Despite the fact that digital health companies raised $4.5 billion in venture funding—accounting for 7 percent of total venture funding, healthcare remains one of the most difficult industries in which to scale new technologies.1
RubiconMD was one of those digital health companies that did well in 2014, raising significant funds. The premise of its solution is simple: shift the market from unnecessary specialists referrals to a less expensive option, e-consults. The platform allows primary care providers to talk to specialists online for opinions. Since its commercial launch two years ago it's seen exponential growth and is now used by customers in half the states across the U.S. But as with any startup, growth came with its share of pain.
Here are a few lessons I learned along the way about growing digital health ventures:
1. Solve for where a group is today and help them evolve.
As the movement from volume- to value-based care gains steam, more organizations are being forced to balance priorities—for example, seeing more patients versus providing more cost-effective care.
"We're constantly having to re-examine the investment tipping point between volume and value," said John Polanowicz, executive vice president of Network, Insurance & Physician Operations at Steward Health Care of Massachusetts.
We discovered early on that organizations like Steward focus not only on a technology's fit in a value-based setting, but how the technology can help them transition to more cost-effective care by predicting and managing costs. By providing primary care physicians with counsel from specialists, RubiconMD allows for advanced primary care, often cutting down on more costly specialist visits. In addition, by collecting data on e-consults we can better understand what's driving specialist visits/referrals. Ultimately with this type of transparency, health systems are able to see, reduce, and reliably predict future costs associated with specialist services. For executives like Polanowicz entering valued-based contracts, that's manna from heaven.
2. Don't recreate the wheel when it comes to data.
In digital health, demonstrating your benefit means showing the data. However, early company-sponsored studies often don't have enough data points to show a statistically significant benefit. Here's where a mix of third-party data and customer-generated data can support a compelling story.
When potential customers say "Show me the data!" what they are really saying is: "Prove this will really provide those benefits to my organization." For a potential customer trying to figure out if e-consults will benefit them, data published by a third party can be more compelling than a self-audited cost savings study. Even better, prove the benefit with the organization's own data, either through models or a pilot.
3. Understand the priorities of your target organization and pitch accordingly..
Make sure to define the criteria for success early on with a customer to ensure you're addressing the true priorities. For us, this has allowed us to focus on relationships with real growth potential rather than pursue business that we're doomed to lose.
Health systems have traditionally prioritized top-line benefits [revenue] while payers and employers have been more concerned with bottom-line benefits [costs]. One of RubiconMD's advantages is that e-consults save costs in specialist services. But these cost savings weren't a business priority for many health systems we approached, and strong initial interest always dwindled. By contrast, employers and regional plans signed up within a few months because the primary benefit resonated.
4. Understand the current clinical workflow—then improve it.
Doctors love to spend time with patients. If your solution enhances patient-physician interaction, the ROI becomes a justification for keeping it. By contrast, there is no faster way to kill a sale than to demo something that will add to doctors' burden. (Check out ZDoggMD's latest video and #letdoctorsbedoctors movement to see what I mean.)
One of RubiconMD's first major wins was a 3-year contract with a major health network, beating out two large tech software giants. Expectations were low. But it turns out those two tech giants didn't understand patient care and pitched tools that added numerous processes that wouldn't fit the clinical workflow. By contrast, RubiconMD showed how it can reduce clicks and eliminate unnecessary prompts, resulting in a key business win.
5. Be able to integrate, but be prepared to win without integration.
When it comes to fitting the clinical workflow, interoperability is the buzzword. I applaud EHR vendors including Epic and athenahealth that have joined the Carequality Interoperability Framework. And as a recent partner through athenahealth's More Disruption Please (MDP) program, I truly get the power of a cloud-based network. Through the network's simple integration we were able to fast track our e-consult solution and can now connect to any of the athena's 75,000 providers and relevant data.
Though times are changing, the free flow of data and easy EHR integration are still rare, so be prepared to show clinical benefit without. Case in point: During one of our deployments last year, we found there was no way to cleanly extract lab reports from the EHR of a major primary care group. The contract would have died on the vine waiting for the resource-constrained internal IT team to solve this problem within the integration. To avoid a major fail, our team built a secure repository that allowed any clinician to take pictures of labs and send them directly to us. Eight months later, the primary care group's internal IT team still hasn't developed a better extraction method.
Interoperability is important, but be ready to demonstrate the value of your solution with little or no integration. The good news: Once a customer is sold, you can build deeper integrations and leverage for future customers.
Growing your own company and have advice to share? We'd love to hear from you. Leave your comments below.
1http://rockhealth.com/reports/digital-health-funding-2015-year-in-review/
Gil Addo is co-founder and CEO of RubiconMD, a New York and Boston-based digital health company that develops doctor-to-doctor e-consult programs. Formerly as a healthcare consultant, Gil designed payer and market access strategies for Fortune 500 pharma/biotechs. He holds a BS in Economics and Biomedical Engineering from Yale and an MBA from Harvard. He was named one of Forbes "30 Under 30" in healthcare.
Follow him on Twitter at @giladdo.
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