What Happens When Clinicians Become Innovators | Live @ Civic Health Forum

0:03Sara Holoubek: It's really not about who per se pays, but that there's a lot of collaboration. It's not patients or profits. It's better health and health care. And I think we now are on the verge of having the data infrastructure and the tools to be able to do that a lot better. And I think the onus is on everyone. So if you're a health system, if you're an investor, you can't silo that way. You have to be able to look at the full picture and think about the inefficiencies that are going to get there.

0:37Gillian Sandler: Welcome back to Startup Health Now, the podcast where we celebrate the entrepreneurs and innovators who are transforming health. Thank you all for joining us again. I'm delighted to be here with three incredible innovators and funders of innovation. And if you spent any amount of time in health tech, you are probably familiar with the fact that a lot of tech companies believe they will fix health care. We've seen it many times. Tech is really, really important to how we will imagine our future. But what I think we're about to discuss today is where innovation actually starts. And if there isn't a real human problem, the tech could be wonderful.

1:26Gillian Sandler: The ambitions for ROI are wonderful. But if we're not solving a real human need with the people on the ground, it's not likely to succeed. So we're going to talk a little bit about provider-led innovation. What I'd like for each of our panels to do is just give a quick introduction, who you are and what your function is. And so we're going to start with Kevin on the end. Sounds good. Hi, everyone. I'm Kevin Chen. I'm a primary care physician at a public clinic in Brooklyn, and I also work at New York City Health and Hospitals as the Assistant Vice President of Design and Evaluation in our Office of Clinical Services.

1:59Gillian Sandler: My team is called the Innovation Lab, and really our mission is to bring frontline ideas, rigorously test them, and see how we can scale them across the health system. Anais. Hi, everybody. My name is Anais Rameau. I am a laryngologist. Basically, I'm a doctor of the VoiceBox. I'm a subspecialist and vice chair of research in our department of otolaryngology at Weill Cornell Medicine. And my lab has been dedicated to leveraging technology to see if we can use AI to detect communication disorders early.

2:32Sara Holoubek: My name is Jillian Sandler. I am at Northwell Health and also managing partner of a new business we're building called Northwell Health Equity Partners. Northwell is the largest health system in New York and in four regions of Connecticut. And the new firm Northwell Health Equity Partners is developing a growth investment fund for investing in biomedical and health technology innovation, the growth stage commercialization.

2:58Gillian Sandler: What I love about this panel is that we have a provider inventor, a catalyst within a system, and somebody who invests. And so I'm excited to have this conversation. Jillian, we are going to turn to you last, but feel free to chime in along the way because I think where the money comes from is so important. Anaïs, we were just having a conversation where you were talking about your invention and I asked you, do you consider yourself an inventor and what does that look like for you as a provider? Over the past eight years, I've been really focusing on my clinical skills and how they allow me to detect disease early.

3:39Gillian Sandler: So I think this is really relevant to this audience today because prevention includes detection and screening. And so one thing that I kept on seeing in my clinic is that a lot of the patients who presented with voice disorders or swallowing disorders were coming after complications. And yet, when the moment they stepped into my clinic, just from the sound of their voice and the way they talked, I could already pick up that there was potential disease. So what I really focused on is think about how we can average the power of sounds and voice to see if we can create tools to detect disease early.

4:14Gillian Sandler: And particularly for swallowing disorders, because the very frequent story in my clinic is that patient had a pneumonia, went to the emergency room, were found to have a swallowing problem, and now they come to me. So what I'm trying to do now with AI is to detect the swallowing problems before patients go to the emergency room with a pneumonia. And so when you said this, I said, so you as a human are able to detect this initially. When did you get the idea to say, how do I take that to the next step, which would be a vocal biomarker that AI could pick up? So that was actually eight years ago.

4:51Gillian Sandler: And it's a long story, but I collaborated with colleagues in Ithaca at the Cornell Lab of Ornithology, because the ornithologists actually have been using sound for a long time to monitor events in nature, including looking at birds' population. And so it's been eight years that basically we've been trying to discover these vocal biomarkers of disease with an initial focus on swallowing dysfunction. I was going to ask, birds?

5:18Sara Holoubek: We're talking about birds, right? And Cornell has a great app for bird listeners. You should Google it.

5:27Gillian Sandler: Especially if you're like, I think it's like second grade in New York where they do the bird unit. That was great. That's how I learned about that app. So Kevin, I'd asked you, do you see the providers inside of H &H as inventors? And you said something really interesting, which was anybody can be an inventor. Tell us more about what that looks like. Yeah. So I think innovation belongs to all of us. And the ethos that we try to take in my team is that if there's anybody who is experiencing a problem themselves or is in a position to observe somebody else experiencing a problem, that person is in a great place to be an innovator.

6:06Gillian Sandler: And so, for example, my team has taken on projects from call center staff, from front desk registrars, from nurses, physicians, other people who just think of something that they feel like can improve care delivery or the way that the system works. And then they may not have the time to blow out that idea and test it and evolve it, which I think cognitively sometimes limits people to be like, oh, I'm not in a position to do that or I can't do that. But we're trying to encourage and catalyze that transition from like, oh, this is possible. And this kind of relates to the culture of work as well.

6:39Gillian Sandler: We want to create a space where anybody can feel safe presenting an idea. There are no wrong answers. And then exploring that idea, finding out if it works or not. If it does, great. And then how can we scale it across the health system? If it doesn't work, what have we learned? And then how can we try something different to solve the same problem? But really anybody who has experienced a problem or like works with people who are experiencing a certain situation, we want to bring them to the table to co-create these ideas. And for both of you, what is unique about the provider or care environment that allows for the possibility of technology to flourish?

7:16Gillian Sandler: In contrast to maybe a technologist coming in with an idea without the background. Tell us a little bit about what you believe to be true. So I think we have a really deep understanding of the patient's problem because we actually see them. And I could not agree more with Kevin that we really see the problems and then we try to find solutions. And oftentimes as clinicians, we're actually very innovative because we try to come up with unique solutions for every single patient. So it's part of being a clinician that you actually think in these innovative ways. And I think the problem sometimes with technology is that that understanding of the problems and also the diversity in the way these problems are presented to the clinician is not quite evident.

8:00Gillian Sandler: So I think we have a really unique place in this dialogue. I would just add to that that I think empathy is another big part of problem solving and designing solutions that work for the population you're trying to address. And physicians and other clinicians are often very empathetic people. and other staff who work in, for example, a safety net setting, I think there is that desire to connect and help people. So I think that's one great feature. And I think another part of innovation is that it doesn't have to be a technological solution. In fact, I think some of my favorite solutions that we've implemented in our health system have nothing to do with digital tools or AI or anything.

8:37Gillian Sandler: It's really just a clever design feature that makes something much more intuitive to apply in their day-to-day life. Can you give us a little bit more here? Like the street medicine project could be interesting to hear about. I can talk about the street medicine problem, but I think... Or maybe the bridge to home. Bridge to home. I'll mention what bridge to home is and maybe I'll bring up a different example where I think the design is a big part of it. So Bridge to Home is a city-funded initiative to essentially provide transitional housing or temporary housing for people experiencing serious mental illness and also have a lot of kind of emergency department or inpatient utilization related to their psychiatric condition.

9:17Gillian Sandler: And this was one of those things that honestly was years in the making with the city where we have a lot of resources dedicated towards serving patients experiencing homelessness and with serious mental illness. And the city also has identified it as a high priority area. So we got together and repurposed a lot of resources to provide housing for 50, now 100 individuals on an annual basis to help them find permanent housing. I would say that's a win for public sector innovation in a way. Another program, which I think is a good example, is our NYC Care program. So NYC Care is essentially an insurance-like program for people who don't qualify for insurance legally or cannot afford insurance.

9:58Gillian Sandler: And essentially, as a public health care system, we always would have taken care of the patient who comes to us regardless of their ability to pay or regardless of their immigration status. But where the design comes in with this is we created an insurance card, an insurance-like card with a benefit package. And it essentially made people feel like this was insurance. And that was like a thing that they knew what to expect of and to use. And so it reduced the stigma around walking to our health system, feeling like, oh, I don't have insurance. I don't have coverage plan, even though we would have seen them regardless in the past.

10:32Gillian Sandler: So I think that's just one way that we built some new features into that program. But just redesigning the way we presented it enabled a lot more people to feel comfortable and welcomed in any way. Thank you. That's really beautiful. Going back to technology, though, this is interesting. And Jillian, I'm going to ask you about this. You had noted that there's this big gap between technology, what technology can do and what can actually be deployed. What does that look like inside of Northwell, which is not only New York State's largest employer, but I believe the largest nonprofit health care system in the Northeast in New York?

11:07Sara Holoubek: I guess there's a here I'll just kind of try to bridge back here in terms of what's possible in the way of innovation at the provider level now. And that's changing very, very fast because of everything from 3D printing to the cost of sequencing to the cost of large language models and compute. It's almost infinite when you look forward, which is also interesting. Northwell has 13 ,500 affiliated providers, 22 ,000 nurses. So one of the stop gaps is now that anything's possible with imagination, what does that mean in terms of funding for those small opportunities? And so that's one of the kind of friction points in this tipping point of democratization of innovation and what you can do at an individual level with experience and an understanding of a patient population to how you get it from an idea and a prototype to something larger when there are so many people that can try different ways to solve the same idea.

12:06Sara Holoubek: So that's just one kind of this funny tipping point of extraordinary opportunity democratized and then that hitting at once from every health system and every zip code. The piece that's more relevant for large scale, for innovation that takes real data and is going to be something that has risk to it, to the patient. So that could be medical devices or diagnostic or procedural technology that really needs to play out with a significant amount of research and funding. And one of the challenges is, you know, I don't know if anyone saw 12 Angry Men many, many moons ago, but there are so many different questions that need to be asked from different perspectives beyond the first clinical questions that the chances for there to be bottlenecks at every stage of risk and fault lines is so high.

13:02Sara Holoubek: So part of the challenge has been in just the last decade was really about consolidation and it was about data infrastructure. So everyone thinks about the challenges of no meaningful use in data and things that are really obviously affecting how doctors and patients deliver care and receive care. But there's also a lot of challenges associated with silos within systems, you know, not talking to reimbursement, not talking to workflow, not talking to revenue cycle management, not talking. So you may have thought that you checked every box as an investor or a provider or a innovator, but you haven't.

13:44Sara Holoubek: And it's hard to know where the Achilles heel is that might prevent the opportunity down the line. So I think one of the other really optimistic moments from a technology perspective is that these large health systems have a lot of institutional knowledge now and also their own organizational tools and technologies to understand how each division works and to have platforms that allow exchange of information and the understanding of what those questions are in order to be able to provide feedback to vendors and technology companies at the earliest stages to influence how they're thinking about evidence building and scale and the likelihood that they make it through the system after.

14:27Sara Holoubek: And I think that's one of the biggest, it's like just a last thought, but I think we are decoupling for the first time between FDA approval and the opportunity to scale commercially. In the last 10 years, you look at the amount of innovation and it's been enormous. There have been so many technology problems solved, but the United States doubled, caused, and halved outcomes compared to the rest of the world. And that's really about the fact that technology was de-risked, but it starts off in a very small percentage of the population. and lack of scale means lack of ability to invest in scale, de-risk manufacturing, get to automation, lower gross cost, and also have the demand curve move fast because you can do well with a small number of populations and a high price.

15:16Sara Holoubek: So I think the real opportunity right now is that there's an ability to look, these health systems are now coming to a place where they can actually save population health and mean it and start to help de-risk and collaborate more with investors and companies to say could get you to that demand that can justify, you know, we see all these milestones and all these challenges that you don't see. We've done our own self-diagnosis. We understand why we're a wall preventing that scale and we can help you break down that wall and that can justify larger scale investment to solve some of those problems sooner in the demand curve.

15:55Gillian Sandler: that's fascinating and i'm glad that exists i'm curious from your perspective on this what does it look like for you to navigate all of the hurdles that jillian mentioned like as a provider you have a perspective but then what happens with like procurement and reimbursement how do you navigate that as a provider for technology specifically so we're in the middle of that we created a startup and now we are defining the business plan and the reimbursement pathway. This is not something that providers are actually trained in doing. So I think there's room for partnering with industry in training clinicians in defining these business plans, these go-to-market plans, because we don't know how to do that.

16:39Gillian Sandler: But we know the problems and we come up with solutions. It would be really nice to also have that partnership for operationalizing the solutions. And Kevin, you elaborated earlier on how anybody can own innovation. And you mentioned a little bit about some of the services you offer, but what inside of H &H do you find to be the most valuable to providers who come to you? I think we have sort of a card end-to-end offering or menu of services that can be anything from just a consultation on how an intervention might be designed or evaluated to actually pulling the data and doing the evaluation and dissemination aspect.

17:21Gillian Sandler: So anything from crafting the idea to scaling it or some combination between. where I think people find the most value is in helping them put a framework around the innovation and specifically around how do you get from an idea to the scalable product and how do you think about the return on this product or how do you communicate this the value of this product to leadership that are in a position to pull the lever on yes we want to scale this across the health system or we want to put x amount of money of internal funds to develop this program further So I think that communication aspect, which we often facilitate through rigorous evaluation and data to show that something works, is probably what most people find the value in.

18:03Gillian Sandler: I probably should have asked this earlier. How many providers are here? If you're a provider. Hands higher. Okay. And how many providers have startups or are inventors? Do you guys have questions for our panel? Anybody? Okay. We have networking opportunities. where you can do that. I guess we might be a little shy. What do you wish you knew before you started on this journey, Anais? I wish I knew how important it is to build the right team from the beginning. I think that us as physicians and people in academia, we don't necessarily know well where to find our allies to build these companies. And I think that finding the right people, learning about how to build these teams is really essential.

18:54Gillian Sandler: I wish I knew a little bit more about how to build the best teams. And Kevin, what do you wish provider inventors knew or you could provide them before they came knocking on your door?

19:09Gillian Sandler: I think having been on the other side of that as well, in a prior life, I was also in health tech startup worlds and in a variety of nonprofits. I think you can find common ground with aligning your solutions with the problems of a health system if you're trying to pitch something to the health system is really important. Some of that is finding the right person to talk to, but also it's how do you frame your problem and how do you articulate that? Because there are sometimes, we get pitched all the time from 50, 60 degrees, and there are certain things that we are not interested in the way that it's presented to us, but other problems, because we're so large, we have no end to the frictions that we're experiencing.

19:49Gillian Sandler: So a little bit of attention into how that message is tuned to the right audience, the person that you're talking to. Are they the right person? Can they help you find the right person? I think these are all helpful. And also there's the positive intention of, you know, we're here, at least my team, we have an open door policy. There's no wrong door is what we want to say. And if you come to us and you are looking for something, we may not be the final stop, but maybe we can help you find that final stop. And as long as you're open-minded about the way to navigate and there's not a particular, you're not tied to a particular methodology of getting to where you want to go and you're open-minded about it, I think you can kind of follow the different channels and see where that takes you.

20:28Gillian Sandler: So I think we should probably end on a very popular topic today, which is who should pay for innovation and health and specifically public health. Jillian, there's a disconnect between the venture side and the nonprofit side, and that's been brought up a few times today. I'm curious how you see it And what would your hopes and dreams be for this audience and those working on innovation in public health? I think I was talking about areas of optimism.

21:01Sara Holoubek: I do think that we couldn't be more inefficient with our capital as a system. So that's very optimistic. I mean, Northwell has about$2.7 billion in community reinvestment a year. Northwell spent a lot of time since 2022 doing all of the research to really redefine in a new age of needs and resources what is really needed from the patient perspective because Northwell is over 30 percent of the inpatient market and the largest health system and takes care of a good part of the population in New York that needs help that doesn't have the money to pay. So that's off the table as an option. And so really understanding, you know, 5 % of the population is 50 % of the costs.

21:50Sara Holoubek: So the solutions that are low hanging fruit and can work well with people that are not in that 5 % are really hard. It's really difficult to crack that knot on cost because of the complexity of the populations. And one hit wonder solutions are not easily findable. I do think that in terms of who pays, I think the big opportunity right now, we're all paying, we're paying 20 % of our taxes, our insurance costs, our co-pays, our deductibles. And so any way you look at it, we're all paying, this room is paying. So I think what's really optimistic right now is we're getting so much better. Yes, we all used to rely on that CDC health database for so many decisions from a public health perspective.

22:35Sara Holoubek: Now the data and the community involvement and the definition of how to change things is just much more transparent. So I think that in terms of who pays, I think we do have to get more aligned between private market and nonprofit market. The healthcare economies rest in the hands of the largest nonprofit health system in most states. And then the for profit model inspires the investment of a lot of innovation. So I think that it's really not about who per se pays, but that there's a lot of collaboration. It's not patients or profits, it's better health and healthcare. And I think we now are on the verge of having the data infrastructure and the tools to be able to do that a lot better.

23:21Sara Holoubek: And I think the onus is on everyone. So if you're a health system, if you're an investor, you can't silo that way. You have to be able to look at the full picture and think about the inefficiencies, which is why I said what's extraordinary for me in terms of Northwell's viewpoint is coming from a leader in the market that doesn't have to think this way is really how do we step up and leverage all of our intangible assets in a way that doesn't endanger our nonprofit status and help lead the way for for-profit investors to understand better how this stuff gets to scale because it's just become so hard because the systems and the companies are so large to move the needle at scale.

24:05Sara Holoubek: And so I think that's, I do feel hopeful we can get there.

24:08Gillian Sandler: We all pay. We're not doing it efficiently and we need to find a better way. Is that correct?

24:13Sara Holoubek: And I think we are. The tools are there. I think everyone has the case studies and the tools and I think we're going to get there.

24:19Gillian Sandler: Well, thank you so very much for joining us and thank you to our panelists.

24:28Gillian Sandler: and finally an invitation to all of the extraordinary health transformers whether you are a startup someone building the future of health or whether you are an investor funder or buyer of the solutions out there in the marketplace this is an invitation to you to join the Startup Health member community. Learn more at startuphelp.com. Look forward to hopefully seeing you soon.