of startups. What are the typical kinds of mistakes that these folks make when trying to spark partnership conversations?
AD: Again, I don't want all of this to be specific to HP because these are common employer problems. I have served several employers and I'm talking out of my experience across large employers with different age groups and generations, so to say. These are some examples, but this is not one company; every organization is striving to invest in the health and well being of their employees.
If you ever looked at my inbox at HP or HPE in the past, and now I’m starting to see it at UHC, at least 60% of emails are inbound from vendor partners. My assistant is constantly curating many inbound requests for solutions that come from HR and benefits and the CMOs of different companies and organizations. And it happens, because we are still in version 1.0 of the digital health revolution. My advice for the individuals is, as you're building your digital health solution, work with a friendly employer, or the buyer of that solution so that they can provide deep insights into the incentives of a partnership. What are the pain points that you're solving? And how does it work? How do either employers or health plans buy a solution? What is the buying process? And that's something that is very enlightening, especially because I've sat on both the buying and selling side of the table. So, whether it’s getting into a pilot scenario, which I would highly recommend to have a tail to the pilot, which ramps up to a full implementation, because otherwise solutions die in a pilot, or working with a champion partner who's willing to give insights into the product team. So, for example, when we were building a solution at Alivecor, we had early pioneer employers, who were willing to sit down with a product team, and provide insight so that we could enhance the product while it was in the MVP state. So, those things that do become really critical is to find the champion, talk to them at a regular cadence, and then see how you can solve the pain points. Chances are that the employer is not unique, and the needs of that employer or the health plan are very common across the industry.
RP: So, in a nutshell, strategically try and understand the incentives and the pain points and the buying process. And, from a practical perspective, try and establish a pilot or a POC and find a champion who can give you critical, unvarnished feedback.
AD: Yes and then make sure whatever agreement that you created, the MSA or SOW, has a path to full implementation built into that agreement. I would not end it at just a pilot or a POC.
RP: Let's talk a little bit about innovation and that's the third pillar that you spoke about when we got this conversation started. Let's talk specifically about innovation gaps: so not only have you had big roles inside large corporations, but you also co-founded Invent Health as a series of events to identify startups. What are some of the interesting growth areas you see today?
AD: The four areas that are always of concern for the employer group or the health plans: one is mental health and behavioral health. This is not a new problem, it existed before, but we didn't have solutions, we did not have a conversation, and we never democratized it, but it has been an underlying cause for either rising healthcare costs or declining health problems. For example, most diabetics have depression. It is well known, well documented in clinical literature, but it has never surfaced before. We are having a conversation now because it is coming to a head, so this is the number one concern across the board. The second one is cardiovascular, and the third is oncology or cancer care. That includes everything from what drives higher levels of screening to early detection to early intervention and treatment. So, looking at the full lifecycle of cancer and cancer treatment allows for a good solution. And then fourth is musculoskeletal because the cost of musculoskeletal is not only high but poorly utilized, there's an unnecessary utilization of health care dollars there.
Across all those four areas, if you could also focus on health equity and health disparity, that would also help to make your solution more scalable, but also more meaningful and purpose driven so that you're able to scale care across all economics, all social determinants of health that become barriers in healthcare. So, think of the four areas and infuse it with health equity if you are thinking of building solutions.
RP: Thanks Archana, those were very nice and useful, specific responses and hopefully the listeners will be inspired to start companies around these things. So, let me just ask you, do you see some areas of innovation where there's just too many me too companies trying to play in the same space?
AD: Absolutely, especially in 2021 and 2022, which were times in which the funding flowing quite freely, I'm trying to think of very diplomatic words here, I wouldn't call it recklessly but ample funds were flowing in healthcare and digital health. This is not new, we have seen this happen in the dot-com times, we have seen the bubbles that have happened before, but as the funds were flowing, companies were being valued at levels that we have never seen, that did not justify their traction in the population and also with clients. One area that got overpopulated with a lot of me too was mental and behavioral health. That's a space that can do with some level of consolidation, and it is happening, as we saw with Headspace, and that's a good thing because you want mental health solutions that are taking care of the full severity of mental health issues but what was happening was everybody was trying to get pieces of it solved.
The other area that also got heavily populated was the telehealth space. Now, don't get me wrong, I'm a big proponent of telehealth; just this morning I was speaking at Stanford and I said, “that is a classic example in which you level access to care across all economies. This is the one way that you can scale a physician, which is a rare asset, in the world across geography.” So, telehealth is important, it's critical, it's here to stay but the me toos, and what I call “the minions," have multiplied and so we do need some level of standardization and maybe consolidation in that space. Some has happened in musculoskeletal also, but there's less of me too there, and more specialization overinnovation, so I think there will be some consolidation there, too.
RP: So, overall, the valuations and the ample amounts of money flowing in may have given people a skewed idea of how much progress was actually being made.
RP: Let's flip to the happy side of this question: what are some areas in healthcare where technology has really streamlined the process well?
AD: I did give a big high five to telehealth, I did share that. Even though there are many me toos, it has actually impacted the access to care in a very meaningful way. I do feel that we have fundamentally changed interactions with medical and health and well being with digital first and in-person next. That is something that most every physician group, health system, hospital was trying to do for years and COVID accelerated that growth. It's a positive thing, this is the happy side of it. Even though there are many me toos in the mental and behavioral health space, they have created a keen focus in the mental and behavioral health space, and also, collectively, removed the stigma around it. Those are the positive fallouts. It doesn't matter if there are too many me toos, it has actually done us good.
Utilizing digital health in the musculoskeletal space is also a positive thing because one of the referrals that does not ever get done is the physical therapy referral; this is something that is a known problem because people, when they have chronic pain, or even acute pain, because of time constraints, or cost constraints, they don't go to physical therapy and they end up getting surgery, which is a far bigger change on the body than actually trying to heal it with physical therapy. So, that is something that is also the positive side of too many me toos.
RP: Are there any challenges that you can think of that technology cannot solve? You've touched on this a little bit in your previous responses, but can you pinpoint some of those?
AD: One of the things that the digital health revolution created is fragmented care. And that's something that we all need to be very thoughtful of, how do we solve it? Because, in the past, when the care used to be more traditional, you had one doctor who knew everything about you, your resources, which pharmacy you're going to, what insurance you have, what kinds of services you could obtain and use. The one quarterback for you. Now, what is happening is that you have that doctor, but then you have Livongo, then you have a musculoskeletal solution, now you have a behavioral health solution. That clinician has no insight into what other tools and solutions that the patient is using, and that is creating a fragmented patient and doctor experience. So, you're unable to quantify the impact of these interventions in a meaningful way and then also coordinate between these so that you can have a more augmented outcome, rather than having that fragmented outcome. So, that cohesiveness in the experience, even though it was not as omnipresent in the past, actually had a strategy that was driving good healthcare. Now that it's fragmented, there is no strategic quarterback that the patient has. So, that is something to be considered, and responded to, and if we have a mechanism, and there's some solutions that are happening that are coming up, like Included Health, that are trying to make sense in the navigation space, but then, again, the navigation is harder for that individual to understand. So, think of how you empower that patient or member and their primary care to provide all of that information in one consolidated form, so that the care is integrated and not fragmented.
RP: That's a great response. We’ll close out with a couple of questions that are related to specific technologies. So, the first one we wanted to talk about was telehealth. So, telehealth is often used to triage patients and you mentioned that telehealth has made significant advances during the pandemic timeframe. But, according to the data we have, it's only a small percentage of all visits, so where can we improve with regard to triaging patients better in general?
AD: Telehealth used to be a triage engine before and it has become a therapeutic engine now, after COVID. There is a lot of assessment, evaluation and management of care that has started happening instead of just the triage. Yes, the percentage of people and care that is delivered through telehealth is smaller, but it has grown exponentially. So, where it was minuscule, it is minimal now. But from minimal to omnipresent needs to happen, because What is holding it back are incentives, both financial and medical, legal, and also patient driven. So the financials are the reimbursement for a doctor when they do a virtual visit is much, much less than in-person. So, they're more incentivized to bring the patient in and do a visit even though they may not need to because they may need to just adjust their medication or just go over how they are feeling. And still, they're brought back and billed by a higher code. If you're able to create incentives around that, that would help to streamline that process. Second is patient perception. So, most patients think that if the doctor has not listened to my heart, they cannot make a decision based on my clinical condition but 80% of care can be delivered virtually. If you ask the right questions, and if you have a good history with the patient, you really do not need to put your hands or listen to the heart as much, because we have remote patient monitoring tools that can be present in the patient's home that allows them to get sooner care without exposure to other infections, right there in the comfort of the home. But the patient's perception is that you have a better diagnostic ability when you have to see the doctor in person. The third is the technology issue: there is a tech disparity that exists where people do not have access to even WiFi. That includes Medicare or Medicaid populations, where there's lower income or digital literacy, in the older population. That gap is closing fast but that does exist today.
RP: Just to segue off of that in terms of remote monitoring, we've had wearables around for a while, so what sort of part do they play in terms of getting clinicians to help make better diagnoses?
AD: The wearables that have been clinically validated, that is the most important word for most people who are playing in the med device or wearable space, that clinical validation is an important aspect. Things that we routinely use like, let's say, a blood pressure cuff; we prefer using something like Omron because they have gone through lengths to do studies and they've proven that in-office blood pressure and their ambulatory blood pressure machine are at par.
I'll talk from my personal experience with Alivecor: independent research studies have published data that shows that the ECG device that Alivecor has, which is cardiomobile, is able to detect atrial fibrillation at the same, or sometimes even at a higher, level of accuracy than a cardiologist. And so, that clinical validation process becomes really important for adoption by clinicians in the remote patient monitoring setting.
The second aspect is remote patient monitoring is minimally reimbursed, which is the sad part of this whole reimbursement cycle. Just like they do not reimburse telehealth or virtual care at appropriate levels, in the same way the reimbursement dollars are very low for remote patient monitoring. And so, the doctor is more incentivized to bring the patient back in and do an EKG which could be 300% the cost than doing a remote ECG.
RP: We often hear about false positives from different devices where they indicate that you're in a state of bad health and then you're actually okay. People need to get all of that fixed as well.
AD: What happens is most patients and, most importantly, the clinicians, need to know the difference between a fitness device and a clinical device. A fitness device is more a screening device, it tells you there’s a problem, “go check it out.” But a clinical device gives the diagnosis. So, there is a difference between the two. For doctors to make a decision digitally, we need a clinical device in the hands of the patients.
RP: Thank you so much, Archana. you have given us some very articulate and detailed responses.
This interview has been edited for clarity. You can listen to the podcast of our conversation with Archana below:
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