#CEO2CEO: Blake Marggraff of Epharmix and ­­­­Anthony Tersigni of Ascension on Healthcare Technology

The first 2017 CEO2CEO event took place on April 10 at T-REX, bringing together Blake Marggraff of Epharmix and ­­­­Anthony Tersigni of Ascension for a conversation centered around healthcare.

To kick off the event, Accelerate St. Louis program manager Sarah Arnosky welcomed guests and introduced the new Vice President of Entrepreneurship and Innovation for the St. Louis Regional Chamber, Andrew Smith.

Smith teed up the discussion by emphasizing the healthcare industry’s importance to St. Louis. “We have two of the most interesting, exciting, healthcare leaders in the St. Louis area [for today’s event]. Those of you who are involved in the entrepreneurial community know how important healthcare is to the St. Louis innovation economy. About 35 percent of all of our startups in the last year have been in the healthcare or social services space.”

The conversation that followed centered covered a lot of ground, and was moderated by Jack Speer of NPR. Here are excerpts from the lively discussion.

Jack Speer: Blake, tell me a little about your company and what you are doing.

Blake Marggraff: I run Epharmix, which has the tagline “evidence-based digital health.” The premise is that, by using relatively simple high technology, we can keep the 25 percent of generally medically under-served and most expensive patients out there in touch with their providers. And that is, of course, a means to multiple ends. The first is better clinical outcomes for those patients, but the second–and this is hopefully a substantial part of the conversation today–is economic outcomes for the folks who have been tasked with efficiently spending money and delivering care for those patients as well. And at a high level, Epharmix does that for 23 different diseases using text messages, phone calls and some of the most rudimentary technology from the patient’s perspective. But, the back end is pretty sophisticated and there’s a lot of research behind it.

Speer: Anthony, your company is much bigger, with 155,000 employees with 7,000 physicians. You’re doing something very different from what Blake is doing, but technology is very much a part of it as well. So first, tell us a little bit about Ascension and then a little bit about how that technology plays in to what you’re doing.

Anthony Tersigni: We’re the largest not-for-profit health system in the country. We actually have 2,500 different sites where we provide care to people around the country. And actually, we need inventors like Blake and what they provide, because our focus and our mission at Ascension is to care for all, with special attention to the poor and vulnerable. Technology like what Blake has introduced is something that is very important to our organization and any other organization that cares for people who are struggling.

Speer: Could you elaborate on how you’re working to serve that under-served segment of the population?

Tersigni: We continue to do things, and we keep continuing to look for inventors like Blake to help us transform healthcare in this country. Last year alone, Ascension invested $1.8 billion in community benefit and charity care. We believe that if we take some of that $1.8 billion and look at emerging technologies, we could serve more people. And it’s through forums like this and opportunities like this that we get to meet different inventors that allow us to look at how we can partner to truly transform healthcare. We can only do it using the bright minds around us, as well as technology that’s available in other industries.

Speer: Blake, how would Epharmix help the under-served?

Marggraff: So let’s tell a story about a patient with heart failure, going on year 20 of statistically 30 with heart failure as well as several other comorbid conditions. Epharmix will ask that patient, say Sharon, what she weighs today, whether her legs feel more swollen than usual, whether she has a hard time breathing at night, which is a sign of water retention. And if something might be going wrong, then that data is put in front of the care manager that has been tasked with keeping Sharon healthy, who can then reach out and act. The problem is, up until that technology existed in the kind of the disappearing filling between the patient and the provider, something could have gone wrong and the only way you’d know about it, is the patient winds up in a hospital, which is a major expense on claims three months later.

Speer: Blake, I’ve been reading Friedman’s latest book which is called Thank You for Being Late. He talks about artificial intelligence and then he talks about intelligent systems. I think the idea of intelligent systems, especially in the healthcare field, is really interesting. So, maybe you can speak to that.

Marggraff: This is the question. At what point does a recommendation to a really experienced physician or nurse–or other care provider– become their M.O. as opposed to part of their consideration? And when a physician looks at the lab results and says “oh, I know exactly which bacteria this is now, there’s no question,” that’s gone through a standardized process. In fact, that’s where the FDA can actually be really strong. But when technology provides data and makes no other claims, when technology provides data and says, you know, “we think these patients are in this risk category,” when technology provides data and says “this patient has a 70 percent chance of passing away unless immediate action is taken,” should that inform care? I certainly don’t know. But I will say that that’s one of the most promising parts of healthcare because we haven’t had that type of capability until about 18 months ago.

Speer: Blake, what do you see as health problems entrepreneurs should be tackling?

Marggraff: If we accept the premise that the world is moving toward a fee-for-value world, a true value-based care world–and I firmly agree with that assessment–then the question is, what’s the best way to take preventative action as opposed to ameliorative? In other words, what’s the best way to preempt the cost before it bites you? The answer to that seems to be engaging patients that might not otherwise think they should be engaged, or want to be engaged, or engage period, even if they think they should and want to. And that’s again where care comes in, the sustainable financial model, which Ascension has built in a pretty unprecedented way. That’s where [entrepreneurs] should be looking–how do you prove you’re delivering value and how do you deliver value in a way that’s sustainable financially, but also in a way that engages patients and helps them feel good about their care.

Speer: Anthony, just like Uber is the biggest taxi car company in the world with no cars and Airbnb is the biggest hotel company with no hotels, do you see a change as a result of technology that might dramatically alter your model?

Tersigni: Oh, absolutely. We’re trying to get ahead of the curve and disrupt our own industry at Ascension, because we believe it’s going to happen to us by someone. Either Blake or someone else is going to do it. We’re really spending a lot of time looking at new and creative ideas. We’ve had a couple of pilots and they’re on the way right now. We’ve partnered with a young company to have consumers actually engage in their healthcare and create their own appointments. It’s amazing the response we’ve gotten from that to date. It just tells me that we, and everyone in this room, as healthcare consumers are not going to tolerate what my parents or grandparents tolerated in healthcare as we move into the future. So we’re going to have to respond to that. Someone is going to respond. At Ascension, we want to be among the first movers in being able to disrupt our own industry.

Speer: Anthony, why is it important for larger corporations to be involved in the startup community?

Tersigni: Quite simply, because the inventiveness comes from startup companies. It’s exactly what we need to transform our industry. An organization like ours is very large, very hierarchical, and has a tendency to want to maintain the status quo as we’re growing. Whereas, we need to have relationships that push the envelope and question everything we do, and challenge us in terms of what we’re doing. In that regard, we just started a program called Launchpad, where we’ve told 150,000 of our employees and 36,000 of our affiliated physicians, ‘if you have an idea that would help us move to transforming just our system, we’ll seed them.’ Because we believe we have a 150,000 inventors, and nobody’s asked them how to improve the service. I think it’s important and that’s why relationships between young entrepreneurs and known companies lead to mature companies. It’s valuable for us because we learn a lot. We challenge ourselves. We start thinking differently about what we need to do as a healthcare system.

Speer: Blake, can you speak to how your model personalizes healthcare?

Marggraff: The personalized healthcare spectrum goes from genetics to simply receiving the right question at the right time through a medium that makes sense for you as a patient. We’re firmly on the latter when it comes to that spectrum. But it turns out that patients really don’t want to engage with a healthcare system that feels selfish. When I go to the doctor, I hate that conversation about my weight and metrics and all of that. What I really want to be talking about is how do I feel and whether I going to feel better when I walk out. That’s the premise for our company–meeting patients where they are. The cool upside to that is that as soon as you shift messaging from ‘hey, did you take that pill,’ to instead, ‘hey, how are you feeling in this specific way today,’ engagement more than doubles, every single time.

Speer: How does technology help us to facilitate personalization?

Marggraff: Ideally, the technology does a lot of the busy work. A care manager might be able to interpret the signs and signals and then reach out appropriately. But, that patient has a style, has needs, has a life that he or she is living and that’s where technology should really bear the brunt of the responsibility.

Speer: But, each patient is going to be different. So how do you customize?

Marggraff: Maybe the simplest way is that patients, especially patients with chronic illnesses, need care in sometimes very high granularity and sometimes very low. That’s the simplest way technology can reach out, in those times where a lot of data must be collected much more frequently and then back off as the patient settles back into his or her regular flow of life.

Tersigni: And let me just add to that because Blake made an interesting point. The success we’ve had, in addition to the technology, is especially in chronic diseases. We’ve found out that people want to be associated in a community with people that have like diseases. So they think they can talk about their real life experiences as a diabetic, and what it means and what it doesn’t mean. And that has been really successful. It really extends the community of people that are caring for each other as well as sharing information with each other.

Speer: Anthony, you’ve been doing this a long time. Are you finding some [patients] are still technologically resistant?

Tersigni: Actually, no. It’s amazing every age group is really comfortable with mobile devices. Therefore, we need to use those mobile devices in a way to allow them to care, to be an active participant in their own care process.

Speer: Blake, is there something that you wish large corporations knew more about when it comes to startups like yours?

Marggraff: So the really candid answer is that all too often large corporations assume that we know, to some extent, what we’re doing, and in ways that are really procedural. So we might have the inkling of a really compelling technology, we might have a really effective way to implement that, to scale it up. But, for heaven’s sake, the master service agreement for some of the folks with whom we’re speaking is about 75 pages long. And I don’t know how to approach that. So if there’s a single phrase that I wish I could hear, it’s “you’re doing it wrong,” followed by “here’s how you might approach it.”

Speer: What made you decide that you wanted to look at the healthcare piece of this and try to bring technology to bear on it?

Marggraff: That’s both a personal and professional choice. That’s as much a part of me, and generally, my generation, as it is a sound business decision. If you’re going to impact people, the best way is to help them live better lives, or longer lives, or ideally both, and that means education or healthcare. Healthcare is really two birds with one stone.

Speer: Same thing Anthony. What is it that you wished the start ups knew about your company?

Tersigni: That we don’t do everything right, either. And that we really need partners and Ascension is really supportive of partnerships. We know that we need to promise the community that we’re going to take care of them throughout the continuum of care. We just can’t do it alone. And so we need value-based partners as we move into the future, that have a creative bent that will challenge us.

Speer: When you look into the horizon, what do you see as some of the biggest changes that people are going to see in their healthcare delivery systems 10 to 20 years out?

Tersigni: I believe, and I think we’re moving there, we’re really going to focus on keeping people well, and keeping people from getting chronic diseases, and managing those chronic diseases much earlier up stream so that people have a quality of life that they currently don’t have there. And I think that’s going to be huge as we move into the future.

Speer: What do you see as the biggest technological change coming to healthcare?

Marggraff: On the inpatient side, I’m extremely bullish on virtual reality. Once you can craft every component of care in something that is just as real as the actual patient, everything gets pretty cool including compliance and risk.

Speer: I want to ask you a little bit about the VR piece. I know they’re using VR to treat PSTD. They’re using it for cancer patients, to help them deal with the ramifications of the disease. How do you see virtual reality working in terms of the medical fields?

Marggraff: One really specific and pragmatic example, it’s darn hard to model where a beam of some form of nuclear energy is going to go through a patient’s body when that patient is in the real world. What if you could have a virtual model that showed how that patient is breathing and moving around anatomically and allowed the radiologist to better position that cancer therapy?

Speer: We’re using [virtual reality] very successfully with post traumatic stress syndrome with our veterans, where we’re actually recreating the event that caused the trauma, and over a period of 15 sessions we get them to understand how to control it. They’re never going to forget. So our approach is, how do we control that event every time that it appears? And virtual reality has been just amazing.

Speer: Anthony, what is something that you would tell your past self, in your 20s, having gone through this whole evolution in terms of healthcare?

Speer: What I’d tell young men and women is “don’t look for a job or a profession, look for a vocation.” What I mean by that is, a vocation is where your personal passion intersects with a community need. And once you find that, I guarantee you will never have to work a day in your life.

Speer: Blake, different question. What do you find the most rewarding, the most fulfilling about what you’ve been doing with Epharmix?

Marggraff: It’s easy. Every day, every week, for the past several weeks, we’ve added more patients, week over week. And exactly in step with that, we get more feedback from care managers using Epharmix saying we’ve been able to help those people. It’s almost unfair how rewarding that is.

Stay tuned for the next CEO2CEO event.

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