Welcome to the HealthChangers podcast presented by Cambia Health Solutions, where we share real stories of health care transformation from those experiencing it and those helping to make health care more personalized. I’m your host, Kendal.
Today on HealthChangers, we’re introducing the first episode in a three-part series looking at the role of start-up competitions, pitch-fests and “Shark Tank”-style challenges in advancing health care innovation.
In this episode, we go behind the scenes of one such competition: The UCSF’s Rosenman Institute’s ADAPT Challenge, where 500 entrepreneurs proposed solutions to rapid COVID testing in health care and home settings, telemedicine, behavioral health, remote patient monitoring and palliative care.
We talked with one of the judges of the competition, Karim Botros, Managing Partner at Echo Health Ventures about his experience and what excited him the most about the innovative ideas presented to today’s most pressing health care problems. Here to tell us more is Karim.
Karim Botros (KB): It's a compelling model because you can get an incredible amount of depth in a very short period of time. That would be very difficult to do in a different manner. Now, the challenge would be, can you generate enough buzz? Can you generate enough interest to solicit all the right applicants and really knock it out there? A group like UCSF with their international reach getting applicants from all over the world, is pretty compelling. That model works really well. The takeaway is that if you can get the reach, these competitions are pretty impressive. The buzz that generates around them, I think it's a lot less about the prizes and the awards. I think it's a lot more about the contacts and the network that's created from it. I think that's something that's pretty special.
Kendal Kemery (KK): I can imagine just the networking that happens between payers, purchasers, providers, patients, people involved with policy, having them all on the same page and rallied around the same competition is a great opportunity. Within that, I think part of what you're talking about is how to improve some of the efficiencies in health care. There are definitely inefficiencies to be improved as we look at COVID and our response to that. Was there anything that stood out to you there?
KB: Yeah, what was interesting was in the ADAPT Program, we had UnitedHealth, Amazon, Express Scripts and Echo. We're in a pretty interesting crowd of people and their different perspectives on how they view health care. When we think about how the efficiencies, it looked down a couple of different levels, how efficient to bring a product to market, how to launch something quickly using the leverage that may be an Amazon or a United, or a Scripts could help in that way, or maybe even the breadth of solutions that are out there. You think about things that might be really attractive to a United or an Echo, might be very different when looked at from an Express Scripts sort of lens. We've had the good fortune, I think, being a part of that and watching how some of those companies were able to make their pitch and make their presentations resonate with the different sponsors at that meeting.
KK: Sure. I’m hearing a lot of big national names there. I know that Echo has a presence on both coasts. I wanted to ask you how you got involved with the competition. I know they're based out of San Francisco, but these solutions were coming from across the country, correct?
KB: There were over 500 different companies that participated in this ADAPT challenge and they were global. We heard presentations from Northern Europe, the Middle East, the Asian markets, as well as all over the United States. I think how we got involved was actually interesting. Rob Coppedge, our CEO at Echo, reached out to us and asked if there was an interest in partnering with UCSF in this new concept. And it was what could you UCSF do to help its part in COVID-19 and the response that was needed? And from there, Rob asked our team to jump on it. Between myself and Gregg Shibata, we really dug our feet in. We did not expect 500 applicants, so was a pretty big process but it was fantastic to be a part of.
KK: Wow, 500 applicants. Within that, sifting through those applications, what was your role in the ADAPT competition and how did you navigate that?
KB: With that many applicants, Echo was alongside the other three sponsors: Amazon, Express Scripts and United. We were the initial curation team to take that list down from 500, ultimately down to 20. That took it through three different passes where we would review under a certain matrix, score and look at each applicant. They had presentations. Once you got it down to about 50, we actually started doing presentations with the companies to taper it down to a final number of 20. Curating all the opportunities from numbers 500 to 480 and filtering out that list was pretty refreshing to see all the different ideas. There are a lot of really interesting companies and it's tough to get it down to 20.
KK: Did you see a lot of overlap between the applicants? Did you see a focus in any particular kind of sector, solution, or major problem that folks were looking to solve in relation to COVID?
I think some of the ones that we really resonated with at Echo were, how can you make this process a little bit easier recognizing how serious the discussion is, how important it is and that it impacts some COVID patients, but it really impacts everybody. If you can deal with end of life in a much more compassionate way, you can get really great results from it. It's not easy, but you really want it to feel good at the end.
KB: I think there are a couple of themes that sort of resonated. A lot of remote patient monitoring. How can you reduce the risk to caregivers through remote patient monitoring and maybe slow down the spread of COVID? That was a big theme. Remember the timeframe. This was occurring in the summertime and ramping up through the last couple months. It was summer to September. Another theme that we really heard quite a bit of and saw a lot of applicants around were rapid testing approaches.
Some may be focused on the antigen. Some focused on the antibody, different approaches. Some required extra hardware. Some required that all the system was right there in place, like site of care testing. The third theme was, what are the outcomes of patients that end up getting COVID, how can we help deal with that better? That could be everything from behavioral health to providing telemedicine services all the way to how end of life and palliative care might come into play, especially as it related to the impact that we've seen in skilled nursing facilities and much more vulnerable populations.
KK: Talking about end of life, it's interesting that you mentioned mental health. I'm thinking about what we were terming “long haulers” in terms of COVID. We really don't know what the tail end of this illness, what the mental impacts are long-term down the road. Could you talk a little bit more about end of life and the serious illness care planning? I don't want to tease too much, but I know that's ultimately a big focus for you through this competition.
KB: I'll share a story. My brother's a critical care pulmonary physician and on his floor, he has a COVID floor of maybe 20 or 25 patients, the end of life question comes up every single day. Being able to have that discussion and being able to document it properly was hard pre-COVID. Now, with COVID, there are no family members that are coming into the hospital floor. Those are all being set aside. It's very hard to do it over a Zoom or a Teams call and those discussions are tough.
I think some of the ones that we really resonated with at Echo were, how can you make this process a little bit easier recognizing how serious the discussion is, how important it is and that it impacts some COVID patients, but it really impacts everybody. If you can deal with end of life in a much more compassionate way, you can get really great results from it. It's not easy, but you really want it to feel good at the end.
KK: It's interesting that you say ultimately it is a conversation that everybody does need to have. I know that just even in America, as well as internationally, there's a big hesitancy in talking about these things. They're scary. They're not easy to talk about. Within health care, I think there's room for a lot more empathy in terms of how we approach those conversations. Again, just lessons for the larger health care system and how we integrate empathy into more solutions, not only in serious illness care but across the board. Within listening to those solutions, have you seen any sort of shift in how people are thinking about serious illness care after the crazy year of 2020? Is there more openness to talking about it? Are people realizing it's just a part of life, or are we still where we started?
KB: It's interesting when you think about the impact from a behavioral health standpoint and how many more individuals are impacted by some form of a behavioral health challenge or a stressor. You think of life by itself being stressful enough. When you augment that with now, I have to work from home. I am no longer socially engaged with other people. Just looking at Zoom has been a stressor for people, especially when they're on it all day. So we've seen at Echo, as well as in the ADAPT competition, an incredible jump in the number of behavioral health opportunities that have presented themselves. Some are service-oriented, meaning matching a person, an individual and a need with a hard to find resource like a therapist or a coach, depending on the severity of their needs. All the way to someone who presents sort of a broker type model where we work with the advanced primary care doctors and make sure that you can connect a patient in need with a physician or a therapist that has available time so you can match the two together.
KK: By partnering with established organizations like Echo and these other mentors involved with ADAPT, these smaller companies are able to reach much larger patient populations, which is not unlike Echo's core strategy of partnering with startups to scale and roll out to our parent companies. How are you seeing this benefit these smaller solutions that are being scaled in partnership with these mentor organizations? What's the benefit to them?
KB: Absolutely. If we look at the Echo model and talk a little bit about the dual mandate, not only do we provide an opportunity to generate a positive return for our parents, we also have the opportunity to drive strategic value and that objective can cross many sort of areas. When the ADAPT Program applicants are working with such large sort of supporters; an Amazon, a United, or even an Express Scripts. The advantage for them, at some part, is just certainly building the network and the different pieces that come from it. Getting the insight from an Amazon, how something works within their model and being able to translate that into the business model of the startup of what actually works for them. “How do you actually make a sale to an Amazon? How do you actually make a sale to a United or a Scripts?” is the type of transparency that you just normally don't get.
When they're making a pitch to Amazon as a potential customer, they're certainly not going to get the same exposure that they're going to get in an environment like this, where the judges are providing one-on-one feedback to these companies. I think as we look at it, it's exciting to see so many applicants. It's exciting to see the impact that the ADAPT Program can have on these companies. I think one of the outcomes is meeting with these companies but maybe the most important is how do you make your business model better? How do you make it grow faster? How do you continue to have a positive impact on health care? These competitions put that all together.
KK: When you were looking through applicants? I know in health care, sometimes there's innovation just for the sake of novelty, just to have another solution that's new and fresh. I’m wondering if there were any examples from your time as a judge of how you sifted through impact versus novelty in these solutions?
KB: I would say maybe 20 percent of the applicants, maybe less, were such a stretch to see how it tied to COVID-19. That between Gregg and myself, we were like, "Pass, pass, pass," because in a competition like this, it's important to stay true to the mission of the competition. In this case, it was really about how do we have an impact on COVID, whether it's the patients, the family, the caregiver or the provider? There has to be some context to it. I would say that maybe the eye-opening, the aha moment to us was there were a lot of firms that were really desperate to get dollars or to get the eyeballs of a United or an Express Scripts and are willing to stretch in their applications. I think we've learned quite a bit from that. Maybe we create more stringent sort of guidelines. At the same time, there were a lot of really interesting companies that didn't really match but could still be unbelievable companies, just not for that competition.
KK: So, Karim, you've had the opportunity to meet with so many of these founders who I'm sure had great stories and experiences that kind of led to the impetus for their solution. Are there any stories that founders shared that really stuck with you and left a lasting impression?
KB: I would say that there were some that were just pure business. They recognized an opportunity and they moved on it. That would be more like the folks that were pursuing, "We have a mask that we can mass produce," and was really meant for, let's say, "How can you take advantage of a certain situation in the market.” Those don't really resonate and they certainly did not resonate with the judges. What really had an impact was when you start hearing really the story around, "I want to see my parents. I'm not able to see my parents because they're in a skilled nursing home. What can I do to help make that easier?" As a result, I worked with my other Ph.D. friends, and we came up with a rapid test that could be delivered in 15 minutes.
That's something that makes a lot of difference. It has a direct impact to that person's life. They were virtually rocket scientists. It's amazing what they can do with their technology and their degrees but that brought it home. I think that type of experience, when you hear it, it's like a lot of other companies but when you have that passion and that energy, it just makes it so much more meaningful. I think, during this time with the pandemic, seeing light at the end of the tunnel and seeing the passion that people have and the energy that they have and working. It could be Ph.D. students out of a university all the way through to serial entrepreneurs in Europe that have done this before and just are ready to do it again.
It's exciting to see the impact that the ADAPT Program can have on these companies. I think one of the outcomes is meeting with these companies but maybe the most important is how do you make your business model better? How do you make it grow faster? How do you continue to have a positive impact on health care? These competitions put that all together.
KK: I'm sure that UCSF Rosenman Institute has sorts of competitions that are normally run in person but given the unique circumstances of this year, how did you see ADAPT, adapt?
KB: I think it was probably my first venture competition where the entire program was done virtually. Everything from, "Here are the 200 opportunities that, Karim, you have to review." They capped it at 200 each, so Gregg also reviewed 200. All the way down to the judging, all being completely remote. We had different time zones. I recall one company that we met was from Israel and I think they were at two in the morning, their time, or some unbelievable time just to make their slot for the pitch. It was virtual the entire way, without any in-person contact and never meeting a single one of the founders or companies directly. I would say that's a new experience for me. And certainly, one that has been repeated, I think, for a lot of people in 2020.
KK: Let's talk about who you ultimately decided to partner with. Can you share the partner company that you decided to go with on Echo's behalf and talk us through what that decision process was like for you?
KB: Absolutely. We ended up partnering with Vynca and what Vynca does that was really differentiated in the competition is they provided an end-to-end solution for end of life care, in terms of documenting end of life care. It does not mean that that hard decision was being made in real-time but rather, setting up all of that information and making sure all of the key entities that need to be involved in a document that is signed off for end of life care are handled. If you think about it from like a physician's perspective, it's a very difficult conversation. It's hard to have with a patient. It is 10 times harder to have it when they're actually sick and there's no family members around.
So what Vynca's story was, that really resonated with us, was that by making the process easier and making it a little less urgent, doing it in the course of care of a regular primary care visit and getting it in the hands of more physicians, it helped that patient at the time where they really needed it. That made a difference. The Vynca team's got a lot of experience. They were able to bring their product out to a pretty large and substantial customer base already and it lined up, quite frankly, with a lot of the things that Echo saw as a real opportunity to make a difference and have a positive impact on health care.
We're starting to see a lot of change in that area. We're starting to see things like Walmart offering health care. We're seeing trends. We're seeing coaching online. We're seeing nutrition online. We're seeing health care online. Peloton, working out and physical fitness, physical therapy.
KK: Karim, looking at 2020, do you think we've had a cultural shift around attitudes where people are more open to receiving care in a new place, whether that be their home, whether that be through their phone? What are you seeing?
KB: I think if we were to take a look back at 2019 and think for a moment that 20 percent of outpatient visits could be done remotely, most people would think that would make no sense at all. It wouldn't even register in reality. Today, telemedicine visits seemed like a secondary thought. It seems very easy to think about it. The risks that we thought were barriers have all disappeared in a relatively short period of time. We've seen companies go public like a Teladoc, for instance, or an AmWell, purely on the basis of telemedicine. Other aspects that we saw that were also interesting was the openness to other things that we normally don't necessarily see in medicine. That might be delivering acute care to the home or delivering hospital care to the home. I think the realities of, "I don't want to get the risk of an infection if I go into a health care facility. What can I do for alternative sites?"
We're starting to see a lot of change in that area. We're starting to see things like Walmart offering health care. We're seeing trends. We're seeing coaching online. We're seeing nutrition online. We're seeing health care online. Peloton, working out and physical fitness, physical therapy. Things that I think maybe we haven't seen in the past, but they're exciting to see. I think it certainly adds to being a consumer of health care. It's sort of like the Renaissance of health care. We're starting to see so many new things in health care. It's pretty awesome. It's unfortunate that we needed a pandemic to start it all but I think there's going be some sustaining outcomes of all of this.
KK: I love that, the Renaissance of health care. Thinking about the future, do you think that Echo will continue to participate in competitions around health care innovation? If so, what are you looking forward to as you move forward and get involved with more external innovators and have them pitch you?
KB: Yeah, we are involved with others. We are involved with the Employee Health Innovation Roundtable and help curate their competition. They do it two times a year and their groups include the 100 largest employers across the United States. It's a really fine-tuned organization that we're happy to be a part of their curation process as well as their judging process as well. I think the pathway for entrepreneurial competitions is one that Echo views as a differentiator for Echo. We like being a part of it. We think it helps us be more in tune with what's going on. It gets our name out there, which I think is a positive. It provides a great opportunity for the different members within the Echo team to participate. It's not something that any one person can handle, right. It's too big. That's been really rewarding, I think, for the team as a whole.
KK: Karim, this has been a great conversation. Anything else you want to add for our listeners?
KB: Kendal, I really enjoyed the time. I think, where we are today and the investments that Echo makes, and the participation in these innovation competitions, it just really goes to show what kind of impact a strategic investment group can have in the market. Seeing the excitement of these entrepreneurs as they compete for whatever it is, right. Whether it's a venture around or a purchase order, just being in the mix is pretty rewarding. I think, during this time with the pandemic, it's especially rewarding to see so many different groups trying to solve a problem or many problems that are addressed around COVID. I really appreciate the time and thanks for including me in the podcast.
KK: Thanks, Karim.
KB: Thanks a lot, guys.
Karim Botros is Managing Partner of Echo Health Ventures, the investment arm of Cambia Health Solutions. And that wraps up this episode of “HealthChangers.” You can find more information on all our episodes at cambiahealth.com. You can also follow us on Twitter @Cambia: C-A-M-B-I-A.
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.
