It’s clear that the role and function of health systems are changing with the introduction of new digital health technologies, reimbursement models and cultural shifts in the healthcare industry. At the front lines of this transition is Dignity Health Chief Strategic Innovation Officer Richard Roth who is charged with leading innovation efforts at one of the country’s largest health systems. That means developing processes to incorporate and scale up products, services and partnerships meant to improve access and outcomes, while reducing costs.
MedCity News caught up with him last month in San Francisco to talk about common pitfalls that trap digital health entrepreneurs and why he sees healthcare moving towards a membership model analogous to Netflix and Amazon Prime.
This conversation has been lightly edited for clarity.
How have you seen the conversations you’re having with digital health companies changing as the industry has matured?
I think there’s been a couple phases. Phase one was ‘hey we have this amazing product that can help with a lot of different things.’ But when they entered with that product I don’t think many organizations realized the intricacies of dealing with the healthcare system. We don’t want a product that simply works for commercial consumers. The greatest challenges of our time are Medicare and Medicaid patients, they make up two-thirds of who we see. We need a product that can fit holistically and a product that can work within the clinical workflow. So your product really has to be white-labeled, integrated, part of a single-sign on or part of an overall continuum so that the physician doesn’t even think about an additional step.
The second hurdle has been evidence. A lot of these entrepreneurs came out of Google or Apple and so they are amazing designers and engineers creating great products, but products without evidence don’t convince healthcare systems to do a mass implementation. Moving forward, success means you’ve got an amazing product that you understand you’re part of a continuum, you’re committed to making your data available to prove out your solution and you’ve created a solution that can treat care everybody not just the person who walks 10,000 steps and wants to go to 15,000 steps.
Startup founders often complain about long sales cycles that can sink smaller companies, how have you created a system that allows these products to scale up internally?
Rich Roth, Dignity Health Chief Strategic Innovation Officer
We do a couple of things. One is we really focus with three to five organizations at any given time. I think what people don’t appreciate is when you’re doing a legal contract or IT security, no one has experience with something that is on your Apple Watch then goes into the cloud then shares its data with other people and then has a social network created around There’s no singular individual they can say yes to that in any type of organization.
I think the common mistakes for these young companies are that they don’t know who they’re working with in the organization. They may be working with someone who can get a pilot done, but don’t understand the broader ecosystem in the organization to create something that’s lasting and sustainable. If you’re in on a research grant, if you’re in on a innovation pilot, then you’re not really in.
What I say to young organizations that we bring in is that we’re going to make you enterprise ready: We’re going to invest upfront, we’re going to design studies to make sure you’re effective, we’re going to bring in our corporate development people in a given area and we’re going to experiment, learn and hopefully scale over time if it works. But we’re all going to be on the same page on how long things will take, what we will measure and what the process is.
One of the big trends we’ve seen is the consumerization of healthcare, how is Dignity trying to lean into that shift?
For that it’s really our digital model and our increasing diversity of primary care. So, for example, we’ve brought One Medical to Phoenix to act as the primary care provider and refer out to Dignity for more advanced services. We’ve created a pathway where we can offer integrated high access specialty services, but patients can choose One Medical for their primary care. I think that where people are most making their choices today is high access convenience services. At the end of the day when they need greater assistance then lower level care can provide, we want to be there for that greater assistance.
Pretty soon we’re going to launch something really interesting for caring for patients in the home rather than being admitted. It will start with Medicare patients, but will be expanded to other groups, as an alternative for admission by using things like telemedicine and advanced nursing care in a much more comprehensive way for people that have complex issues.
Dignity was one of the first partners for Apple Health Records, how does that relationship fit into your larger philosophy about the patient as consumer?
We’re moving towards a membership culture as a society. Your Netflix membership, your Amazon Prime, your Costco card. What that means is that people are going to take greater agency in customizing an entrypoint for themselves.
That’s why digital is really important as a front door, that’s why these creative primary care models are important. Apple Health Records are a great example of that, there’s a segment of people who want to own their record, have it on them at all times, and there will be entrepreneurs who build upon that.
We also have to realize it’s going to be 20 groups of people taking a 5 percent choice. A lot of people don’t want to have their health records and just want to go into the clinic and have the delivery system care for them. Some people may want to go to a community center and get their blood pressure taken while playing bingo. The great challenge for us will be mapping together these segments and offering something that’s more human and more personalized vs. promoting a one-stop shop model that people are rebelling against across all of society.
I think the membership concept is going to be a big thing and people are going to try to create loyalty in healthcare in a way that’s not been created before. I think there’s the Kaiser model which is really just in California, but it’s a very attractive model because you’re a member. I think they were ahead of the game on this membership issue and there will be many followers. It’s already started and it’s going to be a big theme going forward.
What role should delivery systems play in addressing social determinants of health and offering social services?
One of our themes for innovation is Healthy Populations, which focuses on social determinants to figure out better ways to offer support for the most vulnerable. The reality is we don’t want healthcare providers providing community services in large measures. We should invest and support them and connect them in much more robust ways to elevate the work they do. What I’m passionate about is how do we find the organizations in the community and how do we connect with them digitally and can we refer to them. But I don’t think delivery systems should replace the community model with a medical model because I think it would make it more expensive and lose the special reason why those models really work.
What is your take on the biggest healthcare news over the past 12 months?
You’ve got to start with the entrance of the non healthcare companies into healthcare. I love the phasing of what’s happening recently with Google, for example, hiring David Feinberg. There’s so many divisions of Google working on so many healthcare things, it’s hard for the customer to digest. I think what you’re seeing is what’s with the wave of those organizations and the first they started with technology, then they moved into life sciences and they brought life sciences leadership and now they’re recognizing they need to bring in leadership from the delivery system to help them partner with the delivery systems. I think that’s the big story is not only their entry, but the fact that they’re bringing in leaders from the delivery system because I think they realize they don’t know how to speak the same language and address the same problems.
