Kim MacPherson is the Associate Director for Health Management at the Haas School of Business where she teaches and manages the MBA MPH program. She is also Program Director in the Health Policy and Management faculty group at the UC Berkeley School of Public Health and serves as Co-Director of the Berkeley Center for Health Technology, which focuses on both biomedical and digital innovation. On a recent trip to New York, she sat down with Oliver Wyman Health for a wide-ranging conversation covering the evolution of digital health, advice for recent MBA grads, and the 2016 presidential election. Highlights below:
Oliver Wyman Health: With so many digital health solutions circulating in the market now, what strategies will be most successful?
Kim MacPherson: We don’t want to see a cycle of illusion and disillusion with investments in digital health. Staggering amounts of money are going into digital health, and investors of course will want to see results that translate into value from positive clinical and financial outcomes. Key stakeholders and entrepreneurs need to co-define what success actually looks like so they can evaluate what solutions are working and which should be scaled.
OWH: Which solutions have caught your attention?
KM: I’m interested in evidenced-based solutions and those that are “hybrid” - combining tech with other elements like coaching, as Omada Health has done. Where is tech being used to support a better care delivery model and amplify whatever is happening in the primary care setting? We’ve potentially skewed too far to stand alone solutions as a magic bullet and need to consider how care and behavior change realistically happens. One Medical integrates their technology, and you don’t notice it as much as the consumer. They use tech on the backend so their operations are data driven. They provide valuable tech-driven communication but in an environment where the patient feels valued and delighted to be there. Or consider the Balance Rewards program at Walgreens, where some consumers are being incented to use a wearable to upload biometric data to Walgreens and promote healthy behaviors.
Where is tech being used to support a better care delivery model?
OWH: Are there other ways a digital health startup can differentiate its product?
KM: There is a proliferation of startups that aren’t backed with evidence or haven’t figured out a way to measure and communicate what their results are to stakeholders. Who helps startups design robust studies that support having physicians and/or patients trust the data? Do incubators include these tools in their programs? Entrepreneurs aren’t having conversations around evidence and how they are going to generate it early enough. We don’t want to demonize startups for not doing this but we do need to find ways to help them. It’s easy to pick at healthcare from the outside, but it can be hard to craft a lasting solution in a vacuum. You need to get out and talk to customers repeatedly and vet and test. A lot of places have great stories. You can do a pitch deck for almost any chronic disease and show how your solution will target a pain point. But do you understand the ecosystem that you think you are going to disrupt? Even though a specific solution may address a particular problem well, it may not integrate into the healthcare system neatly. ACOs have heard all of these stories. You need to show how you actually deliver. Solutions with strong metrics will rise.
You need to show how you actually deliver. Solutions with strong metrics will rise.
OWH: How do established healthcare organizations fit into the innovation mix?
KM: Beyond serving as investors as some are doing, one other way is serving as pilot sites or test beds to allow solutions to be implemented in a dynamic and “real world” setting vs a more static, controlled (or virtually) environment. Reverse pitches where an established healthcare organization tells you the problem, and you go fix it can sometimes also be more constructive as you get the problem up front and ask for a fix vs the more common practice of shopping around a digital health solution someone has devised, looking for a home in a complex system. Organizations need an ecosystem where all of these vectors - internal and external innovations and sources - can all cross. Innovation in a silo is a missed opportunity. An organization needs to have a point of view on their digital and innovation strategies so they know if a solution is a good fit for their needs and population. Where would a doctor in their own ACO or health system go to find out what’s available or if a particular idea would work? How would any proposed solutions integrate with the system’s existing EMR and other information systems? A framework is needed.
Innovation in a silo is a missed opportunity.
OWH: Why are we not seeing more clearcut success stories so far?
KM: What evidence does it take to get a system to buy, a doctor to prescribe, and a consumer to buy? On the financial/ROI messaging, there is a lot predicated on reducing downstream admissions or ER visits. Not sure how many solutions are actually demonstrating that so far. Also complicating the efficacy question is trying to measure how consumers feel they are personally benefitting. Apps that help me purchase things help me solve a problem: they deliver food, send a car, buy a plane ticket, move money. Health apps don’t cure diabetes. They don’t solve problems; they create long-term pathways that aim to support those goals but they do not by themselves lower BMI or reduce someone’s cholesterol levels. We have to be fair to the consumer in what we are promising. The system’s and the end user’s problems are not necessarily the same. Wanting to lower medical costs is a different goal perhaps from the consumer’s focus.
OWH: What new ideas are your grad students pursuing?
KM: Given the location of UC Berkeley near San Francisco and Silicon Valley, there is a lot of emphasis and excitement about applying tech solutions to healthcare. Students are increasingly approaching healthcare problems with a broader view that addresses lifestyle issues, not just clinical concerns. In one recent innovation challenge that we sponsored with the Anthem Foundation, a student team designed an app that will guide people with pre-diabetes/diabetes to restaurants that might be more diabetic-friendly and also helped identify meal options that would be the most healthy. They took into consideration that people resist altering their lifestyles and don’t want to be labeled or defined by a chronic condition. They’re developing lifestyle solutions with quick connections to services, normalizing and bringing these ideas into our everyday lives. Students are asking how to make people with illnesses feel less isolated and how to target solutions to the right population.
Students are increasingly approaching healthcare problems with a broader view that addresses lifestyle issues, not just clinical concerns.
OWH: What advice do you give students who are interested in pursuing digital health?
KM: We encourage students interested in innovation to go get experience working in a startup environment. These organizations run looser and require self-starters with minimal direction. How can you cultivate the skills that you realize you need midstream in a job? Can you operate in an environment of uncertainty where there is no right answer, no formula, and limited structure? There are more mentorship opportunities and workflow templates in place at larger organizations but being successful in any part of today’s healthcare industry requires critical thinking, flexibility, and creativity. We also really focus on creating opportunity for applied learning by assigning students to actual client organizations where they can test thinking and utilize the skills they are learning about. You have to be able to think critically, analyze, and know where to start when there is a blank piece of paper. Some find digital health companies too unstructured and tech driven and others absolutely thrive in those environments.
Being successful in any part of today’s healthcare industry requires critical thinking, flexibility, and creativity.
OWH: How has digital health evolved?
KM: What we saw back in the 1990’s were more solutions targeted at the physician. There was zero interest in targeting products to the consumer. Patients were still seen as sheep. The thought was that you could just overlay tech products onto healthcare and make huge strides in productivity and efficiency given how backward the use of tech was vs other sectors. Many emerging e-health solutions were directed at physician workflow and behavior, which is not that easy to change and involves complicated professional dynamics. Epocrates solution around drug interaction information was one of the only success stories to survive. Their convenient digitized drug library caught fire because it solved a real point of care data challenge. This was the era of “e health.” Solution design was sub-optimal back then because they often were solely tech driven and didn’t have doctors involved in design.
OWH: What effect is the 2016 presidential election cycle having on health innovation?
KM: For innovators trying to launch solutions or expand scale during this 2016 presidential election cycle, they may find that they have a very distracted buyer. This is becoming an increasingly difficult political environment to plan for healthcare. If you are trying to pitch a digital health solution, you better hope that whatever solution you have, it looks good whether the ACA continues or it gets ripped up and something not particularly thought out takes its place. You may have to play out a lot of different scenarios or just be patient until the outlook clarifies and health systems and ACOs and other potential customers feel there is a measure of predictability ahead. Both providers and payers have to cope with these issues and if the ACA or key provisions such as the individual mandate and exchange subsidies were repealed, many consumers would also feel that directly. So, this is again where evidence that a solution can achieve the benefits it touts becomes even more important. You need to have a direct and implementable solution to a specific problem you know needs solving and you have to have strong evidence to get a buyer's attention when dealing with an uncertain macro environment. These challenges shouldn’t deter an entrepreneur but they do magnify the need to be able to explain what you are solving and document a clear path to results.