Episode 11: The Nacho Dilemma—Breaking down barriers to behavioral change and care integration with Dr. Carolyn Jasik of Omada Health

Justin Steinman:
Definitively Speaking is a Definitive Healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com.

Justin Steinman:
Hello, and welcome to the latest episode of Definitively Speaking, the podcast where we have data driven conversations on the current state of healthcare. I'm Justin Steinman, Chief Marketing Officer at Definitive Healthcare and your host for this podcast. I'm joined today by Dr. Carolyn Jasik, the Chief Medical Officer at Omada Health. Carolyn is a board certified physician with a career spanning health technology startups, multidisciplinary care, education, and research associate. At Omada, Carolyn supports the clinical and research teams to create and test the next generation of integrated chronic disease for care programming via digital therapeutics. For those of you unfamiliar with Omada, let me tell you a little bit about them quickly. The Omada platform is a virtual first integrated solution that helps members make mindset changes to make lasting health changes on their terms. According to their website, Omada offers behavior change plus integrated care, all delivered at scale. They offer solutions for prediabetes, diabetes, hypertension, and musculoskeletal. And we'll dive into all that pretty shortly.

Justin Steinman:
Carolyn, welcome to Definitively Speaking.

Dr. Carolyn Jasik:
Hi, thank you for having me.

Justin Steinman:
We are excited to have you. Lots to cover here today. Lots to cover. So let's just start with an easy question. What exactly does a behavior change plus integrated care delivered at scale mean?

Dr. Carolyn Jasik:
It is a mouthful isn't it, when you first say it. So essentially, we are focused on what we call the between visit care. So these are the parts of healthcare that kind of get lost. When you go to see your doctor, they give you a diagnosis, a treatment plan, probably some handouts. And it's really on the patient to make that happen. And a lot of it has to do with behavior change. It's taking meds on time. It's eating the right foods. It's remembering to go to a certain appointment.

Dr. Carolyn Jasik:
So what we are is the between visit care that's integrated with your regular provider to really make sure that those care plans and that those key interventions that happen between visits happen. And the scale part is because those types of services aren't accessible to the average patient in a clinic, some people experiment with coaches or people in the clinic. That's not really scalable as a model. So we deliver those kinds of key services virtually, which allows us to reach really anybody.

Justin Steinman:
Are you targeting a certain population? Medicare population, young people, chronic people. How do I think about that?

Dr. Carolyn Jasik:
So our primary focus is in the 18 and above population. And traditionally, we focus mostly in the employed population. So people find us through their employer or through their payer. We do have experience in Medicare, but not as much as with the working population, working age.

Justin Steinman:
Got it. So think it back to my days back at Aetna, we had care managers too that were also offered to all of our clients who were employers as health plans. Are you complimenting those care managers? Are you like replacing? I think every health plan has care managers. My doctor has the nurse practitioner who calls me and follows up. Where do you fit into that kind of spectrum, if you will?

Dr. Carolyn Jasik:
Yeah. So we do definitely work with care managers. I think the big difference with us is we're kind of creating a category of care that hasn't existed before. Our primary discipline and focus is behavior change. Care managers are focused on access, understanding network benefit, making choices about where to seek care, helping get authorizations, that kind of administrative support. That's not really where we operate. We're really there to help people identify barriers where want to do the right thing for their health, but they have things that are holding them back. So we have a much more deeper personal connection versus an administrative type connection that a care manager would have.

Justin Steinman:
Got it. Got it. So that helps. Behavior change is difficult, right? I want to lose 10 pounds. My wife says I need to lose 10 pounds, but I'm not giving up my nachos. So sorry, I love my nachos. So how is Omada getting people to change their behavior?

Dr. Carolyn Jasik:
Well, so that's actually really, I mean you've summarized it better than me. That's that's the trouble with healthcare is a five minute conversation with your doctor is not going to get those nachos out of your life. Right? Because you love those nachos. It's a conversation. It's talking about, "Hey, we don't need to do therapy right now. But what's bringing you to the nachos? What is it that you need from that? What's driving it that it's not good for your heart? But why are you doing that? What are the barriers?" It's a lot of detailed questions, and it's a person's day-to-day.

Dr. Carolyn Jasik:
So what's great about what Omada is able to do is we're essentially virtually in their house with them and we can have those day-to-day conversations. So maybe one week, it's, "Okay, let's go from three days a week of nachos to one day a week. Okay. Maybe next week we're going to order a half order versus a full order." And it's really that incremental, slow change. Understanding why someone's doing the behavior. What's the barriers to help them change it? You just can't get that done in five minutes in a clinic.

Justin Steinman:
Got it. So for me, it's the nachos and it's the cheesy goodness. I'm not going to lie to you. A little bit of jalapenos and the cheesy goodness makes the world go around. So is this something I'd be talking to an Omada coach on my phone from my couch?

Dr. Carolyn Jasik:
That's right. Not to perseverate on the nachos, but let's say that you're dealing with a brand new diagnosis of diabetes and your doctor has said, "Hey, you need to lose 10 pounds." And you're sitting at home and you're starting to reflect on your lifestyle. Maybe you haven't even paid attention to your lifestyle over time. And now you're realizing, "Gosh, not only am I doing the nachos, but I'm having a beer with this and I already ate a full dinner. I don't think I ever noticed that I was doing these kinds of things." You would message your coach about that. And not only that. You would track the meals that you're eating. So you would track that beer and those nachos and the coach would come back maybe the next day and say, "Hey, I saw you had dinner. And then you had some nachos later. Tell me about that. What was that about? Were you still hungry? What's driving you to do that?"

Dr. Carolyn Jasik:
And usually what we find with some of those items like what we're talking about, it's stress. So people aren't really eating with, I always say they're not eating with their stomach, they're eating with their eyes, right? Or their heart. So they're filling a hole in their heart or in their mind, not necessarily in their stomach. So it's that kind of back-to-back, back and forth with the coach where you kind of get down to the details.

Justin Steinman:
Got it. I can tell you it's the Red Sox that are forcing me to eat my nachos. You talk about the stress, and you go up and down.

Dr. Carolyn Jasik:
That's a real thing. It's stress and it's also distracted eating, right? Before you know it, by half time you've had two servings of nachos and you almost don't even remember. That sort of mindless eating is a big thing for people for sure.

Justin Steinman:
Interesting. Interesting. So we've talked about the behavior change. How are you doing this at scale?

Dr. Carolyn Jasik:
Yeah, if I had to pick the thing that is really truly unique about Omada is we have figured that out. So our technology, what we've invested in, a lot of people invest in stanza devices or really interesting apps that have a lot of algorithms, and AI, and different things like that. We've actually deeply invested in something called clinical decision support. So what clinical decision support is, is it takes ambient data from the user. The text strings that they're putting in with their coach, their behavior, what they're logging in the app, and what we know about them. And it's serving up guidance to the human provider about what to do next. And by investing in that type of technology, you make that human provider incredibly efficient.

Dr. Carolyn Jasik:
So we have algorithms and inboxes that push people up and down in the queue based on what the system is telling them. And this is really the secret sauce of Omada is that we're able for the user to feel like they're having an intimate, personal discussion with someone who may in fact be having dozens, or maybe even hundreds of those conversations at the same time. But because of the way the system is set up, it feels intimate and personal.

Justin Steinman:
Got it. When you say provider, those are Omada providers. The Omada coach is not like my personal healthcare provider, my PCP?

Dr. Carolyn Jasik:
That's correct. So Omada started out with health coaches, and now we have a broader care team. So we have diabetes educators, social workers, and physical therapists. So depending on what your needs are, you might be interacting with one or many of those individuals.

Justin Steinman:
So you got any results. Talk to me about what you've done.

Dr. Carolyn Jasik:
I love to talk about results. We have an internal kind of motto for my team called we start with science, we insist on outcomes. And that's a big part of what we do. So we look at the scientific literature of what's been shown to work in behavior change in an in-person setting. We adapt it to a virtual setting with our scaling capabilities, and then we evaluate it afterward. There's a whole area of scientific investigation called implementation science. This is very important. Because just because something works with someone with an NIH grant at a university, that doesn't mean that it's going to work with thousands of people in a virtual environment.

Dr. Carolyn Jasik:
So we invest pretty heavily in clinical research really in all of our different areas. I think the study that I most frequently reference is our large scale randomized controlled trial on diabetes prevention, which we did with the University of Nebraska. And that showed, the goal of implementation science is to show that you get similar outcomes to what's been shown in the in-person setting. And we were able to show weight loss above 5% of the year, and a reduction in hemoglobin A1C compared to controls in that population. So that's kind of how we approach our outcomes.

Justin Steinman:
And for the laymen out there, what will they think about in terms of the outcomes, right? Reducing A1C, are you keeping 10% of the population healthy? Are you cutting thousands of pounds of people? How should a general person like me think about this?

Dr. Carolyn Jasik:
Yeah. So when you think about outcomes, you think about the outcome for an individual, and you think about the outcome for a population. So it depends on who you're talking to. If we're talking to an individual member of ours and what they want to see from our program, it's really what their goals are. So some people come in and their goal is weight loss. Some people's goal is to get off insulin. Some people's goal might be to not have any more back pain.

Dr. Carolyn Jasik:
So for an individual, we would set that goal. So for the average person when they come in with weight loss, about half of the people that come through our program meet the goal that they had set out for themselves, several exceed it. And about half either maintain or do something else. And we're pretty transparent about our outcomes because behavior change is hard. On a population level, when we talk to a different constituent, like an employer or a payer, they really want to know among everybody how is the population shifting? How many more people do I have with diabetes than I had last actually would be the goal. This time next year versus now. And those constituents are also interested in financial outcomes. That's a big part of what we look at. Have we reduced cost and spend across our population? And we do talk about that a lot too.

Justin Steinman:
Are you selling to employers, to health plans, both?

Dr. Carolyn Jasik:
Yeah. So ultimately, we primarily work with employers. But we get to them in two different ways. We either go direct to the employer and talk to the benefits leader about our programming, or we get to the employer through their plan. So their plan may have an arrangement with Omada, and in the course of conversations about the benefits for their client, the employer, the employer may elect to choose the Omada program as part of a portfolio that the payer is offering.

Justin Steinman:
Got it. And just for our listeners out there, might get some stats to kind of talk. We're talking about some big markets here, right? 37.3 million Americans. That's roughly one in 10 have diabetes, according to the CDC. 96 million or roughly one in three Americans have prediabetes, according to the CDC. And 80% of those people don't even know they have it, which is shocking. 69% of adults diagnosed with diabetes had high blood pressure. 44% had high cholesterol. And hypertension, 47%. Hypertension is elevated blood pressure, by the way. 47% of all us adults have hypertension. I mean, you look at these numbers Carolyn, and you would say we are not a healthy country.

Dr. Carolyn Jasik:
No, we are not. There is a lot of opportunity and COVID certainly hasn't helped in terms of the sedentary lifestyle we've all been leading over the last couple years. It is shocking the level of disease in the country and sad that we haven't been able to do more to address it.

Justin Steinman:
Yeah. It's not only sad. It's also expensive, right? I mean, diabetes alone costs the U.S. $327 billion per year in care costs. And just think about what we could do to that $327 billion if we get people like me to stop eating their nachos. I mean, there's a lot of money out there that we could reallocate to other things that we need.

Justin Steinman:
There are a lot of companies targeting these diseases, right? I mean, you're not alone. It's a pretty crowded space. What's making you different? How do you stand out from the crowd?

Dr. Carolyn Jasik:
Yeah, I think the biggest way that we stand out from the crowd is we are very, very focused on adding value and not adding silos and more complexity to the healthcare system. So it kind of goes back to what I was saying before about the between visit care. We really looked at the consumer population to understand where do they want to get their diabetes care? How do they want to work with provider? And then it became very clear that people like their doctors, they want to keep going to their doctors. But the doctors are overwhelmed. Primary care, the workforce is getting drained. It's only gotten worse with COVID. There's very limited time in the office for these activities like behavior change. So I think the thing that makes us the most different is that we have very thoughtfully looked at the entire healthcare system to try to think about how do we add value versus duplicate services and make things more complex. So that's the big difference.

Dr. Carolyn Jasik:
And then of course the behavior change piece. But I could tell you a story about how Omada is the best at behavior change, but you could get any number of our competitors and they would tell you the same thing. But I believe that too, but I think a lot of people would say they're better at behavior change.

Justin Steinman:
Exactly. Your website talks a lot about virtual first, right? I mean, it's everywhere and it's certainly how you're thinking about it. How do you define virtual first and how's that different to what I would get from a Teladoc or American Well, who I think of as more traditional 'telemedicine' providers?

Dr. Carolyn Jasik:
Yeah. So I think virtual first, the concept behind it, it started with an editorial that our CEO wrote in The New England Journal way before COVID actually. And it's meant to be almost a provocative term in some ways, because it's asking the question of what can be done virtually and what needs to be done in person? So when we think virtual first, we think of as you're thinking about seeking healthcare, your first thought should be can I do this virtually versus taking the trouble of transporting myself or the expense of a healthcare institution giving me my care? So what can we think of first is virtual care.

Dr. Carolyn Jasik:
And he did a really interesting follow-up data analysis, which I can share. Looking at the percent of care if you look at CPT codes, that's amenable to virtual care versus not. It's a good 30%. So it's a lot of care. I think the thing that differentiates us from other organizations is I think they would feel that a higher percent could be delivered virtually, but our philosophy is really that there are certain things that are really good for virtual care, and deliver outcomes, and add value to the system as I was mentioning before. And there are other things that really are best provided in person.

Justin Steinman:
So give me an example of those 30%. What are the things that are better virtual first?

Dr. Carolyn Jasik:
So really, the things that are best done virtual first ... well first of all, it depends on who you're working with. So there's two types of virtual care. There's virtual care with a provider who you also see offline, right? So there's the provider who you know, and trust, and love. And you get virtual care through them, like your primary care provider in your community. And then there's virtual care like Omada where it's virtual only care. So it's sort of different. I would say the care that you get with Omada, I've kind of already described. The care that you would get with your trusted clinician who you work with chronically virtually would be quick changes, quick check-ins, follow-ups. Maybe you've started some blood pressure medication, and now you want to make some adjustments. Maybe you have some follow-up questions, or maybe you had a surgery and you're at home and you need to do a follow-up visit, but it's really burdensome for you to go into the office to get that care. But that follow-up surgical visit can't happen with a virtual only company because they didn't do your surgery. Right?

Justin Steinman:
Right. [inaudible 00:16:58] listens this podcast, I've mentioned to them most times that I worked at CVS before I came to Definitive. And back when I worked at Aetna, we actually put together a virtual first primary care offering. We did that in partnership with Teladoc. Because obviously at that point, CVS didn't have any clinicians on staff. But the idea, and I came at it from an insurance angle was you'd pay a lower premium. And your primary care doctor would be delivered through a combination of in-person services at MinuteClinic. You could think lab work, reflex checks, someone feeling the lymph nodes under your neck. Right? And then you'd see your PCP, the actual doctor at a time of your convenience on your iPhone, or your Android, wherever you were. Right?

Justin Steinman:
I left CVS to join Definitive before the program launched. But it has launched since I'm happy to say. I followed CVS before and I was so excited when the press release went out. Right? I was always bullish on virtual primary care. Do you think virtual primary care can work?

Dr. Carolyn Jasik:
Well first, let me compliment you in the MinuteClinic. The MinuteClinic was a big part of my family's COVID lifestyle. We got all of our shots there and some lab work. So I'm a true believer of the MinuteClinic model. What I love about the model, which relates to how I feel about virtual primary care is it's really a hybrid model, right? So you have in-person, eventually you have to take the blood from the body or you need to right examine someone's lymph nodes. Someone has to actually touch you. So the key for me with virtual primary care is, is it hybrid? Because if you have a virtual only primary care provider and you don't have the opportunity to see that same organization or individual in person, you're adding complexity, you're adding handoffs, you're adding information transfer, you're adding duplicative services.

Dr. Carolyn Jasik:
So as an example, let's say I see a only virtual primary care provider. And that primary care provider exists in silo from my medical home. When I go to that ER, or even if I have to go for an in-person visit with another primary care provider, I'm now adding duplicative services to the system. And it generates more expense, more inefficiency. And you're really putting the burden on the patient to navigate their care and have all that information transfer.

Dr. Carolyn Jasik:
So what I think is the best option is hybrid care, or primary care. Where you can see the same person, in-person that you're communicating with virtually. So you have continuative care, you have continuity of data. When you go to the ER, when you need that specialist referral, it's all integrated care. So we think of ourselves as a partner to that system, and that between visit care can be provided.

Justin Steinman:
When we started this program, it was actually before COVID we started developing it in 2018. And what was interesting about it was when we talked to employers, we got a lot of resonance with people who employers say had a large population in their twenties, mostly healthy who were traveling, right? So your consultants, your bankers. People working actually for sports teams, because the theory was I'm never in my hometown to see my doctor. But there's a CVS, no matter what city I'm in. So if I'm traveling. I live in New York and I'm going to Dallas. I'll go to get my blood work in Dallas. The nurse practitioner at CVS will put it in the thing. And then I'd talk to my New York doctor from the airport lounge or wherever I was. And it was interesting. There was very little interest in pretty much anybody over the age of 30 in this program, within the employees. But that 20 year old I'm mostly healthy. And my mom's telling me I got to go to a doctor. That group loved this offering, was really interesting.

Dr. Carolyn Jasik:
I love that you brought that up for two reasons. First, you're reminding me to give a shout out to you and [inaudible 00:20:34] for choosing to use Epic as your EHR for the MinuteClinic. That was a really great choice, because it allowed for interoperability. So if you have somebody who's in a different state receiving care, there were so many smart choices as that was set up.

Dr. Carolyn Jasik:
But you also reminded me of another point that I wanted to make, which is a lot of this call is talking about where the expense is and where the need is from a chronic condition standpoint. I'm all for checkups in the 20 to 30 range and people getting that quick blood work and everything else. But we have to be honest with ourselves. If that's who's going to be accessing virtual primary care, are we going to get the savings on diabetes and cardiovascular disease? Are we going to see those savings anytime soon? You could make an argument. "Okay, we're doing that care now. So we're preventing heart attacks in 30 years." I would like to see that data. Maybe. We'll see. But what we're really talking about is the 45 to 65 year old range that's having their first heart attack. That's having their first diagnosis with diabetes. What are we doing for that population? And do they want to go to the MinuteClinic for virtual primary care?

Justin Steinman:
As someone in that population, thankfully I've not had a heart attack, but I go to MinuteClinics to get my shots, but I go see my doctor in person. He's longitudinally tracking my care, and that's what I want at this point. Right?

Justin Steinman:
My daughter who is 17, will be going to college in a couple years. She doesn't want to go to doctor. She's like, "Yeah, I want to be on my iPhone and talk to my doctor on my iPhone. Why can't I do that?" So it's very much, I think you're right, your age, your state, and life.

Justin Steinman:
Also, I work in the healthcare industry. So I'm more cognizant of my health than maybe some other people who maybe need to get in that system more, but aren't always thinking about it top of mind. So interesting.

Justin Steinman:
Let's pivot a little bit because you hit one of my favorite buzzwords, interoperability. Or as I call it, the holy grail of healthcare, which will never, ever be solved. Achilles heel, pick your favorite phrase Carolyn. Is interoperability possible?

Dr. Carolyn Jasik:
Well it's definitely impossible. I mean the technology is actually not that complex. It's just APIs and agreeing on it. Like many things in healthcare, it's not that hard. It's just really difficult to implement. So I would say 90% of healthcare is the implementation. 10% is the technology in the idea. Because the technology for interoperability exists. What doesn't exist, but we're getting there with fire is a shared data language and an agreement about how to transfer that data. What definitely does not exist is the incentives for people to do it. And that's why interoperability has been so hard.

Dr. Carolyn Jasik:
We could talk a long time about interoperability and the challenges, but I actually find the interoperability data conversation kind of not relevant honestly. I think the more important thing, when people talk about interoperability, what they're really talking about is care handoffs. And they're assuming that data equals a care handoff.

Dr. Carolyn Jasik:
So what we talk about at Omada is transitions of care and care handoffs. And sometimes, you use data for that. But sometimes you use a conversation for that. Sometimes you use education for that with the patient. Telling them where to go, how to access care appropriately. Because what you really want with interoperability is you want a person who went one place, who now goes to a second place to have their data. And for that second provider to know what to do and how to pick up the ball from there. And some of that is empowered by data, but a lot of it is empowered by education, workflow alignment, agreements that are standing trust, clear definition of roles and responsibilities. It's a whole nother part of work beyond just the data piece.

Justin Steinman:
Yeah. So you hit on a key word there. Let's talk about incentives. Because I think you're right. Incentives are powerful, and people do not have the incentive to change their healthcare or their behavior and interoperability. How do you fix the incentives to get people to want to share information and improve those transitions of care?

Dr. Carolyn Jasik:
Yeah. So I'm sure it's been written, but I always ask people a question. I'll ask you, "If you were ever to write a book about healthcare, what would be the title? And mine would be Misaligned Incentives," would be the title. And I'm sure someone's written it. So I've already probably been scooped.

Dr. Carolyn Jasik:
But misaligned incentives is the single biggest barrier to healthcare innovation in the U.S. And the reason is because you have a system where the person paying the bill ... let's talk about the employer population. There's a lot of people paying the bill. Sometimes the individuals, sometimes the government. But let's just talk about employers. So you have the organization who's paying the bill, who's three or four steps away from the actual care, right? Between them and the bill is the payer, the PBM, the patient, the doctor, right?

Dr. Carolyn Jasik:
So you have the person paying the bill isn't even in the room when the money's being spent. Then on the other side, you have the provider who due to our coding infrastructure and fee-for-service structure is really incentivized to spend as much time with the patient, to see them as much as possible, to do as many procedures as possible. Because that's how they get paid. They don't get paid based on value or on outcomes. They get paid based on service.

Dr. Carolyn Jasik:
Now of course, there are models. There are ACOs, there are IDNs, there's exceptions. But the vast majority of the expensive healthcare in the U.S. which is fee-for-service, employer-sponsored healthcare is paid to play. Basically you go there and you get paid. So the incentive for the provider to be efficient, to deliver care that delivers outcomes, to provide care that the customer wants, it's completely misaligned with the way that they get compensated. And stuck in the middle of course, is the patient. Right? Who just wants to get taken care of.

Justin Steinman:
Yeah. But even the patient has misaligned incentives. I mean I remember after my wife and I had our twins 10 plus years ago and we got that hospital bill and it was in March and we're on the annual healthcare plan. I remember turning and going, "Okay honey, we hit our deductibles. Our healthcare for the rest of the year is free for us. What's the elective surgery you've been putting off?"

Dr. Carolyn Jasik:
Oh yeah. Yeah. The entitlement mindset of the healthcare consumer is also a fascinating concept. I'm glad you brought that up. That's changing with high deductible plans and some other models. But for sure. And it makes sense, right? People believe if I'm sick or I need something, I should get that thing. I'm entitled to it. I'm entitled as a human being. And who's paying the bill and feeling the bill? It doesn't seem germane when your loved one's sick or whatever. So for sure, the healthcare consumer definitely feels that they should get the best at any cost.

Justin Steinman:
And that's a really good point because we always talk about everybody wants to lower the cost of healthcare system. You need to see the best specialist or can you see a lower cost provider? But I'll be honest with you. When I'm sick, I want the best care and I'll pay the highest cost. If you're sick Carolyn, you should take the lower cost provider. You should go to the remote facility, but I want the best and that's your problem. So you cut cost, not me.

Dr. Carolyn Jasik:
Yeah. Yeah. I mean not to get too existential, but the American mindset is that independent spirit and that individualistic mindset. So our culture is the best for me and those who are in my circle. Right? And we could have a whole nother podcast about how that affects America in general.

Dr. Carolyn Jasik:
But in terms of healthcare, we fight against that piece too because people do want and feel that they should get the best. Because they know the best exists in the U.S. because we have the best healthcare system in the world I believe in terms of the science, and the treatment, and what we have to offer. So people feel like they're withholding something if they don't get to access the riches of what the health science is here in the U.S.

Justin Steinman:
Yeah. We can get existential by the way. It's all good. Here in Definitively Speaking, we kind of go anywhere we need to go. It's he magic of the podcast.

Justin Steinman:
All right. So speaking of existential, or maybe not speaking of existential, when we were prepping for this podcast, you mentioned something that stuck with me. And it hit my favorite word data. Right? You told me Omada dives deep on smart data, not big data. What's the difference?

Dr. Carolyn Jasik:
Yeah. The difference is, this term I borrowed from a really close friend of mine who's in venture capital who said this at a conference, and it really stuck with me for a long time. And essentially the idea is there's sort of this assumption in our industry that more data is better. I think more data, more problems. Honestly, there's a lot of garbage in, garbage out, especially with EHR data. So what you really need to be thinking about is smart and actionable data. So grabbing the data that's going to make sense and be impactful, make sure that that data is clean and accurate. And then once you have that data, how are you displaying it? Who are you giving it to? Honestly, how is it protected? Is the privacy of that data protected? And it feels like people are focused more on the data grab. And they feel like from the ether, you're going to get some magic, AI-driven, really miracle that's going to emerge from it. But you have to be very smart and targeted all the way from the beginning. At the point of collection to the point of analysis and presentation, it has to be smart.

Justin Steinman:
Got it. Is there a place for big data in healthcare?

Dr. Carolyn Jasik:
Yeah. I mean, I think there are really exciting things going on in radiology as an example. I mean, that's a field that was just created I feel like for machine learning and artificial intelligence, because the data is collected very uniformly, right? Through the machines. You can develop just brilliant algorithms. So I think big data there is really fantastic. I think that claims data and health economic analyses are also beautiful things that can be done. That's messier data for sure than radiology.

Dr. Carolyn Jasik:
I think what people want is algorithms and big data around these chronic conditions that we're talking about. And I know we're going to talk a little bit about remote monitoring. But until we collect that data uniformly, not just remote monitoring data, but also patient reported outcomes, the big data benefit is going to just not be there. Because I think at UCSF when I was there and we were building a blood pressure data field, I don't even know. I'll pick a number. We had 100 different types of blood pressure that we collected at our institution. Blood pressure in the OR, blood pressure in the ER, blood pressure with this machine, blood pressure that was measured manually, blood pressure that was measured with a [inaudible 00:31:12]. And they're all measured in different ways, taken by a different person, taken in different places. So are all those blood pressures the same? They're not, right? So they can't all be put in one place and interpreted as the blood pressure for the individual. So that's an example of where big data, you want that, right? You want all those blood pressures. But ultimately that big data, you can't make any sense of it, because it's just too diverse.

Justin Steinman:
You need to figure out a way to get the signal from the noise essentially. Right?

Dr. Carolyn Jasik:
Right.

Justin Steinman:
And I think that's where the algorithms come in because yeah, you are a clinician, you don't want 100 blood pressure data points to be on a patient every day. You want some sort of trend analysis. "Justin's blood pressure spikes every day at 2:30 in the afternoon. What is he doing at 2:30 that's causing his blood pressure to spike at 2:30?" Right? That's the question. [crosstalk 00:31:59] late night thing. Probably something at work. Someone, they'll remain nameless. They popped into my office said something that caused my blood pressure to spike.

Justin Steinman:
So let's hit on remote patient monitoring. Right? Remote patient monitoring is having a moment. We talked about that recently, Definitive Healthcare at our recent user conference. But some stats that jump out at me are the two remote physiological monitoring treatment service codes, so CPT codes had increases of 185% from 2020 to 2021. And then five remote patient monitoring or RPM codes increased by 20% from 2020 to 2021. So what's going on with the remote patient monitoring here?

Dr. Carolyn Jasik:
Really great things I would say. But any entrepreneur is going to tell you it's not enough, right? You hear that every single week. So I'll tell you the good bit. The good bit is people are getting paid for collecting that data, for the devices being put in the hands of the individual, and for that data being interpreted when it comes back. And that's a really important, really huge first step. Because we didn't have that. Before, patients would come in and say, "Hey, I've got this blood pressure cuff at home. Here's all my Bluetooth data." And the provider would look at that and think, "Oh my gosh, I don't have time to look at that. I'm not going to get paid for it." And I know it sounds crass. You're a doctor, you should look at a person's data. But if someone heads their blood pressure every day for three months that they've brought in and they want you to make sense of it, that feels burdensome. So it's a wonderful first step. In particular, kudos to Medicare for taking leap and compensating people for this. It's fantastic.

Dr. Carolyn Jasik:
The incomplete part with remote monitoring is we have to be really careful about what devices we're putting in people's hands, how are they leveraging those devices. And when the data comes back, how are we interpreting it? And how are we leveraging it?

Dr. Carolyn Jasik:
The other thing that happens with remote patient monitoring is it gets confused with other digital health companies like Omada. Omada is not a remote monitoring company. We do remote monitoring as part of our intervention, but there's a lot more to what we do. And it's the same with telehealth. People assume telehealth is virtual care.

Dr. Carolyn Jasik:
Now for someone like you who worked in virtual care, you would say telehealth is a component of what CVS was doing, but it's not everything, right? There's the chatting. There's the content that people are consuming. There's the devices that they're getting at home. So remote monitoring is a really important part of virtual care as it's going to be defined going forward. But it's not everything.

Justin Steinman:
We're starting to get towards the end of time here. But I got a few more questions I want to get your thoughts on. You are such a diverse person. You got fingers everywhere. Science, healthcare, investing [inaudible 00:34:47]. This is great. Philosophies on big data.

Justin Steinman:
So let's talk about the current healthcare funding environment, right? I mean, you're working in a well-funded startup and it's crazy out there, right? We've seen a ton of investment in healthcare attack over the past two years. According to Rock Health, 29.1 billion, that's with a B was invested in US-based digital health startups in 2021, across 729 deals, with an average deal size of $39.9 million. That seems crazy. And then it makes even more crazy when that doubled 2020's, $14.9 billion, which was a record in and of itself. Why is so much money being invested in healthcare tech right now?

Dr. Carolyn Jasik:
I think the only reasonable answer is COVID, right? So we had COVID and people started to get virtual care at home. I think people smartly know that putting a doctor on Zoom is not the best we can do. So I think people are betting on the future being more just your doctor on Zoom. So they want to invest in what's the next phase. After we do telehealth, what else is there going to be? And people are hoping that there is going to be more and wanting to invest in it. And that's a fantastic thing. It's a really great development.

Dr. Carolyn Jasik:
But like most booming times, we've seen this with tech as well. We're going to have a lot of noise. We're going to have a lot of investment. We're going to learn a lot. There's going to be some wasted money. But from it is going to emerge I think a consolidated next phase vision beyond telehealth and beyond remote monitoring, that'll be really exciting. And we've exited the consumer app in the healthcare space. We've done telehealth and remote monitoring, or at least we've started. And now this investment will bring us to the next phase, and it's quite exciting.

Dr. Carolyn Jasik:
But there will be a lot of waste. And sadly, many of these ventures that started will shutter because they won't gain traction. That'll be hard to watch. But I think ultimately, it's going to be quite exciting.

Justin Steinman:
And do you have any thoughts as to what that vision or phase is going to look like? You kind of mystically alluded to it there.

Dr. Carolyn Jasik:
I think it's value-based care. I think what's going to happen is we're going to see virtual care companies are uniquely positioned to support a value-based care model. Because what has hindered traditional healthcare from doing value based care is if you're going to do value based care, you need a metric that you can link your value to. And data collection has been very hard for hospitals. If you want to do value-based care and diabetes, you actually have to collect diabetes glucose data in order to power your value-based care.

Dr. Carolyn Jasik:
So I think what's going to happen, it's talking about aligned incentives is that the payers and the employers want to have their money be worth it. So they are already coming to us and saying, "We want outcomes based pricing. We want performance guarantees. We want a cost analysis at the end." And I think that's going to be really exciting. So that'll be the next trend is solutions that contribute value.

Justin Steinman:
So that brings me to my last question for you. And it's a little bit of a doozy, so just bear with me here. All right? Value-based care I think really leads nice into this. Right? So we talk a lot in healthcare about bending the cost curve, right? We've been talking about it for as long as I've been in healthcare, which is pushing two decades now. I'm sure you're probably talking about it. And yet for all of our talk about bending the cost curve, healthcare still makes up 20% of our GDP. And according to one academic study, and I'll quote now, "Healthcare spending in the United States is now the biggest driver of the federal budget deficit and outstanding public debt. And healthcare spending is projected to reach a staggering $24 trillion in 2025."

Justin Steinman:
So you could say we don't seem to be making progress on bending the cost curve. But while I suggest the costs aren't coming down, I think we are making significant progress, and you've talked about it a lot today, on improving the quality of care and outcomes. I think people aren't healthy as we talked about earlier, but we are treating a lot more people a lot more effectively. And when we get people into the system, we're generally getting better outcomes.

Justin Steinman:
So, is it really possible to bend the cost curve. Or are we just kidding ourselves? And does it even matter to bend the cost curve since all we really want to do is keep people healthier in the first place?

Dr. Carolyn Jasik:
So I think it is possible to bend the cost curve. With 7 to 10% inflation, it's going to be a little harder actually. But I think it is possible to bend the cost curve. I think the key next step is as we implement value-based solutions and as we bend the cost curve, what we're doing for the most part is adding virtual care on top of the care that we're already paying for. What we haven't done, which is going to be hard, is taken care away from people. So in other words, saying, "Okay, you're going to do this solution before you can go here and do this." And that's going to be hard for people to tolerate. But I think if the healthcare consumer is getting a better experience and is happy with the care that they're getting, they're not going to be upset if they're not able to access the other things as well.

Dr. Carolyn Jasik:
So I do think that it is possible to bend the cost curve. I think it will happen. We have other as I mentioned, macroeconomic things that are driving costs up as well that are beyond our control. But it's going to take the discipline and courage to take some things away from people so that we can do that. And that'll be hard.

Dr. Carolyn Jasik:
On the topic of does it even really matter for outcomes, I mean of course preaching to the choir there. I'm a clinician. I mean, the only thing that matters to me ultimately is that people are taken care of. And the metric that really matters in my mind is life expectancy in the U.S. So that is a number that has gone down. And that's a number that I personally watch. I think we watch the diabetes rates and things like that, but I do think it's possible to reverse our life expectancy. I believe personally, that it's strongly linked to cardiometabolic disease. And if we start to get serious about cardiometabolic disease in the U.S. and invest in solutions not just like Omada, but just our category in general. And we start supporting people in that journey. I think that we will see a reversal of that. But it's going to take a lot of focus in the areas that really contribute, which is cardiometabolic disease.

Dr. Carolyn Jasik:
So I do. I do think both are possible, and more possible now actually after COVID because of the investment and I think the openness to change in healthcare. I mean, I don't know. We lit up telehealth within months, right? I've been at institutions where we're talking about gobs of meetings, dozens of meetings about telehealth and where would the button go? And who's going to staff it on Monday? And just blah, blah, blah for years and years. And then all of a sudden in a week, it was stood up. So we have the ability to do these things. We just have to have the courage and discipline to make it happen.

Justin Steinman:
Those are wise, wise words. The ability to do things that have the courage to make it happen. I think that's a great parting note. So Carol, I can't thank you enough. This has been tremendous. You're intelligent. You're funny. You're brought a lot of good insight here. We're having you back. We're definitely having you back.

Dr. Carolyn Jasik:
Should we call my mom?

Justin Steinman:
If you want, I'll call her. Again, thank you so much. This was great.

Dr. Carolyn Jasik:
Thank you for having me.

Justin Steinman:
And as always to all of your listers, thank you for joining us for another episode of Definitively Speaking, a Definitive Healthcare podcast. Please join me next time or a conversation with Scott Seidelmann, Chief Commercial Officer at Omnicell, about automated pharmacy management, and why a robot may fill your prescription one day.

Justin Steinman:
If you like what you've heard today, please remember to rate, review, and subscribe to the show on Apple Podcasts, Google Podcasts, Spotify, or wherever you get your podcasts. Learn more about healthcare commercial intelligence can support your business, please follow us on twitter @DefinitiveHC or visit us at definitivehc.com. Until next time, take care, please stay healthy, and maybe you should just lay off the nachos.