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Many entrepreneurs are worried that healthcare is not transforming fast enough, while other sectors are leveraging digital solutions to accelerate transformation. In this episode, entrepreneurs explore how to move healthcare forward through an equity centric innovation approach.
The United States has many challenges that require improvement, like other health systems throughout the world. Historically, these challenges disproportionately impact distressed communities. Many of us are working to solve these challenges by leveraging digital health and health data solutions. But if we do not innovate from a health equity perspective, then we run the risk of designing solutions that are misaligned with the needs and desires of communities. If you want the right resources to advance healthcare innovations that work for all communities, stay updated with the most cutting-edge information with 21st Century Health. Tune in every other week as host Michael Crawford talks to global health experts, leaders, and innovators to find out what we need to collaborate and co-create healthcare solutions that enhance health and wellbeing for all communities.
Michael Crawford is the Associate Dean for Strategy, Outreach, and Innovation and Founder and Executive Director of Howard University's 1867 Health Innovations Project.
21st Century Health is a production of Howard University’s 1867 Health Innovations Project and Voxtopica.
Michael Crawford (00:05):
I am Michael Crawford from the Howard University. I am also the founder and executive director of Howard University's 1867 Health Innovations Project, where we are looking for innovative solutions to address longstanding health challenges. This is 21st Century Health.
(00:23):
All around us industries are evolving. They are pivoting to digital innovations, but there are many entrepreneurs who are looking at the healthcare sector and wondering, is it getting left behind?
Dr. Chris Gibbons (00:34):
Many people in healthcare tend to look only at healthcare and say, "Oh, it's so unique, it's so different that we can't and we shouldn't even look at other sectors." I don't think that that's the best way to look at it. And so, one of the things that I've done over the years in trying to understand where things might go in the future and where digital health might take us, is to first understand what it has done in other sectors.
Michael Crawford (01:02):
That was Dr. Chris Gibbons, the chief health innovation advisor at the Federal Communications Commission. Dr. Gibbons has watched digital innovations evolve over the years, but he is not sure if healthcare has developed as quickly as other industries.
Dr. Chris Gibbons (01:17):
Healthcare is probably the last large sector of our economy to embrace digital health. Most if not all other sectors have embraced. And as you look across those sectors and what has happened, you actually begin to find some patterns. And so many years ago, I said to myself, "Okay, well if that's happening in the retail sector and that's happening in the airline sector and that's happening in all these other sectors, what if it happened that way in the healthcare sector? What would that look like?" And that began the way I began looking at things.
(01:53):
If you look outside of healthcare first, what you find is that technology is not just a thing that gets layered on top of what we were already doing. If you look back in history, every single time there's been an introduction of major technologies, it not only changes the way we do things, it actually changes values. It changes what we consider to be valuable. It changes consumer norms. And things that used to be the standard way of doing things are no longer considered adequate. And the technology allows for new ways of doing old things that were impossible before.
(02:39):
And the second thing it does, because of those new ways and because of the technology, it enables brand-new revenue models, business models, way of making money that was not possible before the technology allowed that to happen before. And honestly, those new revenue models usually far outpaced the revenue models that came before them.
(03:06):
And so if you take those learnings and apply it to the health sector, it begins to take you in some places that are very, very different than where many people in healthcare think it's going to go. The reality is because technology allows the transformation in societal norms and customer behaviors, if you don't do it, then over time you become irrelevant because your competition will do it, providing the new value that customers want, the new options that they're looking for, the new revenue models that are more in line with what they want to pay and what they want to do. And therefore you don't have to do anything, but you will increasingly become irrelevant.
(03:51):
I think many in healthcare are making that same mistake. They're just looking for digital bells and whistles to be the front door of their institution and basically at its core not changing anything. Then multiply all that on top of underserved populations who have unique challenges. It can be scary, but it's also I think an amazing opportunity.
Michael Crawford (04:12):
The opportunities seem infinite for entrepreneurs in the healthcare space. That is another thing you should know about Dr. Gibbons. Not only is he the chief health innovation advisor at the FCC, he is also an entrepreneur. He founded The Greystone Group, a digital health innovation and transformation company.
Dr. Chris Gibbons (04:31):
I didn't come from a family of business people or entrepreneurs. My father was a scientist. PhD scientist his whole life. And then I chose to go into medicine. So I spent half my life becoming a doctor and training and all these kinds of things, and that's how I started my professional career. But along the way felt that there was something more, there was something that healthcare wasn't getting right, particularly as it concerns underserved populations.
(05:04):
And the inertia to change was ... The inertia not to change, I guess I should say, was so big that I came to the point where I had to make a choice. I could stay in this more traditional role, have a great life, but not likely to see major changes, particularly with the health of underserved populations based on the past and based on we're currently doing what we've always been doing, or I could try to do something else.
(05:33):
And so I finally decided that perhaps I would start a business and try to explore the ideas I had. But at that point, I wasn't a 19 or 20-year-old anymore. I had a family, I had children, so I couldn't just take the leap. So it took me a few years to prepare, but I finally did and I said, "I'm not sure I can be successful here, but let me do this and if I can make a decent amount of money, then I will leave the traditional healthcare role that I was in behind and go forward."
(06:09):
And so for a period of about five years, I was really doing both, but in fact, I was able to reach the benchmarks that I had set for myself. And in 2015, I decided to switch to doing this entrepreneurial based type work full time and the more traditional healthcare work a little or on a part-time basis and have been there ever since.
Michael Crawford (06:31):
There are several factors that go into developing healthcare innovations, factors we will continue discussing in this podcast, but entrepreneurs are the drivers behind effective innovations. Without entrepreneurship, innovation cannot happen. Every entrepreneur has a different story and comes from a different background, but not every entrepreneur operates with health equity as a central focus of their business. I asked Dr. Gibbons for his perspective on this.
(07:02):
Dr. Gibbons, based on your experience with both the FCC and as an entrepreneur, can digital health function as the great equalizer in closing the health equity gap?
Dr. Chris Gibbons (07:13):
I think the key is the way you say it, can it? And my answer would be yes, but the followup question is, will it? And the answer to that question remains to be seen. It's like many other things in our society, if it's done right, I think it could. We don't need to look back and say the other things haven't worked. We've been doing those for hundreds of years and we still have inequities all over the place and no real change, no matter what we have done.
(07:47):
So this represents ... And I'm talking now not about digitization, I'm talking about digital transformation in healthcare in the health sector. I do believe that has the potential to be the great equalizer.
(08:00):
But if all we attempt to do and all we do do is digitization, and we do it the same way we've been doing it, which means essentially it gets rolled out to certain populations before it gets rolled out to other populations, or the ones that are developing it only come from certain populations and they're the ones developing it for other populations, not only will it not be the great equalizer ... Generally speaking, data travels quicker through technology than it does in person. So we'll not only get the same results, we'll get worse results and we'll get them faster.
Michael Crawford (08:34):
What areas in healthcare are ripe for innovation in transformation?
Dr. Chris Gibbons (08:40):
The real question is what areas in healthcare are not ripe for innovation? I would say every last bit of it, everything, every single thing, nothing is off the table. That includes everything from the research enterprise itself. And you're starting to hear a little bit of this when it comes to clinical trials, which is one part of the research enterprise.
(09:06):
But let's face it, right now it's well known that it takes roughly about, it's been estimated 17 years to go from bench to bedside as they say, to go from the lab to the patient side. 17 years for one innovation in the healthcare sector. If that doesn't change, the healthcare sector will never keep up with the technological changes that are happening that are enabling other things to come.
Michael Crawford (09:38):
Several areas in healthcare could benefit from innovation. I spoke with Taylor McPartland about a specific area where he saw a critical need for innovation.
Taylor McPartland (09:47):
I definitely don't think it's a secret, is the need to address nursing and staffing shortages and really looking at how can we think more productively and a little bit further downstream to address this problem longer term, because it's not a matter of just doing ... I mean, certainly we need to make sure that there are nurses on site to care for the patients right now, but we also need to make sure that we're just not in this constant loop forever of running into nursing shortages.
(10:18):
And so I'm really interested in companies that are looking at different types of models to further address burnout in the nursing community, further incentivize nurses to continue to be excited about the work that they've been excited about for most of their lives, and be able to train more nurses in an impactful long-term way.
Michael Crawford (10:41):
For Taylor, innovation for the sake of innovation is not the answer. Something else must be considered when developing new solutions
Taylor McPartland (10:49):
Pick an aspect of the healthcare industry and the disparities that we see are just off the charts and the data that is being made available is so extensive that a traditional physician just isn't able to ingest and interpret all of the information that they're being bombarded with from different perspectives.
(11:11):
And so digital tools that are able to synthesize information without bias and provide primary care physicians with the resources that they need to be able to provide better care are critical. And I think the digital health is at the center of that.
Michael Crawford (11:27):
Taylor is the CEO of ScaleHealth where innovators are connected with the right partners needed to reach communities with new solutions. Taylor does not have a traditional background in healthcare, but he saw a problem that needed to be addressed. I wanted to hear from Taylor about what it takes to run a startup innovation company that centers health equity in its work.
(11:51):
Taylor, you have such a unique background. Can you tell us how you arrived in the digital health space?
Taylor McPartland (11:58):
I don't traditionally come from healthcare, and I don't traditionally come from business or finance. I'm an art major in school that found myself in the film industry, and then I've stumbled into entrepreneurship and the digital industry and then the digital health industry really out of naivete originally about what I didn't know, but then more recently, just a passion and a desire to work with people that I wanted to work with and do everything I could to realize the change that I felt needed to be seen in our societies and in our world.
(12:35):
And so when I look at my journey, the through line has really been building a community of people, building a team of people that I really like working with, that I really admire that are equally as dedicated to the cause as I am and surrounding ourselves collectively with like-minded partners and collaborators and allies that share that vision and are willing to really share their wisdom on what is the status quo, and what is wrong with that, and where are there opportunities to fix that, and where can a company like mine, like ScaleHealth best play an impactful and positive role.
(13:18):
And then from there with that knowledge, it's a matter of building the vision that we want to see and the company that we want to create and based on the insights that we're getting, and then also making sure that it's a viable business that can continue to grow for a long time.
Michael Crawford (13:32):
What role does health equity play in your overall company vision, mission, roadmap, et cetera?
Taylor McPartland (13:39):
It's a through line for us. It's something that we continue to come back to. It's what gets us the most excited as a company. We look at health very broadly, so we work with companies that are focused on every aspect of health from nutrition all the way through life science, med device, therapeutics, drug discovery.
(14:05):
But for us, what really gets us excited, at the core of our vision of what we want to create here, at the core of our mission of who we are, is ensuring that everyone has access to the health solutions that they not only need but deserve. And so any initiatives that give us an opportunity to better empower not only all types of entrepreneurs to fulfill their vision, but all types of communities to receive that care is central to who we are at ScaleHealth.
(14:43):
So if we have opportunities to speak or to write or to drive specific initiatives around different aspects of health equity, the fire that I see in our team's eyes when that opportunity comes up is unmistakable.
Michael Crawford (15:01):
What are the biggest opportunities and challenges associated with starting a company?
Taylor McPartland (15:06):
I would say the biggest opportunities are just the tremendous purpose, the feeling of purpose that you get, the ability to really chart your own course and to do something that you care very deeply about that changes every single day, that challenges you every single day.
(15:26):
I think the challenges that come along with it are the mental challenges. We touched on mental health earlier, but I think that's probably the biggest barrier in entrepreneurship because it is a lonely journey in many ways. It's a journey filled with second guessing, of doubt, of questioning yourself, whether you're doing the right thing, of being just singly obsessed with a vision. Having that vision be the last thing you think about at night and the first thing you think about in the morning, even if you're hanging out with your kids or you're having dinner with your family in the back of your head.
(16:06):
I was talking to another entrepreneur recently who described founding a company as a specifically unique kind of pain. And I think it is that. It's definitely not something that's for everybody, but I think for those people that it is for, it's the only option. It's no different from an athlete that has no other plan. Regardless of the five highs and lows that you have over the course of any given week, it's just an amazing experience.
Michael Crawford (16:37):
What are the most exciting and transformative innovations in healthcare, and how will they transform healthcare for patients, communities and families?
Taylor McPartland (16:45):
No two communities are built the exact same and no one tool is going to be able to support all communities equally. I just got off a call a few moments ago with the CEO of a company called Zocalo Health, which recently went through the AWS Healthcare Accelerator, focused on health equity.
(17:07):
Really cool company focused on bridging the primary care gap in Latinx communities and doing that in a way that is for the Latino community, by the Latino community, and really making sure that it speaks to that ecosystem, supports that ecosystem and makes sure that everyone in it has the access to care that they need with full transparency around insurance and provider care and whatnot.
(17:35):
I'm really excited about companies like that because they're looking at how to really simplify what has been an increasingly complex process and really deliver unique quality of care for specific populations and really empower patients in a very individual and personalized way.
Michael Crawford (17:57):
It is absolutely possible to frame an entire business model around health equity, but we cannot pretend that the entrepreneurship journey is an easy one. It is challenging to tackle health equity issues, and it is a big challenge to build a sustainable business at the same time. I wanted to find out what entrepreneurs need to know most when it comes to making decisions that benefit their businesses and create solutions for people everywhere.
(18:24):
Dr. Ian Tong was an integral part of Included Health, a startup where he served as chief medical officer, but his career did not begin with entrepreneurship.
Dr. Ian Tong (18:35):
I was a academic, clinician, educator at Stanford, and I had a clinical program and an outreach program at the VA, Palo Alto. My outreach program at the VA was delivering care to rural veterans and homeless veterans. And so in trying to deliver that care, we were using a mobile clinic and I was starting to dabble with technology and see how we could actually set up remote clinics and rural outreach clinics that utilize telemedicine so we wouldn't have to travel as much distance and take that mobile clinic to all these different places.
(19:07):
And so we were successful in doing that. But I think the point there was my journey began really in 2006, 2007, early on in this program that the VA had. And I got a good exposure to, maybe telemedicine 1.0 if you will. We purchased these huge carts that cost $80,000 to $100,000. I had a Blackberry that I loved using at that time. The first iPhone came out in 2007. It didn't have a camera on it. But those were innovations that you could see coming and you could see where all this was going to come together.
(19:41):
So my journey began with just trying to learn as much as I could about something that I thought was really interesting that also was going to serve my patients and give them better access to care. And so in that, I learned a fair amount about how the system supports those virtual visits.
(19:57):
And so then I got recruited to join a company and I feel like that gave me that preparation to ... When I joined Doctor On Demand, I was honestly still very much had a lot of trepidation about leaving academia, stepping away from what was I thought, a pretty good opportunity at the VA to build this outreach. I was doing mission-driven work, which was really important to me, but I saw this opportunity to really translate all of that into a whole new platform and a whole new way of delivering care.
(20:24):
And so that, at some point, the excitement and the fear around that became more exciting, actually. And so then I was like, "Oh, I'm going to have to do this." And I wasn't sure what we were going to be able to do there, but we set a strategy of starting with low complexity and then just seeing what we could prove. And if we could make this a platform that could deliver high quality care without compromising patient outcomes and without compromising the standard of care, the feeling was, well, we should do it and somebody's going to do it and we can do it.
(20:56):
And the other thing that I would say we always believed from the beginning was that this was somehow, I wouldn't have called it an equity platform back then. I would've said this is a platform though that can level the playing field and democratize healthcare.
(21:11):
And so it was really incredible eight years later to look at our practice and realize that over 50% of our ... Or close to 50% of our clinicians. It wasn't over. Sorry. It was really around I think 43% when we measured it. I know it went up from there, but the last time we had counted, we had 43% of our clinicians were black, indigenous people of color.
(21:30):
Our African American doctors, I think around 21% of our doctors were Black, but only 5% of the doctors in the country were Black. So it was just very gratifying to be on that journey to have a vision and build a thing that you thought could produce health equity.
Michael Crawford (21:47):
Can you describe the fundraising process associated with growing a company? Pros? Cons?
Dr. Ian Tong (21:54):
Well, I guess a couple things that I learned was, one is there are people out there in the world, in the venture world, in the investor world, in the financial equity world, that are looking for opportunities to increase value. They want to make investments. But they also, many of them are mission driven as well and want to see good products. They believe fundamentally that healthcare delivery needs to change and that therapeutics need to be more effective and be more focused or personalized.
(22:23):
And so I'm glad that there's a great deal of energy and it's amazing that we have this mechanism for this, to go out and for entrepreneurs to share their ideas and to get funding for those ideas. But there's early stages and there's different types of investors, but fundamentally it starts with an idea and a team. And it does seem to me that the team is probably more important than the idea. The people are what investors seem to invest in.
(22:51):
And so people who have a good track record and have been successful and especially have shown that they can scale through multiple phases of funding, because the funding really maps to the maturity of the company, those people seem to be very valuable.
(23:05):
So early stages are to get someone. Some people start talking to their family and their friends and they do their friends and family round they call it, where they're really getting angel ... And maybe angel investors, people that just love the idea, but don't expect any return for many years, maybe 8 to 10 years on that investment.
(23:23):
And then you may do a seed round where you actually talk to some institutional investors or venture firms. Again, that's very early stage, but those people, again, they know and they're looking for getting into an idea early. And again, I think they're much very much investing on the team and the opportunity.
(23:41):
You can count on a rollercoaster ride of ups and downs all the way through all of that. And no matter what happens, at least three or four times where you expect that this entire thing was a complete waste of time and you just need to pack up and give up. You're going to have that happen at least twice, but I think probably more like three or four.
(24:01):
If you're successful, you probably have it happen three or four times because the reality is, if it's a great idea, it's going to scale and it's going to happen, but you got to see through those first two or three times where you think you're done.
Michael Crawford (24:14):
You alluded to this about the current state of our country. How would you describe the current state of health entrepreneurship and innovation, and how will it look in the future?
Dr. Ian Tong (24:24):
Yeah, it's interesting. I think we are in a bit of a reset right now. We are all still recovering from the last two years with a global pandemic that was incredibly disruptive. It was painful actually, especially if you were in healthcare delivery. I mean it probably felt like the whole system was crumbling down around you if you were in traditional practice.
(24:46):
If you were in digital health, you probably saw amazing opportunity coming up, and the most disruptive thing that could have ever happened that helped people realize that digital health is a thing and it's important and we need this.
(25:00):
And so I think we've gathered a ton of data in the last two years, not just the venture capital world and investors, not just traditional healthcare systems, but payers, Medicare, I mean everybody has really ... There were all these questions about is telemedicine going to be able to be utilized by senior populations, for instance? Well, we have data that says that they like it, and that yes, and that they can actually get high quality care in their homes.
(25:28):
And so really we have enough data I would say, to show that we probably can make some changes at the legislative level that really show that we can lean into digital health, but this is where we are. This is why I say we're in a reset because it's not happening yet.
(25:43):
And so I scratch my head all the time. Your listeners can't see me, but I have no hair left because I'm scratching away trying to figure out how is it that we have not enabled Medicare Part B recipients to be able to receive care in their homes through telemedicine?
(26:00):
Why are we going to require them, the most senior people in our population that probably have more difficulty with mobility and transportation and they have financial limitations as well, why are we going to force those people to have to go to a brick and mortar healthcare system to get the care that they need?
(26:18):
So that does not make sense to me. And I think that we are hopefully, in the reset that I'm talking about includes those legislators looking at the data, actually talking to experts. They need to talk to people beyond the traditional healthcare players to really understand this because those people may not have as much investment in what the future of healthcare needs to look like. They're probably more invested in what healthcare used to look like and getting back to what it used to be.
(26:47):
But I think we've had this major disruption, and so I think there'll be an acceleration, especially in the use of data. And I think the personalized medicine age that we have been talking about for probably a decade, it has to be right around the corner.
Michael Crawford (27:01):
How will the venture capital and private equity sector impact the future of digital health and health equity?
Dr. Ian Tong (27:07):
Well, I think it'll fuel it. There's a lot of data out there. There's a lot of smart people creating clinical models, care delivery models, but also utilizing just scientific discovery just as we saw with COVID and the coronavirus vaccines that came out. I don't know if people realize what a scientific breakthrough that was to be able to use that technology so quickly and so safely.
(27:34):
So I think we'll see venture capital pouring more investment into that and we'll also see more consolidation probably of companies that'll just make them stronger. And so what'll happen probably in the next few years is the companies that are still here will be the goods one. You'll have a lot of good, strong digital health companies that have stood the test of time.
(27:55):
And then there'll be a number of them probably that maybe weren't as strong that popped up in the last two years. The companies that were just aimed at COVID probably are going to struggle a little bit and they're going to have to pivot and figure out what to do next and who they need to partner with so that they can stay afloat.
Michael Crawford (28:11):
From your perspective as an expert in your field, where do you see the intersections between health data, digital health and health equity, and how is your sector making those connections?
Dr. Ian Tong (28:22):
The data that we collect is not complete, especially for people who live in the Black community or the LGBTQ+ community or other communities of color. We should be building tools and platforms that recognize those people as individuals that in their own right have interests and culture and practices and behaviors that might be different from the household that a lot of those innovators and entrepreneurs grew up in.
(28:53):
We have to have more cultural competency and probably better cultural concordance across our leadership teams so that digital health can build the right products and start to build that trusting relationship from the very beginning. But it really requires that we go back to our data and even look and challenge some of our paradigms of, well, these are the different racial categories.
(29:14):
I understand why it's important to look at race, I'm a Black doctor. I get that from a public health standpoint, but we need to start thinking about more individualized care and looking ... And I'll just use the example of a Black American who is from Ethiopia might be very different and is really genetically different than a Black person who's in America who maybe came through the Caribbean or is from Nigeria, just right on the other side of the continent.
(29:49):
So we really need to reset how we categorize folks. We need more categories and more individualized categories. And then we have to educate our workforce to approach them in a way that builds trust from the beginning and that we understand that these differences exist.
Michael Crawford (30:05):
Every entrepreneur I spoke with comes from a different background. They each offer something unique to the healthcare innovations landscape. And no matter their background, there are things every entrepreneur should know before diving into healthcare entrepreneurship
Dr. Chris Gibbons (30:19):
Become very, very clear on what health equity challenge you're trying to address, not at a general level, at a specific level as possible. If you are going to be critical of it and say, we need to do something else, then you have to be part of the solution. So I would say become very familiar with what you're talking about. Understand at a very granular level the pain point that you see in the health equity space and devise real solutions that are designed to affect that.
Dr. Ian Tong (30:55):
If you don't think about health equity, if you don't think about what's going on in those low income zip codes, you could easily build a solution that exacerbates those problems and that exacerbates the barriers. So think about that from the beginning. They should not be shy or bashful or apologetic about wanting to build something that also builds health equity.
(31:17):
Build a real business though. Don't just build something that's just a mission and that's giving away the services. I mean, if you do that, people may not take it as seriously and they may not put their funding behind it. But the flywheel in this country is around value creation. And so you want those investors to pour their financial fuel onto your idea, and so make sure you do build it as a business.
Michael Crawford (31:46):
In future episodes, we will dive into more topics that entrepreneurs and their investors need to know when it comes to healthcare innovations. We will take a short break during the holidays, but we'll be back on January 3rd with more cutting edge information for healthcare innovators. Until then, happy holidays, and thank you for listening to this episode of 21st Century Health. Subscribe now on Apple Podcasts, Spotify, or wherever you listen to great podcasts.