Gathering scattered medical data about a patient and giving it to the doctor in time for a visit is Connective Health’s aim. Founder, Ryan Hess, updates us on the progress of his startup in improving care and lowering costs.
Highlights:
Sal Daher Introduces Ryan Hess
Connective Health: The Problem It's Solving
Patient Info Doctors Are Missing and Why It Matters
"... it's something a provider wants to see because they want that short story..."
Connective Health's Next Step
"... if it is a provider that is about to deliver treatment and there is an entity that has your data, that entity, as long as it's under the realm of HIPAA, can provide that data to the provider..."
Advice to the Audience
ANGEL INVEST BOSTON IS SPONSORED BY:
Transcript of "Timely Data, Better Care”
Guest: Ryan Hess
Sal Daher: I'm really proud to say that the Angel Invest Boston Podcast is sponsored by Purdue University Entrepreneurship and Peter Fasse, patent attorney at Fish & Richardson. Purdue is exceptional in its support of its faculty, faculty for its top-five engineering school, in helping them get their technology from the lab out to the market, out to industry, out to the clinic. Peter Fasse is also a great support to entrepreneurs. He is a patent attorney specializing in microfluidics and has been tremendously helpful. Some of the startups which I'm involved, including a startup that came out of Purdue, Savran Technologies. I'm proud to have these two sponsors for my podcast.
[music]
Welcome to Angel Invest Boston, conversations of Boston's most interesting founders and angels. I am Sal Daher, an angel investor who is very curious to learn how to better build really tremendous startup technology companies. Today, we are privileged to have back with us Ryan Hess. Welcome, Ryan.
Sal Daher Introduces Ryan Hess
Ryan Hess: Thank you, Sal. Appreciate you inviting me back.
Sal Daher: Well, Ryan is the founder of Connective Health. He was my guest when I and my brother-in-law, Martin Aboitiz, who's a specialist in digital health, interviewed Ryan in an episode called Delivering on the Promise of Medical Records. It was a wide-ranging interview in which we discussed Connective Health, but we also discussed the state of the whole electronic health records market and so forth. If you want a primer on that topic, it'd be really good to find Delivering on the Promise of Medical Records with Ryan Hess.
Today, this is a free-standing episode that's going to center more on Connective Health, what problem it's solving, traction it's getting. Anyway, let's catch our audience up on what problem Connective Health is solving.
Connective Health: The Problem It's Solving
Ryan Hess: The problem that we're solving is the treatment of complex patients. In particular, how we expect primary care providers to be the quarterback for complex patients. What happens is the complex patient see many different specialists and then we expect the primary care provider to know everything that's happened about that patient. We also expect the primary care provider to see 15 patients a day. Those two facts in the current world just are not cohabitating.
Sal Daher: Okay. The focus is a small percentage of patients. The patients themselves are not complex, but they have health conditions that are complex because they require a multidisciplinary approach, and therefore, they also represent a very significant chunk of the reimbursements by insurers and other payers.
Ryan Hess: You got it. They account for about 5% of total patients, but they account for over 50% of the costs.
Sal Daher: Okay. How is it that you are addressing this problem of patients with complex conditions?
Ryan Hess: What we're doing is saying, "Okay, the primary care provider is expected to be the quarterback." They're expected to be the ones that know everything that's going on about these patients but they don't. What is possible now, though, is to go out and find out what has happened to those patients. We can do is see every place in the healthcare system that the patient has been, we can then go and pull records from those locations and bring back something that primary care provider can use. It takes quite a bit of work because what comes out of a cardiologist location or an emergency department is very different than what comes out of your mini-clinic.
Given the recent laws and the recent changes in the laws, it's now possible to get the data, we do the work to retrieve it, make it meaningful, and then supply it to the primary care provider to help treat that patient.
Sal Daher: Okay. The thesis here is that if you can bring together information about a patient with complex conditions, from all the different places where the patient touches the medical system, that will allow the primary care physician to have a much better care of the patient, and therefore, much more effective and more economical treatment. This has been made possible by recent changes in regulation which allow the flow of this information. This is what makes Connective Health a timely opportunity.
Ryan, by the way, comes from a deep background in this area of digital health. He's very knowledgeable about this and about the whole business of integrating information from different sources in the health space. If you could just speak very briefly about that experience and how it ties in to what you're doing now.
Ryan Hess: In various ways, shapes, and forms I've been trying to do interoperability for 15 years, and this all falls under the general blanket of interoperability. I started way back working within Aetna, working within CVS to do this. I spent a long time at Surescripts, doing this for medications. Surescripts, if folks don't know, it's actually the largest health information exchange in the US, connected to every provider, every pharmacy that's out there.
They do a very good job of making sure that your doctor knows the meds that you are on prior to prescribing a new one, or Surescripts have gotten into making sure they know the price of the meds before they prescribe something. That is meaningful interoperability, where they are providing something to the provider to say, "Hey, you're about to do something. Here's some information that you should have."
Sal Daher: Right.
Ryan Hess: A group of us and myself included left Surescripts to do the same thing with the medical data, really to make medical data meaningful by pulling it from different parts of the healthcare system.
Sal Daher: Excellent. Ryan, where were we when we last spoke before year-end of last year, and where are things now with Connective Health?
Ryan Hess: We've come a long way since our last conversation. When we were last talking, we were laying the blueprint for how this would all come together, how we would be able to go out and get all the different information, how we would be able to do it from a legal perspective, from a technology perspective, all of the different steps required to make it into meaningful data and to get it back into the doctor's workflow.
We have since built all the connections. Launched the service with some early providers, and we're now at the stage where they've been out. They've been using it for the past eight months. We're starting to see some of the results of what meaningful interoperability can really do to help providers deliver care.
Sal Daher: Excellent. Do you have some results that you can share with us?
Patient Info Doctors Are Missing and Why It Matters
Ryan Hess: Absolutely. The first thing that we would say is that it is sad, but I think all of us know that this is inherently true, that primary care providers are often missing information.
Sal Daher: Yes.
Ryan Hess: A couple of examples that are quite striking but are pretty common, where a gentleman came into a primary care provider's office in Pittsburgh. He had actually had a stroke, but he was out of state when he had the stroke. The primary care provider didn't know that he had a stroke and patients, in general, are not going to call up their primary care provider and say, "Hey, this is something you should know about me." They just show up.
We were able to identify that. It was an out-of-state instance. We were able to go into the hospital, grab the information, send it to the primary care provider beforehand so that when that patient walked in the conversation was about how to treat them better. Not about where they've been or what has happened to them, but around, "Okay, what are we going to do now? What is the best path of treatment for you?"
Sal Daher: Particularly a patient who's had a stroke is not going to be a patient who is going to be having necessarily the sharpest memory and is going to have that top of mind unless he or she has someone there that's close helping and reminding and so forth. Maybe that's going to get missed. This is really valuable. Are there numbers that can also support the thesis of Connective Health?
Ryan Hess: We've been live for, as I said, eight months. We're working across a number of different practices. We've delivered tens of thousands of these. We would say, measuring across that, 33% of the time a provider is finding out something important about the patient that they did not know. I know it's shocking statistic, but I think as all of us think back in our interactions with the healthcare system, it's not surprising that it is that frequent that the primary care provider is missing a really important piece of information about you.
Sal Daher: Wow. A third of the time the primary care physician goes, "Whoa, I didn't know that. This is pretty significant." Any inkling of any effect that it has on the care of the patients.
Ryan Hess: We've been tracking that over the past couple of months as well. We deliver this information for all patients. For any patient that a primary care provider is seeing, we will make sure that they know that short story of the patient. If a primary care provider has a behavioral health issue or suspected to have a behavioral health issue, given the pandemic, we have elected to put that at the top. We actually do a little bit of analytics on top of this, using some artificial intelligence connections to identify when a condition exists and has been diagnosed somewhere else in the healthcare system or when a condition might exist.
That in particular, we've been tracking. We haven't been tracking all instances, but we have been tracking those. What we can see is 22% of the time a doctor is seeing that and making some change in the treatment plan for the patient. This could be that they are changing a dosage. This could even just be that they're acknowledging that a distinct underlying condition exists and altering another part of the care plan. It could be that they're changing their hypertension medications now that they've been made aware that they're on depression and alprazolam. It could be that they're changing that, but 22% of the time they're changing the treatment plan of the patient.
Sal Daher: Okay, but how do you ascribe that they're changing the treatment plan to the fact that you're providing additional information? What percentage of the time do they change the treatment plan for the patient sort of a control group? Is there a control?
Ryan Hess: For the 22% it's very specific to a set of conditions that that patient has had. What we're measuring is before the patient walked in they were on this specific medication for behavioral health and it was changed. In general, you're looking at like 5% of the time that will have changed, 22% of the time when we intervene and say, "Look, here's a better picture of the behavior health for the patient. Here are some things you might not have known." They are making a change. It is a substantial increase in terms of the adjustments.
Sal Daher: You're 4X-ing the level of information that the primary care physician has effectively?
Ryan Hess: We're 4X-ing the action of the primary care provider.
Sal Daher: The action. Right.
Ryan Hess: It's going to be a one-time adjustment where many of these times the patient is coming back and the provider then already has a better picture. To a degree, there's this first-time adjustment now that they get a much clearer picture. Again, this is just in behavioral health. We measure this aspect. They get a much clearer picture and they make an adjustment. After that, it becomes more fine-tuning, but there's that one time where we are just materially improving the picture of the patient, highlighting specific things in behavioral health, and making a much better treatment plan for those patients.
Sal Daher: It makes sense then that should be tracking cohorts, just to see the impact of the initial spike in actions that the primary care physician is taking. Is this more or less what you expected? Is this more than what you expected, the more than 4X increase in actions taken?
Ryan Hess: As I mentioned, I've been doing interoperability for a long time. 22% action is actually a very, very high activity rate. Normally what you're used to seeing is if a health plan is sending in a notification, you're getting about a 2% to 3% action rate on those.
Sal Daher: Wow.
"... it's something a provider wants to see because they want that short story..."
Ryan Hess: Meaning that the provider looks at that and does something. Most of the time everybody knows this. Most of the time nobody even looks at it. Most of the time it's sent in and it just goes straight into the recycling bin.
Sal Daher: Your information is more like 7 to 10X, more actionable than the information that was previously provided.
Ryan Hess: Its critical characteristics are it's something a provider wants to see because they want that short story. They want to know that short story of the patient, and then getting it into the EHR workflow is the other really important part. There's no hope of getting a provider to look at something outside that came in over the fax machine or that has a separate website. It's got to go into the EHR the day before the patient arrives is really important aspect of the service.
Sal Daher: Okay. Where are you in terms of how many primary care physicians you're serving and how many patients are on board?
Ryan Hess: There's three different clinics working up and down the East Coast. Working with clinics in Massachusetts, New York, Pennsylvania. Those are the ones that we've started with. We've seen tens of thousand patients at this point. The patients aren't enrolled per se, the patients it's as they come into the provider's office that we see them. That's where we are today. We've got three more pilots going. Again, expanding the geographies a little bit. Now we're starting to go a little bit west across the United States. The service works nationally. We've tested it in 20 different states. We've got three more pilots going and we're expecting to see the same results there as well.
Sal Daher: We're talking about tens of thousands of patients whose medical record were pulled because they were seeing a primary care physician in your three pilot programs.
Ryan Hess: Correct.
Sal Daher: You have many times those tens of thousands. You might have hundreds of thousands of patients but they haven't been to the physician.
Ryan Hess: They haven't shown up to their doctor.
Sal Daher: Yes. Haven't shown up yet. Very good. Very interesting. You're having off-the-charts results in terms of providing meaningful information in terms of changing the course of treatment for the patients. What are the kinds of metrics are you expecting to get to validate this to payers and to other people who might be making decisions about signing up to Connective Health?
Ryan Hess: The key things that we're measuring now, the six-month results that we're measuring, are diagnosis rate. For the complex areas, they need to be diagnosed. You increase the diagnosis rate, you're going to prevent long downstream effects of emergency room admissions, acute stays. Measuring diagnosis rate. We're measuring the quality of the treatment for something like depression that oftentimes correlates to the strength of dosage, and we're measuring things like referral success rates. If the PCP truly cannot handle the treatment for that patient, are they making a successful referral out?
Those are the three things that we're looking at now, which we know tie very well to total cost downstream which are emergency department visits, acute stay admissions. Those are the big things that we're all trying to avoid.
Sal Daher: Okay. You're trying to prove out that in the next six months you're going to be affecting changes relating to diagnoses and prescription and referrals that are very highly correlated with improved results and reduced costs?
Ryan Hess: Correct.
Sal Daher: Very good. What's the plan? Let's say you hit the marks in there as you've done. So far the results you have is off the charts. Let's say that you have consistently good results with these other measures, what's the next step for Connective Health?
Connective Health's Next Step
Ryan Hess: Our goal is to make sure that every primary care visit is well supported. That's our goal, to really revolutionize how primary care is done in the US. That is through meaningful interoperability, so making sure the primary care provider knows every place the patient has been, and then really helping them. Every time you go in a primary care provider visit, they're going through the same heuristics in their mind, like let's think through whether this person might have hypertension, let's think through if they might have diabetes, let's think through if there might be a behavioral condition.
We can take all of those heuristics and put them into a little bit of artificial intelligence to say, "Hey, we'll look for the clinical and social markers for you and we'll tee them up." Our aspiration, our vision is to make sure that every primary care provider is well supported with the story and then well supported with that intelligence so that they can really just engage the patient. It's the way it's meant to be.
Sal Daher: Basically the primary care physician would have a roadmap for what directions they might take in their conversations with the patient that might be more fruitful than other directions. Like, "There are various paths you can take. We think this could be a very fruitful path. Maybe you could explore that."
Ryan Hess: I'd say that's a good summary. I would say that if you think about it from the perspective of the average visit is 12 minutes, right now they spend 10 minutes just finding out about you, and then two minutes saying, "Okay, let's come up with the treatment plan." We want to make that the reverse. Let's make sure they spend two minutes finding out about you and know everything about you now and then 10 minutes talking with you about your treatment plan.
Sal Daher: Excellent. Very good. Explain to me what you anticipate at this moment is going to be the business model for Connective Health. How are we going to make money in Connective Health? By the way, I'm an investor in Connective Health. I'm a continuing investor. I'm planning to participate in future rounds if things continue to go well, so very, very interested to know.
Ryan Hess: The business model is that we improve outcomes and we go to whoever is the risk-bearing entity to say, "Okay, you're receiving improved outcomes, that is what we monetize." We tie to the value that we're creating very closely. I say risk-bearing entity because in this new world that we're all in, that could mean a health plan, that could mean a primary care-centered home. There's ACOs in between those. There're all sorts of variations of risk-bearing entities today. We're selling to everybody in that space and saying, "Hey, you're the ones receiving the benefits, you're the ones who should be funding this service."
Sal Daher: Right. Common parlance. It might either be the health insurers who might be the payer. It might be the ACO, the Accountable Care Organization, which receives a per-person allowance for certain conditions and then they try to manage the care within that payment so they're responsible. It might be an individual practice that has certain reimbursements that they're receiving. Very good. Basically a percentage of what you're saving. You're being compensated on the basis of your performance in improving care and reducing costs.
Ryan Hess: Yes. That is exactly what we're pursuing.
Sal Daher: What is the team right now?
Ryan Hess: There are five of us that are on board. There is myself as the CEO. There's a director of operations. Now that we have customers up and live, we need a director of operations, a chief product officer with the vision for the product, and then two engineers who have done an amazing job in assembling and delivering the product to date.
Sal Daher: Excellent. Do you want to give a shout-out to people, mention names?
Ryan Hess: Chris DiBlasi is the chief product officer; Caroline Wight is our director of operations, and then we have two other engineers. I didn't ask if I could name the engineers.
Sal Daher: Oh, no, no, no, no, no they might not want to be named. Okay. Just the people who are in the nameplate. When you get the evidence that you hope to get in the next six months, how is it that you are going to reach out? How is it that you're going to get the world to find out about the tremendous value of what you're doing? Are you going to create an inside sales force?
Ryan Hess: From the go-to-market approach, because we're approaching the risk-bearing entities, they're the ones that we engage and we do need the provider engaged. What we've found is that when we go to the health plans, and we're in discussions with a number of health plans now, they want to introduce us to the primary care providers. They want credit for, "Hey, I am solving something. I am making your life easier. I am helping you treat the patients."
They generally want credit so they actually are great evangelists for us where they see the benefits and they want to go out to the primary care community to say, "Hey, there is a great solution here. It will save you time. It will actually help you make more money. The PCPs make more money because they can get higher health plan quality ratings, and it will help you deliver better care. It's a wonderful thing for you. It's a wonderful thing for the health plan, it's a wonderful thing for the primary care provider." Generally, they are helping us evangelize the primary care providers.
Sal Daher: I remember from our previous interview that one of the really satisfying things in this work that you're doing is that all the incentives are aligned in the same direction. The provider, the payers. Everybody wants more effective healthcare, fewer mess-ups so that the patient gets the best treatment and then they end up spending less money. Better treatment means lower costs. Less waste, less frustration, and fewer missed opportunities.
Ryan Hess: It is well-aligned and it's what we've all been aiming for. Interoperability really is something, as I mentioned before, that's something we've all been aiming for too. The doctor should know that short story about you. The specialist should know that short story about you, right?
Sal Daher: Right.
Ryan Hess: We have a wonderful system, but we just need to connect it a little bit better.
Sal Daher: That is so important because I see so many startups, particularly in this area of digital health which are precisely about bringing in different types of information to bear in different ways. What you're saying is that the payers will have a very strong motivation. The payers are a handful, so they're easy for you to find. They will have a very strong incentive once you present evidence to them to go to the primary care physician and say, "Hey, pay attention to these guys. They are going to make you money, they are going to help you have better care of your patients, they're going to save you headaches. You're going to have fewer gray hairs working with the system."
You're counting on the payers to be your evangelists, and the payers are a limited number to get to, so that's what makes the whole thing doable in terms of getting out to the primary care physicians. You're not going to be chasing primary care physicians individually. They're going to be attracted, they're going to be prompted to action by the payers.
Ryan Hess: Right. In this world that we live in, it could be a payer, meaning a Blue Cross Blue Shield entity that is doing it, or it could be somebody like UnitedHealth Group, who also happens to employ 75,000 primary care providers. The line between that payer and that risk-bearing provider is a little bit blurred, but yes, it will be the risk-bearing entity that's saying, "This is great for me. I will either introduce you to or I already employ and I will simply push out to my providers, so long as they accept it, your service."
Sal Daher: Excellent. Good. Ryan, are they any other thoughts that you want to communicate to our audience, things that we haven't covered in our conversation so far?
"... if it is a provider that is about to deliver treatment and there is an entity that has your data, that entity, as long as it's under the realm of HIPAA, can provide that data to the provider..."
Ryan Hess: I think the surprising thing that we still run into pretty frequently is a misunderstanding of how available the data is.
Sal Daher: Aah, okay. Which is a question that I had myself in the beginning.
Ryan Hess: We had a conversation just yesterday with a medium-sized clinic with some folks that have been in healthcare a long time that were still under the belief that the patient has to authorize access to the data for every instance.
Sal Daher: Yes.
Ryan Hess: That was done away with 21st Century Cures. What is stated is that if it is a provider that is about to deliver treatment and there is an entity that has your data, that entity, as long as it's under the realm of HIPAA, can provide that data to the provider. The patient can opt out, but the patient does not have to opt in. All patient data, as long as you can find the place that it's stored and that entity is willing to follow the guidelines, that data is accessible.
Sal Daher: Okay. There's a change in regulation. Would you state the name of it again and unpack it a little bit, please.
Ryan Hess: Yes. There was actually a couple of rounds, 21st Century Cures was the latest one, and that was really the latest push to say, "Hey, this information is available, please make use of it." The regulations actually in that go so far as to say, "Hey, if you have the data and you do not give it up you will be fined." It's gone beyond simply setting a construct of here's when you can access it. They are now saying, "You the holders of the data must allow access to it or we will fine you."
21st Century Cures was the latest iteration of it. It goes back to the HITECH act, and there's a couple of other acts even before that that have a established the guidelines for this to happen, but the government has kept pushing it and pushing it to the point where the data really is available.
Sal Daher: This is very promising. We're about to see an explosion of interoperability in an area that has been very siloed before because of this regulatory change, so you're plowing fertile field here in season.
Ryan Hess: I like that analogy.
Sal Daher: That is tremendous. Let's emphasize that again because I remember when I first connected with you, I spoke with my daughter who's a primary care physician, and her first objection was exactly that. She said, "Oh, this will never work. They will have to get so many approvals for every bit of data they're going to get. It's not going to work. It'd be great to have it. We need it, but they can't do it."
Then the interview, Delivering on the Promise of Medical Records, there was already some changes that were in place at that time that Martin determined, "Yes, it can be done," because Martin is in this space. He's moving data from medical records to medical records all the time. This is so funny that you should mention this. I'm going to tell my daughter this. I got to tell her, "Your objection, 21st Century Cures." She'll be very interested to hear this. Very good. Any other thoughts that you want to leave our audience or founders and angel investors?
Advice to the Audience
Ryan Hess: Yes. I'd say that solve a problem. There is a million problems in the healthcare system. We as Connective and me personally, I have a strong belief that you need to find a problem that you can solve and just keep going after it and keep working at it and working at it. It can be solved. Every problem in healthcare can be solved. Now more so than ever. Keep focusing at it and we will make the healthcare system better.
Sal Daher: Right. It sounds as a-- There's a Brazilian image. You have the knife and the cheese in hand, so you can just start serving yourself some cheese. The problem very often is that you have the cheese, but you don't have a knife, or you have a knife but you have no cheese, but this guy has a cheese and a knife in hand. I talk this in the day where I'm fasting.
[laughter]
So I have all these food images, but we won't go into any details about that. Anyway, very good. Well, Ryan, I'm very grateful to you for making the time to catch our audience up on this really, really-- A very important aspect. Because as we discussed in delivering on the promise of medical records, medical records are an accident. They were created as a way for the healthcare providers, the hospitals, and the people who are actually delivering medical care to be paid by the payers, by the insurance companies and all the different payers, so they were designed in a way that is not conducive to sharing information.
Information is very siloed. For a long time, we couldn't have information moving from one system to another. There are a lot of legacy systems, but there have been a lot of efforts over the years to make that information useful because so much time is spent on gathering that information, and there's a massive amounts of it. Now I think we're just beginning to see the dawn on this idea of interoperability, of the information that's in the medical records being actually valuable for the patient. This is a really very heartening, very promising moment.
In another area that I invest in, in the area of wet lab or biotech stuff that I do, this is a 10-year anniversary of the first cell therapy that was applied. There was a young woman named Emily Whitehead, who had a very terrible childhood cancer, and she has been in remission now for 10 years because of this first CAR T-cell treatment, this first cell-based treatment for a horrible childhood blood cancer leukemia. I can imagine what impact this is going to have, that we can have information in the medical records actually made useful to the primary care physician. Medical records have been around now for what? 40 years. This is like the dawn of effective medical records.
Ryan Hess: We completely agree. That is the mission of Connective Health, is to unlock that data and make it meaningful for primary care providers to improve care.
Sal Daher: Tremendous. Thanks again.
Ryan Hess: Yes. Thank you for having me, Sal. Wonderful to be talking to you.
Sal Daher: This is Angel Invest Boston. I'm Sal Daher. Thanks for listening.
[music]
I'm glad you were able to join us. Our engineer is Raul Rosa. Our theme is composed by John McKusick. Our graphic design is by Katharine Woodman-Maynard. Our host is coached by Grace Daher.