This Week Health

March 18, 2022: Missy Krasner is a digital health pioneer hailing from Google, Box and  Amazon. She now sits as Venture Chair at Redesign Health. They elevate healthcare companies that empower people to live their healthiest lives. The current healthcare service model is not as good as it can be. In what areas can healthcare serve patients better? How do venture companies determine what area is next to improve upon? What are some of the companies that Redesign is supporting? How does Redesign empower entrepreneurs? How do you approach this from a global perspective? And is there a world in which a big tech company buys a health system or a hospital? 



Key Points:

00:00:00 - Intro

00:05:30 - Redesign Health empowers entrepreneurs to redesign the world's health care system in service to patients

00:12:00 - Google and Amazon have really figured out how to appeal to consumers through the entire experience of the technology that they offer. The user experience that they offer. And the brand that they offer. 

00:19:05 - One area of healthcare that is fascinating is elder care

00:29:05 - Google is very good at AI. They're very good at predictive analytics. And they're very good at finding data and using the data to actually predict outcomes. 

Redesign Health

Transcript

Today on This Week Health.

What I learned from the investment side was wow. If there was a way that I could get involved much earlier in company creation and have much more of an operational influence, I could essentially bend the risk curve and take down a lot of the areas where startups fail, which is founding teams are difficult to . construct and put together. There's all the regulatory hurdles. And like the number one reason why startups and digital health fail is they don't understand who their buyer is.

Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system 📍 and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health 📍 leaders.

All right. Today we are joined by Missy Krasner, Digital Health Pioneer at Google, Box, Amazon, and now Venture Chair at Redesign Health. And one of my favorite people in healthcare. Missy, welcome to the show.

I can't believe I'm getting that title Bill. Thank you so much. I've been so excited. I've been looking at the show from afar and I'm finally here. So can't tell you how excited I am and we go back we go back since my Box days. So it's just been an absolute pleasure working with you. And many, many different scenarios, Amazon, Box and now back in company creation and value creation mode that I'm in. Over at Redesign.

Well, I'm looking forward to that, but you know, Google, Box, Amazon, that doesn't cover everything. You actually go back. Y`ou've also done some government work as well.

I have, I have, I have an odd background because a few people have done non-profit government, big tech venture. And my government work was, was I was in the first office of the national coordinator for health IT. This was under George W Bush's first term. Dr. David Brailer was the force coordinator. And I had the privilege of working with David when he was in private industry at his company Care Science, that went public. And so when he got tapped to come over to the Bush administration to try to figure out what, like a health ITs are meant for the, for the nation.

He said, do you want to, do you want to come and figure this out with me? And I was like, what, what are we going to DC? What's going on? And I was like this could, this could be big. So yeah, I had the privilege of being in that first term and we were the ones that constructed the whole the whole concept of a Rio regional health information organization, which turned into HIE health information exchange, and then meaningful use and certifying your electronic health records. Those were all the kind of really early good ideas that led to the high-tech act.

This marks your career. Isn't it? So then you go over to Google. That's early days of Google Health, then you go to Box and stand up Box healthcare's solution and whatnot. Amazon you were working on, on Alexa?

Yeah, that was the latter half. Yeah. The theme, the theme here would be really, I, early in my career, I had been I had been selling software to hospitals that was really looking at secondary infections and throughput. So I very early days was in technology in a clinical setting and selling into the enterprise. After that, that was David's company, David Brailer, Cure Science. Then we hopped over to government. And that the four years in government really set me up to have both a policy, kind of a little bit of a policy appetite, a policy background as to like what was happening with data and interoperability and the interoperability challenges in healthcare.

And that once I stepped out of the administration and government, I had IBM, Salesforce, Google, Cisco, Intel, like many of the big tech companies were like, wow healthcare seems to be the next wave. The government is actually incentivizing physicians to adopt electronic health records. Data's going to free up. We're going to start seeing a platform wars. And so coming out, I was, was being courted by a couple of these big tech companies. And of course Google was extremely interesting at the time. And when I joined they were really, they were really trying to figure out how they could build a consumer mediated patient portal that would allow consumers to aggregate all their data from disparate sources, disparate places, and then essentially have control over where that data went. And we've all heard the PHS

I'm smiling and laughing because we're still doing that.

And we're still doing it. Yeah. And I was V1 of Google Health and there's been two more teams. As our esteemed colleague, Dave Feinberg was there and really took a big swab at it. And you know, it's not to say that Google has actually lots of irons in the fire and health care and I don't think they're going anywhere.

But you know, as far as Apple, Apple's got their their iRecord their aggregation of medical records effort, and they've got research kit, healthcare kit, all that good stuff.

I'm going to stop you here because you're going to get to the meat. At the end of this episode, people are going to have to listen to all 35 to 40 minutes to get to the end of this episode. You and I are going to go through big tech. There's been some interesting things said about that. Sachin Jain wrote an article, said big tech should buy a hospital system. You can ruminate on that for a second. And we'll, we'll come back to that but Redesign Health. I go out to your websites. It says we empower entrepreneurs to redesign the world's health care system in service to patients. Tell us about redesign health and your role there.

Yeah. I was really attracted to this this mission. So I did a short stint in venture capital. I was, I was at Morgan Taylor ventures, I came in as an EIR. And then I turned into one of the investment professionals there on digital health investments. So we did practice fusion series A, we did Doximity series B. We did Health Loop series A, patient engagement platform that sold to Get Well network. And then just about when I left, we did Buick's and Vita Health. And I, I really enjoyed my time and venture. It's it was a, it's a special group Morgan Taylor, which is now called Canvas Ventures. And what I learned was digital health has a longer, like a much, much longer maturation phase.

And back then, we, weren't seeing the kind of exits that we're seeing now. The whole entire segment has really matured because of the things that we're now seeing with COVID opening up innovation. But I'll set that aside. So what I learned from the investment side was wow. If there was a way that I could get involved much earlier in company creation and have much more of an operational influence, I could essentially bend the risk curve and take down a lot of the areas where startups fail, which is founding teams are difficult to construct and put together, there's all the regulatory hurdles. And like the number one reason why startups and digital health fail is they don't understand who their buyer is. And that, that, so that's what Redesign does really well. We are a company creation platform. Some people think of us, tthey look on the, look on the outside in, and they think we're a venture studio, but actually we've got a hundred professionals that have either come from banking. They've been operators themselves in four well businesses and our digital health companies. And we essentially incubate these companies from scratch.

So what that means is it's three months of research on a concept. We're doing market mapping, we're doing work. We build a clickable MVP where we're essentially doing a ton of consumer. Insights research. We're calling down experts. Once we gain conviction that we actually liked this concept. And we think that there's business model innovation, or there's some really unique Denovo IP.

We actually facilitate funding it. So we've got a bunch of seed investors that have put money to work at redesign and we facilitate that investment. And then folks like me, I'm a venture to. I jump in and I hire the leadership team in and I marched the company towards a commercial launch. And then I actually helped them go out and fundraise more institutional and or strategic capital on, on top of the seed investment that Redesign put in. So it is in fact, a company gration platform, exclusively devoted to digital health.

Well, it solves one of the biggest problems that I've found out there. Yeah, everybody wants to hire Glen Tullman to run their company. And the reason they wanted to hire Glen Tullman is he truly understands healthcare from end to end. He understands the financial. Are you interested in the business of health care. And he understandsthe pain points and all those things. And so he's able to look at it and see. Here's the value to this group, to this group, to this group, and he's able to build those things. And when I talk to entrepreneurs and they have this startup idea, they're like, I don't understand why anyone's not buying this.

A lot of times it comes back to that really understanding the buyer and really understanding the value proposition. And it sounds like that's one of the significant values that a redesign would bring to an entrepeneur.

Yeah. I mean, it's look, it's a really interesting model because we cut, a typical, a typical entrepreneur who are two, two or three guys or gals in a garage that are the first 18 months you're kind of out in the woods, right? You're either bankrolling to start up yourself. Or you're working, full-time at another job and you're doing it on nights and weekends, you go out and you raise a friends and family round, maybe it's 300 to $500,000, $250,000.

Right. And you're essentially building a clickable MVP or some kind of MVP, the biggest area that these startups get stuck, even if they go out and raise a convertible note is they don't have an incumbent healthcare partner to pilot their solution with and, or give immediate view. And what redesigned does so well, as we have these centers of excellence that we've built all throughout our platform.

We've got a whole product and engineering team. We have a group creating team. We have a business development team that their sole job is to go find incumbent healthcare partners that are like, Hey I'm Devita, I'm looking for this particular chronic kidney disease solution and we happen to be building it. And so is there a way that we can work with you now? We just to be clear, we are not a co-development shop. We are not a corporate innovation arm. That is not what we do, but we do find healthcare incumbent brands that are looking to actually have an innovation partner and or work with a young agile startup that has tons of resources, is well-funded, and it has veteran talent leading, leading the ship.

📍 📍 We'll get to our show in just a minute. As you've probably heard, we've launched a new show TownHall on our Community channel. This Week Health community. And it airs on Tuesdays and Thursdays. I'll be taking a back seat to some of these people who are on the front lines. TownHall is hosted by an array of talented healthcare leaders who are facing today's challenges head-on. We're going to hear from professionals and their networks on hot button issues, technical deep dives, and the tactical challenges that healthcare faces. We have some great hosts on this. We have Charles Boicey and Angelique Russell, Data Scientist, Craig richard v ille, Lee Milligan, Reid, Stephan, who are all CIOs. We have Jake Lancaster and Brett Oliver who are CMIOs and Matt Sickles, a Cybersecurity first responder. I'd love to have you listen to these episodes. You can subscribe on our Community channel. This Week Health Community, wherever you find and listen to podcasts. Now let's get to the show. 📍 📍

I'm going to go back to the the mission statement here. So Redesign the world's health care system in service to patients. In service to patients to me, it seems to indicate that the current model isn't serving patients, maybe as well as it could. In what areas do you see that we as healthcare providers or healthcare in general can serve patients better?

Yeah. I mean, one of the things that , I mean, people are like, Missy, why don't you go to Box? Why did you work at Google? Why don't you work at Amazon? And one of the things that I was really drawn to was these are, particularly Google and Amazon, these are brands that have really figured out how to appeal to consumers through the entire, the entire experience of the technology that they offer, the user experience that they offer and the brand that they offer. And I. How do we bring that same awareness to health care, which as we all know, just does not have that level of sophistication around technology, customer service and user user design.

And so one of the things that I was really curious about it redesign is that part of the business model innovation work that they're doing is that they're one of the few platforms out there that have a lot of D to C business that they're launching. So I'll give you a great example. One of the things that I've, I've launched one business and we've got two others that are launching in this space.

So the thesis here is that payers have had a hard time aggregating certain allied professions. So they have thin networks. A great example would be therapists, right? Like mental health has taken off during COVID it's it's, it's 5 billion more overall in investments than like any other disease state.

MSK has really high as well. But you know, therapists are not aggregated. Lactation consultants are not aggregated really well. Reproductive health is not really aggregated really well. You know chiro and acupuncture is not aggregated really well. So one of the business model innovations that we've had is what would it look like if we could actually go out and aggregate those networks ourselves, get them fully credentialed into insurance and create a double-sided marketplace where we do all the work to actually pull the consumer in who's like looking for an acupuncturist, looking for a chiro, but I want someone in network that actually looking for a physical therapist, looking for a lactation consultant, looking for a dietician, right? These are the, these are not well-served by either your employer and your benefits are not well-served by payers. And it's not that they don't have that in their networks. They don't know how to talk to consumers. They don't know how to recruit consumers in. They don't know how to show consumers where to go. And it's not an easy workflow if you will.

So does that end up being a portion of a digital front door. Is there like a digital way to access that I'm looking for a dietician in my market? Or is that something that gets sold to the payers and the payers incorporate it into their digital tools?

What you're seeing is, is there's been a, there's been a trend where a lot of these agile, small, smaller startups are building these networks and they're building them rather fast. And then they've got a payer who's really interested in playing ball because all of a sudden they turn around and they're like, wow. And this particular geo, this startup has aggregated these many professionals faster than I could. Right. And so then you've got a payer who's, who's a strategic partner to the startup who also has a phenomenal digital front door.

Everything around growth marketing performance, growth marketing, to like the full customer support mantel and the way in which the digital touch points of having a virtual service frame, where people are engaging both online and then also with either a chat bot or a human behind some kind of powered customer service agent.

So I feel like that is payers are starting to say, Hey, that's pretty interesting. We we haven't been able to do that across our full stack, but like, we're really interested in like the amount of penetration that this agile startup is getting in this particular geo that's of interest to us.

There's several RFPs that I've seen just in the last six months, particularly coming out for payers asking for some of these these, these what I call virtual aggregators to actually be there. Aggregator for a particular ally professional. So they're definitely catching wind of it.

This is interesting in and of itself. Not that I want you to, to promote all of your startups, but that's an interesting model to me. I hadn't, hadn't really considered that. So what are some of the other areas that you guys are innovating?

Yeah. So another company that has gotten a tremendous amount of attention and our friends over at SevenWires are in is a company called Jasper. This is a company that really, it came from like the early days of us thinking about cancer navigation and really not just navigating your care, but navigating your life when you get a cancer diagnosis. And some of our early research. And the company is really morphed from, from where we started at which, which is we come up with a thesis statement and a problem statement, and we do a lot of research.

And we become very open. Once we launched the company, the market feedback, and we rapidly innovate and iterate. So Jasper really started out with the concept of, Hey, I need a life planner. I've just been diagnosed with cancer. There were two things that were really interesting, which is how do I organize my life.

And also a lot of people want to help. I don't want it to start a GoFundMe campaign because I may or may not need money. That's a little awkward, uncomfortable, but a lot of people do to help cover their costs. And, or people are using outdated tools, like like carrying brands around, Hey, this is my cancer journey and who wants to help bring food over or take my kids to soccer or donate housekeeping services.

So Jasper really started as a D to C organized I liked to call it sSort of, if anybody's been on the wedding knot, like, Hey, I need to get organized. I need to, like, I'm getting married and I need a place to like save the date for my wedding and I need to put my registry up and I need to get organized. So a lot of other people can come and collaborate with you on that process. I felt like Jasper started that way. What it's turned into is a full-blown patient navigationservice for cancer and now it's actually working into the enterprise. So a lot of the ways that like our friends over at Accolade have provided great concierge services to employers alike.

This is a, this is a specific solution that like really works on the cancer experience and the patient journey. And what patients need holistically, not just for their care or second opinion. But what they need around their entire life while they're in the acute part of their journey.

That's interesting. So it starts with, with one vision, really direct to consumer, and then it morphs it's still direct to consumer, but it morphs a little bit so that it becomes does it become a B2B type solution?

Well, , for us, it's like one of the things that is really interesting for any of the things that we launch is that we have real D to C experience. Like we have hired people that have done performance worth marketing and have been chief marketing officers at pretty big consumer brands. And essentially they're walking into redesign and say, How do I apply the same lessons that I have from like big retail brands. And essentially try to drive interest in either a double-sided marketplace or a D to C service that then employers are like,wow I'm seeing a ton of traction here. This is super interesting. I noticed that I have a gap. I want to actually now bring that into the enterprise.

What are some other areas that you're looking with regard to building and innovating? Do you have anything in the DTC is really fascinating. Do you have anything in the B2B space?

Tons of stuff in the B2B space. So one of the other areas that we've been very fascinated with is elder care. We've been really interested in the Medicare advantage space and figuring out ways that we can innovate for aging in place. So we have a couple of companies in that space. One is Med Arrive, which is really focused on trying to serve the dual eligible market and Medicare advantage as well.

So Med Arrive is using EMS and downtime ambulance drivers to actually come in, we contract with them to come into the home and service the member that is home, home bound and may need a COVID vaccination or may need some kind of assessment around prevention care services.

That is a company that is doing really well. We've got the CEO there who came from Uber health. Dan. And we've got a couple of really interesting investors that are in that right now. But we, we actually have been doing business with a skin health and in a couple other really interesting ma plans around essentially moving care into the home and trying to reduce ed visits of these frequent flyers or people that either not or falling through the cracks and not getting serviced and are repeatedly coming into the ER because they're not able to actually go out and see their primary care physician.

So talk to me about the entrepreneur's journey. So. Let's assume I'm an entrepreneur or I know entrepreneurs and they're sitting there going all right. I have a lot of choices here. Right? I can, I can go out and try to bootstrap this, get some funding and that kind of stuff. I can I can go through one of these accelerators or, partner up with a, with a health system. I could approach someone like Redesign. I could approach venture.

I don't assume private equity makes a lot of sense at this point, but you know, that that startup entrepreneur. How would you be coaching them today if they were trying to get into this market?

Yeah, I have a ton of these conversations. I would say like probably my week is full of these conversations and frankly, a lot of people from Amazon and Google call me and say the market is super exciting right now. It's super agile. I I'm really interested in a career and these are people that either don't have healthcare experience or do and like, how do I break in, right. I've got, I've got skills. How do I break in? Or where do I go? Or I'm talking to a lot of people that are veterans in this space that are, that are looking for a younger seed experience.

So really just to be clear, Redesign is not, we are not an accelerator and we're not a traditional incubator and there's a lot of other models out there where accelerators and their great, like they're essentially looking at applications and they're looking at young startups. They bring them into a three month program in exchange for a little equity in exchange for a little cash.

They'll run them through a program and then they'll do a demo day and they'll try to attract investors to give them a seed investment. Some of these accelerators may have an incumbent strategic that's backing them, like the Cedars-Sinai, which is using tech stars. Right. And they may offer a commercial contract to the startup as well.

They're a laboratory right next door. That's a great model. It's really different. We are not bringing outside entrepreneurs in and programmatically spending three months with them to help them develop. We are completely researching the concept from the beginning and then we go and build the company.

So many of the CEOs and our CEOs or chief product officers that we layer in as a leadership team generally are people that are like either in one of two categories. One I'm a veteran. I've had an exit. I've worked 10 years and I've sold my company. I'm on the beach and I, I,

I get the call from Missy

I'm back in the game. They have been thinking of a problem space that we have been researching. And they might be at a point where they're like I just did this and I don't really want to spend another two or three years, like kind of at the beginning.

I, and they're very backable like, any institutional investor would probably throw money at them. But they really want to get a headstart and they want the resources and they want to jump in and basically run at the idea and have an infrastructure and support to give them a six to 18 month jump in the market.

And so we've a lot of veterans CEOs that fit that particularly Adam Pellegrini who's our CEO of Jasper was head of digital health at Walgreens. Head of digital health at Aetna CVS was head of enterprise at Fitbit. I knew him from my early days at Microsoft when he was on the Microsoft health vault side.

And I was back at his nemesis over at Google. And then before that he was the chief marketing officer at the American cancer society very early in his career. So he's, he's a vet. Like he's very backable and, but he was like fell in love with this problem space. And we were like, Hey, we've been working on this for awhile. And it was like a nice match. So that's a great example of someone who would be a wonderful CEO for redesign. And as we already done a lot in his career and really wants to the exchange of like jumping in and being, being cause Redesign's actually a silent co-founder.

So the way that we position ourselves we are right beside the CEO, we're aligned in the same ways. We're incentivized financially in the same way as someone else, another category is a first-time CEO who's been either a COO or a president or a CFO somewhere else, or even a CPO and has had a really nice exit.

So I'm working with a phenomenal CEO right now, who is the CEO of Uplift. That's my mental health company. That's a double-sided marketplace, Kyle Telcott. He was at Clover health and he was at city block and he is just like unbelievable. And his skillset and what he's seen in healthcare. Very he's had three exits already, but you know, he really wanted to do a D to C company. He wanted to do something in mental health. He was really ready and he wanted to go fast. And so it was a great opportunity for him to come and help us build Uplift tgoether.

So, as you're looking at healthcare and you're looking at this space, what are the things that you think you would like to see innovation over the next five years? What's next on the, on the menu of things that you say, man, if we could solve these problems, this would be fantastic.

Oh, my God. I will tell you in a heartbeat, this has been my whole career. I would love to see the platform wars, what I would love to see one or two major platforms in healthcare, be figured out. And , we have come just in the last year. Back in your day, you were like a spousing cloud and you were one of the pioneers and really moving a large healthcare system from on-prem to cloud. And we've made so much progress there that we're now trying to figure it out like hey what's going to be the established or you're going to have one or two or three platforms that all can can interconnect, but I'd love to figure that out. And that then will lead to true freedom of data, true liquidity of data. And we're already seeing that right now with there's some really big, like real world evidence companies that are doing a phenomenal work with freeing up data and collecting data on is one of them.

So like we're already at the cusp of that. And COVID really gave us the big push forward because, because of all the vaccine development needed and all that, the real world evidence data we needed, we needed to mine all the EHRs quickly and the registries and all that. So that would be the next five years, if we can nail those two things.

And then third would be I would really love to see telehealth and all of the like wide virtual front door. That's one open. I'd really love to see that the, the standard of care. So that we're in these click and mortar hybrids the idea that you can actually go see your physician in person and, or in between see the same physician virtually so that you're increasing access.

you, like I was at Google in:

And we're, we're not even there yet. Like we haven't even, we haven't even like nailed those those two things where we have increased access and it's been, it's taken a global pandemic to figure out how to do that virtually. So that would be my hope in the next five years is that as the standard of care.

Well, the three things were convenience, connectivity and personalization.

Yeah. Wow. Let's get to the big tech conversation, cause I really want to have this with you. Cause you have such great experience. Let let's just go around the horn. Google. So Google's evolved. What's Google's play in healthcare today. What should they be doing? Where do you see them going?

Yeah. I mean, , so just historically Google's mission is to organize the world's information and make it universally accessible for all right. Like that's their mission statement and that's kind of what they're doing with search and with all of their ancillary products.

That where healthcare fit in was how do we unlock. How do we unlock data that is brutal and caught in these proprietary systems? How do we free the data? How do we make it available for consumers to actually interact with and understand? So that was the, the genesis for why they were like, Hey, we need to get into this.

And given that so many people actually search for healthcare information on Google, they were like, there were so many different ways that we can actually educate people and bring their data in. We could do contextual search, which means you tell me a little bit about yourself and I'll do a better job searching for you, right?

Lots of problems without regulatory-wise lots of problems with that around concerns, at least perceived concerns on privacy. So Google really started from that framework back in the day. And . Interestingly enough from a metal standpoint, that's still their driving philosophy. Where Google has excelled to them where they're going to continue to excel too, is they're very good at AI. They're very good at predictive analytics. They're very good at finding data and using the data to actually predict outcomes. Ultimately the goal for Google health back in the day. And it was just the wrong lever to pull, right. Was if we could get a bunch of data and we could do good for the world, right.

There's lots of people that can say, oh, well, all the things that Google could do with your data be careful, but let's just assume that if they could do good, if they could mine the data for good, right. Like for adverse reactions for real-world evidence. Better targets for drug innovation. There's all kinds of really interesting things that could happen.

And so that's still where Google wants to play. What they have done because the PHR was the wrong lever to pull. Like you just can't get enough humans to aggregate their data in any kind of sufficient and longitudinal away to make a real dent. It's just too difficult that a user experience. And even when that data comes in, it's not harmonized, it's not clean.

It's difficult. Right? So what they've done now is Google cloud has grown up and they, they now are brokering all of these really big enterprise deals with health systems on Google cloud, trying to figure out how to get more access to data in ways that make sense from regulatory framework.

And they've also bought a consumer wearable, which was smart, right to also figure out, Hey, that's another touch point where we can get access to data and do really innovative things with personal data. And back in my day, those were the other two levers that I was suggesting to pull. Right. I was like, Hey, if we want, if we want data at this massive level, and we're going to do really good things with it you might wanna think about the enterprise door and you might want to think about a wearable door.

Yeah. When people ask me, I boil it down to this. Google's an information company. And they can do amazing things with information. So we're going to bring it in to them. Mayo has a deal with them. They're doing some really cool things around the AI engine and whatnot, but you're talking about a data set.

That's probably pretty clean when it goes over to Google, they can do some really neat things with it. They've also boxed it off to make sure that the privacy aspect of it is is taken care of Meditech signed a big deal with with Google as their platform of choice for their medics web-based EHR. And so they are signing those deals, which is interesting. The biggest thing they have to overcome is they used to be seen as that fun company with the cool logo and the simple search box. And I it's just, they have a trust challenge. I mean, when the stuff came out with Ascension and whatnot, people went crazy and there there's a somehow Google went from being that lovable little company that was, that made my life a lot easier to somehow I dunno, being involved in a lot of things that scare people so.

That's, unfortunately, that's a little bit of a trend that we're seeing right now with many of the companies that are big and expansive. So there's lots of people that are looking at Amazon, looking at Facebook slash Meta and Google.

And I would even throw Apple into that. Right. Which is these are, these are really expansive platforms with multiple businesses and multiple touchpoints and consumers' lives. And so a lot of people are looking at and they should be, they should be looking at the behavior or the privacy policies.

Unfortunately Facebook Meta has given a lot of people, agina with some of the behaviors and some of the things that have been happening there. Then it's spilled over in a lot of other places. It was really unfortunate what happened at Ascension because like, as you well know, anyone who's an insider in healthcare knows that the entire project was all HIPAA-compliant, was all DA's and it's just, it's, it's a shame that, that wasn't communicated well through the employer.

The employees didn't really a understand and they also got a lot of flack for streams and what they, what they bought with the national health NHS in England. So there was just, , you're always going to find media opportunities where people are going to try to beat up these big tech companies for having too much data.

It's very big brother like. But if you, if you had accurate reporting that we're really looking at what the policies were, , people would become a little bit more comfortable, but in general, from a high level standpoint, it's an important topic.

That's probably the least of these technology companies concerns. As far as like real work concerns, the bigger concerns are. How do you work within the healthcare sandbox? Because a lot of times what I've seen is these big tech companies tend to come in with a very large hubris around I can innovate outside of the sandbox because inside the sandbox, people aren't innovating fast enough. And that that's a real harper concept. And this being a system CIO that there's a cultural, there's a change management factor. And then there, there's just simply a regulatory factor. And so Google 10 years later has totally come around like they are fully working within the health system now, which is great.

Yeah. And there are hires Karen DeSalvo, hiring Feinberg and then eventually having him leave, but

Chubby Cosgrove from Cleveland clinic was highly involved in the good cloud side. And when I was there, I was jumping up and down saying we need healthcare leaders to come in. I mean, I had a 23 person advisory council. Leaders from Kaiser Permanente, ARP, Allsprints. I had all of the leaders at the table. And to help us actually create a real footprint.

One of the brilliant companies here and, and I'll get some pushback from this, but it's Apple because Apple recognized early on, you got to establish the trust in order to be a platform that's going to aggregate consumer data. And they went out feels like it was about five, maybe six or seven years ago. And they said we're the privacy company. We're going to put privacy. And we're going to put that back in the hands of the consumer. And their latest phone release is just so indicative of that. You can determine who gets what data and how they get it and that kind of stuff.

They ticked off Meta Facebook with their changes. They ticked off marketers with their changes. Because they staked out that we care about your privacy. I don't think as many people are really concerned about the fact that we're aggregating our patient record in the Apple platform. It seems like a brilliant move at the time.

Yeah. I mean, I, Apple really had a lot of momentum. I, I would say probably like when they, when they had the health care kit researched. All the APIs that they were building around. And then of course their their health records initiative. That if I have unfortunately fallen a little short on the health records initiative, it's not well adopted by consumers. They're not really promoting it as much.

Here's, here's my 2 cents. My two cents is Apple makes great consumer. Apple even has some great concepts and they bring those concepts to market, but they're such a big company now that they just one, one end, doesn't talk to the other end. There's just . They're just not capitalizing on the amazing platform that they have in front of them.

Well, and also where , and I've had lots of friends to go over and work at Apple and and where they are a great consumer company and they have got great design and their products are, are omnipresent, but they don't have enterprise blood. Their DNA and working with the enterprise is really soft.

And rightfully so, they've, they've leaned in more on being a luxury DVC product. You have to have an enterprise, you have to have an enterprise team that's going out and trying to actually get all of the different disparate organizations to agree to actually share data on their platform.

And so it's a little, a bit of a limited experience and it was , I chuckled because literally when they went out to announce this, and I know Cedars-Sinai was one of their earliest co-development partners on the health record gathering. I was like, wow, that, that was what we tried to do at Google literally ten years ago.. Yeah. So there's a replay of, of that same , Hey, let's be a neutral kind of Swiss territory of an aggregator. And I thought it was a valiant attempt because Hey, everybody's using iPhones now. Be great if I had my entire medical record on my iPhone, but the consumer experience is still bumpy.

It's the same bumpy experience that we had a Google trying to link your Walgreens account. Link your Aetna member portal, right? The industry standards are better now. And maybe, maybe with FHIR in the next five years, we'll even see this dream that we've all been trying to accomplish, come to fruition.

I will say this, the number of CiOs I know who've gone up to Cupertino and you talked to them before they go up and they're like, oh, I'm so excited. This is great. And even one of them was like, Hey, Epic's going to be in the room and Apple's gonna be in the room. This is going to be amazing, whatever. Almost to a person, every one of them when they come out, I said, well, how did they go? They scratching their head going. I, I'm not really sure. I don't, I'm not sure what I can do with them. I'm not that. And that gets to your point of their DNA is really towards the consumer. It's not really, they don't know how to work with a health system and the EHR provider to do to do too much beyond what they, this is, this is what we do. You guys figure out how to use us as the approach.

Yeah. One of the, one of the three lines that I saw at both Google and Amazon is that the way in which teams are set up and Apple's like this as well just mostly from most of my friends and working with apple is that teams are set up individually. So there's not one central healthcare leader. And this is a little bit with Dave Feinberg was up against is he had a big footprint. In order to kind of have a Darwinian approach to innovation, there's lots of different teams, there's little seeds being sprinkled in lots of different places.

And like the idea is, is that there could be some internal competition, right? So there's not a lot of You're on a need to know basis with some projects, some projects are super confidential and there's not like a a holistic experience. So if I'm ethic or I'm Ascension and I'm like, Hey I'm, I'm using AWS at Amazon. So I have I'm Cerner, I have a big footprint there. And I hear that there's some kind of wearable coming out of Amazon devices, which is another division. So can I get the update over there? What's happening over there, right. And, oh, by the way, I got wind that there was something called Amazon care and that's happening.

So why am I not talking to that team? Right. And so that's a great example of this whole concept of technology companies are de-centralized in their innovation efforts. And so if I'm innovating something at Google that has to do with health search, I'm not reporting up to Dave Feinberg, right? Who might be doing something in health search might be doing something with Fitbit, might be doing something with streams in the NHS, and maybe he's talking to the cloud people, maybe he's not right.

So there's this fragmentation inside the company, which makes it really difficult to manage the enterprise client on the outside that you're partnering. Right, because they're holistically looking at all of the things that the technology company could do. And there's pros and cons, right?

Like if you centralize it you might slow down because it gets choked. Right. So I, get kind of being on both companies, I get the management reasons for, both of those sides.

So Amazon's placing bets all over the place and people sometimes get confused. I mean, clearly they're a distribution powerhouse, right? So now they're distributing pharmaceuticals and they're, they're doing that whole pharmacy side. They have an Amazon care over here, which is an interesting play. How I describe it to people is what started out as, Hey, let's take better care of our employees cross country, give them a concierge service with a good technology front end has turned into something that they've sold to several employers, including Peloton, Parent, and a couple of others. You have the, work that you were doing I'm now hearing more and more of that the Echo devices are showing up in patient rooms, even in ORs, oddly enough, that people want to interact by voice with with various things. So is there someone I go to at Amazon that is that person, or is that you just described that, that same thing is true there. There's no, Amazon. health.

So interestingly enough, and again, I I'm no longer at Amazon, so I'll just it's been quite some time since I've been out and I've quite a few colleagues that still work there and are doing really great things. So interestingly enough Amazon has really consolidated a couple of different teams now. So Amazon pharmacy is now really the crux of where a lot of the innovation is coming from, and they do have a home diagnostics and lab wing during COVID. They had such a huge footprint of employees. A million plus that they couldn't get enough COVID tests for their employees.

They went out and they built CLIA labs. This is all public. And they also have invested in their own line of COVID testing. And so they have home diagnostics as well. My sense is, is they're going to expand in that market. And so both Amazon pharmacy, the home diagnostics piece and I believe care all now rolling to one leader. This person's been at Amazon for quite some time and is on the Prime side of business. So at least there. But Amazon halo, which resides in Amazon devices is still on its own. AWS has a huge footprint in healthcare and life sciences. There's leadership there.

That's still in there. I'm doing lots of stuff in AI. And then you also have my former team, the Alexa health and wellness team, which is an Amazon device system sits next to the halo team. Which did in fact take Alexa, but compliance. So you don't have entire centralization. And that's still Amazon's philosophy, but you certainly have some of the big bets kind of kind of converging together. And one of the things I learned being an employee there and also at Google is we every day was like day one and we had lots of different teams running super fast. And so, like, the food enterprise is really good example they had Amazon fresh. Amazon restaurant.

We had Amazon Go this , and so you have all of these bets and then of course we bought whole foods. So you have all of these sorts of different things going on. And then once you find these things that are seeding and mushrooming, and they become independent businesses driving on their own, that's when you're like, wow, that's successful.

Let's now create a whole integrated footprint. Right. And health health at Amazon will like merge once, once these things that are these service lines that are growing and launching kind of become commercially viable.

Missy man. We can talk about so much more. Any thoughts on Oracle acquisition of Cerner? Anything exciting there?

Or, yeah, that is very exciting. Oracle has done some really great things on the life sciences side. And that really puts them back in the game around having a tremendous amount of data to build up those assets. So it's great. It, bring really back. This is, we've all been waiting for this. Like we've all been waiting for one of the big technology companies to buy an EHR. And that would really, that would really tip the point. If we see that acquisition makes a couple other folks say, Hey we could go a lot faster in the healthcare vertical, if we just actually buy one of these intermediaries that's got a huge footprint that's in the enterprise.

Do you in any world to see a big tech company buying a health system or, or a couple of hospitals?

That would be a harder play. I just, I'm just speaking for myself, but like, from my experience being in big tech, that brick and mortar and owning large large system could, could be challenging what I will say, however, is it, it, it could be interesting if it gives legs to having a click and mortar strategy, particularly around being in the services field, but being all virtual. So like as Amazon Care expands and it wants to have a neighborhood hub presence right of like, almost like a brick and mortar cause you see what the retailer, CVS and Walgreens slash are doing.

Right. They're like trying to take their retail stores that have a footprint. And they're trying to think of what. A real community hub look like how do, how do I create a neighborhood hub? And you've got other kinds of really interesting companies out there, like carbon health you've got city MD summit, which started out in urgent care, go health, right.

That are doing these partnerships with, with delivery. So while I'm not quite sure that they would buy a footprint maybe if there's a strategic relationship where they're building, like if you've ever been to an Amazon five-star store, have you ever walked into one of those? Yeah. Like they, they, they know how to do retail.

Like it's not like they don't know how to do a retail storefront, but what most likely would happen is strategically partnering with the healthcare delivery system and then creating some kind of brick and mortar, like retail footprint around it, where you've got a feeder. That would be my prediction as opposed to like just flat out buying poll, like Hey, I'm going to pick up Providence now.

Missy, this has been fantastic. I feel like I missed seeing you at JP Morgan conference. This is what it would have been like if the two of us were sitting across from each other. And we also would have caught up on some of the personal things that are going on. But this was a fantastic conversation. I appreciate it. And hopefully we'll get to catch up another time this year and have you on the show. It will be great.

Such a pleasure Bill. I hope to return soon. Thank you so much for having me.

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