Moving On

Over three years ago, a good friend of mine asked if I’d consider joining the board of a local startup. They were very early stage, in the healthcare space, they’d raised a bit of funding, and were looking to grow.

Great. I meet with a lot of startups, mainly trying to help and provide a sounding board. Many of the founders are inspiring, many have reasonable ideas, some of them will go on to be successful, but it’s really rare that I personally get excited about any particular company. Certainly not enough to join and invest time, money, and energy!

But I owed my buddy a favour, so we met at the closest pub to my flat, and I prepared my gracious-decline speech. Except something strange happened. As Chris talked about what they were building, I became increasingly interested.

Current Health (at the time named Snap40) had designed a clinical grade (requiring FDA approval) wearable intending to replace most of the normal monitoring equipment found within a hospital ICU. This device could then be linked to a phone or tablet, and could help identify patient deterioration, perhaps even before a human would notice. There were other applications too – for example, my mid-sixties father crashed his bike recently, blacked out, went to the hospital and got an MRI, then was held for a further 24 hours for “observation.” In this scenario, perhaps he could have been sent home earlier as long as he was monitored for deterioration. Plenty of conditions could benefit from proactive monitoring at the home linked to a healthcare provider, and even more mundane challenges like medication monitoring (ie, did they take their blood pressure medication? Lets see!) could be significantly improved.

A major challenge for sales within the healthcare industry is dealing with a sophisticated and opinionated Decision Making Unit. Doctors, nurses, pharmacists, administrators, and technical people all factor in, and in a new category educating this market can be really time consuming and expensive. Would healthcare professionals get this? I called a few physicians I knew and asked. They immediately got it, several of them referenced having this idea themselves, and one of them spent more than an hour telling me all the different ways it would save their hospital and health network money. So that seemed promising.

One of the key things that attracted me to this implementation is the wearable is a “dumb” device. Raw signal is sent to the cloud where it’s analysed and processed using a combination of machine learning (yes really) and other algorithms. This means a couple of things – the algorithms can be tuned using all data ever collected from every device out there, and new algorithms can be shipped without replacing the devices. In other words, the more data collected, the higher the accuracy.

This is a crucial distinction: Current Health isn’t a medical device company, it’s not a software company, it’s a platform company.

I joined the board in March of 2016, with one condition – I would resign every year in March. Chris could accept or reject my resignation. While I’ve been a member of the board at Administrate since I joined in 2011, I’d never held a board position on another company before. Maybe I’d suck at it. Maybe the company would outgrow my expertise. In any event, they wouldn’t have to wait too long to get rid of me if that became necessary.

“Is it going to work?”

For the first two years, this was the major question. Pilots at local hospitals were really promising, and we obtained a European CE mark which meant we could sell it within Europe, but we needed to get certified by the FDA to tackle the USA. This was tricky, because the FDA had never certified a hybrid device like this before.

The next three years (and three resignations) passed quickly, and I’m super proud of what we achieved. A CE mark, multiple pilots, FDA certification for use in both the hospital and home environments, recruitment of a fantastic team, an office move, a rebrand, and multiple funding rounds, including one of the largest seed rounds ever raised in Scotland.

But perhaps the achievement I’m most proud of happened recently during an extended pilot project in the United States – we identified a patient’s vitals slipping, and alerted staff to the issue. The traditional monitoring machines didn’t notice, and we saved a life. The first of many I’m sure.

The traditional monitoring machines didn’t notice, and we saved a life. The first of many I’m sure.

Current Health is going to fundamentally transform how we receive and provide healthcare. I’m super excited for the future, but I also realise that the time has come to step down from the board and make way for the next stage of growth. To the disappointment of most, there’s no drama here, it’s simply time to move on.

I remain deeply thankful to Chris (and my pal who introduced us!) and the team at Current Health for giving me this opportunity. I learned a ton, got to work alongside some incredible people, and I believe this experience made me a better CEO – sitting on the other side of the table can be really enlightening! I am extremely excited to watch how Current Health will grow and I couldn’t be more optimistic about their future.

What do Banks have to offer Healthcare?

Most of the discussion during the Medical Banking Leadership Forum seemed to center around the idea of providing PHRs or processing transactions.  The idea goes that banks should somehow get involved in the Personal Health Record (PHR) space by providing platforms for customers to view their health records since so many of their customers are used to logging in through banks.  The other view is that banks are really good at processing transactions, and bank networks are secure, safe, and fast, and so healthcare transaction processing (many of these transactions being financial after all) should logically be handled by financial institutions.

I take a slightly different view.  First, while I think that banks should get involved in the PHR space, I think it should be in a different capacity than simply providing a spot to store or view health data.  Instead, I think that banks should instead focus on being in the identity management business, an “identity broker” if you will, and provide authentication services to any PHR vendor or hospital that might be interested.  If you think about it from the PHR vendor’s perspective, their service increases in value the more confidence they can have in the validity of the identities they serve.  Correctly identified accounts means you can combine them with other data sources (at the account’s request of course) so that the PHR can serve as the hub of a person’s medical data.  Incorrect data is almost impossible to manage or transfer between systems, and serves to defeat the original stated purpose of a PHR. The financial services industry (read: banks) are one of the few industries that take identity management SERIOUSLY.  Multiple forms of identification are required, addresses are consistently maintained, and people really care about making sure their passwords to their accounts are remembered and treated securely.  Nobody types their username and password to their checking account on their monitor at work, or sends it in an email to their friend who needs it, etc.

If I were a bank, I’d use that asset (the one-time and continuous identity management) and sell it to PHR vendors (again, with the account holder’s consent).  Instead of creating a new account with Google Health, let me authenticate with my Chase username and password, and everyone can feel comfortable.  The PHR can now rest assured it’s got clean data, the account holder trusts Chase and has an interest in maintaining their information. As for the second prevailing view: banks are the best at financial transactions, my response is, “So what?”  Maybe as some claim, everything in healthcare is a financial transaction (or should be a financial transaction) but that’s like saying lets let Visa and Mastercard determine the price of the car I’m buying.  Banks already process all the financial transactions, and without in depth knowledge of the services being rendered, they’re not going to be able to price, process, or provide transparency to healthcare claims. 

A lot of discussion seemed to revolve around the vein of “but we can get paid to move the data” and again, who cares?  If banks really wanted to get involved in the healthcare claims adjudication process, they should invest in technology tools that provide a platform for insurance plans to define and transaction rules related to services and payments.  Not a single bank in the Medical Banking Project (save for one that I talked with) has any desire to do this.  The solution for banks in this area is to get closer to the details, not farther away.  That’s where all the cost savings and the benefit of transparency exists anyway – at the long tail of the bell curve.  Banks should know better anyway, they’ve been preaching this for years.

Thoughts on Medical Banking

This past week, I was in Nashville attending the Medical Banking Project’s Leadership Forum, which was hosted by the Vanderbilt University Center for Better Health.  The Medical Banking Project is a think-tank whose goal is to raise awareness of how banks and healthcare can intersect and drive increased efficiency, visibility, etc.  The goal of the forum was to choose a few projects where the members could work together to pilot some use-case concepts that would demonstrate how these two very different industries could work together.When people hear the term “medical banking” they’re often confused, and that confusion doesn’t improve much even among the medical banking project members.  With such a broad scope and so many different vendors and other organizations involved, everyone’s definition seemed to be different.To pare things down, here’s a few points that most members would agree with:

  • Banks specialize in well defined discrete transaction processing coupled with high visibility.
  • Healthcare organizations specialize in complex decision making that often requires the distillation of large amount of data into generalized care protocols that are often adjusted based on specific peculiarities.
  • Financial organizations are not very well equipped to deal with “creative” or “non-standard” processes or products.  When your only tool for evaluation is a balance sheet, context gets lost very quickly.
  • Healthcare organizations face a really large challenge distilling down their very fluid, complex, customizable environment into financial transactions, and as a result, are really bad at providing visibility to anyone involved in the healthcare spectrum (patients, providers, payors, regulators, etc.).
  • Trends suggest that patients will become more responsible for costs out of pocket, and combined with rising expectations of online access and visibility, will begin demanding more from healthcare providers.

When you discuss these items with banks, they feel as though they can provide back office support to healthcare institutions and get paid for the transactions that would flow through their already-established networks.  Healthcare providers are generally just desperate to get out of the billing and payment nightmare that has been created for them so they can focus on providing care.The question is, how?This questions is particularly challenging when you have the CIO of Vanderbilt University Medical Center, Dr. Bill Stead, one of the Leadership Forum’s keynote speakers say with certainty that “we have no systems or technology available today that can provide what we need.”  Healthcare providers want more information that’s more accurate more quickly comprised of huge volumes of more data.  Banks and consumers want less information that can be presented as a line item on a statement, priced accordingly, and compared to other options quickly.The key, we all agreed while at the Forum, was a national network for transacting healthcare and financial data.  Where the group didn’t always agree, was whether querying the data in aggregate would be useful.  The bankers in the group pretty much didn’t understand how valuable such analytics could be and how much cost could be wrung from the system by examining the whys behind the transactions.  That’s typical.  Most who haven’t been in healthcare can’t imagine how small variances can introduce magnificent variations in the costs to provide a service or procure a product.  The healthcare entities in the group kept stressing that they wanted to provide the data, but had nowhere to send it and major challenges paying for the applications and training that would facilitate collection of the data.We’ve got a lot going on right now in the industry, what with the healthcare stimulus (ARRA), an increasing drive by Medicare and Medicaid to introduce pay-for-performance measures and more accurate reporting requirements (example: the Deficit Reduction Act of 2005), and a general push by everyone for better technology and better visibility.  Most of what we covered is too long for a single post, so I’ll continue to post thoughts on the Medical Banking Project over the next few days.