A Pointed Conversation on Health Tech

If you’re listening to this, and you are a healthcare person like the Mayo Clinic and MD Anderson [Cancer Center]…we’re very well known as an 80-year-old not-for-profit academic health system. Very, you know, just a huge health system that has been at it for a really long time. Early adopter of value-based care. And we’re a bit of an odd duck in this conversation because in the world, while we’re very well known in healthcare circles, we’re not super-well known in employer and broker consulting circles. And so that’s part of my role, is to change that. But the brokers, consultants, and HR people that come across us will be viewing us from the lens of a point solution.

So that’s the nearest categorical bucket that they would use is, I’m putting air quotes here around point solutions. So that’s kind of the space that we play in Ochsner Connected Health. But given that our foundation comes from being an old academic health system, it’s a very, very different animal once you start peeling the onion a bit.

Yeah, well, first of all, always excited and pleased to be back here. This is my third year at EBLF and any chance I can get to come out here to the Broadmoor, you know, never to be, never to turn their nose up at that sort of thing. But I’m excited about, even though the meetings for me kick off here in about an hour, I’m excited to be talking to a lot of the national consulting houses. In my role at Ochsner. I’m sort of the one throat to choke for all the big national consulting firms. We do have sales teams out in, you know, out in the territory, so to speak, that are going to work with population health consultants and SMEs [small- and medium-sized enterprises], and producers and client execs, and that sort of thing.

What I’m most excited about in the conversations that I’ve got scheduled is, a.) how can we and our team be better partners with the consulting community? But also, I’m really curious to have conversations about the point solutions space, specifically cardiometabolic solutions. That’s the area that we play in. And there’s been a lot of recent activity, not all of which has been positive in that world in terms of third-party studies on the efficacy of these sort of programs. And I’m really, really curious to have two elements to my conversations. One is, what is the consulting community as they work with their HR leader contacts and they’re surfacing data analytics that show, say, a problem with diabetes or a problem with hypertension, or a company that wants to put in a new weight management program. How are their clients perceiving our space?

Because, let’s be real, the point solution fatigue thing is real. And people have been getting promised ROI numbers and all these outcomes for, you know, 15 years in this space now. And really, as the third-party studies are starting to roll out and show, there hasn’t been a lot of actual results on the clinical side of things, actual tangible outcomes. And so what I’m most curious and excited to learn from my consulting friends is how are they navigating those, forget about Ochsner for a second. How are you, as a consultant, navigating those conversations with your employer clients? You’re in there. I used to be a consultant. I’ve worked at Mercer and Buck. And so you’re always trying to defend yourself from the other consultants that are sharing new ideas, new vendors that are doing really cool things.

And then, No. 2, we’ve got some new things that we’re doing. Obviously, I want to communicate that to the consulting community, specifically launching weight management this year. And so getting those updates. But also, there’s a ton going on in the consulting space. All of the, not to name names, I don’t know if I should or not, but, you know, the Locktons and the Gallaghers and the Aons of the world, just to call out three off the top of my head. There’s a lot of M&A activity happening, and I’m really curious to learn from them how they’re navigating those acquisitions and those mergers. And, again, how does that inform what I do as a partnerships leader for my organization? How can we better partners with the consulting community?

That’s an interesting question. So I was really referring to on their side of things. To your point, there is a little bit of activity, obviously, going on in the healthcare, the brick-and-mortar space, with some of the recent acquisitions. And I don’t think that comes up as much in my conversations because I’m so condition-specific focused in a lot of the conversations that I have. But that is an environment that I think, as I look to the future of. If you think about the last three years of VC investment in point solutions, hundreds of millions of dollars [has] been flowing in, right. And the reality is that you could launch a point solution…pick a condition, any condition. You launch it because you’ve got the secret new algorithm that you figured out.

You launch it last week in your basement, and then four weeks from now, you’ve raised $25 million. And where does that money come from? It’s a kind of silly Monopoly money. And I’m sort of making a joke there, but really, it’s been a ton of money flowing into the space and a lot of effort toward disruption. And what I think is going to happen, if I’m reading the tea leaves and my vision for the future is: the healthcare community, so the brick-and-mortar health systems and players that are actually out there delivering care to real patients, not plan members, actual patients coming in the door….I foresee a lot more collaboration between the health system community or the provider community that’s actually out there doing the work and technology.

And so I think there will be some, there’s going to be some losers in terms of the point solution community that will go by the wayside. That’s just [the] law of large numbers in that world. But I think there’s also going to be a lot more interest for players that recognize, “I need to do something more than just have the cool algorithm and the sexy app. I need to actually be in the community delivering healthcare, leveraging technology.” But also how do we access the local provider community and how do we empower that community even more? So I think there’s going to be a ton of fascinating investment in that area moving forward.

And if I’m a consultant in, let’s say, Kansas City, Missouri, or Rochester, New York, how am I leaning into those kinds of conversations to bring that knowledge to my clients and looking for opportunities for my clients to, you know, to bend the curve and do the right thing.

I think so, yeah. I could be wrong, but, that’s just where I, that’s where I see it headed.

Great question. So there’s a couple studies that come to mind. One is, I think, 2021 or 22, JMIR [Journal of Medical Internet Research] study that just in general studied the clinical efficacy of something, several hundred point solutions. And I’m not talking about in my space in the cardiometabolic world, diabetes, hypertension, but just in general. So MSK [musculoskeletal], behavioral health, cancer, diabetes, just kind of the gamut. And it was a pretty in-depth study, and it really found almost no clinical efficacy over something like two years of the study period. And so that’s pretty damning, but not all that surprising. Because, let’s be real, most of the point solutions out there, even though everybody’s sort of done a flurry of actuarial studies, they’re generally sort of two or three clients fairly cherry-picked. And I’m not judging that. I’m just saying that’s kind of the environment.

So you’re dealing with limited data sets. And so the JMIR results weren’t super surprising to me. A more recent one specifically focused in my world on specifically Type 2 diabetes solutions. And there are some OG players in that space, and I’m not going to name names. And it was not, it was sort of a bloodbath. I read the study and I thought, man, I wouldn’t want to be working for any of these vendors that got named. Because it basically, how do I choose my language and keep it age appropriate here? I’ll just say it was sort of a bloodbath. There are critics of the study, and there’s always two sides to every story. Asterisk: We weren’t included in the study.

We don’t get included in a lot of these studies, I think because we’re a health system, and so since we’re not viewed as a point solution, we’re sort of lended a lot more credibility. Even though we compete against those point solutions now, we don’t generally get invited into those studies, And we’re actually talking to Peterson [Health Technology Institute] right now about, hey…look at our data. We’ve got 40,000 lives of actual Epic claims data, medical results, test results, all that good stuff. So here you go, take a look at this.

I was at a large consulting firm’s sort of annual meeting last week, and there was a lot of buzz in the room about how are we talking to our clients. It wasn’t kind of a vendor thing, it was just kind of them navel gazing, if you will, about, we’ve got to address the elephant in the room that we have been, the consulting community has been bringing these solutions, as we should, to our clients, and now we’re finding that maybe the results aren’t what we had hoped, and that’s not our fault. If I’m a Mercer consultant or a Gallagher consultant, or whoever it is, it’s not necessarily my fault that the vendor isn’t delivering. But now that we know, maybe everybody likes the solution, but maybe you’re not getting great results. So how do we address that? Do we go back to that vendor and keep grinding that axe? Or do we look for newer things out there that maybe have a more clinical basis?

So all this is, I feel great for us because we’ve got nothing to hide in terms of data and a lot of clinical data. But I think if I’m the consulting community, I’m struggling to find the time to have that conversation. Because you’ve got to remember, even though I love my world of cardiometabolic solutions, that’s one tiny little problem in a sea of problems that my clients are dealing with. You’ve got economic issues, worldwide conflict, and labor shortages on one hand, and needing to lay off on other hands. It’s sort of bedlam out there. And if I’m HR, I don’t know how those folks are sleeping at night. Maybe I need whatever they’re taking to sleep well, if they are.

But that, again, my little world of cardiometabolic solutions…it’s one little problem for a consultant to try to take in that one hour that they get once a quarter to sort of strategize at a high level with their client. How do I have this conversation and bring up the right kinds of solutions? So that’s, I think, what I’m sensitive to in the consulting community and my friends in that world are, how can I help them be better stewards of that information? That’s something that we’re really focused on.

That’s a great point. There's definitely a lot of issues, even within healthcare, that they're grappling with. To deal with them all is challenging.

All right, one more question for you that's a little bit different. You're in Louisiana… it's a challenging state for population health. Could maybe talk a little bit about the systemic health challenges in Louisiana and do you see potentially these digital solutions as a way to make inroads there?

Great, great question. And yes, for those of you who aren’t familiar with Ochsner, this health system is based in the Louisiana area. So New Orleans, the Gulf Coast region through Mississippi. We’re well known in the Texas Gulf region. And I do want to make it clear that we have clients all over the country. So if you’re an employer in, say, Kansas or New York or whatever, you don’t have to have employees down in Louisiana. So the solution we’ve launched is national. That’s why it sort of competes in the point solutions space. But I think the reason it came about is because of where we come from in Louisiana. Louisiana and Mississippi duke it out every year for the esteemed honor, and I’m putting air quotes around that, of being the either 49th or 50th least healthy state in the U.S.

You’ve got demographic issues, you’ve got social determinant issues, you’ve got the demographics of significant Medicaid populations, significant Medicare populations, as well as just, hey, if you’re in New Orleans, it’s a great food scene, not exactly great for your A1C levels, right? So it’s just, it’s a perfect storm of unhealthiness. And about 10 years ago, this journey toward Ochsner Connected Health and this national solution came from an effort of us being a very early adopter of value-based care as a health system. And I do think that’s where all health systems philosophically want to head. Any health system that just decided, you know what, tomorrow we’re exclusively value-based care, you flip that switch and you’re going out of business. There has to be sort of this bridge that’s slow over time.

And we just began the process a long time ago. A long time ago, 10 years is, I guess, a long time in our world nowadays. When you’re trying to solve from a value-based care approach for things like population health issues, diabetes, hypertension. If you look at adverse health outcomes in a health system that is, let’s be frank, you’re dying too soon or you’re having a major health event that is significant: hospitalization because you had a heart attack or you had a stroke or what have you. So, when we looked at the data, and we’re built on Epic MyChart as our data source, when we look backwards longitudinally over time on all those adverse outcomes, we traced it back to obesity, diabetes, and hypertension and hyperlipidemia.

So we look at a cardiometabolic spectrum and figured, OK, what we’re doing isn’t working, and what we’re doing, we, not just Ochsner but the health system in general is, whereas if you’re a patient and you have, say, a back issue or you’ve got cancer, you don’t, your PCP [primary care physician] doesn’t manage that. Your PCP isn’t the one that’s managing that condition. It’s a specialist. So, in the cardiometabolic spectrum, unfortunately, the way health systems are handling this is you’ve got PCPs that are the ones that are managing that condition. Well, if you’re the average PCP with a 2,500-patient panel, you do not have [time].

There’s another study on this, by the way, that outlined you need 26 hours in a day to provide evidence-based care to a patient population at 2,500. That’s another fascinating study that I didn’t link for you, but I can provide that. And so, obviously, that’s impossible. Twenty-six hours. You got to sleep sometime and eat and take care of kids and everything. So what’s happening is PCPs are not providing evidence-based care on the cardiometabolic spectrum. So who are the top of licensed people to manage that condition? How can we solve this problem? So we did it by leveraging technology to bring about a sort of a remote center of excellence. So the technology wasn’t the thing, it wasn’t the algorithm, it wasn’t a sexy app.

We have all that, but it was, how do we provide remote center of excellence-style care to this patient population so they don’t have to come in twice a year, and those are the only data points we get. So PCP goes and sees a patient twice a year, and those are the two blood pressure readings they get. Those are the two A1Cs that they get. Well, how can we use technology to give that PCP four readings a week and somebody to manage that patient’s medications appropriately? So it’s not just about the new drugs, the GLP ones that are sucking all the oxygen out of the room right now, but it’s about managing the whole universe of various medications that member might be on. And so that was really sort of the angle that we came at it.

We didn’t ever intend to launch a point solution. We just intended to do better for our patient population and help our PCPs out. So it was sort of, again, that’s the value-based-care aspect. How do we provide better care, get better outcomes? And obviously that helps us on the bottom line in a value-based-care contract. So we solved that problem pretty well, and it worked super well. I call it an accidental point solution, and my marketing team hates it when I do that, but it’s kind of what it is. We didn’t intend to do it. It just worked really well. And word got around, and then our consultant said, hey, can you do this for some of our other clients?

And then we worked with a national oil company that’s in 28 states. Because we’re establishing care, managing medications, and it’s a one-to-one clinician-to-member ratio, we had to get credentialed in those states. We thought, well, we should just rip off the bandage, you know, go national. And so that was it. There was it. It was like we hadn’t even priced it yet. We didn’t have, you know, like VC people tell us here, what’s your growth trajectory? It’s like, no, how can we do better patient care? How do we get more evidence-based medicine in the hands of our patients? So it was, it’s a funny journey.

And that’s what’s really, you know, going back to the earlier part of our conversation when you were talking about sort of the future, what the point solutions will look like. I am hopeful, obviously, I want us to do well with Ochsner, but I’m hopeful in the broad brush of things that there will be more health systems, that as the inexorable migration toward value-based care happens, that more are going to be willing to do this sort of thing, invest in this sort of technology. Either homegrown it, which is very difficult, or partnering with an exterior party like a solution, either on a white label basis or straight up acquiring. You’ll see more of that. There’s a lot of, not VC, but a lot of investment groups within health systems.

We have one called Innovation Ochsner that we’ve invested in several different things that are very interesting. And so I see more health systems doing that sort of thing, and I think we need less disruption by the tech-enabled VC community and more partnership and collaboration. And I think that’s how we get to better end results in the future.

Well, let’s be real, working with a health system, like if I was a point solution, trying to work with a health system, you know, you hear my voice like, oh, we should do that. We should partner with XYZ health system. It’s a tough road. There, there are issues at the health system. I’m not going to ever deny that.

No, there’s a rose every once in a while, but there is hope there and you got to just keep after it.