Sramana Mitra: If you were starting a company today, how would you frame that? Given those trends and those dynamics, how would you frame an opportunity?
Michael O’Neil: This notion of precision medicine is all the rage in healthcare today. It’s about finding very precise therapies – devices, pills, diagnostics – that go directly to DNA or the disease. What I would actually frame up is the analog to precision medicine, which is what we call precision engagement that is about understanding a person holistically from the very outset.
Can we measure a person’s capacity to engage in their own care in a one-to-one scalable way? Can we put a FICO score on every single person in their capacity to engage in their care based on their health literacy? Can we actually provide them interventions to make sure we’re meeting the patients where they are? It doesn’t really matter how good the pill is if the patient doesn’t take the pill consistently.
It doesn’t really matter how good the medicine is if the patients aren’t engaged. As we think about this, there’s this notion of precision engagement. Can we help the healthcare industry understand people in real-time in a more holistic way such that interventions prescribed are based on the person’s capacity to take them on and to deal with their own healthcare.
Sramana Mitra: I’m going to ask you some questions that are slightly outside of what you said, but are things that I’ve been curious about. Since you’re closer to this industry than I am, maybe you have more visibility into what’s happening. We’re in 2018 and we’ve been hearing about artificial intelligence impacting medicine and getting into precision medicine in a much more dramatic way. IBM has been making noise about it for a long time in the context of Watson. Yet our care systems are still very unsatisfactory.
We have a general physician at Menlo Clinic who essentially is allocated 15-minute appointment slots to look at each of our past medical histories. Of course, they can’t do that. They can only do an average job of taking all these multi-variate parameters and optimizing and prescribing a path forward. Where is that solution? Where is that precision medicine solution that can make a doctor actually effective in 15 minutes?
Michael O’Neil: You’re hitting on some of the complexities of the healthcare system. One one level, you have technologies that are getting close to mainstream such as AI and telehealth. You have this massive way of consumerism and people controlling their own lives in a more effective, personal way.
At the same time, you have an incredibly complex business model on the healthcare side where the people who actually get the care don’t actually pay for the care. You have a lot of inertia in the system itself that, in many times, holds back some of the things that might push forward in a retail environment or banking environment.
At the same time, you have a second layer of complexity beyond the business model that is technology. You have very large electronic health record systems and companies that are, frankly, built on older technologies that don’t, oftentimes, integrate openly some of the things that you just mentioned. You have physicians whose business models are tied to those underlying systems that also, at the same time, don’t introduce or invite some of these new technologies into them.
Sramana Mitra: I understand why it isn’t there yet. I understand all the friction and infrastructure issues. I guess the question is how far away are we from all this being resolved.
Michael O’Neil: I actually think there’s good news on this front. When I first started, there were walls that looked so high that you thought you would never be able to overcome them on behalf of patient care being transformed. We saw very large companies making a big claim that they’re going to invest $300 million to reinvent patient care. Within three to five years, they retreat out of the business of healthcare, because it’s difficult.
There are folks who have spent the time and have gotten inside the guts of care. What you have now is a set of patients and physicians who are demanding it be different. You have a regulatory reimbursement model that now has changed and it does encourage collaboration, integration, new technologies, and transformative care. We’re starting to see large organizations starting to demand both the payers and suppliers to break down the walls to provide a different level of care not just for the patient but also for the providers, because they’re getting burnt out as well with all of the inertia.
We are in a time of optimism. We’re now touching six million unique patients a year helping them understand and take more control of their care by using things like secure telehealth visits and both synchronous and asynchronous ways to connect with their physician more effectively and to provide information not just around the meds but on the fact that I don’t have a ride for my elderly father to get to his rehab appointment. How might we intervene to provide better care? We’re starting to see some of the breakthroughs and it’s exciting.