Joshua Liu’s Post

Lots of tactics might get your Health Tech product bought by a health system: 🆓 Free pilots (“it’s free - what do you have to lose?”) ✨ Being a bright shiny object (“look ma, it has AI!”) 🤝 Personal connections (“I created it and I’m on the Board of the health system…”) 🧑🤝🧑 Intros from famous investors or advisors (“a VC thinks we are the next hot thing”) BUT if you don’t actually improve health outcomes, if you don’t earn the right to continue working with the health system… your innovation won’t have staying power. Sure maybe you’ll get the cool press announcement. And the brand name logo on your website. And get invited to speak on stage. But I can tell you that none of those things are nearly as rewarding, impactful or important as delivering an innovation that actually moves the needle on health outcomes. Which means as much work as it is to land a hospital partner… that’s just the beginning. You need to actually deliver on your promise. You have to help health systems measurably improve patient outcomes. Otherwise… what’s the point? Why did you do all this? Every time you sign a contract, that’s not the end goal. A contract is an opportunity to be at the starting line. It’s earning the right to play. Never forget that. And go deliver. #digitalhealth #healthcareinnovation

5 reasons why adoption of Health Tech is slower than many would like: 1️⃣ 𝐏𝐚𝐭𝐢𝐞𝐧𝐭 𝐬𝐚𝐟𝐞𝐭𝐲 It’s annoying but not catastrophic if a new spreadsheet tech doesn’t work. But it can be catastrophic if health tech doesn’t work as intended and puts a patient’s health at risk. Which means health systems must have a lower tolerance risk. Which means tech in healthcare must be more carefully evaluated and thoughtfully deployed. Which means more time. 2️⃣ 𝐅𝐮𝐧𝐝𝐢𝐧𝐠 𝐦𝐨𝐝𝐞𝐥𝐬 𝐝𝐫𝐢𝐯𝐞 𝐡𝐞𝐚𝐥𝐭𝐡 𝐬𝐲𝐬𝐭𝐞𝐦 𝐩𝐫𝐢𝐨𝐫𝐢𝐭𝐢𝐞𝐬 When people complain about Health Tech adoption being too slow, they are most often talking about tech that would lead to better patient outcomes. In a mostly fee-for-service world, tech that increases patient volumes, improves billing, etc. is going to face less resistance to adoption. In contrast, tech that improves patient outcomes is going to have more of an uphill battle - especially if improving patient outcomes may actually lead to less revenue for a health system. 3️⃣ 𝐂𝐥𝐢𝐧𝐢��𝐚𝐥 𝐰𝐨𝐫𝐤𝐟𝐥𝐨𝐰𝐬 𝐚𝐫𝐞 𝐜𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐞𝐝 𝐚𝐧𝐝 𝐟𝐮𝐥𝐥 - 𝐭𝐡𝐞𝐫𝐞 𝐢𝐬𝐧’𝐭 𝐭𝐢𝐦𝐞 𝐭𝐨 𝐚𝐝𝐝 𝐚 𝐧𝐞𝐰 𝐩𝐫𝐨𝐜𝐞𝐬𝐬 Clinicians are barely keeping their head above water with their current workflows and tools they have to use. Asking them to use one more piece of tech? Asking them to educate patients about one more innovation? Good luck… it’s tough to fit it all. 4️⃣ 𝐈𝐭’𝐬 𝐭𝐨𝐨 𝐡𝐚𝐫𝐝 𝐭𝐨 𝐞𝐱𝐩𝐥𝐨𝐫𝐞 - 𝐜𝐥𝐢𝐧𝐢𝐜𝐢𝐚𝐧 𝐬𝐜𝐡𝐞𝐝𝐮𝐥𝐞𝐬 𝐚𝐫𝐞 𝐚𝐥𝐫𝐞𝐚𝐝𝐲 𝐣𝐚𝐦 𝐩𝐚𝐜𝐤𝐞𝐝 In healthcare, sometimes it can take weeks or months to schedule the next meeting, particularly if you need a group of clinicians to weigh-in. It can be hard enough to get time with one clinician whose days are jam packed with clinical work and patient care. Imagine having to find that one time on the calendar where a whole clinical team is available… and then it gets re-scheduled because a patient care issue comes up. Happens all the time. Wouldn’t happen in other industries where stakeholders have more flexible schedules. 5️⃣ 𝐌𝐚𝐧𝐲 𝐬𝐭𝐚𝐤𝐞𝐡𝐨𝐥𝐝𝐞𝐫𝐬 𝐡𝐚𝐯𝐞 𝐭𝐨 𝐛𝐞 𝐜𝐨𝐧𝐯𝐢𝐧𝐜𝐞𝐝 Most Health Tech impacts multiple stakeholders - patients, clinicians, administrators, IT / privacy, etc. Depending on the people dynamics, there may be several folks who can veto the initiative. Which means you need to have a strong value prop for almost every single type of stakeholder. ***** What would you add? #digitalhealth #healthcareinnovation

What does it take to succeed in Health Tech? ❌ 𝐖𝐡𝐚𝐭 𝐈 𝐭𝐡𝐨𝐮𝐠𝐡𝐭 𝐦𝐚𝐭𝐭𝐞𝐫𝐞𝐝: 🤝 Rolodex of connections I thought that health systems would buy simply because you were connected to someone they trust. So you should hire salespeople with a rolodex. Turns out a rolodex would get our foot in the door, but nothing more. And most rolodexes run out quickly. 👩⚕️ Famous medical advisors I thought that health systems would take us more seriously if we showed we had recognizable medical advisors involved. Turns out the value of advisors is not from you being able to associate with them, but from whether they can add direct value to the company. ⭐ Brand name hospital partners I thought that getting famous hospital logos as customers would immediately convince other hospitals to adopt. Turns out the idea of a healthcare “kingmaker” doesn’t exist. Hospitals care more about who “like them” are using your product. 🔬 One amazing research publication I thought that once we had a study with amazing results then health systems would suddenly get on board. Turns out that clinical evidence alone doesn’t create a reason to change practice. In fact, on the flip side, I’ve seen solutions from incumbents get adopted despite nearly zero clinical evidence. ✅ 𝐖𝐡𝐚𝐭 𝐚𝐜𝐭𝐮𝐚𝐥𝐥𝐲 𝐦𝐚𝐭𝐭𝐞𝐫𝐞𝐝: 🧬 Clinical DNA Having 20%+ of our team from the clinical world has been instrumental in our success at building a product and working with frontline healthcare staff in a way that’s produced to industry-leading patient outcomes. 🤔 Intellectual curiosity Healthcare is really complex. There are complex clinical workflows, incentive models, policies, organizational dynamics, regulatory requirements, etc. If you’re genuinely curious, you’re willing to keep asking questions, and be motivated to navigate the complexities. 💪 Focus Because healthcare is so complex, it’s easy to get pulled in 10 different directions to build a product that solves 10 different problems. But you then end up with a frankenstein of a product. Also, with visionary customer champions, there’s the allure of “trust me, if you build X, everyone will want it” (unfortunately, 99% of the time this is not true, no matter how brilliant or visionary your champion is). While not perfect, we’ve done a pretty good job building (and growing) a core product for a core type of use cases. 💨 Nimble hospital partners We’ve grown and innovated the fastest with hospitals and health systems that just wanted to get stuff done. Less bureaucracy and not juggling 100 different research or innovation projects. ***** How does this line up with your experience? #digitalhealth #healthcareinnovation

3 unpopular opinions I have about Digital Health: 1️⃣ Most research and grant funding in Digital Health goes to waste. I’ve seen health systems use tons of grant money to develop and publish research on the same types of digital health apps. And because they are often building V1 of a solution, the studies are focused on feasibility, and any analysis on actual clinical outcomes shows mediocre results. And then… they move onto the next research study idea. I’m not saying there should be no grant funding going to trying new things - but the government would be better off allocating a lot more of these dollars to health systems to just directly purchase the same types of solutions already proven to work. Case in point: that’s basically what the Ontario government did the last few years, and it now has higher digital health adoption than any other province in Canada. 2️⃣ Tech is commoditized. What separates success from failure is People, Process and Clinical. Most companies can build a nice looking app that meets the feature list of a health system. It’s why custom app development shops keep making money from healthcare despite no results on improved outcomes (nor do they care!). Dev shops view results as delivering an app to a client - not helping providers to achieve an outcome. Similarly, if you choose a Digital Health solution based on just a feature comparison, you’re essentially deciding based on who is better at writing product marketing. That’s like hiring a candidate based on how good they are at interviewing as opposed to their track record at past jobs and references from people they’ve actually worked with. Sure you could do it… but you will often be disappointed. What makes Digital Health successful is everything not in the slick product demo: → The quality of people → The proven implementation playbook → The alignment of the solution with clinical workflows → The expertise on clinical content and pathways … all the non-tech things that enable the Tech to work is what really matters. 3️⃣ Less is more: people, money, etc One of my favourite Paul Graham quotes is: “When people visit your startup, they should be surprised how few people you have. A visitor who walks around and is impressed by the magnitude of your operation is implicitly saying "Did it really take all these people to make that crappy product?" It reminds me of how some health systems have over-indexed on signals from Healthcare Venture Capital over the last several years. Some health systems got enamoured with high flying startups who raised hundreds of millions of dollars from big name VCs and scaled to hundreds of employees in no time. I’m not going to name names… but we saw how many of those situations played out. It turns out more money and more people doesn’t magically make one an effective Digital Health vendor partner that actually helps providers improve outcomes. *** Agree or disagree with any of these? #digitalhealth #healthcareinnovation

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 🙏🏻