The Rise of Open APIs in Healthcare: Aneesh Chopra, President, Care Journey  NOW #156

The Rise of Open APIs in Healthcare: Aneesh Chopra, President, Care Journey NOW #156


We are here with the legend, Aneesh Chopra. How are you sir? I’m honored to be with you, Unity. Before we get started, We just have to thank
you from StartUp Health, because if it wasn’t for you and others around you in 2011, when
we launched StartUp Health, we wouldn’t be where we are. So, thank you for really helping us get going,
for when we were nothing, so. This is the easiest thanks in the world, because
I am more thankful of you, because you had come together with this unbelievable story
about how we can catalyze the ecosystem. It was the easiest thing to rally behind. And to see what you’ve accomplished over the
last several years, it’s just blown away all expectations. So, congratulations to you and the team.Thank
you so much. What is your take on where the ecosystem is
today? I mean, we’re a few years into, sort of, what
I’ve been calling phase one of where we are. There’s just been extraordinary progress been
made. You guys were just starting out with Health
Datapalooza, and open API’s, and really opening things up. Data liberación. Where are we today? So, let’s walk through that, so we get a perspective
on it. On the high level, of course, I’m going to
say, we’re great in some areas, weak in others. But let’s just, kind of, take an inventory
of the assets and liabilities. We have digitized the core electronic foundation
of medicine at a pace that I think even the naysayers would say is succeeding expectations. Almost every hospital’s wired, physicians
are on their path to being fully enabled. We’ve seen the meaningful use deployments
take hold. So, on the asset side, we now have manilla
folders replaced with digital infrastructure. Point number one. Liability, we haven’t finished the job on
standardizing how that information should flow. So there’s a frustration that both doctors
have become documentation specialists and data entry clerks and that’s part of the usability
challenge. Another challenge is that the information,
when it’s in, isn’t really connected to the places where it might be useful. And so, we’ve got work to be done. So, on the liability side, it’s a digital
asset, but it’s a digital island. And not so much an internet node connected
ecosystem. But, we’ve also made great progress in payment
reform and changing the way the healthcare delivery system itself is organized. Here, it probably, we over estimated about
how fast it would be, in terms of changing the culture of healthcare, to look at populations
as opposed to one patient at a time. But we’re very much in a position of strength,
especially, as you look at where we are on a bipartisan basis, to move the country towards
value based care. So on the asset side, we have a phenomenal
tail wind on what we need to do to get the incentives right, so people can do the kind
of medicine that they’ve always wanted to do, but weren’t incentivized financially to
do. And so, that’s coming and the IT will follow. The other piece is, massive amounts of capital
reform into the system. Much of it will likely have difficulty, sort
of, scaling. But on the par, There’s billions of dollars
coming in. Capital’s flowing, perhaps anticipating faster
traction in areas like population health that probably underperformed, in terms of actual
demand for those services. So there’s going to be a bit of a shake out
in the industry. But what will emerge on the other end, I think,
will be a very strong technical foundation for the future of healthcare delivery. And that, I think, is very exciting. There’s almost a new generation of entrepreneurs,
doctorpreneurs, all learning for the first time as they’re creating this new future. So, I think, even if some of these companies
aren’t successful on their first try, maybe on their second try. And we saw that during the 1.0 Internet Era. So, I think there’s a lot to learn there. We are seeing thousands of entrepreneurs and
innovators come into this sector. Which is nothing but great. That’s just extraordinary. Because it wasn’t like that. Yeah, but the understory, under-told story,
is that the marginal effort they have to engage on to deliver their product is shrinking. So, if you are a startup in the general internet
economy, you can spin up AWS, You can use all these other openly available tools. You can have a go to market with a product
relatively quickly. So, it didn’t take lot of capital to test
your hypothesis. Right. This is a whole, lean startup movement, right? In healthcare, you might have had an idea
to give patients better decision support to navigate the care delivery system, but to
execute that, you’d have to have had all this underlying technology and contracts and plumbing. Which was super expensive and very capital
intensive, resource-intensive. And it meant that your ability to test that
hypothesis would be very, very difficult. That is shrinking. And the good news is, all those entrepreneurs
now, even if they fail, are failing faster, which requires less capital, so they can then
deploy their brain power and the learning into the next idea. So, that should make us much more capital
efficient going forward. Another thing we are starting to see more
of, is industry start to work with earlier stage startups and entrepreneurs. That wasn’t always the case. You were a catalyst for this. Well, thanks to this, No. whole ecosystem
coming together. You’ve created the conditions for them to
do it. Back a few years ago, you couldn’t even
get in the front door of some of these organizations. What, both do entrepreneurs need to be doing
for where we are today, and what does industry need to be doing more of? So, here’s the, both parties are debating
on the future of the healthcare delivery system. So, in my humble view, I would find the care
delivery system leaders, who are embracing value-based care. Acknowledging that they’ll be some turbulence
in the short run until we make it over some proverbial hump, when that’s going to be the
core operating system for healthcare. And if I’m an entrepreneur, I’d want to
seek those people out to listen to what their challenges are, and what they anticipate those
challenges to be, and meet them where they are needed. And the ability to match make. And that’s one of the benefits of StartUp
Health. You’re helping to weed out organizations that
see that part of the future and want to connect to entrepreneurs who can help them navigate
this short-term turbulence and prepare for that future. Right now, we’ve got, otherwise, mixed incentives. If I’m a healthcare delivery system and I
were to say what is the most important thing that I need? I need documentation support for billing improvement. That’s going to have the highest short-term
return on investment. It may not have a lick of improvement in patient
care, but it improves their reimbursement. It might even improve some other metrics that
they measured against. And that’s interesting, but not solving fundamental
problems in the delivery system. So, if you just told me to solve that problem
I’d make money at it, but I don’t know if I’d really fundamentally change the path of
patient care. Whereas, those who say, no, no, no, let me
tell you the problems I want you to help me solve. For which I don’t really get a lot of economic
benefit from today, but I anticipate that benefit in the future. You identifying both sides of that equation
would be the greatest gift for the current ecosystem. Find those folks who are, kind of, value based
care ready and the entrepreneurs who wish to serve them. That would be a phenomenal service. So, we’re seeing two innovation paths, almost
in parallel. There’s companies focusing on what we call
incremental innovation. Solving some of these very important challenges
that can serve the market needs today. And then there’s another track of what I call
leap forward, leapfrog innovation, which I think is also exciting and extraordinary. It is. I don’t know if you have thoughts on that,
Yeah. And if they’re both needed and, For sure they’re
both needed. And I’ll tell you how I deal with this myself. So, I have aspirations for a leapfrog idea. The leapfrog idea is that we’re going to have
a marketplace of health information fiduciaries. So, right now, the way you enroll in value-based
care is a bit paternalistic. Your doctor has to sign a contract with a
plan who is willing to offer it. So, if you happen to be a patient who has
the benefit of those two pieces in place, you’re going to get value-based care. But what if I, as a patient, want to have
value-based care, without knowing whether my doctor or my hospital is involved. Well, one thing I can do, imagine, is I could
have all of my health information organized in a manner, by what I call a health information
fiduciary. A fidelity, if you will, who can take my information
and say, you know what? Given who your doctor is, and who your hospitals
are, and where you get care, keep them. But here’s how we would route you more effectively
through the system to make sure you are getting the right care at the right setting at the
right time. That routing engine, to me, is the leap frog, or a disruptive, because it’s not told to me by my doctor or my health system, but rather
by my, call it my guardian angel that sits on my shoulder. You might learn about this through The Commonwealth
Fund’s work around the Digital Health Advisor. Which is, sort of, a call to action to create
more and more of those types of services. Tech enabled services. But then on the incremental side, where I
work today in Care Journey, and the services that we make available to Medicare, ACO’s
predominantly, A lot of the ACO’s want to understand if they were operating from the
patient’s standpoint, tell us what you’d be giving advice to them about, so that we
can better coordinate their care and support them. So, there’s an incremental opportunity in
the organizations that want to embrace that future, while there’s a chance to leapfrog
by going right through it, into the consumer model. So, I hope both markets succeed. Right. But, I definitely see an opportunity to, kind
of, build incremental, while pursuing the longer term vision. What are you most excited about? Open API’s. Well, yeah, and, you know, thanks to that
movement you guys started, I mean, it’s exciting to see where we are today, and for some it
seems like it’s been a few years, but it’s really just been a blink of time almost. Look, to me, the internet works at the touch
of a button. I can connect my Spotify playlist to Songkick
and it can alert me whenever a band I like, my wife likes, is coming to town. And that’s a delightful service. I didn’t have to go through some big data
usage agreement. Some complicated custom interfacing engine. It was an offer. I connected. I authorized the service. And it works. And to some degree, we lack that simple connectivity
in making sure our health information is organized in that same manner. So, while I might appreciate a doctor as my
Spotify that has all the services that I need to get my care, I like that ability to bring
Songkick into the equation and it can say it for me, by the way, Aneesh, you might want
to have this service come in, because people that look like you have benefited from this
type of diabetes prevention program, which may not have been told to you by the doctor,
but is available to you through your Medicare benefit. So, I think this idea of open easily accessible
API’s, so that patients can connect apps of their choices through their health data
is the part that I’m so excited about, because we regulated it, the vendors are shipping
it, and we’re just in calendar year 2018 likely to reap the benefits of it. Right. And to see what the potential might mean for
a connected healthcare to run the system. There’s an open position at HHS. Can I get you in there somehow? Are you open? I will say, while I’m on the resist movement
on a lot of the areas where President Trump has done, things that perhaps might not be
in the spirit of where we think the country could go, on his healthcare IT and the leadership
he has in tech innovation more generally, I am so proud that they’ve chosen to depoliticize
and to continue and build upon the work, and the team is phenomenal. I’m proud of the ONC that he’s commissioned,
I’m proud of the CTO Network that’s growing across the agencies, including HHS, and thankfully,
we see a great deal of collaboration in pursuit. Now, the broader, political agenda that’s
happening in Charlottesville and all the rest, difficult. But, I’m very bullish on this team. Getting the plumbing right, and to build on
that progress. Just want to thank you again for all your
leadership and all you’ve done for the startup community and for StartUp Health. So, thank you so much for everything. Unity, a pleasure. Thanks man. Thank you.

Daniel Yohans

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