Emerging Applications for Telemedicine: Q&A with Clay Whitehead, CO-CEO and Founder, PresenceLearning

Recent Joint Commission requirement changes and tighter standards for stroke centers are creating partnership opportunities for telemedicine companies.  Alix Oliver, Director at Oxeon, had a chance to catch-up with Clay Whitehead, Co-CEO & Co-Founder of PresenceLearning, an Oxeon client and investment, a technology company that connects speech, behavioral and occupational therapists with patients in need. Telemedicine isn't new. In fact, physicians started experimenting with telephonic dissemination of diagnoses and treatment in the late 19th century. Nonetheless, the topic finds its way into the popular press regularly, as government and private payers expand coverage and providers find new and innovative ways to leverage telemedicine technologies in attempts to reduce costs, increase patient access, and improve outcomes.

Earlier this year, UnitedHealth announced plans to cover telemedicine services for 20 million members by January 2016 (Aetna and Cigna have offered some telemedicine coverage since 2011 and 2013, respectively). Just this month, Mercy Health in Saint Louis unveiled the nation's first-ever virtual care center to house over 75 telemedicine programs and 300 clinicians and support staff. The $54m facility will enable Mercy to monitor nearly 4,000 chronically ill patients across five states, in addition to other services.

Medicare Part B, which covers diagnostic and preventative services and supplies, currently includes coverage for "certain" videoconferencing services for beneficiaries in "some rural areas." Yet as the aging baby-boomer population's need for home-based care and monitoring increases, many predict/speculate that the federal behemoth will expand coverage for videoconferencing [coverage. Medicaid reimbursement for telehealth is broadly determined at the state level, but in September of this year Washington joined 10 other states in recognizing telemedicine as an "allowable mode" for delivering speech-language, occupational, and other therapies from qualified practitioners in school settings.

One of Oxeon's newest (and most awesome, in my opinion) clients, PresenceLearning is a San Francisco-based technology company that specializes in linking speech therapists with patients in need. With plans to add services in behavioral and occupational therapies, Presence is uniquely positioned to partner with schools, school districts, and now health systems, as Medicaid expands reimbursement policies.

I had the chance to catch-up with PresenceLearning Co-CEO and Co-Founder Clay Whitehead on the changing telemedicine landscape and the amazing work they're doing to enable students across the country to broaden their impact and push virtual care to its fullest potential.

Why did you and Jack decide to build PresenceLearning and the platform?

When I was in first grade, I was diagnosed with learning disabilities, ADHD, and dyslexia. Overcoming those challenges and turning it around was a huge part of my childhood, but I was lucky. I was gifted and had great family support. My co-founder Jack grew up with a cousin on the autism spectrum who is non-verbal.  We both knew the huge impact that complex mental, behavioral, and physical conditions can have on children throughout their lives, and wanted to leverage both our own experiences and our passion for technology to help others at a massive scale.

So, we developed a telemedicine marketplace for mental and behavioral health professionals,speech therapists, occupational therapists and other professionals to connect with patients from our enterprise customers, and a platform that allows them to deliver high quality services remotely. We have a full telemedicine solution that encompasses everything from the softer aspects of service to all the things that technology is great at, like workflow automation, billing, scheduling, and progress tracking.

We started PresenceLearning to give all kids a chance, and we're well on our way to doing that, having seen some fantastic growth. Now that we have five years of experience in providing high quality services at scale -- we're currently delivering over 3,000 sessions per day -- we are excited to expand our mission to helping everyone, and not just children, unlock their potential through telemedicine.

How have you been so successful in selling in the education market?

The number one reason we've been successful is the positive impact that we have on the lives of the children we serve. Every year, there are kids who abandon plans to commit suicide, say their first words ever to their parents, or leave their own house for the first time in years because of the care our clinicians deliver. It's things big and small, from the way that our patients are beating the national outcome averages to the way that many of them are now happy and excited about attending therapy for the first time. So, as families and institutions struggle with a massive national shortage of care professionals, we are increasingly being seen as a new, key part of our enterprise client's continuum of care.

But, obviously, a lot goes into creating that impact and getting those results at scale. We are maniacally focused on attracting and retaining only the best clinicians. In fact, we only have a 5% acceptance rate for clinicians. Beyond that, we think deeply about how we recruit, how we help foster professional development, and how we use data to continually improve.

From a technology standpoint, we break down each part of the experience of every one of our stakeholders -- patients and their caregivers, payers, and any supporting professionals -- and take a design-centered approach to developing elegant patient- and clinician-centric solutions. That approach shows up in our games, therapy tools, progress tracking, and other platform components, and it reflects our passion in bringing the best of Silicon Valley -- our home -- to the world of health care.

What are the most notable trends you’ve observed in telehealth since launching the company?

Attitudes have changed dramatically. As recently as 2013, when we brought up telemedicine with potential partners, they asked us what it was and openly wondered why their peers might use it. Now, not only is there an awareness of telemedicine as a category, but people generally understand the benefits. I think that this increased acceptance is a part of a cultural shift. We have all come to expect high-quality, high-convenience services with almost instant access in so many parts of our lives thanks to Uber, Instacart, and other services. In addition, video has truly become ubiquitous now that everyone has a smart phone in their pocket. Patients and decision makers feel comfortable with telemedicine now, and they both want and need it. It's easy to forget that this wasn't the case just a few short years ago.

Can you talk about your work with hospitals and stroke centers?

We have developed an incredible expertise in delivering online care, conducting over 3,000 sessions per day. That experience allows us to see a lot of new opportunities and to ensure that we have high-quality implementations with partners.

As a result of this track-record, we are increasingly being invited into stroke centers to perform speech therapy evaluations, among other services. Timely speech therapy evaluations are a critical, evidence-based part of treating every stroke patient, as swallowing issues can cause serious complications and even death. In addition, tightening Joint Commission requirements and stroke centers raising their own standards are increasingly driving adoption of telemedicine in this area.

We've seen a great deal of excitement from our partners, once they realize our scale and capabilities, to expand into other services and other settings, including outpatient.

Can you tell me about the new platform and the features and functionality you’ll be introducing?

Since our mission is to help everyone unlock their full potential through telemedicine, we focus our development efforts on three things. First, we focus on increasing access, and so, in our latest release, we halved our bandwidth and CPU requirements and redesigned our whole experience to be native on tablets. This means that the cost and infrastructure barriers to using our services are now next to negligible. Second, we focus on greater patient and clinician engagement. We now have a much more streamlined interface, better tools, and more engaging therapy content. Last, we focus on efficiency, so we also revamped our whole backend infrastructure, including scheduling, clinician matching and more, to equip us to provide ever larger numbers of patients at the the high standard of care demanded of us every day.

Can you talk a bit about your and Jack’s vision for PresenceLearning?

Our vision has always been the same: a global marketplace, paired with a best-in-class platform for the delivery of services, that ensures that everyone has access to the care they need when they need it. For us, that vision means that we will continually be entering new clinical areas and working with new populations. We've proven this model, starting out by providing just one service to schools, expanding to five, and now working with hospitals and stroke centers. We're excited to see this vision coming to life. We know that there is no shortage of hard work ahead, but wake up every day excited to make even more progress towards this vision.















Managing Partner Trevor Price talks healthcare, early-stage investing and entrepreneurship in Relentless Health’s latest podcast

Managing Partner Trevor Price talks healthcare, early-stage investing and entrepreneurship in Relentless Health’s latest podcast. Relentless Health Value is a weekly interview podcast hosted by Stacey Richter, a healthcare entrepreneur celebrating fifteen successful years in the business side of healthcare. Click here to listen>>>

Bryan Sivak discusses the inextricable link between healthcare’s two most influential trends

Oxeon Associate Liam Gallagher recently sat down with Bryan Sivak, former Chief Technology Officer of the U.S. Department of Health and Human Services, to discuss some of the biggest risks facing emerging models within healthcare. Topics covered include the challenges of employer-sponsorship, consumerization, and end-of-life care. Liam Gallagher joined the Oxeon team by way of Williams College where he majored in Chemistry and English. Eventually, he hopes to apply his experience on the business side of healthcare as a physician.

[dropcap]LG:[/dropcap] Bryan, you and I spoke earlier this year about the two big transformations in healthcare: consumerization and accountable care. I’d been stuck on this concern that value-based tools, like telemedicine, were really being adopted to drive patient acquisition and retention, a primarily volume-driven, fee-for-service strategy. As a skeptic at heart, I was really enjoying the question, and then you ruined my fun with a great explanation of how these two transformations are inextricably connected.

[dropcap]BS:[/dropcap] Well, when providers are taking on risk for a population of patients, they’re accountable for future healthcare costs. The proactive strategy for these groups is to invest in the health of the population with preventative medicine and better-coordinated care to make for a healthier group in the future. For that to be a feasible investment model, you’ve got to hold on to your population of patients for their years of relatively healthy living. That’s why patient retention, which might seem like a FFS strategy, is actually key to the success of accountable care models. So, telemedicine and patient-centric models might be doubly valuable to accountable care. From the clinical side, they drive improved outcomes in a cost efficient way. On the experience side, they’re very convenient and might improve patient retention.

That connection is part of the challenge with employer health plans. When an employer thinks about investing in the health of a particular employee with rich benefits, the decision is going to depend on the long-term employment of that employee. Especially today, that employee is likely going to jump ship at some point, and the employer will lose any resources it’s invested in his or her health. That’s one of the biggest challenges in the employer-sponsored framework we have in this country, and maybe why that framework doesn’t make the most sense.

[dropcap]LG:[/dropcap] If customer segmentation in healthcare happens along the lines of the retail world – say like Nordstrom's, Macy’s, and JCPenney, – do you see a risk of creating consumer-selected "classes of care”? Of course, there’s already inequality in access to good healthcare today, but do you see consumerization of health improving or worsening that?

[dropcap]BS:[/dropcap] With healthcare in particular, you’re likely going to find that people who are better off socioeconomically are going to invest more of their time and available resources in their health than those with less resources. It’s unfortunate because that’s probably the opposite of what the need is. One of the possible exciting outcomes of accountable care is that investments are made in helping people in lower socioeconomic strata become healthier simply because there’s a greater potential to save. But, in order to realize those savings, the model of medicine will need to change fundamentally.

A lot of provider networks voice a desire to change today, but are making so much money on the current system that it’s very difficult for them to envision taking on risk and not losing their shirts. And, to date, there have not been a large number of providers that have picked up risk and made money. There’s a lot of progress to be made on that front. That said, there’s no argument that the way the system is set up today is not sustainable.

[dropcap]LG:[/dropcap] We had an OxTalk, what we call our Ted-style learning lunches, with Heidi Allen, one of the investigators on the Oregon Medicaid experiment. The answer, I think, a lot of people were hoping to get from the study was that access to healthcare was enough by itself to improve health and reduce costs. The results showed that the patients did get healthier, but it certainly cost more. Does that point the finger at what we’re actually paying for when we spend on healthcare?

[dropcap]BS:[/dropcap] Sure, the people in the Oregon experiment were suddenly given access to healthcare, but they weren’t given adequate training on how to actually use that access. If you had never been to a doctor before, would you know to seek out a relationship with a PCP or where to even start? I would like to know what the result would have been if they had sub-selected a group of those given coverage and also educated them on how to navigate the system appropriately. Would that reduce costs over time because people are given access and trained to use it in the best way?

[dropcap]LG:[/dropcap] The other way you might approach the challenge could be to incent proper utilization. There may not be much cost-tolerance with Medicaid beneficiaries, but couldn’t you make going to a PCP a much more convenient and enjoyable experience than the ER?

[dropcap]BS:[/dropcap] Well, seeing a PCP is already more enjoyable than the ER. It’s still necessary to communicate that the PCP is even an option. How do you tell someone who has only used the ER that now you can go to a Minute Clinic and you don’t have wait? There are other factors than cost and access that have to be taken into account and I think that education is a huge one.

[dropcap]LG:[/dropcap] When people are healthy, it seems like there’s a neat alignment of costs, outcomes, and experience driven by accountability for downstream costs. What happens when people do get sick, terminally so, and that feedback loop no longer exists? I guess the question is whether transformation of our care model or a cultural transformation around end-of-life?

[dropcap]BS:[/dropcap] Have you read Atul Gawande’s Being Mortal?

[dropcap]LG:[/dropcap] I have – it’s basically required reading at Oxeon.

[dropcap]BS:[/dropcap] I’m a huge fan in general of Gawande, but that book, in particular, was one of the most important things I’ve read in the last decade. To me, it very clearly illustrates the way both physicians and the rest of society need to change the way we think about end-of-life. The thing that really stuck with me was his point that physicians are trained to treat disease as an enemy to be eradicated at all costs. It makes perfect sense, but at the end of the day, death can only be deferred so long. The question Gawande learned to ask, partially through his father’s illness but also as a public health guy, is how can we maximize the enjoyment of the time that is left? Is being stuck in the ICU for the next six months attached to five machines an existence that makes sense? Maybe for some people it is, but in general, people are never really given that choice in a way that is accessible. To answer your question about whether it’s a cultural transformation or clinical transformation that’s necessary: I think it’s both.

The interesting side effect of providing patients with the information to enable them to actually make a decision between the ICU and their homes is that it will inevitably reduce costs. Some huge percentage of total healthcare costs is in the last six months of a person’s life because the medical default at this point is to treat aggressively until the end. With the cultural changes underway, I think that if you enable patients to decide, you’re going to see at least some choose the option that ultimately costs the government less.

I was talking to my friend the other day, whose father has cancer. The decision they were facing was between an operation that would give him maybe a few more months to spend with his family in an idyllic setting, or not do it and have shorter period of time without the family trip. He chose to do it, and you can’t fault that choice because ultimately he made his decision based on what would make a better day or few months.

[dropcap]LG:[/dropcap] There’s definitely a lot of tricky calculus in these decisions as well. It’s hard to evaluate a treatment that might give you 50% odds at living a year longer, 20% at two years, and 1% at five years. How do you weigh those complicated odds, against the other 50% odds you don’t live longer and endure more pain?

[dropcap]BS:[/dropcap] Maybe, that’s the wrong way to ask the question. It doesn’t have be a trade off between a procedure and time. The point that Gawande makes is that it’s all about the quality: which option is going to allow me to find the most enjoyment. Part of the challenge is that we all know of someone who’s taken the long-odds operation and it’s saved their life. It’s easy to hear those stories and hold out hope, but the odds are the odds.

[dropcap]LG:[/dropcap] One piece of evidence for your point that we’re overly focused on how long and not how well is that treatments are evaluated primarily on their ability to fend off death. It’s exciting to imagine a world where the success of a clinical trial is measured in the quality of life delivered, but pulling that off seems tricky.

[dropcap]BS:[/dropcap] Tricky because it’s subjective. Your enjoyable day might look very different than mine. Maybe, my great day is one I spend surfing and, if I can’t surf, I’m not interested. Yours could be spending it in your home with family, maybe not even talking.

It’s where healthcare and medicine get really tricky. On one level, it’s a science, but at the same time, there’s an art to it. My dad’s a doctor, and I’ve talked to him about this in the past. One of the things he’s pointed out is that you can have algorithms and pattern matching for lots of things in medicine, but at the end of the day, a lot of skill as a physician comes down to this art of medicine: the way you talk to someone and the way you listen to someone. That’s something that’s often lost in a lot of our conversations because it’s easier to think of medicine as a science and set of rules about how to diagnose and treat. At the end of the day, though, it misses the art and human interaction that’s at the heart of healthcare.

OxTalk 3.0: Marcus Zachary

Recent Oxeon placement Marcus Zachary took some time out of his day today to swing by our office and have a discussion as part of our OxTalk series. Topics covered included his work with Pioneer ACOs, the importance of culture in change management and how health plan consolidation has its similarities to Star Wars.

Marcus joined Evolent Health as a Senior Vice President & West Coast Regional Medical Executive. Marcus joins from Brown & Toland Medical Group, where he was Vice President for Quality and Senior Medical Director of Population Health. Evolent Health offers the first provider-led, fully integrated platform for population and health plan management to leading health systems.  

Click here for more information on Evolent Health>>>

Q&A with Owen Tripp, Co-Founder and CEO, Grand Rounds Health

Following Grand Rounds Health recent announcement of a Series B with Greylock Partners, Oxeon Associate Kate Herr sat down with Owen Tripp, Co-Founder and CEO at Grand Rounds.  The two delved into the driving mission behind Grand Rounds, the thought and work that goes into building a successful business, and some of the key milestones Grand Rounds has accomplished.  You can find the complete interview on our website where Owen discusses future goals for the company. [dropcap]Q:[/dropcap] Where did the idea behind Grand Rounds come from and how did that idea come to fruition?

My co-founder is Dr. Rusty Hofmann, the Chief of Interventional Radiology at Stanford.  Several years ago, his son Grady was diagnosed with a rare immunological condition.  Because of Rusty’s unique connection to specialists practicing at the leading edge of medicine, he was able to bring together the ideal set of experts from across the country, and get Grady the life-saving care he needed.  Reflecting on this experience, Rusty was all too aware how different the outcome would have been for the average parent, so we committed to build Grand Rounds to democratize access to the best medical experts and ensure that everyone could benefit from the quality of care that had saved Grady’s life.

The more we learned about the huge variation in quality of care in the US, the more confident we became in the massive impact that Grand Rounds can have.  Countless studies have documented the billions of dollars wasted on inappropriate or ineffective care, and the human cost is equally staggering.  The problem is concentrated in the small portion of the population that needs the most intense care – the 6% of patients that drive over 60% of cost.  We know that our experts deliver meaningfully superior care to that population, with lower mortality, faster adoption of improved techniques, and greater avoidance of unnecessary procedures.

Once we started showing our customers what we could deliver, we realized that this was something that they needed and wanted—and that no one was doing it right yet. We started with our Expert Opinion service, which provides access to a “virtual clinic” where patients can work with a top medical expert from anywhere in the country. Then we leveraged our expertise and data and expanded into Office Visits (to find a top specialist in the patient’s geography and within their insurance network) and STAT (expert help while the patient is in the hospital).

[dropcap]Q:[/dropcap] As a second time founder, what are the differences you see in building Grand Rounds compared to Reputation.com? Similarities?

Reputation.com was a fantastic experience, but Grand Rounds is a special mission and is definitely the endeavor I am most proud of.  As an entrepreneur, I want to solve the biggest problems in the world—the ones that really matter. Grand Rounds is about fixing something really broken in the healthcare system: people’s inability to find and access the best medical care when they need it most. I’ve been more energized and received more satisfaction in figuring out how to knock down the enormous walls that separate people from quality health care than anything else I’ve done.

It has also been hugely rewarding to build a team of people that are as deeply passionate about solving this problem as I am.  Our sense of mission pervades the organization, and drives everyone to do their absolute best to make us a success.

[dropcap]Q:[/dropcap] In your opinion, what is the most critical factor in building a successful business? And how have you incorporated that into building Grand Rounds?

When you’re doing something this important, it’s critical to surround yourself with a core team who understands and believes in your mission. And equally as important, you need to maintain a relentless focus on hiring the best people.  I commit to our team that I will give them peers and leaders that they will learn from and feel privileged to work with, and I expect them to maintain that rigor throughout the organization.  I look around the table at my executive team and am continually impressed by how much they teach me and the company.

[dropcap]Q:[/dropcap] You recently announced that you raised $40M in series B funding from Greylock Partners (congratulations!), in addition to partnering with Venrock; can you go into a bit of detail on how the deal came together? What does this funding mean for Grand Rounds?

The funding is great news, but our sights are really set on the growth of covered lives. In tandem with the funding, we’ve passed the milestone of 1 million covered lives.  Our sights are now set on quickly accelerating to 5 million covered lives, as well as developing additional products and channels that will deliver high quality medical outcomes for patients all over the country. Getting our solution to as many patients as possible really drives what we’re doing.

[dropcap]Q:[/dropcap] What is one of your favorite success stories so far in terms of human impact? Pick one.

I’ve heard so many incredible patient stories come through Grand Rounds that it’s hard to pick just one. We recently had a 22 year old college student successfully treat multiple brain tumors with one of the most amazing surgeons in the country and he’s already walking around and on with his normal life—that type of situation could have gone a million different ways. Or how about the multiple patients who we’ve helped avoid amputations by connecting them with leading experts who knew how to perform leg-saving surgeries when no one else could? What we try to produce is a warm positive, empathetic experience while our patients are in the healthcare cycle, and then produce the best possible outcome for them.

[dropcap]Q:[/dropcap] What is one of your favorite success stories so far in terms of company growth and numbers?

I would have to say that reaching our milestone of 1 million covered lives. This is a huge population of people who need a service like Grand Rounds and deserve this level of care—and we are going to give it to them. Next step is hitting the 5 million covered lives mark, and we’ll get there fast.

[dropcap]Q:[/dropcap] What are your aspirations for Grand Rounds? What do you hope to accomplish in the next 3-5 years?  

We want everyone who can benefit from Grand Rounds to be using our product. Right now, the employer channel is the best way for us to approach that goal, and we will continue to build our presence there.  As we grow we are also expanding our connections with insurers and other market participants to ensure that all patients can benefit from the life-saving access and information we provide, not just those with a family member working at one of our employer partners.  We are also working with physicians and institutions to support their efforts to collaborate with their colleagues, making them more efficient and raising their standard of care, one hospital at a time.

An interview with Matt Dumas, who joins as a Partner at Oxeon

Matt Dumas recently joined Oxeon as a Partner. Matt runs a tight ship, and has not yet led a meeting that spills over the allotted time. He so graciously allowed me an untimed window to both grill and get to know him. I’ve been extremely impressed by his ability to dive into the madness that is Oxeon Partners, and not only stay afloat, but also tackle large scale initiatives in his first few weeks. To be frank, I’m really curious—and I imagine others are as well—to understand why Matt has joined us. I know what a special place Oxeon is with both a great team and an unbelievable ability to shape the healthcare landscape like few organizations. What never occurred to me is the possibility that someone like Matt might share this same feeling.

Matt is a straight-shooting, charismatic executive. I find him quite easy to talk to, and he displays effortless diplomacy. He has managed to ever so politely hint to yours truly that it may be in my best interest to occasionally shut up ie, “have you ever noticed that we are created with two ears and one mouth?”

Culturally, Matt fits Oxeon like a glove. He lives and breathes the Oxeon motto of doing well by doing good, and as an active guy, he immediately embraced the Oxeon FitBit challenge. He has upped the office fashion game one hundred-fold with his occasional pocket square, and brings a more worldly perspective having lived in Germany and Switzerland.

[dropcap]Q:[/dropcap] Matt, how would you describe your professional career prior to Oxeon Partners?

Having led new ventures and turn-arounds in both large and small companies the vast majority of my career, I am an entrepreneur at heart. I was lucky early in my career to have mentors at P&G and Nielsen who saw me as an entrepreneurial business builder who was comfortable tackling new business opportunities and broken business models. After 15 years working at both companies, I led multiple high growth ventures across 14 different country markets. Inclusive of these ventures was the launch of a new Pampers European franchise and the build out of Nielsen Health here in the US. I eventually started my own company in 2009 focused on healthcare analytics and technology and have never looked back given the amazing opportunities in this space. Most recently, I was working on the turnaround of WebMD as SVP and Head of Marketing

[dropcap]Q:[/dropcap] In touching on your earliest of entrepreneurial days, what exactly were you creating in your dorm room at Colby College?

While most of my friends were doing what most college kids do, I found myself focused on the poor quality of Colby’s drinking water. Despite being located in Maine, an area people associate with pure spring water, I found the old campus pipes created a horrible taste and smell. I started a bottled water company as an alternative that delivered bottles directly to the dorm rooms and faculty offices. The majority of students lived on campus, and as you can imagine, the business took off, so I needed teams of friends to help with delivery. Early on I learned about the power of subscription revenue models, contract manufacturing, and managing people. I eventually sold the company before graduation. I wouldn’t exactly describe it as a Facebook exit. All joking aside, that early experience gave me the momentum and confidence to pursue new ventures for the rest of my career.

[dropcap]Q:[/dropcap] As the 5th employee at Oxeon, I have personally watched an idea spark and catch fire into a full-fledged business and given my work here in executive search, I witness operations in larger and more mature organizations. I would imagine you bring unique perspectives on matching specific talent and skill sets to an organization regardless of their growth stage?

From experience, I know that the C-Suite talent profile requirements of a pre-revenue start-up are largely different from a later stage, more mature venture. Depending on the growth stage, management team and investor profile, the attributes necessary for a successful leader will obviously vary. The trick is to identify the winning combination of management skills and leadership attributes through a close partnership with both clients and candidates. To do that effectively for early stage businesses, one needs to leverage experience. I think my early and later stage venture experiences across different size companies, business models and company cultures, gives me an advantage.

Interestingly, Oxeon represents an excellent example of this. Trevor and the original leadership team have been incredibly successful driving company growth over the past two and a half years. Given the major scaling opportunities to take Oxeon to the next level in search and investing, Trevor needed another Partner who had the operating experience and cultural fit to do that. I’m lucky to be seen as that person, and I’m looking forward to also help search clients address their own leadership needs.

[dropcap]Q:[/dropcap] As you considered what your passions were and where you saw yourself going professionally, I understand healthcare executive search to be a no brainer. With that in mind, the million-dollar question: “how did you end up at Oxeon Partners?”

It was kind of like an arranged marriage.

Trevor and I were introduced by multiple investors and entrepreneurs who saw how we could fit together culturally while having complementary operating and industry experience. However, there were no expectations. Before meeting Trevor, all I knew about Oxeon was that their culture was incredibly unique, and they had the best professional network in healthcare. When we met, there was immediate chemistry around both life and work experiences: differentiated but quite similar. After a series of conversations and lots of drinks, I found myself sharing a desk with him - but more on that later!

When Trevor and I first met, I had already been seriously considering the Executive Search space over the last several years given the talent issues facing the healthcare technology space. As an entrepreneur with an investor mindset, I struggled with the transactional orientation of traditional executive search firms. With the lethargic legacy of innovation in healthcare technology and services when compared to the vast scientific advances, until now, there have been only a limited number of players in the industry who have the C-Level leadership and management qualities from years and years of experience. With the overall transformation of the healthcare system, we are now seeing early stage healthcare technology related companies reach Series A, B and C funding stages as they try to scale into larger more mature businesses. In most cases, these investors and management teams need help in finding executives who know how to do this. Given my background and interest in talent, I see this as a tremendous career opportunity and a real way to make an impact on how our healthcare system transforms over the next few years. After spending time with Trevor and the team, it was clear to me that Oxeon, with its unique business model and culture, was the best place to do that.

[dropcap]Q:[/dropcap] Just as you talk about executive level talent being critical for our clients to move to the next level of success, the parallel need clearly exists at Oxeon Partners. As Oxeon continues to grow and evolve, where do you see your biggest opportunity to add value internally?

I am primarily focusing on two areas internally to help drive the scale needed to support our growth: Process and People. While keeping the unique culture alive and thriving, I see ways to introduce more efficient approaches to our research and industry outreach in a way that maximizes candidate quality and client timeliness. Our business model and culture focuses on people being the most important and unique asset. A top priority for me is to enable growth by also investing in training and management development in a way that preserves the Oxeon DNA and giving our younger leaders more responsibility.

[dropcap]Q:[/dropcap] In what is considered either the dumbest or boldest move, you are sharing a desk with Trevor. Not an office but literally a desk. What in the world is that like and why did the two of you decide to take that approach?

It’s very unconventional, but we both thought it would be the best way for me to quickly on-board with Trevor by my side. Talk about checks and balances! But seriously, with an organization like Oxeon, bringing a second senior leader into the mix is not without risk and we felt that sitting together would both help drive alignment but also would send a message to the organization that we are operating together. After two weeks, we liked the real time decision making and open communication so much that we agreed to work permanently next to each other. The architect responsible for building our new office space on Hudson Street in Soho was the one most surprised when we asked her to think last minute about how we can create a custom space for the two of us to co-locate. At least I’ll have my own desk when we move in September!

[dropcap]Q:[/dropcap] In light of some of these conversations about culture and talent, what was the best professional lesson you have learned thus far?

Regardless of industry or business model, all of us are in the people business. Through my 20 years of experiences at P&G, Nielsen, WebMD and as an entrepreneur, there has been one prevailing theme: the right combination of certain leadership attributes, personality traits and cultural norms are the electricity that fuels an organization behind every successful business. Whether working in mature businesses or building start-ups, I’ve personally experienced success and failure. The common denominator behind those experiences was the type of people involved and fit within the culture. I am at Oxeon today to leverage those experiences. [dropcap]Q:[/dropcap] Matt, I applaud you for being an active guy and a baseball fan. As a New Yorker, I take offense to your allegiance to the Boston Red Sox. When you are not in the office, what are you doing?

I am very much a family person and enjoy raising my three children with my wife, Melanie. Being an only child, I think I am vicariously living through their experiences as part of a larger family and love every minute of it. Living in Darien, Connecticut, my biggest challenge is to keep them in touch with nature and focus on boating, camping and skiing as an outlet that removes them from suburbia and the digital world. When I have the time, I still tend to my passion of fly fishing for trout or mountain biking, both in the middle of nowhere. And yes, I love the Red Sox as much as Trevor does.


Q&A with Sean Duffy, Co-Founder & CEO, Omada Health

Following Omada Health’s recent announcement of a Series B with Andreessen Horowitz, Oxeon Senior Associate and Editor of Oxeon’s newsletter ‘F.W.I.W.’ Lauren Brickman sat down with Sean Duffy, Founder and CEO at Omada. The two discussed Omada’s unique approach to digital therapeutics, their rapid growth since inception in 2011, the team they have built, and what the road ahead looks like as the company continues to expand it’s product lines and market focus. You can find the complete interview on our website. [dropcap]Q:[/dropcap] What was the inspiration behind launching Omada Health and how did the company get its start?

The founding thesis behind Omada Health was that by applying significant clinical rigor, to digital product experiences, we could build programs that delivered outcomes, that our users would love, and that the market would trust.

At the time when we incorporated (2011), a lot of the companies that built the best products in digital health didn’t necessarily have a desire to sell them into the enterprise. Additionally, their products didn’t necessarily solve clinical needs. This is the gap we saw, and we thought we could fill that void by building a company that did both things right; create engaging, delightful products, but also commercialize them on the basis of their outcomes in the enterprise health care world.

Our first product is called Prevent, and it helps people at risk for type 2 diabetes lose weight and make lifestyle change. It is based on a landmark clinical trial called the Diabetes Prevention Program (DPP) that the ACA is working to catalyze across the country via an effort called the National Diabetes Prevention Program. We work with plans, employers, and select providers to help them deploy DPP at scale.

Down the road, we’ll build a whole host of these digital programs that are increasingly known as digital therapeutics.

[dropcap]Q:[/dropcap] You had a big announcement a few months ago with a Series B round from Andreessen Horowitz, congratulations. With Omada being their first digital health investment, how did you two come together?

It was actually a fortuitous coincidence. A friend and advisor to Omada is the Chief Commercial Officer at a very successful health care company called Counsyl. One of Andreessen’s more recent GPs, Balaji Srinivasan, was one of the co-founders of Counsyl. Our advisor thought that Balaji and I would get along well, even outside the context of an investment. We met up, he was right, and the rest is history.

Andreessen Horowitz was an exciting lead for us, because the reason we’re different than other companies in our space is our blend of consumer-grade tech and design talent with serious enterprise health care chops. I wanted Omada to have a Board that reflected this diversity. Given that we already had stellar health care investors, joining forces with a16z accomplished this in spades. Many of our investors have never done deals together before, and I love that. This is the sort of diversity that will allow us to build a lasting, differentiated company.

[dropcap]Q:[/dropcap] As a first-time CEO, what has surprised you the most through Omada’s first few years?

The healthcare system in the US is complicated at a level above and beyond what I even thought was possible when I founded Omada. It’s amazing. I’m still learning every single day, and even people who’ve worked in the industry for 20 years are still turning over stones to find something new. This is equal parts frustrating and fun. You have to constantly be willing to learn and not be embarrassed to ask questions to experts. To this day, I still pick everybody’s brain possible.

The other thing that surprised me as a first-time CEO is the importance of the mentorship and infrastructure opportunities in Silicon Valley. If you’re new to this world and you’re working on your first venture – it’s extremely helpful to be surrounded by other people who have run that road ahead of you, or are running it alongside you. I left medical school to found Omada and had a lot of catching up to do on the business side. My peers and friends in the Valley have been exceptionally helpful – I appreciate them so very much.

[dropcap]Q:[/dropcap] What aspect of Omada are you most proud of? What are some of the milestone achievements that have defined the company’s success thus far?

Hands down, I’m most proud of our team. It’s a really fun mix of people, ranging from senior leaders in health care to some of the top design talent in the Valley. I mean, where else does the former Senior Director of Commercial Strategy at Gilead work alongside the former Executive Editor of Cosmopolitan?

Like our investor base, this group of people have never before sat in the same room together and worked toward the same aim. That’s the thing I’m most proud of. I’m in the fortunate place of slowly becoming the worst person to do any particular thing in my company, which is exactly how you should feel as CEO.

In terms of achievements that have defined our success, in healthcare it can be tough to get your first contract, especially with a product like ours that requires data and demonstration of results in order to get even the tiniest drop of commercial traction. There is a big lag from when you first start coding before you’re even able to sell.

Your commercial partners need to know that your program will work, and they also need to feel confident that you’re here to stay as an enterprise. Getting through the chasm this creates can be quite tricky. Signing our first big set of commercial contracts with large enterprises was an extremely meaningful milestone for us.

[dropcap]Q:[/dropcap] How have you approached building your team and can you describe the importance of culture to the organization?

The quality of our team is the thing I’ve cared about most from Day 1. I think every founder feels this. We put so much blood, sweat, and tears into recruiting the best people we could, even while we were still just a dream. This is especially important early on, because your first 10 people really help set the culture, which honestly can’t be defined or faked. The key is to hire people that put the company’s goals above their own and then reward the things you find valuable to your mission.

[dropcap]Q:[/dropcap] Oxeon first started working with you right as you were coming out of Rock Health and heading into your Series A, at which time your major focus was the employer market. Can you talk about traction you’ve gained in that space and how you’re contemplating further expansion into additional markets?

That’s actually going well – employers were a big focus for Omada early on and they continue to be a market that we serve in a significant way. We’re continuing this trajectory.

Honestly, we’ve been a little bit surprised on the plan side; we hadn’t really expected to have the level of interest from plans as we currently have. I think there are a couple reasons for that: healthplans know that they’re employer clients and member bases need innovative health-promotion solutions that work. Also, the CDC’s National Diabetes Prevention Program is gaining traction in certain pockets of the plan world. That’s why we dialed-up Oxeon again, but this time to find our head of health plan sales.

[dropcap]Q:[/dropcap] Looking forward, what are some exciting things on the horizon for Omada and can you talk about the company vision for the future?

We’re taking a swing at bat to build the Genentech for digital health. We believe it’s possible to create a whole host of behavioral science programs aimed at achieving a whole variety of health outcomes.

To get there, we’ll have to be quite deliberate, especially because getting these digital experiences right takes an extraordinary amount of time and energy. They’re not just apps. They involve a very careful cocktail of digital tools, curriculum, timelines, people, and more.

This year, we’re going to double down on our Prevent program and scale that even more broadly. In the background we’re in the planning process to see what things we might want to build next.

Q&A with Shirley Bergin, Partner, Chief Operating Officer & Chief Marketing Officer, TEDMED

Following TEDMED’s announcement last month to expand its annual gathering of thought leaders across health and medicine into a simultaneous worldwide event hosted in multiple cities, Oxeon Associate and Editor of Oxeon’s newsletter ‘F.W.I.W.’ Jamie Villadolid sat down with Shirley Bergin, Partner, COO & CMO at TEDMED, an Oxeon portfolio company. The two discussed TEDMED’s growth in recent years, its core mission and what the road ahead looks like as the company continues its global expansion. [dropcap]Q:[/dropcap] You’ve worked closely alongside TEDMED Curator and Chairman Jay Walker for about 15 years now, since the early days of Priceline.com. What was the initial motivation behind you, Jay and your leadership team getting involved with TEDMED and assuming ownership in 2011, and how did it come about?

Jay has actually been a patron of TED for some 20 years, and in 2010 its founder, Richard Saul Wurman, asked him to give a series of short talks. It was really through that that we got to know the TEDMED ethos, and we loved that mission and purpose. At the time we were already doing some work in medication adherence through our lab and as a part of our think tank, and that gave us the first behind-the-scenes viewpoint on what was happening in a very big, meaty, complex system – the healthcare system.

We see and saw that there is going to be a huge movement as people take a much more active role in demanding, prescribing and guiding the care that they receive, as well as the access to information and tools that allow them to take care of themselves in such a way that they are able to prevent many of the life threatening diseases we see today. We saw an industry just ripe for participation, ripe for multidisciplinary collaboration, ripe for people from both inside and outside of healthcare to come in and drive real change.

The more we did the research, the more we became personally invested in the opportunity to take the TEDMED brand and expand it into a meaningful platform with a unique position on health and medicine. We saw it as an opportunity to convene leaders and ideas around the important innovations in health and medicine, and a platform to form powerful collaborations that could spearhead positive, transformative impact on the future.

[dropcap]Q:[/dropcap] You had a big announcement a few weeks ago, with the news that TEDMED will hold its first live, simultaneous multi-city event this September. Can you talk a bit about the impetus behind this, and what it means for TEDMED 2014?

Even just a few years ago, TEDMED was a small, somewhat out of the way conference at a hotel in San Diego, California. Now it’s a bi-coastal gathering at The Kennedy Center in Washington D.C., being simulcast this year in an equally iconic venue to be announced in San Francisco where we have formed a powerful new partnership with University of California San Francisco, a top medical research institution in the world.

It is our objective to align and partner with premier medical research institutions around the globe as part of our continued host city expansion. The focus there is to recognize and amplify the importance of these medical institutions in innovation and in driving forward all of the work that needs to be done in the space.

For 2014, we're having those host cities in San Francisco and Washington D.C., but we're also simulcasting to 100+ countries to teaching hospitals, medical schools, non-profits and government agencies, to make sure that all of those on the frontlines of health and medicine are getting access to the amazing content that will be coming from the stage.

[dropcap]Q:[/dropcap] How else do you think TEDMED has grown in recent years?

I think we have started to look at ourselves as more than an annual event. We've grown up in that we recognize the importance of the TEDMED brand and our ability to convene both people and ideas as really important year-round. While that meaningful physical convening once a year is vital, we are also recognizing that part of the value of the TEDMED brand is in our ability to provoke the conversations around the great challenges of health and medicine. And that shouldn't happen simply one time a year, for a week. It should happen year round.

[dropcap]Q:[/dropcap] In conversations with you, Jay and the rest of the TEDMED team, you all emphasize the importance of an interdisciplinary approach to the world of health and medicine – can you elaborate on why this is such an integral part of TEDMED’s mission?

Some of the problems we face in health and medicine, like cancer, still require a specialist to drill down to find the answers. But many of the problems we face today have other causes that are social, economic, cultural, legal, educational, psychological and more. If we are truly going to understand the problems, much less move forward toward a successful coping mechanism or a solution, we have to see the big picture. What we really need is to embrace all of the perspectives that address the complexities that make these challenges so difficult to solve. We have to put together all of the different perspectives so that we can achieve a comprehensive understanding – that is the only way to drive successful action.

[dropcap]Q:[/dropcap] With all the innovation occurring in health and medicine, how does TEDMED provide a unique platform for thought leaders in the space, both at the annual event and year round?

We carefully produce our annual stage program as ten or twelve distinct sessions, but I think it is important to say that each talk does not occur in isolation. Those sessions are an hour and a half to an hour and forty-five minutes each, built around carefully selected themes; they are powerfully quilted together to represent a broader thematic topic we want to explore. And we are exploring it from all different perspectives, all different sorts of innovation, all different points of view, experience levels, backgrounds. We really believe from that stage you are seeing the beauty of cross-pollination: cross-fields, cross industries, cross perspectives, cross society. That's what makes each of the gatherings so powerful, and each of those talks pulled together so powerful. Each talk itself comments and supplements the others: the whole is greater than the parts. You can sum up a talk in an isolated 15-18 minute segment, but its not, it's actually a piece of a bigger puzzle.

The Great Challenges program is a perfect example of how we're continuing to elevate and showcase innovation in research and in technology year-round, covering everything from care delivery to reimbursements. It cultivates year-round conversation, whether it is through Google Hangouts or through Q&A’s or Facebook chats or the blog, it's looking to convene the community in a broad way that builds on the amazing content that came out of our annual conference. You spend the year talking about and exploring the important topics as they are amplified in the news and are awarded additional recognition and exposure and then you reconvene back at TEDMED to either revisit those and/or explore new topics that have emerged since the last time we convened.

Really the culmination of all those conversations is in some ways represented at the annual event through the community we bring together. I would say TEDMED's focus is about convening people and ideas, and those ideas are innovations. At the heart of how we look at innovation, we say it stems from the human imagination, to imagine something to be better, to imagine something to be different, to be more effective, to be more creative. And so, our objective in convening is absolutely to showcase and amplify the power of human potential as a direct output of the human imagination.

[dropcap]Q:[/dropcap] TEDMED has a host of impressive partners – how do these relationships play a key role in TEDMED’s overall mission and growth?

Our priority is for the TEDMED community to embrace and celebrate passionate, committed game-changers, intellectually curious all-stars and those on the frontlines driving the future in health and medicine we all want. TEDMED is a thought leadership platform. That's why our partners cover the broadest possible range of expertise, from the largest global corporations in health and medicine, to leading technology companies, top educational and research institutions and the most important U.S. government health agencies and institutions.

Obviously, some partners provide critical financial support and we also have key non-financial relationships as well. These include relationships with government health leaders from the U.S. Surgeon General, to the chairs and directors of the Institute of Medicine, the NIH and the CDC. With our recent announcement of a permanent relationship with UCSF, we’ve set the pace for a global series of alliances with the world's most accomplished medical research institutions, as well.

Our partners' leadership and expertise provides critical insight into the topics, innovation and themes that need to be explored, discussed and celebrated among the TEDMED community. These partners help us stay ahead of the curve with cutting-edge developments in science, policy, technology, law, markets and more. This enables us to keep the full TEDMED community informed as we address the total environment for health and medicine.

In all these ways, then, our partners are a critical part of the overall experience and our platform's larger success, from our stage program to our year-round Great Challenges discussions and our global live streaming opportunities.

[dropcap]Q:[/dropcap] Looking beyond 2014, how do you envision TEDMED’s continued evolution and what are some key goals for the future? Ultimately, how can TEDMED transform the world of health and medicine and add value on a global level?

Our evolution is toward a strong global community that is 24/7 all year round. We can transform health and medicine by acting as a super-connector for people who would never meet anywhere else, by bringing together ideas and institutions for all those important creative collisions, on a global scale. Innovation and imagination recognize no national boundaries, and neither does TEDMED. We're having some key partnership discussions now around what it will look like to bring TEDMED to the world, and to bring it to the world simultaneously.

We started off with a large domestic focus and presence, and now we're looking to expand that into conversation about the important work being done globally and around world health. That's our expansion. In 2017, we expect to be in seven cities around the world, as one annual TEDMED event occurring simultaneously across those seven stages.

Our vision is to create one week a year where the world comes together to focus on what’s new and important in health and medicine. We hope that during that time we’ll be exposing the world to the amazing progress that's being made and we're also exposing the world to all the transformative work that’s going to happen.

Q&A with Josh Benner, President and Co-Founder, RxAnte

Coming off the heels of RxAnte's recent acquisition by Millennium Laboratories, Oxeon Director Tim Gordon spent time with founder and President Josh Benner to discuss the company's unique approach to improving medication use, their rapid growth since inception three years ago, and how he envisions their trajectory moving forward. RxAnte, a portfolio company of Oxeon Partners LLC, counted Aberdare Ventures and West Health Investment Fund among its investors. [dropcap]Q:[/dropcap] What was the inspiration behind launching RxAnte and how did the company get its start?

[dropcap]A:[/dropcap] We are a very mission-oriented group of health care guys with long histories in the fields of advanced analytics, medication use, health IT, quality improvement, and health policy. The co-founders knew each other from prior relationships and got together to tackle what we all agreed is the biggest opportunity in the health care system: the problem of misused prescription drugs. The statistic that continues to baffle me is that the U.S. is going to spend $325 billion this year on prescription drugs and we’re also going to spend almost exactly the same amount on hospitalizations, doctor visits, lab tests, and disability caused by the misuse of those medications. To say that more simply, we’re spending equivalent amounts of money on drugs as we do to clean up the problems that the misuse of those drugs causes. If you look at that figure in the grand scheme of things, it’s between a quarter and a third of all preventable costs in the health care system, and many of those preventable costs like hospital readmissions root back to how people do or don’t use their medication correctly. So there’s a huge ROI to the biggest players in the health care system if we can solve the problems of underuse, overuse, and mis-prescribing of prescription drugs. That’s an intensely motivating problem for us, we have backgrounds in the space, and we set out to build some unique tools and solutions to help organizations improve the use of medications in their populations.

[dropcap]Q:[/dropcap] Can you talk about RxAnte’s approach to medication adherence, and the kind of impact you’re ultimately looking to drive with this solution?

[dropcap]A:[/dropcap] For contrast, let me first explain the typical approach. Big health care organizations that are trying to support better use of prescription drugs have a number of available tools in their toolboxes. Those include things like sending refill reminder letters to patients who are late to fill their medicines, using automated phone calls, and most of them have some live care management call centers staffed by nurses or pharmacists who can also do case management with selected cases. They choose these activities because, due to cost, that’s all they can scale over millions of lives taking these medications. Unfortunately, these are the things that are often less effective.

The business problem we wanted to fix was to help these organizations do two things differently. First, we wanted to enable our clients to do more of what works which is engaging patients’ own health care providers in the process of managing their medication outcomes. We do this using advanced analytics to identify and target those patients who will most benefit from outreach from health care providers. And second, we want to get ahead of the problem and prevent the misuse of prescription drugs before it happens because then it’s too late. RxAnte treats medication misuse as a prevention problem by identifying who’s at risk of stopping their medicines too early, or of overusing certain classes of medications, and heading it off before it actually happens. And if you take that approach, you find yourself talking to smaller groups of patients and you can afford to do the things that really work best for those at-risk patients.

[dropcap]Q:[/dropcap] Can you talk a bit about certain goals you’ve had in mind when you set out on this path, how you’re doing against those goals, and some key milestones that you’ve achieved?

[dropcap]A:[/dropcap] We’re making great progress overall, but we’re far from done. We are the first company to deliver an accurate, scalable cross-therapy-area, patient stratification tool that runs on ordinary data that every big health care organization already has. We can predict the medication adherence of patients as early as the first time they fill a prescription in any chronic therapy area today. That’s a big achievement not just for us, but for the field of drug therapy management.

I’d say the next step is to take that knowledge and use it to change the future. We can take accurate predictions and what we know about how different patients respond to different interventions, and match patients to the intervention most likely to benefit them, or most likely to achieve a health plan’s needs or a provider’s needs. It’s pretty exciting that our decision support guides not only specific interventions for each patient, but timing as well.

Our newest offering, which we built in the second half of 2013, is a product called RxEffect™, which allows us to help an organization reach out and activate a patient’s own health care providers, their own doctors, their own nurses, their own pharmacists, to actually better manage their medication outcomes. It involves sophisticated analytics and real-time cloud-based tools for those practices or those pharmacies, identifying which of their patients need support and when. The outcomes that we’ve seen so far are better adherence at a lower cost, and include the associated improvements you would expect in terms of utilization of health care services. We’re really creating value for customers, and I’m excited about that. One nice capstone statistic is that because those tools work, we’re managing the medication use of about 8 million patients today, and that’s another big accomplishment. We have nationally recognized customers using these tools to manage millions of lives, and we can see that it’s making a difference in the right direction.

[dropcap]Q:[/dropcap] As a first-time CEO, what has surprised you most through RxAnte’s first few years?

[dropcap]A:[/dropcap] There’s this perception out there that it’s very hard to engage and help big health care organizations innovate and change their processes of care or population care management. I was quite convinced from listening to others that it would take years to work our way into a trusting relationship with those big organizations. I think the surprise was that the macro trends in health care are making those big organizations really receptive right now to creative ideas, and they’re actively seeking new tools and innovative ways of taking care of their patients or their members. It was a pleasant surprise to find people really embracing the ideas we brought, testing new products, and then buying them in multi-year contracts as they proved their value. I think it’s a myth that you can’t turn these big battleship health care organizations, and I think we’ve proven that it’s possible.

[dropcap]Q:[/dropcap] How have you approached building your team and can you describe the importance of culture to the organization? What impact has this had on RxAnte’s growth?

[dropcap]A:[/dropcap] Hands down, there’s absolutely nothing more important than team. The team has to share a common vision and has to have a track record of both success and failure to have taught them how to succeed against headwinds. And the team has to ultimately be capable of achieving and executing on the vision. We built the founding team for the most part from people whom I had worked with in one capacity or another previously and who were nationally renowned experts in the space and then there were still gaps. To fill the gaps we looked for the best fit in terms of a recruiter who got what we were trying to do and could represent it well to people who were happy in their jobs and then recruit them anyway. That was Oxeon and Trevor and I think you guys have worked out great.

[dropcap]Q:[/dropcap] The terms “big data” and “analytics” are thrown around the health care industry perpetually at this point. How is RxAnte different?

[dropcap]A:[/dropcap] That’s a great question and it’s really important. Data are ubiquitous— everyone has big data. Everyone has big data and small data. Everyone probably has people who can run statistical software to calculate rates, proportions, and statistics. It makes it seem like the barriers to entry in this field are very low. The reality is big data and analytics are tools for creating value and improving outcomes in the health care system. What I think has differentiated us is that perspective. We look at big data and analytics not as the offering and not as the solution, but as tools to achieve the goal, which is better outcomes, better quality scores, and lower costs. So yes, we do predictive analytics, and we do a lot of advanced analytics measuring programs’ performance, but the most important thing we do is take everything we’re learning from that and build solutions that help these organizations do things like engage providers to work better with their patients. That’s what moves the needle on the most important things: the outcomes and the cost savings and the goals of the client. Our mantra is “Know the future. Then change it.” It’s that second half that really differentiates us.

[dropcap]Q:[/dropcap] How does RxAnte fit into the broader population health management discussion and the shift from fee-for-service to value-based care?

[dropcap]A:[/dropcap] We’re enabling it. More and more organizations are now at risk for the outcomes of patients’ prescription drug use. That means more health plans, more PBMs, more pharmacy chains, more physician groups, and more hospitals now have an interest in making sure patients take their medicines the right way and get the best possible outcomes. And as those organizations have become more accountable economically, they need tools to help manage that process in a very efficient way. They can’t deliver the most effective intervention to every patient in their population. It’s not sustainable; it’s not affordable. What they need are the tools to know which patients are at risk, what to do about those patients who are at risk, and how to solve the problem so that those patients take their medications as appropriately as possible. That’s the solution that we’ve built and I think, in many ways, it’s made us a partner to these accountable care organizations today.

[dropcap]Q:[/dropcap] You have had some big news recently with the recent acquisition by Millennium Labs! Can you talk a bit about this and the long-term vision for RxAnte moving forward?

[dropcap]A:[/dropcap] We’re really excited about our partnership with Millennium. I hate the term “congratulations on the exit” because this is not an exit for anyone here, this is just the end of the beginning and we’re moving on to the next chapter of RxAnte’s development. We still have big goals for our customers and the evolution of our products. We will continue to move on the same trajectory with rapid growth, very customer focused innovation, and a high degree of customer service. So it’s business as usual for me and the management team and the people here at RxAnte going forward. Over the longer term, we will explore with Millennium some interesting opportunities that are created by the coupling of our businesses. Millennium in many ways focuses on that same problem of the cost of misused prescription drugs, but they address it as a lab testing company that enables more personalized treatment plans based on pharmacogenetic testing and drug therapy monitoring with other forms of testing. We approach that same problem by guiding the delivery of personalized care management programs. Together there will be some very interesting synergies, and we’re aiming to explore those over the next couple of years while making sure that first and foremost, our core businesses remain healthy and growing.

Q&A with Seth Blackley, President, Evolent Health

Oxeon co-founder and Senior Associate Schuyler Yost recently sat down to talk with Seth Blackley, who alongside Frank Williams and Tom Peterson has led Evolent Health from its inception in 2011 as the joint venture between The Advisory Board Company and UPMC Health Plan. Together with Oxeon’s Managing Partner Trevor Price, Schuyler has led the majority of our firm’s projects throughout our partnership with Evolent, working closely with Seth over the past couple of years. You can find the complete interview on our website. [dropcap]Q:[/dropcap] What was the inspiration behind launching Evolent Health and how did the company get its start?

[dropcap]A:[/dropcap] It really started with an effort that Frank and I led when we were at The Advisory Board. Frank and I—and eventually Tom Peterson—spent significant time with health systems executives around their future approach to how they were going to grow and manage their delivery systems. It was very clear, given everything going on in the market, that there was a push toward the value-based approach to health care and that the leading systems were going to need to evolve to look like UPMC (University of Pittsburgh Medical Center), Kaiser and other delivery systems that successfully integrate care both clinically and financially. That’s where value is created in healthcare—when you get the alignment right.

We studied existing approaches and what payers were doing and got the sense that while there was a great deal of administrative complexity, it wasn’t creating a great deal of benefit. Instead, what was needed was for providers to have real incentive to manage healthcare costs; to decidedly ask, “If this were your money, if you were in control—how would you do this differently?” We think that physicians and clinical teams within provider organizations are best positioned to figure out how to create the most clinical value, in a way that makes financial sense. It’s just that, historically, they had not been asked or granted the resources and the accountability to make it happen.

That was really the guiding light behind how we set the company up.  Other organizations were doing things in this area too, but we really feel like the provider-led approach to doing this was the big insight. That brought us to the UPMC Health Plan partnership. UPMC stepped forward as an innovative organization that knew how to do this work but who also shared our vision for an independently-run organization. This was important—for health systems to know they had a company solely dedicated to this effort, with the capital to attract the right talent to execute on this big idea. That was really the genesis of how it started.

I think each of us—Tom, Frank and I—all have personal experiences as well that help validate this. We’ve all experienced health crises in our immediate families and seen how much better it can work when health is managed effectively, and how it doesn’t work when it’s not managed effectively.

[dropcap]Q:[/dropcap] How has human capital played a role in the company’s success? How do you manage to maintain your company culture in the midst of rapid growth?

[dropcap]A:[/dropcap] We have several strategic pillars that make our company what it is. Human capital is at the forefront. A lot of players in the population health world are selling technology that falls short of offering a true solution. We really feel that the talent piece is a big part, if not the biggest, of what makes or breaks a locally deployed organization.

In terms of culture, having enough volume to see enough candidates, to have the right pool to pick from, is really important. Having a vision and mission you can articulate in the screening process, both by Oxeon and by our team, which becomes further clear when they come in for the interview—this is really important. We want to attract people who are attracted to the mission. We’re not trying to sell a role or a job description as much as we are trying to identify someone who is trying to be part of changing health and health care. Selecting the right people is key. And then making sure we’re reinforcing that culture and who’s creating value with recognition, including competitive compensation.

[dropcap]Q:[/dropcap] Two years ago, there seemed to be a great deal of uncertainty around the Affordable Care Act and the migration to value-based care. Do you find now that things have quieted down or are providers still hesitant to move away from fee-for-service models of care in favor of value-based models?

[dropcap]A:[/dropcap] Two years ago, it was almost a fringe issue exclusive to health systems that either were very innovative or in a unique position. Last summer, when the Supreme Court decision came down, it became a more mainstream issue with systems generally supportive but not necessarily eager to take aggressive action. And now, for almost every system we spend time with, it has become, or soon will be, a core part of their strategy. System executives increasingly understand it’s a holistic undertaking—you can’t make it work as merely a piece of your health system, off to the side. It’s actually the core of your growth strategy. This has been a huge evolution in the market.

From an Evolent standpoint, we always felt that there was enough of a market and an opportunity. That even if the Affordable Care Act was, that there would remain enough innovative, smart systems, like UPMC, that understand there’s a business opportunity to provide more value to the end consumers of health care. So it has changed, both a year ago and in the last three to six months it continues to accelerate, but I also think this is a timeless issue apart from reform.

[dropcap]Q:[/dropcap] How does migrating to value-based care impact how systems work with payers? How does Evolent partner with providers and payers to ensure incentives and payments are aligned with value-based care objectives?

[dropcap]A:[/dropcap] Our view is that ultimately providers are best positioned to offer high-quality and low-cost care. That essentially is their product expertise—they’re manufacturing high-quality, low-cost care. The more that providers have incentives and tools and competencies to manufacture lower cost, higher quality product, the better off everyone is. Essentially, once you figure out how to manufacture that product for the benefit of patients and communities, you have to figure out how to distribute it.

We think a majority of the market will likely elect to distribute through traditional insurance companies, and an innovative partnership with an insurance company can be a real win-win. We support our providers in examining how to evolve or set up a relationship with a payer to distribute that higher value product. Under a certain set of circumstances it might make sense for the provider to launch their own plan—like UPMC—either for their employees or commercially. In those instances, we also offer robust support and infrastructure to make this happen.

I think it’s partly about designing the right contracting model and partly about having the right approach to managing under that contractual model, both clinically and administratively. It’s absolutely something we believe is the foundation for success, and something we’re actively supporting across the country. Our role is to help providers distribute maximal clinical value through the most financially sustainable means possible.

[dropcap]Q:[/dropcap] What has been the biggest unforeseen challenge that you’ve faced as the President of the company?

[dropcap]A:[/dropcap] How long do you have? Let me answer for Frank, Tom and myself together. For us as well as the entire executive team, I would say the biggest unforeseen challenge is just working with our health system partners to help them understand the magnitude of change and the magnitude of investment required to be successful with this strategy. And that the population health effort is not a service line, it’s not an initiative or a pilot program. It’s actually at the center of the entire health system’s growth and sustainability strategy.

Whether you’re a for-profit or non-profit health system, it’s core to your mission. It’s core to the value you deliver to the patients as individuals, to the community you serve. It’s core to how you work with your physicians so they are able to practice medicine the way they want to practice medicine—where they are not just part of the value-based care movement but leaders of it. Making sure not only the breadth of the opportunity, but also the breadth of the change required, are understood is probably the biggest challenge. It’s exciting and it reflects a huge opportunity for our systems and for Evolent, but it’s also a monumental undertaking.

[dropcap]Q:[/dropcap] Where do you think the company will be in five years and what would you say are the biggest threats to the company’s success?

[dropcap]A:[/dropcap] In five years our goal is to be partnered with systems in 40 markets around the country and providing the people, the process and technology that enable these partners to be highly successful with their value-based care strategies. This has all kinds of metrics you can wrap around it, but most importantly with presence in these 40 markets we’ll be able to positively impact care for the majority of Americans. This is our mission.

The biggest obstacle would probably be the consistency of leadership within these systems. These systems really hold the cards as to whether they’ll continue to pursue this strategy in a sustained fashion. That’s the biggest threat.

As far as challenges, it’s what I said earlier. Ensuring that the systems are willing to make the hard choices, and are appreciative of the magnitude of the effort. This is also the opportunity.

[dropcap]Q:[/dropcap] What aspect of Evolent are you most proud of? What are some of the milestone achievements thus far that have defined the company’s success?

[dropcap]A:[/dropcap] Delivering on our promises and keeping our commitments—that’s probably the thing I’m most proud of, and of course, our team that makes it happen every day. For our health system partners, like MedStar, it’s doing what we told them we were going to do in terms of achieving savings, and investing in their success long term. If you’re Piedmont-Wellstar, same thing—and so on down the line. For each and every health system we work with, we’ve earned their trust to deliver on our commitments and we take great care to honor that trust in everything we do. For our team members, we strive to deliver on our commitment from a professional and career growth standpoint. If you’re a patient in need of higher value care, or a physician who’s looking to practice common sense medicine, we are similarly dedicated. That’s how I frame it—delivering on our promises on the smallest and grandest of scales.

[dropcap]Q:[/dropcap] When you started Evolent two years ago, what did you envision the growth trajectory of the company to look like, and how has it done relative to your expectations?

[dropcap]A:[/dropcap] We set a high bar, yet have succeeded in achieving beyond what we originally envisioned—in terms of number of systems, number of employees—across the board. We had projected a big opportunity and the market has moved more quickly than even we thought it might. We’re ahead and our big challenge and opportunity is to continue to get the right people to join the mission—people who want to be part of it so we can stay ahead. We’re probably more constrained by the right talent and the right people than we are constrained by the opportunity in the market. That’s actually a commercial for Oxeon. In all seriousness, I’m proud of what you have done. Oxeon has been an important part of Evolent and its impact on health and health care.