Joshua Liu’s Post

I had never been kicked out of a startup program until this happened. Our health tech startup SeamlessMD was several months into an accelerator. We were 1 year old and still didn’t have a live hospital customer. Every two months there would be a big accelerator event where every company still in the program had to sit before all of the mentors and get grilled on their progress. The mentors were some of the most successful tech entrepreneurs in the country - which meant it was a huge privilege to participate. But it also meant they knew their stuff and could credibly call companies out if they were struggling. Mentors would openly debate in front of the companies what they were excited about and what also made them deeply concerned. To make companies earn the right to keep participating, 2-3 companies which made the least progress would be kicked out every two months. We were halfway through the program and had been unscathed… so far. We showed up to the meeting proud to say that we had met all of our recent goals. We then launched into discussing a partnership we were exploring that we felt could dramatically change the trajectory of the business and get us hospital customers faster. And that’s when things took a nasty turn. Many of the mentors tore our proposal apart. They thought we were giving away too much. Later that day we found out we were kicked out. While we knew it was possible… we were stunned. The reason? They thought we “lacked the backbone” to succeed in the complicated healthcare industry. We were a few kids just out of university trying to break into healthcare, competing against companies led by veterans with 20+ years of experience. Why would anyone trust us? That’s probably why we still had 0 live hospital customers despite working on our company for a year. What really hurt was that the message came from some of the most successful entrepreneurs in the country. We could have said: “I guess they’re right. We’ve worked for a year on this and have nothing to show for it. Let’s just give up.” But we didn’t. We took it on the chin. We picked ourselves back up. Over the next 12 months we: → Launched our product at 2 hospitals and 2 clinics → Had our 1st abstract presentation at a medical conference by a customer → Expanded our product from just a mobile app to an integrated web and mobile app → Had our 1st ever patient user organically blog about using SeamlessMD → Won 1st place at the TieQuest business competition Today SeamlessMD is used by hospitals and health systems across North America, is backed by 40+ studies and evaluations and is the only solution in our space with direct turn-key integrations with all of Epic, Cerner and MEDITECH. Now the mentors were right that the partnership structure we proposed was bad (it didn’t end up happening). And maybe they were right that sometimes we were meek. But they were dead wrong about our drive, grit and commitment to our mission.

Healthcare needs less Tech innovation and more innovation Everywhere Else: 💰 𝐑𝐞𝐢𝐦𝐛𝐮𝐫𝐬𝐞𝐦𝐞𝐧𝐭 𝐢𝐧𝐧𝐨𝐯𝐚𝐭𝐢𝐨𝐧: how do we better align payment to achieve the outcomes we actually want? We have a mountain of data and experience to suggest that the primarily fee for service model doesn’t incentivize the care we want… yet we remain stuck here. 🏥 𝐂𝐚𝐫𝐞 𝐦𝐨𝐝𝐞𝐥 𝐢𝐧𝐧𝐨𝐯𝐚𝐭𝐢𝐨𝐧: how should the care team actually be designed around the patient? I don’t think any of us would recommend siloed providers with fragmented care around a patient… and yet that’s the reality for most. 👩⚕️ 𝐖𝐨𝐫𝐤𝐟𝐨𝐫𝐜𝐞 𝐢𝐧𝐧𝐨𝐯𝐚𝐭𝐢𝐨𝐧: how do we recruit more people into healthcare? How do we retain them? As helpful as I think AI scribes and AI drafts for patient portal replies will be for clinician well being, our workforce challenges are much bigger than day to day administrative workflows. AI is not going to get the next generation of young folks excited about working in healthcare. We require major solutions at the system level. That has to come from people. It’s not that I don’t think Tech Innovation is impactful or important - I obviously do otherwise I wouldn’t be building SeamlessMD ! But Tech Innovation is mostly designed for the current state of Reimbursement, Care Delivery and Workforce models. Which means Tech often just strengthens the parts of the status quo that we don’t actually want. E.g. EHRs make it more scalable to document stuff that’s “required” but doesn’t actually improve patient care. Whereas if we innovate on Reimbursement, Care Delivery and Workforce to build a future that makes more sense, then there will be market forces to build the Tech innovation that will further enable and accelerate those other innovations. Otherwise we will continue to see a graveyard of well-intentioned Health Tech innovations that were dead on arrival… because they were designed for a future state that didn’t yet exist. #digitalhealth #healthcareinnovation

Sachin H. Jain, MD, MBA recently wrote how we should be careful not to get enamoured with “toxic positivity” for the Hospital-at-Home (HaH) model. 𝐃𝐫. 𝐉𝐚𝐢𝐧’𝐬 𝐦𝐚𝐢𝐧 𝐩𝐨𝐢𝐧𝐭𝐬: → HaH should be reimbursed at 70%-80% of a typical hospitalization since the resources required (especially staff needs) are lower - and payers shouldn’t be “paid the same for doing less”. → Logistics have a higher risk of failure with HaH (e.g. equipment delivery, reliability of medication administration, etc.) than in-hospital (higher bar for quality and redundancies in place). → More burden on family and caregivers to take care of patients in HaH, which is unpaid work. → More HaH use isn’t the goal. The goal should be fewer hospitalizations of any type. 𝐌𝐲 𝐭𝐡𝐨𝐮𝐠𝐡𝐭𝐬: I agree that Hospital at Home is a tool and should not be the end goal. Less hospital care is better, and eventually we will say less HaH is better too. The goal is health. In terms of reimbursement: what happens if we lower HaH payments to 70-80% of a hospitalization? On the one hand, this would be charging closer to value. On the other hand, you disincentivize HaH for hospitals with already tiny operating margins. I’m more concerned this would discourage appropriate HaH enrollment. Currently patient enrollment is based more on clinical appropriateness… but what if providers now have to scrutinize each patient’s impact on operating margins? E.g. patients who live further away are seen as too costly now. You’re going to see patients no longer eligible for HaH if they are seen as “money losers” for a health system. With regards to logistics, of course there will be some error rate - unfortunately there will be some (hopefully rare) occasions where equipment doesn’t make it on time. Logistic errors are not impossible, but what matters is the actual error rates and outcomes are, not simply that potential failures exist. I don’t know the data, but the data should inform if we should be majorly concerned. I do agree that the real challenge is not understanding how to keep patients out of acute care - we know how to do that. The real challenge is a reimbursement model that has limited incentives to manage health conditions in a way to avoid the need for hospital at home or actual hospital care in the first place. Ultimately I expect we will see care exist on a continuum that patients flow between as needed:  Healthy (no active care) ←→ outpatient office based care ←→ home-based low acuity care ←→ home-based higher acuity such as HaH) ←→ hospital care. In fact, we will get to the point where eventually patients may be admitted directly from their own home into HaH if they get sick enough - without having to go to the hospital first. But that’s only possible in a truly integrated payment and care delivery system, where your care team not only is monitoring you as an outpatient, but can directly escalate that care themselves as needed. What do you think about HaH?

You might be bought-in at your health system, but Digital Health transformation is a team effort. You still have to convince your leadership team, IT folks, admin partners and clinicians to get on-board with a very different approach to engaging patients. And if even one group says “No”... you’re dead in the water. So how do you get them on-board? Based on 12+ years of success and failure, here are 6 ways we’ve seen work with internal champions to get buy-in across their hospital or health system: 1️⃣ “Show me the money” 💰 Money talks. Even if your C-suite believes in your innovation, they need to document a business case that makes sense. So you need a compelling possible ROI they can point to. Ideally financially (increased revenue, lower costs) with contributing metrics to support the financial ROI (e.g. more patient volume = more revenue, lower length of stay = lower costs). 2️⃣ “Show me others who’ve succeeded” 🏆 To make the ROI model grounded in reality, show that it’s based on results the solution has achieved with similar institutions. And be conservative… because your team certainly will be. If other institutions have used the solution to achieve 20% to 40% reduction in readmissions, put 20% into your model. 3️⃣ “Show me the clinical outcomes” 📈 Most of your clinician colleagues won’t care about whether the solution improves the health system’s bottom line. But they ALL care about improving patient outcomes. Show them clinical evidence of how the innovation has helped other institutions reduce complications, readmissions etc and align on opportunities to improve patient care. 4️⃣ “Show me: Why us? Why now?” 📅 You’ll get more momentum if your innovation connects to an existing org priority. Because if it checks off a box your org is supposed to be working on, then no one will view it as a distraction from their main work. E.g. health systems have tied SeamlessMD to many different priorities:  → Increasing same day surgery → Hospital to home → Digital front door → Cutting surgery backlogs → Enhanced recovery after surgery But you do need to do your homework to understand what matters right now. 5️⃣ “Show me how clicks will be minimized” 🖥️ Everyone is afraid of more clicks, more logins, more passwords. If you have a vendor partner who has truly integrated with your EHR vendor at other health systems before - with workflows that directly embed the solution in the EHR and makes it easy for clinicians to engage - that’s a win-win for clinicians and IT. 6️⃣ “Show me an implementation playbook that’s been battle tested” 📓 Every stakeholder has been part of a failed initiative. And has learned that success is 1% idea + 99% execution. So your vendor must have a proven, repeatable process that works. Because if your team isn’t confident in what they’re hearing, they’ll have zero confidence in the vendor partner. And no one wants to deal with yet another failed initiative. What would you add?

Thrilled for Nova Scotia Health Authority to expand its use of SeamlessMD to bring Digital Patient Engagement and Remote Monitoring to Cardiac Surgery! Thank you Rob Baxter Ryan Gainer Gail Tomblin Murphy Karen Oldfield for the opportunity to be part of your leadership in Digital Health Transformation 🙏🏻

On this Canada Day I’ll share what folks got wrong about building SeamlessMD in 🇨🇦: 🗣️ They said: 🇺🇸 health systems won’t buy innovation from non-American companies. You should move the company. 🤔 Turns out: 🇺🇸 health systems just want to invest in the best products and teams no matter where they’re from. 🗣️ They said: 🇨🇦 healthcare system is way slower to adopt Health Tech than the 🇺🇸. 🤔 Turns out: was true for us before 2020… but since then, the 🇨🇦 market has dramatically accelerated adoption of SeamlessMD. The success factors? Governments (yes governments!) prioritizing Digital Health and the amazing work of CAN Health Network , Digital Technology Supercluster and other initiatives driving adoption of healthcare innovation. 🗣️ They said: You won’t be able to raise enough investor capital in Canada. 🤔 Turns out: The vast majority of our investors are Canadian. Was our path harder than if we had raised capital from Silicon Valley? Almost certainly… but it WAS possible to do it all here. 🗣�� They said: You might become a 🇨🇦 category leader, but you won’t be seen as an international leader. 🤔 Turns out: We are repeatedly at the top of international lists alongside other great companies, including being rated #1 for Improving Outcomes by KLAS Research in 2023. Contrary to what you may be thinking, my point actually isn’t that 🇨🇦 is the absolutely best place to build a Health Tech company. Maybe it is, maybe it isn’t. But what I do know is that you CAN build great things here in 🇨🇦. While building in healthcare is certainly hard here… trust me, it’s hard anywhere. What our country may lack in investor capital, appetite for risk and aligned economic incentives in healthcare… … we make up for in a highly collaborative culture, significant government and non-profit support and incredible grit. Y Combinator told us EHRs would build what SeamlessMD was planning to do... … NEXT Canada told us to build it anyways. I feel blessed and fortunate that we had the opportunity to build SeamlessMD in Canada. And the work we do here, already has helped patients and providers beyond our borders, and will continue to do so for years to come. Happy Canada Day! 🙏 #digitalhealth #healthcareinnovation

AI and automation can’t solve everything for healthcare providers: AI may predict a patient’s risk of mortality… but you still need protocols for how to act on that risk prediction, otherwise that alert just sits uselessly on your screen. AI may recommend more personalized treatment options… but no one is better than you to truly understand the patient and engage in shared decision making. AI may automate reminding patients to follow a treatment plan… but patients will only buy-in to the treatment because of their trust in you. AI may automatically document your patient encounter… but you still need to review, sign off and be accountable to whatever’s in the note. AI may coordinate staff schedules faster and smarter than any human… but healthcare staff will only show up engaged and motivated if you can inspire and support them. AI may draft a response to a patient portal message… but you still need to decide if that’s the best course of action. AI will be an incredible assistant, partner and sounding board. It will help us do things faster and smarter. But for the foreseeable future, human providers must and will remain in the driver’s seat - with AI as an amazing GPS and sometimes on auto-pilot. … as it should be. Agree or disagree? #digitalhealth #healthcareinnovation

“𝐑𝐎𝐈 𝐢𝐬 𝐞𝐯𝐞𝐫𝐲𝐭𝐡𝐢𝐧𝐠 𝐫𝐢𝐠𝐡𝐭 𝐧𝐨𝐰 𝐢𝐧 𝐡𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞.” … 𝐛𝐮𝐭 𝐬𝐡𝐨𝐮𝐥𝐝 𝐢𝐭 𝐛𝐞? Just because you can’t measure ROI easily for certain things doesn’t mean it doesn’t have value in the patient journey. It’s easy to measure the ROI for interventions that increase patient volumes and thus immediately drive revenue - e.g. self-scheduling tools. → Did we have more patient visits than expected this month?  → How did that translate to more billings and revenue? But it can be hard to measure ROI for interventions that improve the patient experience, clinical outcomes and costs: → If improved patient education decreases patient anxiety… how do you place a $ value on that? → If an intervention has a positive ROI for patient experience and outcomes but a negative ROI financially for the health system… how much of the intervention can you justify using? → If preventive care produces ROI decades down the line… how do you justify investing $ today, especially if you’re unsure if your own health system will be the ones getting that financial return on the cost saving? → If an intervention may reduce ER visits… but you need many months of data collection + analysis time to truly measure the impact… do you have the patience? → If you have multiple parallel interventions in place to prevent readmissions… but as a result you are unsure what’s driving the impact… how much effort will you put into trying to figure out the attribution for each? So in the short term many folks will focus on what generates financial ROI the fastest… which often is what increases patient volumes. But if that’s all you do… then in the long term you end up focusing on something other than what pulled most of us to healthcare in the first place. ROI is definitely important. We have to measure it to ensure we’re not doing wildly unuseful things. We also must make it easier to measure ROI for interventions that improve patient experience and outcomes. For example: it’s still too hard for many frontline providers to access data on patient experience, outcomes and cost reduction. But the more barriers we create for that, the harder it is to measure ROI on those items, and the harder it is for providers to invest in and justify those types of interventions. Because if we keep focusing on short term ROI and ROI that’s easiest to measure… we’ll miss out on many interventions that would’ve had important long-term impacts on patient health... ... but is that what we really want?

Most hospitals are stuck in Patient Engagement 1.0 Here’s how to shift to Patient Engagement 2.0: 1.0: Manually call each patient once after discharge about their symptoms 2.0: Automatically engage patients every day after discharge to monitor their symptoms via text, web or mobile ***** 1.0: Out of date, paper-based patient education that eventually gets updated every 5 years 2.0: Digital patient education that gets updated in real-time ***** 1.0: Hoping that patients remember their instructions 2.0: Automated, just-in-time reminders by text, email or in-app notification ***** 1.0: Reactive care to sick patients who end up in the ER or readmitted 2.0: Proactive care via remote monitoring to prevent ER visits or readmissions ***** 1.0: Patients call providers about low-risk common issues 2.0: Patients self-manage low-risk issues based on automated triage and feedback via tech ***** 1.0: One-size fits all patient education for all patients 2.0: Personalized education based on each patient’s unique demographics and medical history ***** Why make this shift? For over 12 years now we’ve seen hospitals who made the leap to 2.0 achieve: ⬇️ mortality ⬇️ length of stay ⬇️ readmissions ⬇️ ER visits ⬇️ costs … all while ⬆️ patient satisfaction. The longer you wait to shift from 1.0 to 2.0… the more missed improvements in patient outcomes that will accumulate: → Deaths that could’ve been avoided. → Hospitalizations that could’ve been prevented. The technology and playbook are now here. The patient motivation is there. The question for hospitals still thinking is: what’s stopping you? P.S. If you want to learn how your hospital or health system can transition to Patient Engagement 2.0 by leveraging Digital Health, our team at SeamlessMD would be happy to chat. #digitalhealth #healthcareinnovation