Vivian DeWoskin: Connecting Dots with Komodo Health

Show Notes

Meg welcomes, Vivian DeWoskin, VP of Strategy and Head of Life Sciences at Komodo Health.

Meg and Vivian discuss Komodo Health, which brings together large amounts of anonymized, linked patient-level data used to understand how patients navigate their care journey in the real world; Komodo Health’s “Healthcare Map;” data and rare diseases; access to clinical research; Komodo’s ability to reduce the time to diagnosis for challenging conditions; increasing diversity in clinical research patient populations; Vivian’s background in and love of Neuroscience; her mentors and mentees; and much more. 

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With two years under her belt overseeing commercial operations at Komodo, where she is responsible for helping the world’s leading life sciences companies tap into real-world patient data to spot gaps in care, identify sweet spots for new drug development and improve provider engagement strategies, DeWoskin also hosts female mentorship groups aiming to emulate her own impressive career mentors in helping women succeed in the sciences.

Further Reading:

 

The Man Who Mistook His Wife for a Hat

Episode Credits: 

The Game-Changing Women of Healthcare is a production of The Krinsky Company. 

Hosted by Meg Escobosa. 

Produced by Meg Escobosa, Calvin Marty, Chelsea Ho, Medina Sabic, and Wendy Nielsen.

Edited, engineered, and mixed by Calvin Marty. 

All music composed and performed by Calvin Marty. 

©2022 The Krinsky Company

Creators & Guests

Host

Meg Escobosa

Meg Escobosa has 15 years of innovation consulting experience, focusing on the unique challenges of healthcare since 2012. For The Krinsky Company, Meg leads client engagements overseeing advisory board design, creation and management. She also leads industry research, expert recruitment and trend analysis to support corporate innovation initiatives centered on the future of healthcare. Her background in innovation and strategy consulting began at IdeaScope Associates where she was involved all aspects of strategic innovation initiatives including understanding the voice of the customer, industry research and aligning the executive team to invest in promising strategic growth opportunities. Meg received her BA in Latin American Studies from Trinity College in Hartford and her MBA in sustainable management from the pioneering Master’s degree program, Presidio Graduate School. She is also on the board of a non-profit foundation focused on researching and developing technology to support a sustainable society. She lives in San Francisco with her husband and two teenage daughters.

Producer

Calvin Marty

A man of many hats, Calvin Marty is a Podcast Producer, Editor, Engineer, Voice Actor, Actor, Composer, Singer/Songwriter, Musician, and Tennis Enthusiast. Calvin produces, engineers, edits, mixes, and scores The Game-Changing Women of Healthcare. Calvin is also the creator of the 2020 podcast, irRegular People, among others. Find his music under the names Calvin Marty, Billy Dubbs, Nature Show, and The Sunken Ship. Over his long career as an actor, Calvin's has voiced many Radio and TV commercials for a wide-range of companies and products and has appeared in small on-camera roles on shows such as Chicago Fire and Empire.

What is The Game-Changing Women of Healthcare?

The Game-Changing Women of Healthcare is a podcast featuring exceptional women making an impact in healthcare today. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers. We dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. Join host Meg Escobosa in conversation with some of the many brilliant, courageous women on the front lines of the future of health.

Vivian Dewoskin: We need to do better; we need to have more than white men in clinical trials and clinical research. And that means going out and finding patients, educating more providers about these research opportunities and bringing it to patients where they are. I’ve been lucky to see us here build a really extensive body of sociodemographic information alongside our Healthcare Map so that you can not only help perhaps predictively identify a patient at risk of having a rare disease, but also say, “And this patient represents an underserved minority, this patient represents a population that you’re not yet recruiting enough of into your trial. 

Meg Escobosa: Welcome back to The Game Changing Women of Healthcare. I'm your host, Meg Escobosa. Today on the show we have Vivian Dewoskin, VP of Strategy and Head of Life Sciences at Komodo Health. She earned a BA in Psychology and Computational Neuroscience at Princeton and an MBA from the Haas of Business at UC Berkeley.

But Vivian, I know your bio says you could have been anything from a vet to an astrophysicist, so what drew you to this particular opportunity at Komodo Health?

Vivian Dewoskin: Hi, Meg. It's great to be here, and thank you so much for having me. I've always really been drawn to healthcare as a field and to the sciences, and one of the things that really made an impact on me in my career in the last few years was having the opportunity to learn more about the potential of real-world evidence, the potential of connected patient level health data.

When I was searching for the next opportunity, you know, before I joined Komodo Health, it really struck me that Komodo was in an amazing position with the data assets that we have to really help achieve much of the promise that we all hope for in the real world evidence space by bringing together a tremendous amount of anonymized, but linked patient level data that you can actually use to understand how patients are navigating their care journey in the real world, what their outcomes really are. So that's what drew me to Komodo ultimately and to the work that we do here.

Meg Escobosa: Awesome. Tell us a little bit more about what you do at Komodo Health and what problems you guys are solving.

Vivian Dewoskin: Yeah…Komodo Health is this company that really sits at the intersection of healthcare, data and technology. And in my role leading the strategy business for our life sciences clients, I help us build software and solutions on the base of what we call our Healthcare Map.
 
Our Healthcare Map is a longitudinal set of anonymized, patient level data across the US, covering most of the US - over 330 million unique lives, and that's the foundation that we use to like, as I said, provide solutions, analytics, and software that help serve the life science and ultimately further Komodo’s overall mission, which is to reduce the burden of disease. 

Most of our Healthcare Map is made up of what we'd call administrative data - claims data. So most of that is, I mean, it's medical and pharmacy claims. So for many of us in the field of healthcare, we're intimately familiar with how medical services and therapeutics are paid for and documented in the US anyway.

And we receive a large body of medical benefit and pharmacy benefit claims from a wide variety of sources across the US.[00:03:05] But Komodo really takes that a step further and rather than relying just on these common intermediary sources, which often provide only samples of a given patient's history or samples of a given provider's claims or an institution's claims, we also work directly with insurers, with pharmacies, with other entities to collect complete records as much as possible. So in the claims world, we differentiate between open claims, which are sampled, and closed claims, which we believe are complete along at least one axis. And we have a great deal of both payer complete and provider complete sources here. And that tells us that we are seeing every claim, medical or pharmacy for that patient, for that health plan during that defined period of time when they were enrolled.

And we stitch all of these different pieces of the claims journey back together. 

So the bulk of what we work with is made up of claims data, and we have really, really rigorous standards for cleaning and organizing and processing that data before it can become part of our Healthcare Map.

We also allow linkability, for those of you familiar with Datavant, for example, that's one of the most common sources of anonymization and tokenization of patient level data in the industry today. And you can always bring in other sources of data. So even if it's not native to Komodo, like patient generated data, whether maybe that's from a wearable device or maybe we're talking about lab data or an EMR system, or consumer data, it could be a wide variety of other different types of data sources that might not be native to our assets, but will allow that to be linked so that the appropriate analyses can be done.

Meg Escobosa: Fantastic. That's a really nice explanation showing just the complexity of health data and the sources of it. And walk us through what a client comes to you for. What problems are you helping them solve?

Vivian Dewoskin: Yeah, so within the life sciences, we really work across the entire life cycle of drug development. And with many, many functions within the biopharma and med tech space. So when I say life sciences, I'm gonna include any biopharma, but we also work extensively with devices and diagnostics and digital therapeutics as well. 

We can help all the way from clinical development through maybe early commercial planning or market education, real world evidence and outcomes research through commercialization. So I'll give you a couple examples along the way of how we help.

Let's say in the clinical development space, there's significant need early on, once a candidate's been identified, it's gone through preclinical research, you're about to dive deeply into phase 1, 2, 3 trials, into clinical research. There's a great deal of planning that has to go into that from identifying the proper investigators, the proper sites, identifying or understanding what your enrollment criteria should be, even inclusion or exclusion criteria, and what that's going to mean for the feasibility of your trial in the real world.

Are you going to be able to secure the volume of patients you need to reach statistical significance, right. So we help clinical development teams do a lot of that planning, first and foremost, by looking at the entire US or looking at geographic area around perhaps a site they've already identified, and we can help them do some of that protocol planning as well as the tactical planning of where should we set up this clinical trial based on the volume of patients in the vicinity or the expertise of a particular principal investigator at an academic institution.

We also support recruitment for trials. Using anonymized data, we can still identify events that are happening in the patient journey and help our clients steer toward providers that have a patient population that might be eligible for a trial or might be in need of the therapeutic that's being studied in a trial, so we can help speed up the clinical research process. 

Meg Escobosa: That’s amazing.

Vivian Dewoskin: Thank you, we’ve really had a lot of success there, especially in rare diseases.

Rare disease is a big blanket term. Every single one is different, but one thing they all have in common is very small patient populations. And there's a big gradation, a big range when we talk about rare disease - are we talking ultra orphan or are we talking Just, you know, just orphan disease, the limit of what that means in terms of prevalence.

But very often it can be challenging to find patients in very rare conditions, often genetic conditions, that can have a number of differential diagnoses that are possible. 

And one of the things that Komodo Health does through the completeness and the depth of the patient level data that we have is to help model the likelihood that patients have a given rare disease, even if there's, even if they don't have that diagnosis code, even if a diagnosis code perhaps doesn't exist. So we've had a lot of success in being able to help make these trials possible.

Meg Escobosa: I was sort of trying to, you know, I think in one of your, online you referenced MS, multiple sclerosis patients, and I was thinking, okay, so is this scenario where you can help, you know, drug makers identify even patients who don't yet know they may have MS, and you can help by seeing, oh, this provider asked for this test, and you even have the test results data to show that it's actually possible. So that's kind of amazing to me that that is the level that you guys are working at.

Vivian Dewoskin: I think so too, and, and I think I mentioned earlier, I referenced Komodos mission: to reduce the burden of disease, and it's really an ambitious goal, but I think lots of us work in healthcare because we have the ambitious goal of helping people, right, of reducing disease burden. And to me, one, this is one really tangible way that Komodo has been able to do this. And we often do this through partnerships with the life sciences, but increasingly partnerships also with patient advocacy organizations and with research institutions, academic institutions. One of these things that we've learned that we do exceedingly well is help reduce the time to diagnosis for challenging conditions for very rare conditions where providers might not have ever seen a patient with this before or, you know, the expected journey in the real world is that it's gonna take a patient five years to get the proper diagnosis because they're gonna cycle through a number of more common things first, and we can really speed that up and that makes a really significant difference to patients' lives and not just in the research space, right, but also just getting patients to treatment faster. 

Meg Escobosa: Makes me think about population health management strategy. Do you work with providers as well? 

Vivian Dewoskin: We increasingly are starting to work with providers and I'd say most of our work with providers, thus far, has gone through our partnerships with advocacy organizations and patient networks or with other like academic research institutions, but we, an interesting thing that many people might not know about Komodo Health is that in addition to serving the life sciences directly and partnering with some of these different types of organizations I just mentioned, we also open up our platform for other companies or researchers or individuals to build on top of the data that we have.

So we have this platform that allows, say, another startup out there or another company out there that really specializes in bringing solutions directly to providers to leverage the solutions that we've built to enable their own product. 

So, although at the moment I would say that most of our business lies in working with the life sciences and we don't have provider-direct solutions that we've built so far, we're able to empower and enable a lot of other companies and organizations to bring those solutions to providers. I'm excited about what that means for us in the future and how much more impact we can have on patient disease burden by opening up this platform, like I said, to empower others who have greater expertise in those specific areas to deliver really powerful solutions. 

Meg Escobosa: That's great. You reference orphan disease–and I'm just sort of asking for clarification–What's an orphan disease, just so I'm clear?

Vivian Dewoskin: Yeah, of course. So the definition of an orphan disease is actually set by, if I'm not mistaken, the American Orphan Drug Act 1983. The definition is it's a condition that affects fewer than 200,000 people. Like prevalence-wise, and that's a US-based definition, but I believe that's kind of been, it can be translated into a rough prevalence estimate, like 86 per 100,000, and that's approximately the limit of what we consider to be an orphan disease.

And then below that, you know, as you talk about even rarer conditions, you'll hear the term “ultra orphan” thrown around quite a lot. And it's a little fuzzy exactly where you draw the line. An ultra orphan, but sometimes we're talking about conditions that affect less than a thousand people in the US at a time, hundreds of people, sometimes tens of people.

When we talk about rare disease, orphan disease, it can really be anywhere in that range. But when you add all these rare diseases together, it's actually quite a lot of people and that's why there's so much emphasis on finding treatment solutions and options for rare disease in the life sciences, and academic research community today, because it really does have a very wide ranging impact on patients even if each individual condition may affect only a small number of people. 

Meg Escobosa: Clinical trials are difficult to get patients into them, partly because patients don't know there's a clinical trial. Their providers don't know, their doctors don't know, so they don't know to put them forward to be part of a clinical trial. Other challenges are maybe not getting a diverse enough patient population. Does your approach help to address some of that access issue and how does it do that? 
 
Vivian Dewoskin: I'm really glad you asked that. One of the areas that I've been really excited to see Komodo diving into in the last couple of years is addressing the need for diversity in clinical trials and also addressing disparities in care that are often related to racial or sociodemographic factors.

One thing that Komodo has really leaned into is supporting clinical development teams with creating those diverse trials. There's a very strong understanding in the industry that we need to do better. We need to have more than white men in clinical trials, in clinical research, and that means going out and finding patients, right and educating more providers about these research opportunities and bringing it to patients where they are. So I've been lucky to see us here build a really extensive body of sociodemographic information alongside our Healthcare Map so that you can not only help, perhaps predictively identify a patient at risk of having a rare disease, but also say, “and this patient represents an underserved minority and this patient represents a population that you're not yet recruiting enough of into your trial.”

We've seen a really big uptake in that offering from our clinical development customers, partners, because there's such a tangible need to increase access to clinical research.

I think there's hopefully going to be a shift in more of the commercial side of the life sciences toward identifying inequities, identifying unfair disparities in care, race-based or otherwise, and hopefully putting solutions into place to help address those, really, and close the gap. Komodo does a lot of work on that. From our own research and publications team, we just published a study earlier this week finding that rates of uterine cancer are higher in black populations that patients spend longer between diagnosis and the start of treatment. If they're black, not white, that outcomes are worse, and we need to give visibility to these issues so that patients can advocate for themselves so that providers are aware that they might be kind of falling prey to some of these fallacies and that hopefully our partners and our clients in the life sciences, as well, take actions to help educate the market and close these gaps.

Meg Escobosa: What do you say to people who are worried that their participation in a clinical trial will be exploitative? You know, there is a terrible history, unfortunately. What do you say to patients who might be worried about that experience and has the industry shifted so that people can feel confident that they are being treated fairly and well by participating?

Vivian Dewoskin: Right. I think first of all, to anyone who's feeling that way, that's extremely justified, right? Given this history, right? It's not pretty. The history of clinical research in general is unfortunately, and scientific research, it's riddled with pretty terrible things when you, when you go back and look at it. And so I'd say that's extremely understandable and my best advice is that these should be educated decisions that you make with your physician, with your family, with as thorough of an understanding of what the study is, who is sponsoring it, right? Where it's going to go, what's required of you, and that's hard information to know and wrap your head around too.

Meg Escobosa: And that you have a right to ask and know it, so you’re not at their mercy. 

Vivian Dewoskin: Absolutely, and my best advice is, you know, don't, don't go seeking these for profit or if you're being kind of like strongarmed into it. It should really be something that where you understand how this research is going to benefit yourself, benefit others, and where you've, you know, signed informed consent, right? That you understand the safeguards that are in place to prevent that kind of exploitation.

Meg Escobosa: Very sound words. Thank you. Can we talk a little bit about your neuroscience experience studying neuroscience? …psychology and neuroscience - both really interesting fields. Was this something that, you know, you were standing in line buying books for one class, but came across a really interesting book on the shelf and was like, “this is what I've gotta do.” Tell us about how you got to that.

Vivian Dewoskin: Yeah, thanks for asking. Well, when I was younger I always had a strong interest and passion for science. Also the arts. I think I am a very liberal arts type of person. I have wide ranging interests. One thing that really left its mark on me was that my grandmother was diagnosed with Alzheimer's when I was in elementary school.

Meg Escobosa: I'm sorry.

Vivian Dewoskin: Thank you. It's a terrible disease or anybody who's gone through it, I do not wish it upon you. My family and my grandparents were quite close. We spent a very significant amount of time together. And so over the, and I've ensuing 10 or so years as I was in high school, I saw the effect that this disease was having on my grandmother, just slowly stealing away her memory, her personality, her sense of self.

It was really that experience that led me to want to study 
neuroscience. As a teenager, like a half-formed human being in a sense, like you're trying to wrap your mind around what you're seeing and what I'm seeing tells me that a disease that's destroying parts of her brain is destroying parts of her.

Why is that? Right? What, what's happening? Are we our brains, right. 

Meg Escobosa: Cool question.

Vivian Dewoskin: Yeah. It's a great, it's an interesting question, but it led me immediately upon the beginning of freshman year saying, “no, I wanna be in the field of neuroscience.” 
The first course I took was in cognitive neuroscience.

Cognitive neuroscience is just fascinating. If you are interested, it's not just about the brain, right? It's about people. It's about behavior. It's about why we are the way we are. For anybody who's never delved into neuroscience, but is interested in kind of better understanding what I'm talking about, I really recommend anything by Oliver Sacks. 

And I remember coming across Olivers Sacks for the first time, 18 years old, in this neuroscience course and reading the case studies and the humanist style that he brought, which was controversial to a lot of other physicians at the time - in his lifetime. But I appreciated so much that he would look at people as humans, and with curiosity and empathy, try to understand and convey to the reader what's going on in their brains.Why is that man mistaking his wife for a hat?

Meg Escobosa: Yes. That's such, I was gonna reference the title!

Vivian Dewoskin: I just fell in love with the field and found that the interdisciplinary of nature of neuroscience also speaks very much to my personality, the way that my mind works and the things that I'm interested in. I love that it transcends so many different fields from biology to chemistry, to physics, to computer science, to psychology. It really is very wide ranging and I found that to be also extremely exciting and compelling, and leads you to take really interesting courses in, you know, study pure psychology in a sense. Like what is the nature of personality, but also to take electrical engineering courses that are entirely about computationally modeling what the brain is doing in response to a task, and that's ultimately what I ended up spending my research years on was representation, learning and reinforcement learning in the human brain.

Meg Escobosa: Yeah. With your background in neuroscience, what practices do you use, like meditation, if at all, if any, to maintain your brain health?

Vivian Dewoskin: So I do find meditation to be extremely valuable. First of all, it's something that I've practiced off and on for many years, and whenever I stray too far from it, I get a reminder one way or another that it's really important to bring back into the mix to keep yourself grounded, especially. Komodo Health is a startup. Anybody who has ever worked in one, you know that it can be, the highs are high, the lows are low. Lots of things are happening at one point in time, and the healthcare industry is no different, really. No matter what part of the healthcare industry you work in, it can feel like this, and I think it's important to find ways to keep yourself grounded and think about the impact you're actually having. So when I have a bad day or a bad meeting, I can take a few deep breaths and remember that, hey, we are actually doing a really great job of helping identify patients early for, you know, diagnosis and improve their lives. So it puts things into perspective.

I also took a really fabulous course, in undergrad that really stuck with me. That was about memory and using. Like memory palace or mnemonics to remember things. I still do that all the time and I think it's so valuable. My favorite example is if I need to go out to the store and pick something up and I'm worried I'll forget, you attach that to the doorknob. Like, okay, when I think of my door knob on my front door and I pull it, I'm gonna remember I'm supposed to go to CVS, right. And it works. And so just try to, there are some little ways you can, you know, I hate the word hack in that sense. but like, hack your brain, right? You can, you can use these little tricks because if you, if you understand what it's doing right and,what sorts of heuristics the brain most commonly uses, you can take advantage of the good ones and hopefully combat some of the not so good ones that we're all prone to. 

Meg Escobosa: That is great advice. I will do that…CVS to the doorknob.

Vivian Dewoskin:  It works!

Meg Escobosa: I know mentorship is really important to you. You even referenced mentors you've benefited from. You founded a mentorship program. Can you tell us about that and any other experience you've had, a story or an experience you've had either mentoring or being mentored.

Vivian Dewoskin: Yeah, I, it's so funny…for a really long time, probably all the way through college, I didn't think I had mentors or needed mentors. I think I was, in a sense, almost blissfully oblivious to the challenges, especially that women face in the workplace, in so many facets of our lives. And I remember my thesis advisor, who I mentioned, Dr. Yael Niv, and she offered me at the time, a senior year of college, you know, we're part of this women's networking organization here on campus. And I was like, “why would I need that?” And, in a sense, I like I envy my younger self because that was sort of this blissful ignorance that, you know, everything had always gone right, how could anything go wrong? And the real world can hit you fast. I became a consultant after I graduated and I've been so fortunate in my career, in my early career as a consultant and in my time since then to have had really wonderful managers and people who've taken time to be a mentor and a resource for me.

The first couple of managers I had in my early career were just fantastic people. They were really good at managing and that’s extended now because of that relationship into friendship that's lasting as we've all gone our separate ways. And I have people, like my first manager, Rachel, I'm calling her out here in case she listens to this, that I can give her, you know, shoot her a text or give her a call if I'm facing a challenging dilemma in my workplace, and I know that she'll pick up and we'll hop on the phone and she’ll give me her advice and it'll be candid and it'll be valuable.

Meg Escobosa: And what was it about her management that you know that made a difference to you?

Vivian Dewoskin: Two things stand out to me. The first is, I think Rachel practiced radical candor, and it's something that I also ascribe to. The idea that you can both be caring and you can be honest, and that if you are neither caring nor honest, you're a terrible person, but you know, a lot of people who are caring or are not honest and are not upfront. She embodied that kind of philosophy, I think very well. Maybe without even knowing she was doing it.

I'm not sure that that Kim Scott essay had even been written at the time.

And second, I think she recognized talent and potential and made you feel that recognition and that had a really big impact on me being able, early in your career, to have somebody see your wins and acknowledge them and say, “Hey, I think you can go places,” right, somebody in your corner cheering for you makes all the difference sometimes, right? And I just feel so lucky that between her and many others, over the course of my career, I've had people in my corner saying, “I think you're gonna go places” or  “that was really good work.” I've always really admired leaders who respond positively to a junior individual, challenging them or asking a question, right, and people who respond, not defensively, but respond thoughtfully are, I think, make a fantastic leaders. And again, I feel lucky that I've had a lot of those people over the course of my career who have let me express myself, let me ask questions, let me challenge where I think there's a reason to challenge and who've responded to that by saying, “good job, keep it up.” I wouldn't be where I am today without that, you know, in my consulting days, I also took a really fantastic course in business school and I went to Haas at Berkeley. And I took this amazing course, with professor Kellie McElhaney, that was the business case for investing in women.

I actually, it's so fantastic and I took half of her course back, you know, to my company and said, “we don't have any affinity groups here. I'm starting the, you know, women's affinity group for our company and we're gonna start doing anti-bias training and we're going to build this community,” and it really, it took off. It was so great to be able to bring the work I was doing in business school back to the company and have other women and men at the company say, “I'm excited to, that someone's doing this. I'm glad I work for a company that has it,” and ultimately it led to a full kind of affinity group program getting started and that was many, that was many years ago. And they're my old employer. They're a much bigger company now. But I was glad to be able to kinda leave that mark and pay it forward, if you will. And it's something I really try very hard to do in, in my career overall is make time for mentorship, men or women, but especially I wanna make sure that women who are in junior or mid-level managerial positions, that they can see someone in leadership who is, who sees them, right? And who is listening and who is living a life and having a career that they could see themselves having. And that they aspire to and that I'm kind of reaching back to offer whatever help, mentorship, advice and guidance that I can to those women like many people have done before for me.

Meg Escobosa: Awesome. Thank you, Vivian. Great work, great job building that for your colleagues. I'm excited. And for the young women. The mentorship program especially. That's so great.

Meg Escobosa: Thank you.  Um, thank you so much. It has been such a pleasure to talk with you, Vivian. I know you also can sing. Someday, I would love to hear it. Maybe you'll get back out there and sing for real.

Vivian Dewoskin: I hope so. I really hope so. Thank you.

Meg Escobosa: Your popstar career awaits.

Vivian Dewoskin: It's been a real pleasure being here and talking with you too. Thank you so much for having me, and I feel very humbled to be part of your kind of esteemed network of guests that you've had on this podcast. So thank you again for giving me the chance to speak with you today.

Meg Escobosa: The feeling is mutual. Thank you, Vivian.