The coronavirus has altered the lives of people all over the world.
The COVID-19 outbreak has also forced health care providers to rapidly change their long-established delivery models in order to tackle this sudden and widespread pandemic and keep patients safe. In this episode of HealthChangers, we’ll hear from two health care innovators who talk about how one company, Upfront Healthcare, pivoted to meet the demands of this new world of care, and how they think the coronavirus could impact health care over the long run.
Rob Coppedge is the CEO of Echo Health Ventures, an investment firm that seeks out and grows tomorrow’s great health care companies. And Ben Albert is co-founder of Upfront Healthcare, a company that has created a platform to personalize care navigation to efficiently engage all patients and improve health outcomes.
Leslie Constans (LC): To kick it off, I just wanted to check in with you both, see how you're doing and ask you how your businesses are addressing this serious public health issue. Ben, do you want to start us off?
Ben Albert (BA): Sure. Thank you very much, Leslie. Yeah. It is a crazy time without question. As we sit today on March 31, there's 165,000 reported cases in the United States and that continues to grow rapidly. And we at Upfront Healthcare are all focused on how do we help get patients to the services that they need through our platform? When this started to evolve and health systems began responding in such an aggressive way, it aligned directly with what our mission is as a company, to really help enable them at scale to get the patients to the services that they needed. We've been working around the clock to help our clients and health systems meet their mission of getting the care the patients need, to the patient.
LC: Yes. Ben, can I ask you, where are you calling in from? I'm assuming you're remote and working from home and staying safe and healthy.
BA: Yes. Thank you Leslie. I'm calling in from Evanston, Illinois. We are working from home and I apologize if you hear a dog barking in the background as a result of that, but I'm certainly focused here and it's not only a national problem, as everyone knows, it's quite a local one as well.
LC: Thank you. Rob, where are you today and how is Echo Health Centers looking at this critical public health issue?
Unprecedented Tools During Unprecedented Times
Rob Coppedge (RC): Sure. Thanks, Leslie. And after spending probably the past six months of my life on airplanes, going to meetings all over the place, I'm calling in now from a guest bedroom in our house in Portland, Oregon, trying to find a quiet place away from the kids. That's the reality for our whole team and for all the companies we support as an investor in transformative companies in the health care space. We've been investing at Echo in these transformative businesses for the past three-and-a-half years. This is a good reminder for our team, even as we hunker down and try to do our jobs a little differently, of why innovation and transformation is so essential in this health care system. It makes our work feel a lot more relevant, especially because we've made it our practice not to invest in novelty act apps and digital health silliness, but instead focus on those companies that are making a big difference in today's health care system and tomorrow's.
You did an unprecedented thing by bringing and offering to launch a COVID-19 program free to reduce barriers for your clients, to bring these tools to improve how they engage in outreach with patients.
RC: Our teams are all hunkered down across the country. We have folks in Boston, Portland, Seattle and Durham who are working closely with both Cambia and Blue Cross North Carolina to bring these transformative solutions into their business and our portfolio companies on ensuring their companies stay strong through a period of real transformation and challenge. Probably no company is doing more right now for the delivery system as they face this challenge than Upfront. So, it's really a pleasure to be here with them. I want to start off our conversation by asking you a few questions. It's great to be on your board. I worked with you for years now, but this has been a different time in our relationship. One where it's been fun to watch how you and the team have stared down something that's a challenge to so many startup and early stage companies and found opportunity to engage more deeply with your clients and their patients.
You guys have built this platform that automates and personalizes care navigation for patients as they're engaging with large health systems. You did an unprecedented thing by bringing and offering to launch a COVID-19 program free to reduce barriers for your clients, to bring these tools to improve how they engage in outreach with patients. Tell us a little bit more about how you and the team came up with that idea and decided to make this available in this way to your clients?
We really needed to step in and help with our platform's capabilities to guide patients to services at a scale that we just had not encountered before and also the content that patients needed to be successful and understand how to navigate the COVID-19 pandemic in their communities.
BA: Thanks Rob, and I appreciate that. Our team is a very mission- driven organization and one of our core values is to serve. Ultimately, we started engaging our clients in how they were readying themselves for the oncoming COVID-19 pandemic. It became apparent that we really needed to step in and help with not only our platform's capabilities to guide patients to services at a scale that we just had not encountered before, but with the content that patients needed to be successful and understand how to navigate the COVID-19 pandemic in their communities. As that evolved through conversations with our clients, we just understood what a unique position we were in with them, to really deliver value to them and their patients that they were trying to serve rapidly.
We could turn this around in a number of days, not weeks. They had the motivation to make it happen for obvious reasons and so we partnered with our clients, linked arms, and just tried to help them get the information their patients needed to be successful. We were fortunate from a client perspective and a company perspective to have this platform that truly helps and drives value in a matter of days. We were able to show those results back to our clients with being able to get to almost 50 percent of their population with specific personalized care navigation plans for each patient and teaching them about what services were available to them and what information they needed in order to manage their own position in the community.
RC: Yes. That's amazing. It feels like the resource dedication it required to make that change was significant. Maybe tell us a little bit about where the company started and what you had built before this, what you're bringing to clients before this and it puts this pivot in context? And maybe in the process, share a little bit about how you had engineered the platform to engage with patients? Because that feels like what's the compelling hook right now, and the service you're bringing to providers is that ability to engage deeply with folks who need information and are really longing for it.
BA: The platform itself uses analytics to identify what action the patient truly needs to take in a personalized way. We look at the patient's specific data. When you talk about it from a COVID perspective, there are several risk factors that may mean COVID's going to be more acute for an individual. Whether that's age, or a chronic or preexisting condition that they may have.
Using our platform to understand who each patient is, and then automate the content and guidance that the patient gets based on who they are as a person, enabled us to leverage the platform’s capabilities of personalizing the information and the actions a patient needs to take in order to get the care that they need. This is really no different, and I know we're using the word pivot, but to us it's really isn't a pivot at all. This is just what our platform is designed do. It's just at a much more robust scale than we were doing prior to this, given the urgency and need of information in a personalized way to each patient.
Prior to this, we were working with these same clients but on other types of initiatives. Making sure patients came back for necessary care on time, like annual wellness visits or care gaps, or making sure patients knew about immediate care options so they didn't have to go to the emergency room. Identifying those types of actions for patients and then teaching them about how to use the other services available to them or how to come back for care to the right places.
With COVID, it changed everything nearly overnight because those programs stopped. Health systems were no longer interested in trying to recall all their patients that needed necessary visits, because they needed to free up capacity to help manage and triage all of the patients in their community who were either going to be symptomatic or were currently symptomatic of COVID. We were able to help them pivot, on a dime, away from some of those things that they were really focused on. And rightfully so, candidly, over to Care Traffic Control, over to supporting the larger issue in their communities about helping patients get the information they need around COVID.
RC: It does. I get how this is not a pivot from Upfront, but it certainly was a huge dedication and resource and a big lift for the team. You did this during a period of time where your employees are shifting to remote work and lots of things going on in all of our employees lives beyond the stress of the workplace. Talk a little bit about how challenging it was to drive this development program forward and how your team is doing, as they have had to balance all these different stressors in their lives?
We view ourselves as the air cover for those front lines, so that we can proactively engage the patients and their population.
BA: That's a great question. The reality is, we're still right in the middle of it, Rob. We're scaling very quickly, we are continuing to engage hundreds of thousands of patients weekly to guide them to services they need and bringing more clients online. I don't think that story is fully written quite yet, about how we're managing through it, but I can tell you that this team is incredibly dedicated to this mission. We are all working very, very hard to scale our platform to support our clients’ needs to guide their patients to services. When we think about it, we think about our clients who are really on the front lines of health care, helping triage and guide patients to the services. All of the things that they're struggling with on a day to day basis, pales in comparison to what we're struggling with, trying to get our technology scaled out enough in order to support them.
We view ourselves as the air cover for those front lines, so that we can proactively engage the patients and their population. Essentially, to guide them and make sure that they're only utilizing the health system resources when they absolutely need them. Because, we all know right now the issues with the availability of masks and swabs and just human resources and capital to support the influx in certain communities of patients struggling with COVID.
RC: Yes. The challenge here is great. I've talked to caregivers on the front line or folks who are delivering solutions out to support them. One of the few things that's kept them going as they go through this intensive time period, is the feedback. The feedback loop is pretty short now and figuring out if the solutions you're bringing or the carrier delivering is working and making a difference. I'd be interested if you're hearing anything from your clients or the patients, they serve about how your tools are being utilized or the impacts they're having on the population now.
BA: We are getting an awful lot of feedback. And that's heartening for all of us and that's motivation for our team as well. We get feedback from the client side of just how flexible our platform is to help them get to their patients in the way that they need to, and how we're bringing content to them. I really think that the partnership element of the relationship as health systems in us are working closely together, helps our team as much as it helps the client's team. Just making sure we're in this together to help them solve the problems that they have around navigating their patients.
The data that supports it, are feedback we get from patients who are texting back through this digital platform we have. Or commenting back to their health system about how appreciative they are about the health system being proactive and getting them the information they need. How cared for they feel by the system that's supporting them when they're proactively being engaged in a personalized way as opposed to throw for some templated email or something of that nature that they may be more used to receiving in this instance.
And the data also, underpinning what we're doing that supports it, makes our team feel like really helping move the needle here to flatten the curve. We can get to 45 percent of the patients for a health system within a matter of days to help educate and guide them to the right setting of care for them based on who they are. When you asked earlier about how it's impacting our business and scale, that's the scale that we're seeing now, in the hundreds and hundreds of thousands. That is really powerful and brings that energy back to our team and to our clients, to let them know that that difference is being made.
Startups and Early-Stage Companies Can Use their Skills to Change the Health Care System
RC: I can only imagine. It's one of the legacy challenges in health care and health care I see especially, is then just to take so long to figure out if your solution is working or if it resonates or how to improve it. If nothing else is out, there's an opportunity now for companies like yours to discover more quickly what's working and what's not. Since the impact that you're having and be able to adjust more quickly, if there's a silver lining to this very, very large dark cloud, it probably is that these innovations are getting tested more quickly and some cases getting deployed more efficiently to what we would hope would help the system overall. I'm on countless Zoom calls every day with entrepreneurs and other investors and I'll say, it is hard to overstate the amount of a challenge that's facing the health care startup/early stage world.
You've got a whole flock of black swans flying in from the slowdown, from the end users and purchasers of these solutions and that disruptions. It's the financial models of these businesses and they are making it a lot harder for many of these companies to raise capital. There's a lot of entrepreneurs who are just feeling this tension’s very real. I just got off a phone call with a number of investors and many were comparing notes on how many layoffs each of their companies had to have.
It's heartening to see companies that have built solutions that, even though the initial use case may not be the one that's the hook right now, they've found a way to adapt what they're doing, adapt their solution and go help on the front lines of how the health systems scales to address what is the unprecedented problem.
RC: This becomes real on a health care level. It's real for folks who are working out in this business and taking care of their families. It's heartening. It's heartening to see companies that have built solutions that, even though the initial use case may not be the one that's the hook right now, they've found a way to adapt what they're doing, adapt their solution and go help on the front lines of how the health systems scales to address what is the unprecedented problem. As I mentioned earlier, I've put Upfront and a small group of the portfolio companies I have seen in our portfolio or more broadly, who've been able to really find ways to lean into this crisis, to bring value and to help people and hopefully to help advance their business.
I'd say as we look out at our portfolio, we use this as an example for many of our CEOs, many of our other portfolio companies, one of several and say, "This is a way though. This is an example of how to lean into a crisis like this and how to hopefully create some of your own luck." As you look around to your peers in the startup world, in health care executive world, do you see similar trends? Which are the business models, partners or the other companies that are out there, that there are types of companies that you see that may end up emerging out of this crisis stronger and those where you feel they may not weather the storm? Do you see any patterns in that?
Digital health capabilities like telehealth or e-visits, are being put to the test right now in a very positive way, to help extend the health systems’ reach and to enable them to triage all the patients that they're supporting. In some form or fashion, those were here beforehand, those will be a stronger player in the market after.
BA: It's tough to say right now. I was actually gearing up to ask you the very same question. Nationally, we're trying to triage our population because of the rates of people who are actually sick. It’s highlighting this need for how we triage on a much larger scale than we have before. The chatbots and the digital health capabilities like telehealth or e-visits, are being put to the test right now in a very positive way, to help extend the health systems’ reach and to enable them to triage all the patients that they're supporting. In some form or fashion, those were here beforehand, those will be a stronger player in the market after. To what extent, I'm still not sure because this is a very extenuating circumstance of a triage need in the marketplace, to get patients to the services that they need and understand what their care is.
Those are pretty clearly inclined to have a big role going forward as they did beforehand, but perhaps a bigger one. As we go from where we are right now and we head towards flattening that curve, how do we navigate and follow them once that the care has been delivered and hopefully, they have returned home and are well? There's still a follow-up need to support those patients and to continue to support them going forward. So, I'm interested to hear your perspective on where does it go from that triage and virtual care need once we move into the next phase of COVID?
RC: In the history of my involvement investing in health care, I see in health care services, there've been several transformative moments where business models have shifted. It's embarrassing to acknowledge that most of those had been driven by reimbursement. This, I think may be the first time in my career where we will likely see major changes in technology adoption workflow. Just the health care systems architecture that are driven less by reimbursement changes than they are by optimizing the system to serve people better/public health priorities. I'm optimistic that, that actually happens, but I think that would be good for the system, that it would be good for the innovators that we believe in.
We're seeing it across the portfolio, the adoption of virtual care, nontraditional care modalities. More convenient care and more consumer centric care modalities to be honest, accelerating in a rate they haven't accelerated despite all the lip service and hype over the years. So, that's heartening to me, that this systemic transformation will continue and lead us to new business models that actually will serve us much better and likely costs a lot less, and where you come from. I don't know if you agree with that though.
BA: I do. I definitely agree with that. I think it does move us towards a different definition of population health going forward as we look ahead and truly, how are you using your community services? How are you truly engaging all of the resources available to enable patients or people to be successful in their care at a lower cost with efficiency underpinning the whole thing given what we're seeing today?
RC: Yes. Not to get philosophical on you, but you think about how much we've talked about social determinants of health over the past couple of years. There's nothing disparaging about the businesses that are going after the traditional models of that, but oftentimes it's been about a third party relationship between a deliverer of a service and a population. In this pandemic, every individual has a role to play. They are themselves a vector of social determinants. They are, by walking six feet away from somebody, by staying home from work, by changing the way they live, by making personal sacrifice, they can have a positive impact on the health of the population and the health of many individuals.
The Potential for Systemic Transformation Continues
RC: That makes the value of some of these things much more real. In a way that the theoretical discussions of the past does not. Not as an exception to or instead of but as an and I think, personal responsibility and community responsibility. The ability to leverage them enforce a better president of the community therefore, is going to become much more part of the conversation going forward.
BA: In order for that to occur, we have to give people the right information to enable them to understand what their role in that greater population is, on an individualized basis. If we can help enable every person to know exactly what they're supposed to be doing, it will at scale, it will also benefit the people around them as you just pointed out.
RC: That's a powerful statement. What it says about your leadership and entrepreneurial approach. I can imagine if I built a business with a hypothesis about what the market was going to look like and I had engineered it for this reimbursement angle or this niche and the wheel shifts this way. I can totally understand how like a deer in the headlights I would feel staring down this tidal wave coming at me. What you just described as a way of thinking about innovation. The ways a thing like entrepreneurship is much more agile and dynamic.
The health care market historically, has been slow to change except when it changes quickly. I think we're seeing a moment where that change may come more quickly and some of the old ground rules may shift under our feet. I think about the entrepreneurs that will be successful going through that, the ones who can actually reimagine their value proposition as the market is dynamically emerging and evolving. As you say, we're upfront at the core of it. You all are personalizing this navigation, this engagement for the individual patient as they go through something that's very complicated, very complex, hard to access, hard to understand. That challenge is changing, it's only getting more extreme and your solution can adapt to fit that.
I think as I think about entrepreneurs who will be successful coming through this, is that they can think about their own business in that abstracted way and reimagine their value proposition and pivot accordingly to be able to capture opportunities. Those that have come in to solve either a small problem or go after a reimbursement loophole, they may be very unpleasantly surprised by what comes next.
We're seeing a moment where that change may come more quickly and some of the old ground rules may shift under our feet.
BA: It makes a lot of sense to me. As an entrepreneur you always have to stay nimble and understand and listen to what the market is telling you, and in this particular case the market is literally screaming at you. Hopefully, most entrepreneurs can hear what this market is telling you and try and navigate your way through it. It's when there's more nuance in it to me, that is actually more challenging than when something is macro like this is really coming to us and we're so naturally well prepared to support it. Now, I will state though having both of us being in this general space for as long as we have been, I have never seen health systems move this fast to make decisions and to activate services and resources, to make things happen. And that is awfully heartening to see them bow their necks and make things happen at a scale and a speed that candidly didn't know they were capable of doing.
One more question for you before we wrap up, though. From a payer side when we talk about innovation and the change in how care is delivered and how patients can access care. Do you see payment changing for some of those different models of care delivery more rapidly now?
RC: I think the health plans are still thinking a lot about how their models can evolve to address these evolving needs and the changes in the way they care will be delivered and care will be, is very early game. And so, I think the providers, your clients, are moving first because they must, they have a crisis on their hands and health plans are in a supporting role as these changes ripple out over the course of time. The more service delivery changes and as a new normal sets in for how care is accessed, health plans will evolve with it. So, I'm optimistic that that change will come. I'm not sure it will come as fast as the service delivery has needed to evolve, but I think it's will be a fast follow up.
BA: That's great to hear.
LC: Thank you again, Ben Albert and Rob Coppedge, so much for joining our HealthChangers today and sharing how you're both responding to the coronavirus pandemic from your respective points of view. We really appreciate your time today.
BA: Thanks Leslie. Really appreciate you inviting me on. And Rob, it's always great to chat with you.
RC: Absolutely. Thank you, Leslie. Really appreciate the opportunity to be with you. And Ben, we just continue to be appreciative for all you and your team are doing. It's great to spend time with you.
BA: Thank you.
You can find more information on all our episodes at cambiahealth.com. Follow us on Twitter @Cambia. You can now find HealthChangers on all of your favorite platforms. Just search for “HealthChangers” on platforms like Apple podcasts, Spotify and iHeartRadio. Please subscribe and leave a review.