Episode #3 - Dhruv Vasishtha, Advisor and Former SVP of Product at firsthand

Written By Omar Mousa

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Description

Concept to Care speaks to Dhruv Vasishtha. Dhruv is a seasoned product expert, actively operates, advises, and angel invests in various health tech startups. Dhruv most recently served as the former Senior Vice President of Product at firsthand, and he now serves as an advisor. Before joining firsthand, he served as the Director of Product at Patient Ping, which was subsequently acquired by Bamboo Health. Dhruv is also the creator and instructor of the Healthcare Product 201 course offered by Out of Pocket.

In our conversation, we discuss:

  • Dhruv's perspective on the essence of value-based care and the experience of building within this pivotal healthcare domain

  • Characteristics defining a best-in-class value-based care tech stack

  • Strategies for discerning between build vs. buy solutions

  • Prospects for tech-enabled services to develop proprietary software tailored to specific needs and creating defensibility in the market

  • Exploration of innovation dynamics within Medicaid and the strategies adopted by startups operating within this sphere

  • Essential qualities and competencies of the native health tech product manager

  • Top questions asked by individuals who want to operate in health tech product

  • Frustrations of health tech product managers and product leaders

www.concepttocare.com

Show Notes

Where to find Dhruv Vasishtha:

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Where to find Angela and Omar:

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Referenced:

Check out our website: https://www.concepttocare.com

Subscribe to our newsletter: https://concepttocare.substack.com/p/episode-3-dhruv-vasishtha-advisor

Transcript

[00:00:00] Dhruv: How do I do that? And so I tell them, you know, and I've told Jay Desai, the co founder and CEO of PatientPing this, um, he gave me very intimidating advice early on in my career at PatientPing. 28, I was a senior PM, we're working on like a new product initiative. And he told me, he was like, Any product person worth their salt has five buyer executives on speed dial to vet, you know, product ideas with, and I was like, dude, I'm 28.

[00:00:29] Dhruv: Like, I don't know how I'm supposed to do this.

[00:00:32] Angela: Welcome to concept to care, where we hear candid stories of success and failure, discuss strategy and dive into the details that offer advice on what to do and what not to do in health tech,

[00:00:43] Omar: whether you're a seasoned pro growing your career or just starting out.

[00:00:47] Omar: Our aim for this podcast is to be relevant, real world and tactical. We're dedicated to not only entertaining you all, but also empowering you with actionable insights that can be applied beyond the podcast one concept at a time.

[00:00:58] Angela: This is Angela,

[00:01:00] Omar: and this is Omar.

[00:01:01] Angela: Welcome to Concept to Care.

[00:01:03] Omar: In today's episode of Concept to Care, we have a conversation with dta.

[00:01:08] Omar: DR is a product expert who advises and Angel invest in numerous health tech startups. Juve most recently served as the former Senior Vice President of Product at FirstHand, and now serves as an advisor to the business. FirstHand is a behavioral health tech enabled services startup focused on treating serious mental illness.

[00:01:23] Omar: Before joining FirstHand, he served as the Director of Product at PatientPing, which was subsequently acquired by Bamboo Health. Patient Ping is a technology platform that offers real time notifications of patient care transitions among hospitals, emergency rooms, and post acute facilities. Dhruv is also the creator and instructor of Healthcare Product 201, a course offered by Out of Pocket.

[00:01:43] Omar: This course is tailored for the health tech professional seeking to understand the intricacies of the native digital health product manager. Healthcare buyers, stakeholder communication, and healthcare go to market. The next cohort begins May 6th, 2024. Registration is now open at out of pocket. help. Now for our conversation with Drew.

[00:02:05] Omar: Hey, Drew, welcome to Concept2Care. How are you doing? Hey, I'm good. Thanks for having me. Yeah, it's a pleasure. Angela and I have been. I'm incredibly excited for this conversation. A lot of the topic that we'll go over is very near and dear for Angela, given the companies that we currently work for. And I think there's going to be a lot of value conversation that like every one of us here are going to be able to contribute to very hard.

[00:02:30] Omar: So I, I'm, I'm very excited for it. And it was very excited. Likewise.

[00:02:35] Dhruv: No, I think, I think that this is going to be a lot of fun. It's, it's something that has been much needed and overdue for healthcare and healthcare product folks.

[00:02:42] Omar: So, you know, want to give some context because not everybody knows, but for the audience, could you just briefly describe, you know, what is value based care?

[00:02:51] Dhruv: Yeah. So the way that I describe value based care is being incentivized to, in some financial arrangement, to drive better longitudinal outcomes for individuals, either in their utilization of healthcare or in the specific quality of the care that they receive. And so the most basic version of value based care that I describe is, and you know, I think that Healthcare policy wonks and the real, you know, health economists will get frustrated at this example, but for folks that are very new to value based care, I just say, hey, You know, decades ago, you could be a health system and you could do some type of surgery with, uh, with a person and you may have done a bad surgery.

[00:03:45] Dhruv: And because of that surgery or because of the way that that person got discharged back to home, maybe they didn't spend enough time in a rehab facility. Maybe they didn't have the right home health care setup, they may not have been set up for success to recover from that surgery and they ended up back in your hospital for, you know, some follow up for that surgery in 30 days, 60 days, 90 days, 120 days.

[00:04:10] Dhruv: And in a reductive sense, that health system got paid twice, like they didn't do a great job. And they got paid twice to provide a service. They got paid a fee to provide a service, which was, you know, some DRG code for a surgery. And in many ways, value based care is ostensibly trying to incentivize and pay Providers to do the right things on a longer term scale, typically on an annual basis to say, Hey, you know, if you are more focused on what's going on with that person outside of your four walls and you are able to have their care be below a certain benchmark, we'll share the savings with you.

[00:04:56] Dhruv: Or if you're willing to be accountable for basically all of that person's care, And the cost of that care based on, you know, the premiums that they receive and adjusted a little bit for how sick they are or their social needs and you and their care costs less than their premiums, you get to, you know, share in that savings that you generated and that could be more financially attractive than just getting paid for the services you provided that person.

[00:05:26] Angela: Drew, I like the way that you describe that. And so there's sort of this idea of. We need to do better. We need to be accountable for the type of care that we're providing and an appropriate amount, right? Not too little, not too much. And so in the context of building products for value based care, how do you think about that?

[00:05:47] Angela: And you know, it'd be great if you could share some stories of. Um, where you got this right and maybe there are areas of pitfalls that, you know, we should be aware of.

[00:05:56] Dhruv: Yeah. You know, so I will, I'll, I'll approach it in a couple of different ways. And you know, you know, I usually say this at the outset, which is I'm not dogmatic about value based care, but there's some very structural places where value based care is not well set up to succeed.

[00:06:14] Dhruv: So, you know, for example, value based care works really well. When a patient population already has high utilization, because, you know, you can really model and build a financial model and a care model to say, Hey, somebody is going to the hospital two, three, four times a year. Somebody is taking some very, very expensive drug or receiving some very expensive intervention.

[00:06:39] Dhruv: And we're going to try to take that existing state and reduce waste in the system. And, you know, it's like, okay, wonderful, amazing. And, and, you know, like that can, and I think personally I've seen that work for the people that are highest acute, like highest need, highest acuity. So much of the firsthand model supporting individuals on Medicaid living with serious mental illness was focused on folks that are really slipping through the cracks in the system and are ostensibly using the emergency room or the hospital for primary care.

[00:07:09] Dhruv: But. If you're basically saying, Hey, I want to take somebody and build a model for them that I think would prevent something that may have happened, but you know, we don't really know if it would or wouldn't. It's just good practice, good clinical practice, good standard of care. It's very hard in value based care to try to capture value of the ROI of a counterfactual.

[00:07:36] Dhruv: Like it's very hard to say to somebody, Hey, I think that this person was going to have a heart attack this year. And I prevented that because we did better medication management around their cardiometabolic health around their, you know, like a variety of their comorbidities. Really hard to say that it's much easier to say, Hey, somebody had a stroke.

[00:07:56] Dhruv: And we're going to make sure that they don't get readmitted to the hospital 90 days after that stroke, which is a bundle, a bundled payments program, like the BPSI model that exists. And so value based care isn't really great in that way. And actually, if you were to say, Hey, you know, the best way to support this person is for them to get on a GLP 1.

[00:08:16] Dhruv: Fever service is actually the right business model there to say, Hey, there's a great intervention. And the thing to solve is try to get As much access and easy access to something. So, you know, I try to, I try to highlight that to say, look, I don't think that value based care is this magic pill. I think, and nor do I think fee for service is, you know, at the outset a bad thing.

[00:08:37] Dhruv: I just think that they have their roles to play and you just need to make sure that they're deployed in the right way. Now, the reason why I say that is that I think that there are A lot of software products or, you know, services or tech enabled products in value based care that would succeed or fail just because it's the wrong business model or it's the wrong value based arrangement.

[00:08:57] Dhruv: But if you have the right value based arrangement, the way that I think about product is that there are two types of product in a value based care offering. There's capital P product and there's lowercase P product. Capital P product is not your tech. It's not, you know, even just your services, it's everything.

[00:09:17] Dhruv: It is what outcome are you going to deliver for whoever your customer is? You know, whether that's a risk bearing entity, a pay fighter health plan, your capital P product is what outcomes are we going to deliver for some patient population that we're working with and your lowercase P product. Is your, you know, tech software, the stuff that three of us are more familiar with, and that's more around what are the blockers that currently in, you know, clinical practice or standard of care are not well utilized or are, you know, facing some challenge to drive that outcome for the patient population.

[00:09:59] Dhruv: And then specifically, what if those challenges. Are things that tech has a right to solve because you know, you can't just throw humans at it. You can't just have good services designed to solve it that like that. That's really how I think about tying where you can build amazing software product that enables value based care models.

[00:10:23] Dhruv: That are truly, you know, like tech forward and thoughtful that, you know, couldn't just be obviated by a really amazing human, which we saw plenty of times at firsthand. We're like, we just don't need to build something because we found an amazing clinician or admin person or frontline staff that, you know, just just.

[00:10:40] Dhruv: You know, amazing. Or we have created a services model that allows them to work at the top of their license and allocating tech there isn't going to be particularly high ROI or proprietary or moat for us.

[00:10:55] Angela: So you were at patient ping, right? And so I think patient ping falls into that category where it is really valuable, rich data source.

[00:11:04] Angela: That is sort of embedded into the model so that we know some signal about the patient or the member. And so could you talk a little bit about that product and how that supported the value based model?

[00:11:19] Dhruv: Yeah. Okay. So I'm actually glad you asked this because this falls like really well into the like framework of capital P and lowercase p product.

[00:11:26] Dhruv: So patient ping is a care coordination software platform that aggregates ADTs, which is admin, admin discharge transferred feeds from facilities all over the country. And basically to be very simplistic about the tech, because there's a lot of, you know, powerful technology built to actually enable this backend.

[00:11:48] Dhruv: The way to think about it is we're getting Information from hospitals and a nursing home, like skilled nursing facilities and home health agencies and hospices across the country. That's basically like this is who was admitted. This is who was transferred. This is where they are. This is, you know what their diagnosis were.

[00:12:03] Dhruv: This is who got discharged and then we have these patient panels or rosters of folks that are attributed lives for a value based care provider. And, you know, like this was a problem that we had to solve, which is if you are an ACO in Texas, or if you're a value based care provider in Texas, you may have many Maria Hernandez's that live in similar zip codes, same zip codes, have the same birth date.

[00:12:27] Dhruv: And you need to make sure that when the particular, that particular person is showing up to, you know, Houston Methodist or Baylor, Scott and White, or, you know, any of the big Texas health systems that. You are notifying the right provider for the right patient in real time to say, Hey, this person has shown up somewhere in this facility.

[00:12:51] Dhruv: Now, you know, the, the lowercase P product, the software that we call that is an event notification system. The capital P product, like why do you know, value based care providers purchase patient paying or some other similar software product to find out this information is the outcome that they need to drive is good discharge planning and good transition of care management, like transitional care management in service of reducing.

[00:13:21] Dhruv: You know, seven day, 14 day, 30 day, 90 day readmissions or to make sure that patients are going to the right post acutes that are high quality, that are in network, that and that, you know, patients discharge plans are being followed. So capital P product here is. We have great transitions of care in service of allowing patients to recover safely in the right side of care after an ER visit, after a hospitalization, and really prevent that boomerang visit.

[00:13:52] Dhruv: The ADT notification, that like ping that you get of, Hey, my patient just got discharged from this hospital. is a trigger, but it's a trigger for like a very, like, you know, complex set of workflows with many different people coordinating multiple things, such as calling caregivers and patients to educate them on, you know, discharge, like instructions or getting a primary care visit or specialist visits scheduled within, you know, seven days and 14 days for HEDIS measures.

[00:14:20] Dhruv: Like there's so many things happening and some of them are services designed, are enabled by other technology platforms. Or, you know, they are triggered by that patient ping platform. The product isn't patient ping. Like patient ping, you know, and I did not really appreciate this until I left a digital health vendor like patient ping to then go.

[00:14:39] Dhruv: and work at a customer of patient paying where I was like, Oh, wow, how myopic my, you know, like, or narrow my aperture was about everything that was happening. Then you kind of realize, Oh, the software is just one piece of the puzzle and actually enabling the outcome takes a variety of things to succeed that all deserve, you know, good product thinking around who's doing what.

[00:15:01] Dhruv: You know, who's accountable to what, what does the good, like, what is the right workflow look like? And then how does technology enable that, you know, transitions of care workflow?

[00:15:09] Omar: That's a really good point. Is it fair to say that, like, you know, patient ping, which I think later was acquired by Bamboo Health.

[00:15:15] Omar: You called it the capital P product. And then you mentioned that, like, you'd be later worked at a company that was a customer of the capital P product. The lowercase p, like So I would actually

[00:15:28] Dhruv: say patient ping would be lowercase p product. And then the work that our customers did around driving some patient outcome, that was capital P product.

[00:15:37] Omar: Oh, well, help me understand the distinction then, because is it like, I was thinking that the lowercase p product is cobbling together a lot of endpoint solutions to drive outcomes, whereas the capital P product is creating the.

[00:15:51] Dhruv: Yeah, no, no, no, unfortunately for us pure tech folks that like we are one small piece of the puzzle and it's the, you know, providers and the clinical staff that are cobbling everything together and driving an outcome that are actually like doing the high value stuff and honestly it's why I was so excited to go jump into a tech enabled services business like, you know, I'll give you an example.

[00:16:14] Dhruv: You know, like somebody gets discharged from, this is actually like quite typical, you know, somebody shows up to an emergency room, they don't get discharged, but let's say they show up to an emergency room at two in the morning and we send a ping to the, you know, care manager in the community that works with that individual.

[00:16:31] Dhruv: A care manager isn't working at two in the morning. And so what did our software do? And we sent a ping. But, you know, is it really valuable if there's nobody there to do something about that piece of information? And so, you know, so much of where my mind went around, you know, what, What is truly valuable is driving the outcome, like, you know, it's great, like, there's, there's so much value in being able to tell somebody real time, hey, this is where your patient is, and this is what's happening with them.

[00:17:01] Dhruv: If, like, at the end of the day, the outcome isn't letting them know that piece of information, the outcome is, hey, you know, can that person get an appointment with their primary care physician? In 12 hours so that they don't need to stay in the emergency room for their need. Maybe they can get some follow up and you know, you're able to avoid a hospitalization like that's the outcome and the software is just one piece of it.

[00:17:21] Omar: So the capital P product company is leveraging that paying to either they're creating software around it to alert the appropriate individual to drive some sort of intervention. Or they're leveraging people like human capital to drive that outcome that you mentioned with that. The pain. Okay. And I think

[00:17:41] Angela: for me, this is where the, what I refer to as the frontline care team.

[00:17:46] Angela: So these could be physicians, nurses, pharmacies, pharmacists, community health workers, like these people are the stars. Because Oh, yeah. Right? They're, they're working day in, day out with these people. Their job is incredibly difficult. And so a lot of our work is how do we enable them to be successful so that they can in turn help members.

[00:18:05] Angela: And so what information do they need? How can they do their work most efficiently, et cetera. Yeah.

[00:18:11] Dhruv: No. And Angela, that like, that's exactly it. You know, you were asking like, Hey, what, what, what is value based care product? And at the end of the day, value based care product is just spending as much time shadowing your, you know, high performing staff and figuring out either, what do they do that is so special that needs to be productized?

[00:18:35] Dhruv: Or what do they really struggle with that gets that that's just bottom of license, that gets in their way of doing their top of license tasks or the things that make them really effective. And so, you know, I think that like 30 to 40 percent of this actually at value based care organizations is quite common.

[00:18:52] Dhruv: I think value based care has matured to a place where a lot of us, you know, like in this, you know, product leaders in digital health community I run, you know, a lot of us at the tech enabled services companies were laughing because we were just like, we're all building the same thing. We're all building clover assistant to, you know, like close care gaps at the point of care.

[00:19:09] Dhruv: And like, you know, we're all building a like risk stratification algorithm to, you know, make sure that we're prioritizing the right members and we're building some type of like CRM esque, you know, internal care management tool. And so like, in a way, you know, like if I had to, like, if I talk to any value based care company, I'm just, those are my first three things.

[00:19:26] Dhruv: I'm like, are you building this? And, you know, most likely they're like, yeah, you know, we have to build this because there's no great vendor that we have found that's really specific to our use case. So like, there's that, there's like the common infrastructure around value based care. value based care entity, for the most part, that is in some type of downside risk arrangement, is going to have to build a transition of care program where they are using a bamboo or point click care or, you know, like one of these vendors to make sure that they know when somebody's showing up at the emergency room or getting discharged from the hospital.

[00:19:57] Dhruv: Now there, there's then like value based care software product that is very special and that's very, you know, proprietary to your care model, especially if you have a somewhat unique care model. And so the, the example that I always think about is, you know, for firsthand, our model was saying, Hey, you know, we want to find and engage individuals that are typically the ones that are really struggling with poverty.

[00:20:25] Dhruv: They're on Medicaid. They're really struggling with living with a serious mental illness, such as, uh, bipolar disorder, schizoaffective disorder, or major mood disorder. And they're really struggling with a healthcare condition. Maybe they have, you know, some somatic chronic condition, like a COPD. And just one of those is very difficult.

[00:20:44] Dhruv: The combination of three is truly difficult and, you know, we, we don't have the easiest access resources for folks in that situation. And so what FirstHand would do is we had a care team of peers. Who were individuals with some lived experience of serious mental illness, addiction, you know, social risk, like housing insecurity that could really have honest, authentic, nonjudgmental conversations with folks that had been stigmatized by the legacy health system.

[00:21:14] Dhruv: And the roles of those peers were to find these individuals and engage them. And when I say find, I mean like, boots on the ground work. Like finding folks under a bridge, going to, you know, like a halfway home, going to like some, I've shadowed our peers and gone to some very rough neighborhoods with them.

[00:21:30] Dhruv: And, you know, just like knocking on doors and trying to see if they could find somebody. And then, you know, there's an element of like a social worker that would try to address this person's social needs, which usually are more pressing and urgent than their health care needs. Right. And then a nurse practitioner that would just do really great primary care and chronic care stabilization with them until then we refer them to existing outpatient primary care and behavioral health.

[00:21:54] Dhruv: Now, the tip of the first hand care model is peers finding and engaging these individuals. If, if we can't do that, then, you know, everything else doesn't work. That, that's the, you know, top of the funnel that we need to crack the nut on. And remember, we have this one peer in Knoxville named Angela, where I'm just like, you know, Angela's a star.

[00:22:13] Dhruv: Like, Angela just is able to, like, find individuals. a lot more effectively than a baseline or benchmark. And so what I really enjoy doing, I think like every product person and honestly, every, like every person that was on our support centralized team was, you know, in the markets in Tennessee, Ohio, or Florida, like once a month, once every other month, just spending time shadowing these individuals.

[00:22:39] Dhruv: And I remember Sitting next to Angela in Knoxville at her, you know, in our clinic there, and just being like, Angela, just show me what you do. Like, take me through, stop to finish, how you're finding Individuals. And I remember Angela was just like, Oh, you know, you put together this like claim snapshot. We had claims from the payer and we, you know, we just have like a snapshot.

[00:23:00] Dhruv: And she was like, look, you know, one of the things that I realized was that if I called somebody's phone number and I called their, and I went to their home and I can't get in, get through to them or, you know, like, like the phone number doesn't work, the addresses may be old and you know, they don't live there anymore.

[00:23:14] Dhruv: If that person, if that person has gone to a pharmacy consistently over the last three months, the same pharmacy. At which we have from the claims data, then I call that pharmacy and I'm just like, Hey, I'm calling on behalf of, you know, this person's health plan, you know, this is the information I have on them, you know, do you have information that you have that you can share like that's permissible under HIPAA for operations purposes and, and she found so many people because the pharmacy, if they were going to consistently had an updated phone number, contact information address and I'm like, Okay.

[00:23:47] Dhruv: I would have never figured this out by just, you know, like instrumenting our product or, or not figured out as fast by the typical product stuff of instrumenting things and doing user research. Like it was just being next to Angela being like, this is a product. This is, this is a feature that we should build, that we should operationalize.

[00:24:05] Dhruv: Like, Angela doesn't need to be going and doing this exercise and analyzing this claim snapshot that we have. Like, we should just, you know, surface this information very easily and then like roll it out to all of our peers across three states and just say, do this. Like, this is a, this is a good tactic that works.

[00:24:20] Dhruv: And there's a services component to it and there's a product component to it. And so stuff like that, that, you know, was really unique and special to, The problems that firsthand was solving around got to figure out how to find and engage these individuals that no off the shelf vendor would have done for us.

[00:24:37] Dhruv: That, you know, that was like our own lowercase P product that enabled some high value action that enabled capital P product.

[00:24:46] Angela: I feel like we've had shared lives because we did the same thing. We made sure that the product, the care management platform that we built, which was proprietary had the pharmacy number.

[00:24:55] Angela: Because that was a discovery that we had from the community health workers is that's how you find the latest and greatest contact information. Yeah. So I fully appreciate that.

[00:25:04] Omar: Drew, have you mentioned common infrastructure and, you know, all of us product folks are, you know, who are, are at these VBC tech enabled service companies who are trying to build the best, best in class stack to support their unique use case, trying to build purpose built, obviously the tech landscape out there.

[00:25:24] Omar: Just isn't, it's just, there aren't point solutions for everything that we're trying to do, but to your point, like, you're asking all the questions, like, did you do this? Did you, like, what is the common infrastructure? The question is like, is, is there a best in class tech stack and like, what are the specific tools, like, let's get very specific around, like, what are the APIs?

[00:25:44] Omar: What are the, what are the end point end solutions? And then like, are there just like, is there a set of use cases that have to be solved? You know, patient engagement was one of them.

[00:25:52] Dhruv: Yeah. You know, I think about this in two ways. I, and I think that digital health is in a little bit of, um, interesting place right now.

[00:26:00] Dhruv: I think that if we had had more. You know, zero interest venture capital dollars that I think, you know, a bunch of. Uh, vendors would have come out and probably had the time to find their niche in building for, you know, value based care organizations. But at the end of the day, if you just build for VBC orgs and then on top of that, like specific value based care, you know, types of organizations, I think it's very hard to build a venture scale business at this point for too many use cases.

[00:26:31] Dhruv: I do think that there's a couple of core use cases that, that I'll get into in a moment. What I do think. is very true. And we really saw this, this, this was such a difference in just the like teams that you could build when, you know, it was like the Oscar days or the, you know, like flat iron days or the patient ping days, kind of like 2012 to 2018 of digital health to like 2019 to now.

[00:26:56] Dhruv: And. I don't think that, you know, there's a best in class tech stack, but I think that there's a best in class tech team. And so, you know, if I, if I really had to give out flowers to, you know, any, like any tech stack, it would, it would honestly be a lot of the product and engineering team at firsthand, because that was just a native digital health team tech team.

[00:27:15] Dhruv: And that is like, we hired data scientists and analytics engineers and software engineers that were coming from devoted and Eleanor health and reify. And I was coming from patient paying and, you know, we had folks coming from city block or Oscar. And so, you know, so many folks across tech biz ops, like all of these different functions, stellar health, like we'd all, we might not have had the tech stack vendors available to us.

[00:27:42] Dhruv: Everybody hit the ground running. And, you know, like, like, I, I love the, you know, like a lot, a lot of the work that we built around point of care, you know, clinical decision support was something that, you know, like a very tenured data scientist from, from devoted had built there. And so, you know, like we were able to build that very quickly.

[00:28:00] Dhruv: A lot of the. You know, proprietary care management tools. And, you know, the way that we thought about that was our, you know, head of engineering that was coming from city block. It was just like, I've seen this before. Like our, like our view on interoperability solutions was just stuff that I'd seen a patient paying.

[00:28:15] Dhruv: And so I think that's, what's really special where, you know, five years ago, most folks in product and Eng like, you know, EPD, Eng product data at digital health were maybe like doing their first or second stints. in digital health. And now it's like you have career operators that have just spent their career over the last, you know, 10 plus years in venture backed digital health.

[00:28:40] Dhruv: And so I think like there's a way where you can build that tech infrastructure, even though it's common, even though they're, you know, like 60 to 80 percent of it is common and it, you know, could have probably been outsourced. I actually think that you can build it pretty quickly because you just have teams that have built that stuff before.

[00:28:57] Dhruv: I do think that then there's like a couple of areas that you're starting to see some, you know, like best in class vendors break out. So, you know, I was a big fan of Zeus because for me, you know, kind of coming from my patient ping days, I'm like, I don't want to have to contract with 10 interoperability vendors.

[00:29:14] Dhruv: Like I just get. You know, med lists and ADTs and, you know, CCDAs and commonwealth, commonwealth and care quality record. Like I just get a bunch of data from Zeus out of the box. It's one API and, you know, we can do things like, okay, if you're building a transitions of care, you know, model where you're kind of trying to say, Hey, you know, here are people that we have found currently at some facility, Zeus just, you know, was pulling data from a bunch of different places.

[00:29:40] Dhruv: And they just like turned that into an encounter staple that we, you know, had an API that called. Okay. And I remember they like added a new ADT vendor and our front end that was this, you know, like transitions of care queue for our staff just automatically updated with the new ADT vendor because we didn't have to do any integration on our end.

[00:29:59] Dhruv: Zeus was just, you know, updating their encounters table. So I think Zeus is like a really good example where I've been very happy with what they've done. And, you know, like, and I think that that also kind of like speaks to a lot of the vendors that they integrate with, like, like a bamboo health. Where there's just like common things that you need to build.

[00:30:19] Dhruv: Honestly, I think beyond that, I, you know what, I will say, I think that some of the EHRs have gotten a lot better. I think that, you know, Alation and Athena and Healthy have really kind of made strides. Alation in particular in their app stores and, you know, they're like, Partner integrations where you're like, okay, like we can be on elation.

[00:30:38] Dhruv: They have robust APIs. They've been continuing to invest in them. Same thing with healthy and they're just adding more and more, like more and more partners where you're like, okay, you know, I can just use a, you know, elation partner for claim submission, like, like, like those types of things. No one, I think blows you away because I still think that so much of this is so specific to your care model and your staff.

[00:31:03] Dhruv: And so I still think that there's a lot of, you know, configuration and maintenance and management that needs to be done, which is why I think that, you know, with a lot of these vendors, you are just like, look, you want them to be good enough. And then you recognize that there's a bunch of stuff that you will probably build yourself because net net, it will be cheaper and faster to build it yourself, maintain it yourself, and then increment it and improve it yourself as your care model evolves.

[00:31:30] Angela: Um, I was laughing earlier because. You know, you talk about these things that people in product are building for value based care organizations. And it, it just sounds like we're trying to solve the same problems and we all feel like, well, our use case is unique. So we have to build it. We have to build it ourselves.

[00:31:49] Angela: And I feel like I'm, I'm seeing you both nodding and I certainly have this bias myself. And so how do you think about the buy versus build and do you use any specific framework? Because I think I get challenged a lot when I'm like, no, we have to build this ourselves. Like it has to be proprietary, has to fit these use cases and these specific workflows.

[00:32:09] Dhruv: You know, I'm trying to remember there was, there was like some framework that, that I'd used, but, or that, you know, like I've, I've kind of shared with folks before, but broadly speaking, it's just, you know, I think it's just how critical the use cases to the success of your business, how much you think it's static versus dynamic and whether you think the.

[00:32:34] Dhruv: Level of effort relative to the ROI, like how does that stack between, you know, like building yourself versus buying a vendor and really like baking and, you know, like configuration and maintenance costs and price increases, like you are going to pay more maintenance costs internally when you build for yourself, but you know, you are going to be beholden to a vendor and move a lot more slowly when you buy, like they each have their pros and cons, but ultimately, Yeah.

[00:33:01] Dhruv: What it comes down to is how unique is your care model relative to what the market offers. So for us, you know, I'll give an example, right? Like a peer led care model that is hybrid in nature. So like has a very heavy in person and, you know, virtual or asynchronous component that is working with, you know, this care team of peers, which is a little bit of a unique, you know, like staff.

[00:33:25] Dhruv: And, you know, working with individuals who are on Medicaid living with serious mental illness, there's not a lot of care models that are similar to that. And so, you know, one of the things that was so critical, like, you know, one of the things that was really the cause of success for our proprietary care management system was that it was Extremely mobile friendly.

[00:33:44] Dhruv: It was just mobile optimized web app. And for a care team like peers and social workers and nurse practitioners that are doing home visits, that are doing house calls, that are visiting, you know, folks in the community that are taking individuals to the, you know, the housing authority or to food shelters, our peers are on the go.

[00:34:02] Dhruv: They have to have a best in class mobile experience to do things like documentation. And, you know, data submission or, you know, like access critical information on the go. Like, you know, one of the, one of the metrics that one of the product managers at first hand was really focused on was, you know, downtime or like dead time or after hours documentation.

[00:34:21] Dhruv: Like after hours documentation was a really good, you know, proxy for, wow, this person had dead time and that they couldn't document in and therefore, you know, they ended up having to document after hours or on weekends. And I remember we, we got that number down from like 15 percent of documentation was happening Uh, outside of core working hours and on weekends.

[00:34:40] Dhruv: And then we, you know, after release, we released this mobile friendly care management system called helping hand. That number came down to like, you know, three to 0 percent based on care team. And so do I think that there is a better care management software that is mobile friendly and mobile optimized for individuals that are, you know, Peers who, you know, may have access needs or, you know, maybe neurodivergent like, like, you know, that's something that product manager is thinking about now that also meets our data model and, you know, like is capturing data in a way that we know we need to report to payers.

[00:35:17] Dhruv: Absolutely not like I can very confidently just say that, you know, like that is going to be something that we need to own. But if we were a. diabetes chronic care management platform, or if we were doing, you know, MA risk based primary care, I'd think about it differently because, you know, those value based care models have had a lot more time to mature and therefore the vendor market for them has had more time to mature.

[00:35:40] Dhruv: And, you know, there's a larger market for vendors to serve those types of VBC models. So I think that's probably the biggest thing, which is just how common or uncommon and how static or dynamic your care model is.

[00:35:54] Angela: Yeah. When I was at Somatis, we also had care teams that would do home visits and that was a large part of how they took care of these members.

[00:36:01] Angela: And I remember that we needed the ability to have offline. Functionality of the, of the platform because they would go into these remote areas where there was no signal, but they still had to do their documentation because they were in the home. And so, yeah, absolutely.

[00:36:17] Dhruv: No, exactly. There's, it's just, you know, what are the key things that are necessary for your care model or necessary for it to succeed?

[00:36:24] Dhruv: And you know, that, that's it. Like that becomes a requirements doc and you can do a pretty quick pulse check on, you know, is that well served by the market? I I do think that like, you know, I think a lot of people come with scars here truth be told I think that there i've spoken to plenty of operators who are like Tech teams build a lot of widgets that don't get used and therefore I am hesitant to you know, like Just build internally and solve for tech.

[00:36:49] Dhruv: And then, you know, for me, like I, like, I think that there are folks that come in, they're like, I have been burnt by vendors and I've really been burnt by digital health vendors. And so I, you know, like it's a pendulum and I think that it like is really about finding a balance and kind of navigating the like scars that your organization has.

[00:37:04] Dhruv: And then kind of turning, like, you know, setting those aside and trying to make it as neutral as possible, which is why I think like you really need to be thoughtful about laying out all of the costs. I think teams can really tend to Underestimate the maintenance costs of, you know, maintaining their own products on the build yourself.

[00:37:21] Dhruv: And then I really think that teams can underestimate the management and coordination cost of managing a vendor that is external to you. So, you know, I think it's just being thoughtful about the pros and cons of each.

[00:37:33] Angela: Yeah, absolutely. I think like, you know, when, when you want to build something, you know, typically we like to underestimate the time required and the effort required.

[00:37:43] Angela: And so it typically takes longer than what you're anticipating. And then on the vendor side, you know, I feel like sometimes you're tied because you don't have that flexibility to just, Oh, we need like these three extra features to solve these problems. But now we're working with a vendor. So what do we do?

[00:38:00] Angela: Right.

[00:38:01] Dhruv: You know, I, I think that that's very true. These, you know, Can be very dynamic relationships. And I remember we purchased a vendor for two use cases. There was kind of like a primary analytics use case. And then there was a primary kind of like operational analytics use case. Like imagine, you know, like you're building dashboards or you're building kind of like insights to make, you know, operating, operating decisions on.

[00:38:21] Dhruv: And we thought that, you know, we'd really use this vendor for analytics, but turns out we really needed them for the operational insights and, you know, at the end of the day, what we realized is that if, you know, if there was some breakage in a data pipeline. You know, when you're building dashboards, that can be fixed in 3, 5, 7 days, whereas if you are making decisions on, you know, which patients to prioritize, for example, and a pipeline breaks, that needs to be fixed in an hour.

[00:38:51] Dhruv: You know, like you, you have a care teams at the other end of that, you know, report that are like, I'm going to be, you know, assigning work for the week, or I'm going to be signing work for the day based on what you're going to come back to me with. And you know, that, that speed of like incrementation. was so critical to us that we were like, Oh, shoot.

[00:39:09] Dhruv: You know, like we, like, even though this vendor might be good, you know, the speed is not something that's reasonable. And this like vendor basically said to us, they're like, Hey, like if you want faster response times, you need to pay us more for professional services. And we're like, wow, the cost of the cost just ballooned here.

[00:39:25] Dhruv: And, you know, so, so in a way, what I, what I tell people is I'm like delay making a vendor decision for as long as possible in the early days as a startup, because you, things will just change and you don't know. What you need. And I think that the other benefit is that I don't think people appreciate, you know, how much speed is going to be necessary in that build and buy decision like.

[00:39:47] Dhruv: One of the best pieces of advice, like one of our, one of my technical advisors is this woman, Margaret McKenna, who is brilliant, former co CTO at Devoted, and she gave me this piece of advice and really stuck with me. She was like, look, you have to remember that most operators, like most clinicians and ops folks in healthcare services have had to succeed in spite of their IT teams or tech teams, not because of them.

[00:40:10] Dhruv: And so she was just like, You are just constantly needing to exceed their expectations, which means that, you know, speed and continuous improvement is the name of the game, like, and I just remember, you know, like the look on people's faces and some of our care teams where it's like, you know, some dashboard broken and analytics engineers, like, I'm going to fix this now and within a few hours, they're like fixed and, you know, that aspect of building trust and credibility by folks with just saying, Hey, you know, we're going to, if you have a problem, if you have a bug, we're going to fix it quickly.

[00:40:40] Dhruv: Okay. And the MVP might not be everything that you want, but it'll definitely solve some key problems and then we're just going to continue to increment on it and add to it. That's just so fresh for these folks because they're very used to, you know, legacy organizations where their IT or tech team is a black box and they send some like, you know, long requirements documentation, they don't hear back.

[00:41:03] Dhruv: And then maybe like, you know, six months with a extra two month delay, they get some product that was based on the requirements doc, things have changed and they're like, this isn't what we wanted. Like, that's almost the current state. And so for us as a culture, we were just like, We're going to ship very quickly.

[00:41:19] Dhruv: We're going to solve bugs. And I will say, like, that this is, you know, because of a tech team that just hustled and was so gritty and so resilient that we were able to change that culture and really kind of make a close relationship between tech, like product engineering data and technology. Our staff, but you don't have as much of that control when you're working with a vendor.

[00:41:44] Dhruv: And so, you know, like, like, I think that that was another thing culturally that we kind of like decided on where it's like, wow, like if speed is the name of the game and then to like match the speed at the rate that the business is growing and evolving and the, you know, like needs of our frontline staff.

[00:41:58] Dhruv: We're going to have to pay more. Well, then that, you know, kind of changes the numbers on the build versus buy. So there's just like a lot of dynamics that kind of evolved as we just dug in for going from like year zero to year one to year two to year three.

[00:42:11] Omar: I'm a big proponent of the like immediate reaction should maybe operationalize first before having some sort of conviction around, you know, a build versus buyer, you know, it's, it's, Often, even especially early on when the customer use cases are light and then each net new customer, you're establishing all these very specific contracts.

[00:42:34] Omar: You learn that like, oh, this isn't actually going to work out. Right? And so like, build some tech as you go along. Sure. But like, certainly like hit the ground running, be very flexible. So that mantra makes a ton of sense.

[00:42:48] Dhruv: Honestly, Omar, like based on your question, like if I had to say like, what's core like tech infrastructure for VBC, I'd be like sign a BAA with Google or like with Google for workspace.

[00:42:58] Dhruv: And then just like. You know, 5 tran data out of your, like, EHR, like, documentation tool, whatever it is, into Google Sheets, and that, or sorry, into, like, you know, Snowflake or your Data Lake, and then, like, high touch data out of your Data Lake into Google Sheets, and, like, have these, you know, like, like, you could get very far with just that for, like, 6 to 12 months of, like, Dashboards and like worklists and panel management and you know, like prioritization and all of that stuff.

[00:43:27] Dhruv: Like you could do that fairly well for a while and just delay a vendor decision in a way that I wish that we had done for way longer than, than, than we did that would have allowed us to save a lot more time on, you know, making vendor decisions that. Outdated probably the minute we signed the contract.

[00:43:48] Omar: Yeah, I, that's incredible. I love that. Listen, people, that's, that's, that's what you should be saying. If anyone says anything about, we should do this. This is, that's the answer you should provide. Um, I want to, I don't want to belabor the point, but I do want to ask the one, one question here on just, you know, if you're, you know, it seems like what I'm extracting from the answer, it's like an, it depends, right.

[00:44:08] Omar: And you figure it out as you go along. But, you know, you and I and Angela have heard this countless times, whether it's from an investor or from the management team, or like, don't come trickling down into the product team. It's like. And if we're not building things in house, like how are we creating defensibility in the market?

[00:44:27] Omar: And so like, what is, you know, what's your advice or take on like, what is actually defensible in this space? Is it building? What is it?

[00:44:37] Dhruv: I don't think it's a binary. I just think it's how much, you know, and, and really, I think that the, the question will just come down to margin. And like margin expansion, which is just, you know, like, you know, like, like we, we think about this a lot.

[00:44:49] Dhruv: I think like any, any value based care model. That employs extremely expensive clinicians. So mid levels and up like mid levels, physicians, specialists, you have to be thinking about how you make them more efficient and effective because that is a finite pool of labor that does not grow. Yeah. That grows at a very consistent rate year over year.

[00:45:14] Dhruv: That is an extreme in an extremely competitive market between any other digital health company that is also in that segment, you know, like firsthand For our peers, like we didn't have this problem because we actually felt like we could expand the pool of labor. Like we were like, Hey, you know, we will pay for peers to get certified.

[00:45:31] Dhruv: We will, you know, we, we always talk about this where like one of the big milestones that we will always aim for is when somebody who's an individual we work with graduates from the care program and gets hired as a peer at firsthand. So, you know, like there are different needs from a. Staff efficiency and margin perspective, depending on who you're working with.

[00:45:53] Dhruv: But yeah, like if I am a value-based GI business and I have to, you know, hire gastroenterologists or you know, like, like a very expensive specialist, I have to be thinking about how I can make them more effective and more efficient and have them focused on higher, like top of license tasks. And I think that that allows you to expand your margin.

[00:46:13] Dhruv: But it also allows you to build moat because you're able to improve provider acquisition and retention, or you're able to, you know, create something particularly unique around patient experience and, you know, patient outcomes because those physicians are able to focus on like top of license tasks. So. I don't think, you know, like, I think that the bit is that the market is kind of catching up to when we're in this high interest rate environment, when the venture markets are, you know, starting to look a little bit more like private equity and, you know, funding and valuations and multiples and expectations to basically saying what is, what outcomes of the business need to hit.

[00:46:48] Dhruv: And what is tech uniquely going to be good at and it's always going to be something that allows you to scale or it's going to be something that allows you to, you know, like have a mass impact across your entire provider base or your patient population. And it has to be against one of those things. It has to be.

[00:47:06] Dhruv: Expanding margin or it has to be defending the business in terms of, you know, strategic, like strategic outcomes. But I think the thing that's changed is that might be lumpy. Like, you know, you might need to build a lot of tech in years 1, 2 and 3 to get there. And you might not need as much of that tech investment in years 5 as you have accomplished some of those things.

[00:47:27] Dhruv: And so I think that, you know, like if anything, Uh, I just think that that means that you need much leaner tech teams that can, you know, flex and maybe like layer on more people little by little. And I think the way that you get there is you just hire these, you know, tech teams that have been there, done that and have a lot of reps and therefore can span a lot of different subject matter areas and, you know, be gritty for the long haul.

[00:47:53] Angela: I think also. You know, the way that we think about it is it's not just because we got this vendor and we implement it and that's why we're going to be successful, right? A lot of it is what is proprietary to us versus what is not, right? And being smart about keeping the proprietary stuff proprietary and then, you know, using vendors for other stuff and how you instrument that together.

[00:48:16] Angela: That makes, you know, the solution, I think, unique and end to end and defensible. Let's switch gears a little bit. I think we'd be remiss if we didn't ask you more about innovations in Medicaid, just with your experience at firsthand. So I'd love for you to tell us a little bit about what's happening in Medicaid, you know, who's in the space.

[00:48:36] Angela: You know, obviously this is a very vulnerable population and so very interested here.

[00:48:41] Dhruv: You know, so my, my general take is that the incentives for value based care are most aligned in Medicaid. So, you know, if you think about the macro, I think that there has been a lot of, uh, Kind of like a mixed bag in terms of outcomes and, you know, sticky outcomes in the like Medicare and ACO space.

[00:49:06] Dhruv: And I think that, you know, the elephant in the room for those spaces is risk adjustment because you kind of just have had uncapped risk adjustment in Medicare for quite some time and also Medicare and MA reimbursed. Well enough for health systems. So the way that I kind of saw it play out at patient paying them first hand is that, you know, for MA and for Medicare and then of course for commercial, you know, health systems want that patient.

[00:49:36] Dhruv: And I have never gotten a straight answer from a health system owned ACO on, you know, when they a, an Medicare ACO patient gets hospitalized or readmitted to the hospital, you know, how does the health system net out between maybe the penalty for, from like the hospital readmission reduction program or for the ACO versus the fee for service reimbursement that they got?

[00:50:00] Dhruv: And so there's kind of this like perverse incentive where the hospital is like, look, you know, we want to see this, these Medicare and MA patients. We, you know, we might make like three to 5 percent margin. on a margin on like net income for those patients. Now, on the other hand, in Medicaid, you know, actually the health system usually feels like, hey, you know, I usually get undercompensated care for this person, especially for a high needs acute Medicaid population that is using the health system for primary care for like the ER and the hospital.

[00:50:34] Dhruv: You, you, you might have Longer than desired lengths of stay and so the health system is kind of like, look, you know, I really want to get this person out to the community and a lot of community providers in Medicaid, especially FQHCs and community mental health centers are usually in some kind of arrangement with the state Medicaid program or the MCO where they have some attribution or kind of like, you know, like a Connection with that patient where it's like, Hey, you know, like you are the, you know, assigned primary care provider for this Medicaid patient.

[00:51:04] Dhruv: And of course, the MCO and the MCO and the state Medicaid plans want to really judiciously manage a smaller pot of dollars. And most importantly, those MCOs are competing every five years for like, 50 customers, there are 50 state Medicaid plans and you have a bunch of publicly traded, you know, insurance companies that have Medicaid lines of businesses that are like every five years when a state Medicaid RFP goes out, we got to win that.

[00:51:31] Dhruv: And so they try to win those by, you know, really, um, aligning themselves with services and programs that are part of that state's RFP, usually around public health outcomes that the state is dealing with. Maybe it's maternal health, maybe it's serious mental illness. something or the other. And so all of a sudden, in a very tough, you know, patient like environment, you have all the incentives for people to want to do the right thing, you know, both like both, you know, because it's the right thing to do for the patient, but also financially, it makes more sense, which is get Medicaid patients connected with longitudinal, preventative, proactive care.

[00:52:07] Dhruv: In the community so that you can reduce any unnecessary acute utilization. And so I think like that is the biggest thing that makes Medicaid historically in the last, you know, maybe like six to eight years different from Medicare. And I think that that's like, you know, so much of. What, like the, the path that, you know, city block paved and saying, Hey, we think that there's a business here.

[00:52:31] Dhruv: And so I think that that's a, that's a fundamental thing, which is like, you know, there's a lot of plays in Medicaid, which is basically saying, Hey, how can we work with a high needs population, whether that is any Medicaid patient, whether that is individuals living with substance use disorder, opioid use disorder, addiction, whether that's individuals with behavioral health needs or serious mental illness needs.

[00:52:50] Dhruv: Like serious mental illness, how can we support them because they have high utilization already in getting them connected to outpatient providers to reduce hospitalization? Like in a, in a way, you know, like that's, that's how you can describe like City Block and Waymark with their community health worker model.

[00:53:05] Dhruv: That's how you could describe, you know, Eleanor with their, or like Boulder Care with their substance use disorder, either facilities or programs. That's how you would describe a, you know, firsthand. And so I think that's fundamentally the like overarching perspective on, you know, the different plays there.

[00:53:23] Dhruv: Now, I think that because the Biden administration and CMS is coming out more and more and basically saying, Hey, we're not, we're no longer having this risk adjustment, like upcoding game, you know, with like just uncapped risk adjustment potential. I think that from an investor perspective, it's saying, well, okay, like the way that you can drive venture returns in.

[00:53:46] Dhruv: Healthcare is by reducing total cost of care in a value based arrangement. And I think that there are ways to do that in the ACO program and the ACO REACH program. But I think that that is most so, you know, like existing in Medicaid with a lot of operators that are, you know, coming out to kind of do that in different ways in Medicaid.

[00:54:07] Dhruv: So I think that like those incentives are already there. Like that's the DNA of a lot of these Medicaid businesses or operators that have worked with the Medicaid population. And so I think that I'm seeing that, you know, manifest in a couple of different places. So I think, you know, any like specialty patient population that's, you know, you're trying to do some type of engagement and navigation to outpatient community care for sure.

[00:54:33] Dhruv: I think like that's, you know, somewhat like an established track in Medicaid. I think the other areas that are. very, you know, that come out a lot is probably one, anything around redetermination and benefits enrollment. So, you know, full disclosure, I'm an angel in a business here called Fortuna. And the reason why I invested in Fortuna is that, you know, when I talk to like any MCOs and even where, you know, firsthand payer partners were kind of coming to us, they were just like, Hey, millions of Americans are getting redetermined out of Medicaid when they should be eligible for Medicaid.

[00:55:05] Dhruv: And, you know, you hear all these crazy stories where it's like the, you know, The daughter of a Medicaid enrollee who works at California Medicaid couldn't, like, get her, you know, parent, like, enrolled back after redetermination, like, truly, like, difficult things that is purely administrative, for, like, administrative reasons, people are getting disenrolled from Medicaid.

[00:55:24] Dhruv: So, I think, Any business that's focused on, you know, getting Medicaid beneficiaries enrolled back into Medicaid because of the public health emergency expiring and redeterminations happening, I think that is very, very hot topic, just because for a lot of these Medicaid plans, you're just like, hey, I just lost my premium dollars on individuals.

[00:55:45] Dhruv: Like from a financial perspective, it's just like, Hey, like I got premium dollars on these individuals that I would work with and that's gone. And you know, like that was actually incorrect. It's not like, you know, every single one of that person should just get an exchange plan. Like they should be on Medicaid.

[00:55:58] Dhruv: They're eligible for Medicaid. So I think that that's like a very big area. And you're kind of starting to see that in like different like benefits enrollment as well to kind of say, Hey, like, let's make sure that we get, you know, like Ounce of Care is a, is a good example here where Ounce of Care was doing stuff around like housing.

[00:56:13] Dhruv: I think Unitas is, you know, being very thoughtful about this, where it's just like, Hey, here are folks that are eligible for a lot of community based services and are eligible for like, Housing or utility assistance and so on like let's get them in those services and you know close the social referral because that like reduction of social risk or social determinants risk is going to lead to good health care utilization outcomes.

[00:56:38] Dhruv: So I think that like. Redetermination, but broadly like, you know, Medicaid enrollment churn and then benefits enrollment is another area that is very active. The other part that is just getting a lot of attention from venture investors is getting family caregivers paid. So, you know, there's the structured family caregiver program.

[00:56:55] Dhruv: There's the self directed services program. These are kind of like state programs that have state or some like, I don't know if it is federally subsidized, but I do know that there is basically Government dollars to family caregivers who are already doing, you know, like the work of kind of like a home health aid or a home care aid paid to be a family caregiver.

[00:57:14] Dhruv: And so, you know, that space has gotten a lot of, you know, attention and early stage venture investing because the whole idea is, hey. You know, if you can build a strong relationship with a family caregiver who is a, you know, basically now getting paid to be a provider in the home, one, you know, like there's a business to be built there, but two, you can potentially like then turn that into a novel care model.

[00:57:36] Dhruv: I think that the other areas that are really particularly interesting is a lot of Medicaid waivers. So, you know, I'm an angel and pair team that is having a lot of success with some like Medicaid programs in California. I am an angel investor in UVO because I think the whole concept of Getting FQHCs to, you know, be able to successfully enter into value based arrangements for the good work that they already do is, like, very critical.

[00:57:59] Dhruv: The other area that I'm getting very excited about is this new Medicaid waiver to allow individuals that are incarcerated to get enrolled in Medicaid 90 days prior to the release. And, you know, like, Oh my God, like I remember going to a healthcare coalition in Wisconsin that, you know, had folks from like Advocate Aurora and Freighter and like, and, you know, a lot of the, the health systems in Wisconsin, especially around the Milwaukee area coming together and they were just like, Hey, our emergency rooms are basically, you know, Places for folks that were recently released from a, from the justice system to like detox because they got 30 days of a prescription and they don't, and they lose their, you know, jail insurance and they're now supposed to figure out, uh, aside from like getting their lives, you know, like restarted, they're supposed to figure out, like getting a Prescribe like a physician to prescribe them a script and get insurance and then go to like a pharmacy to get a you know, medication Of course, they're going to go to the emergency room to like get that care And so I think that like that's the other area that's quite exciting to me where again, right?

[00:59:02] Dhruv: it's just like the incentives are there like these are folks that are utilizing the hospital and are In need and in our communities in need and they're slipping through the cracks and now there's this medicaid waiver That's saying hey, you know Let's support them, you know, like let's get them enrolled in Medicaid and then when they, and I think there's an opportunity for a business that says when these individuals are discharged, let's keep them enrolled in Medicaid and then let's get them all of the social and clinical care that they need to have a better shot at reentry and prevent, you know, decompensation or recidivism.

[00:59:33] Dhruv: There's like a bunch of stuff like that. And I just think that the space is going to continue to do more and more as states either. Add more things to their RFPs for MCOs to say, we want you to have a service that's, you know, around X, Y, or Z, or as CMS comes out with or state, you know, like CMS comes out with more waivers or state, states come out with more waivers to say, Hey, We think that this is a novel way to support Medicaid patients.

[00:59:58] Omar: I'm glad the incentives are, are switching. Like, I'm glad to see that folks are, you know, not only are, is the intention there to do the right thing by the patient, but the, the incentive structure is changing and making it a viable business opportunity to do so, so that everybody wins. Drew, I mean, I just, I have never spoken to somebody who knows so much about Medicaid.

[01:00:20] Omar: So kudos to you. And I think if anyone listening to this podcast, if they're looking for an advisor, like I would throw, I throw you a plug immediately because that was, I will say they're

[01:00:30] Dhruv: like six or seven Medicaid people that are so much deeper on each of these individual areas. And I like each time I've said one of these things, I'm like, Oh man, I hope that person isn't less listening.

[01:00:39] Dhruv: Cause they're going to text me and be like, here's everything that you oversimplified. So, you know, like, I will say like. You know, obviously I like, I tend to be very optimistic and I like, I tend to be a little bit of like an energizer bunny about these things and be like, this is, this could be like really awesome.

[01:00:53] Dhruv: I mean, there's so much execution risk here and there truly is like, you know, complexities around state waivers that I'm not getting into that, you know, people need to think through. But again, I think that's why there's an opportunity to build a business here. And at least like, I think we're seeing that being done by several successful venture backed Medicaid businesses that, you know, are good.

[01:01:14] Dhruv: Examples to try to follow.

[01:01:16] Angela: It's incredibly important that we're serving this population and if it were easy, then everyone would be doing it.

[01:01:22] Dhruv: Yeah, exactly. Yeah, exactly.

[01:01:24] Omar: So, so Drew, you're, you're becoming quite an authority on like product and healthcare. You've, you, you know, working in concert without a pocket on, you've delivered a course like a health tech product course.

[01:01:36] Omar: I think they called it two Oh one kind of adhering product

[01:01:39] Dhruv: to a one.

[01:01:40] Omar: Yeah. Adhering to the, you know, the university naming structure. But. I want to talk a little bit about like, what does the health tech product manager of the future look like? Like what are those attributes? What are the skills expertise required to be a health tech product manager?

[01:01:55] Omar: You mentioned a couple of things like risk adjustment and like unit economics and like there's certain like PNLs that folks are managing gross margin. So like, tell the audience about that.

[01:02:05] Dhruv: Yeah, look, I honestly, I think it's kind of rough for healthcare product managers out there right now. Like I, I have a very cynical view of the state of the industry right now.

[01:02:16] Dhruv: I think that One, a lot of people got hired into product roles, especially during the, like, zero interest environment and the mania of like 2021, 2022, and even a little bit before then, and they were hired into product roles that were product roles in title and were probably more, you know, coordination roles or coordination esque roles because companies were just Blitz scaling so quickly.

[01:02:41] Dhruv: And, you know, they were just kind of like thrown at different problems of being like, figure out if there's something there without the, like a real structure and culture of good product management. And I think that, you know, we're seeing that correction right now where, you know, I talk to hiring managers.

[01:02:57] Dhruv: And they're like, look, I opened up a PM role or a senior PM role and I got 700 applicants within 72 hours of which 20 percent have healthcare experience. And so, you know, of those, you know, another 20 percent have really strong, relevant experience to what we're looking for. And all of a sudden you're like, you know, one of 700 applicants and the company is like really sifting through 30 strong candidates.

[01:03:25] Dhruv: And so I think that like, We've definitely seen a lot of product folks get impacted by layoffs and we've definitely seen more, you know, judiciousness around tech investment in general as companies have to focus on profitability or, you know, unit economics. And so I think that the bar on what a good product manager looks like has really been raised.

[01:03:50] Dhruv: And I think that the pro the healthcare product manager of the future looks like one of two things. And I actually think that it's like very akin to what Brian Chesky did at Airbnb. Where I think that the healthcare product manager of the future can go down one of two routes. I think that they Can still work very closely with engineering teams, but should be more technical, like, like, you know, and when I say be more technical, you know, I think some like healthcare product managers that I've seen in the past have been former software engineers that, you know, really were able to kind of round out their customer facing and kind of user facing skill sets and were able to build, you know, do like, you know, product management with product engineers, but really like build good product, but accelerate the engineering team just because they had a good understanding of not just the what they And why, but like how things should be built.

[01:04:38] Dhruv: And they were able to kind of like translate those, you know, requirements into technical requirements for the engineering team very quickly. And that led to, you know, one of the ways that you currently evaluate product managers, which is just, are you accelerating the engineering team? Like, you know, by adding you, are we getting like 30%, 40 percent greater velocity from an, from a.

[01:04:59] Dhruv: And I think that specifically, you know, like table stakes now for that, that product manager is good SQL skills to basically say, Hey, like, let me take a lot of, you know, low value requests that are coming your way where we're getting, you know, like user requests, you know, bug escalations, triages, things where really like the solve is just doing so like a reasonably complex SQL query to kind of find out, you know, what insight you can glean from joining a few different databases or tables.

[01:05:24] Dhruv: Or, you know, like, some solid, like, Python skills to even, like, you know, do some of the scripting to, you know, Answer some of those questions or inform some of your product thinking around just what your own data, the data is telling you. So I think there's definitely a role for like a more technical product manager.

[01:05:42] Dhruv: I think for most healthcare PMs, right, obviously nobody wants to be like, thanks dude, thanks for telling me that I should have like studied comp sci in college, you know, eight years into my career. I get it. I think that similar to what Airbnb did, and as the saying, what Brian Chesky said is the vast majority of healthcare product managers of the future need to be.

[01:06:02] Dhruv: Product managers that also have really great product marketing skills. And what I mean by that is they need to have really impeccable. Subject matter expertise and domain expertise of where they are in healthcare and their kind of like niche of healthcare for their business and really good go to market understanding of how to translate, like basically translate what they are hearing from the market and customers to be the voice of the market into what are the highest cost.

[01:06:28] Dhruv: Priority business cases or initiatives that their business can work on because they are aligning what they're hearing from the market to what the company strategy is and you know what the level of effort from a technical perspective or services perspective would be to try to generate value for a customer and then capture that value.

[01:06:46] Dhruv: And so what I mean by that, you know, like the reason why I say kind of risk adjustment as an example is like the most common thing that I hear from. Product leaders and CEOs, especially ones that even like send, you know, PMs to my class and, you know, like I think the classes for like Existing product managers and senior PMs.

[01:07:03] Dhruv: But like a lot, oftentimes what I hear from hiring managers is, Hey, like, I need you to know how dollars and healthcare flow, like, I need you to know how our customers make money and like how our, how our business makes money in just as good of, you know, like detail as the person that owns the PNL at the business or the person that, you know, like.

[01:07:23] Dhruv: Like an executive that owns at P& L at our company. And so what I mean by that is, you know, like, if you're working, if you're working in value based care and you don't really understand how HCCs work, and, you know, how risk adjustment, like RAF scores are calculated, or at least just like, you know, what, like, the high value RAF codes are, and how that, you know, drives dollars to flow for a value based care organization or a VBC customer.

[01:07:46] Dhruv: You know, like that really gets in your way of understanding what product to build. If you don't have a sense of how, you know, benchmarks are set or shared savings are calculated and You know, like, that makes it very hard for you to be able to build for that, you know, customer. And so, so much of the Product 201 class is just that.

[01:08:08] Dhruv: It's just like, you know, if you, usually most students are interested in working with health systems, payers, providers, sometimes employers in pharma, but it's like literally just let's understand how, you know, those customer segments, business models work, who the buyer personas are, what their incentives are, what their P& L and like KPIs look like.

[01:08:25] Dhruv: And like understand how you can align that insight around what their challenges are with what a user's challenges such that if you can solve that user's problem that drive some behavior that solves that buyer's problem that drives value for the enterprise and let's just make sure that you have a sense you know with your tech lead or your tech team on what feasibility and level effort looks like so that you can just make decent High ROI business cases and like business case analysis.

[01:08:54] Dhruv: And so I think that like, that's, that is the push, like, like if you truly want to be a, you know, as they say, like a mini CEO or somebody that is doing high leverage strategic product work, you need to know your customers P and L like at least as you know, in a way that they would respect your perspective on how you're thinking about how you can help them solve.

[01:09:14] Dhruv: Challenges that they're experiencing with their P and L.

[01:09:16] Omar: You made, it's like, it's, I love hearing that. So it's not enough to, to be a PM coming from another industry. And this is for the IC PMs out there, but like, it's not enough to be like a PM coming from another industry into healthcare and having some decent PM skills and like thinking that that's going to smooth over and you're going to succeed.

[01:09:36] Omar: Like maybe you do, but it's because you do a lot of work in those other areas. Or like, it's not enough that, you know, you maybe know a lot about a very specific condition and you're coming in, like maybe you were bedside for, you know, maybe COPD or something like that. Right. And you know, a lot about that specific condition and you're being hired to come in and be somewhat of the subject matter expert, but you don't really understand any other aspects of the business.

[01:10:05] Omar: And so wholeheartedly agree with that. I think that's like a fantastic perspective. And I think for the audience, like, When you're applying to these companies or when you're interviewing for them, like, you know, if Dhruv is the hiring manager, one, you know how to impress him, but two, this should be applicable, you know, across the board.

[01:10:23] Omar: And so love, love that perspective.

[01:10:27] Dhruv: Yeah. And look, you know, like, I think that that can be very intimidating to hear. And maybe I'm being unnecessarily bearish because, you know, economies are cyclical and venture markets are cyclical. But like, I think that's the bar and I think that we should be, we should aspire for that as the bar.

[01:10:46] Dhruv: And, you know, what, what I talk about in the course is the concept of the native digital health product manager. And it's basically that it's somebody that has deep healthcare domain expertise and subject matter expertise from a voice of market, voice of customer perspective. That also has really strong product chops of translating that into the product process of identifying areas that your company has a right to solve or a right to win at, and, you know, being able to work with technical teams and a, and a, you know, diverse, uh, cross functional stakeholder group to take something from validated problem to product that exists that's solving that, you know, that problem for that customer such that you're achieving product market fit.

[01:11:30] Angela: I think the bar should be high because this job is not an easy one, right? You've talked about your course. I'd love to touch a little bit more on it. So it's with out of pocket, you teach a product 201 class. Can you tell us about the inspiration for the course? And your top requested areas or questions that you get the most often.

[01:11:53] Dhruv: Yeah. So man, I don't, like, I don't even know what the inspiration was. I think, you know, like I'm, I'm very lucky. And I, and I like walk totally backwards into lucking into being college friends with Nikhil Krishnan. I did not know him originally as, you know, Nikhil from out of pocket. I just knew him as that very charismatic and funny guy who like, Is on the Bhangra team that I see breaking it down on dance floors at weddings that we were both invited to and I think he just reached out to me he was like, Hey, you know, like this gets requested a lot like a lot of people like ask are asking for a course around product management and and I think that like I was like, you know, I get asked a lot about it.

[01:12:32] Dhruv: Again, for better or for worse, like I still, I still have that imposter, like imposter syndrome of like, okay, like, you know, like, you want to hear my advice and I'm just going to tell you my, my experience in NF1, but I was like, okay, this could be interesting to like marry these together. Like there's this, you know, request or ask that Nicola's hearing and, and I, you know, kind of have this interest or kind of get asked a lot about, you know, like, like my product career.

[01:12:55] Dhruv: So. Kind of combined that and, and honestly, like it took several iterations where we're about to be on the seventh iteration or sixth or seventh cohort of the course, where I think it really took a bunch of them to be like, yeah, this is, I think that the course now is getting to product market fit. And so the, it was just like kind of random and just like happenstance.

[01:13:16] Dhruv: I think that probably the most common requests that I get from the course is the, the top one is, How do I build relationships with buyers? Because basically like the, the course is structured into four classes. Class two is live buyer interviews. Like, you know, based on the target customer segments and kind of product problems that students are trying to solve as like a capstone through the course.

[01:13:39] Dhruv: I get them to interview in like groups of three, you know, anywhere from five to seven, like five to eight buyers. And they're just like, how do I do that? And so I tell them, you know, and I've told Jay Desai, the, the co founder CEO of PatientPing this, um, he gave me very intimidating advice early on in my career at PatientPing.

[01:14:00] Dhruv: I think I was like 28. I was a senior PM. We're working on like a new product initiative. And he told me, he was like, any product person worth their salt has five buyer executives on speed dial to vet, you know, product ideas with. And I was like, dude, I'm 28. Like, I don't know how I'm supposed to do this, but it really stuck with me.

[01:14:22] Dhruv: And what I kind of realized is that, you know, and granted like this, this was kind of like an insight because patient paying was a networks business. And I was just like, look, you know, like a lot of these buyers are so heads down trying to succeed in, you know, making their single digit margin business, like health system.

[01:14:40] Dhruv: stay in the black and stay afloat. And so they're very, very heads down. And they really appreciate when a product person is coming to them and kind of sharing insights that they're seeing across the industry, across, you know, many of like different folks that might have similar roles or, you know, kind of, kind of might be complimentary and in like a payroll or post acute role, et cetera.

[01:15:01] Dhruv: And so what I tell every student is, Any product person worth their salt has five buyer executives on speed dial to vet and validate ideas with. And the way that you do that is you build relationships, and that could even be cold outreaching folks, but you build relationships on Mutual benefit and you know, like a share, like mutual sharing of insights and the easiest way for a product person to do that because they have a wider aperture is to share what they're hearing across many people in a given segment or space.

[01:15:33] Dhruv: So, you know, like if a patient ping, you're working with emergency room care management teams and discharge planning teams or social work teams. Like, I would go in and say, Hey, like, this is what I'm hearing from you guys, and this is what I hear from other folks that I've spoken with, and that really, like, allowed me to start building some longer term relationships where I'm still in touch with, like, you know, probably my favorite product, like, buyer at PatientPeng, and, you know, he's, like, I've brought him in as a consultant for like future ventures.

[01:16:01] Dhruv: I think, you know, like we, we text back and forth. Like there's an opportunity to really build like strong relationships and friendships with by, with, with buyers where really you're, you're just both trying to sell, like help solve healthcare questions. So that's probably the most like typical one. The second, the second set of questions and the second and third set of questions are typically around stakeholder management as two and the third is really like around, you know, very like specific nuanced questions about like, you know, a particular student's like business area or product area, but so many of the stakeholder management questions are just like, Hey, I feel like I have a lot of, you know, Tension, whether it's sometimes healthy or unhealthy with, you know, different, with different stakeholders.

[01:16:44] Dhruv: And, and it's a lot of content around like navigating that, you know, like I, I recommend people, you know, like everybody should read, I think the book is called hard conversations and that like, that was hugely helpful for me, but you know, it basically talked to people about the shared goals framework.

[01:16:58] Dhruv: Like, you know, I tell product managers, like when you're talking to a salesperson and they're like, Hey, you deprioritize my feature. And you're like, well, you know, like we got to prioritize this other higher value feature for this other customer segment on the roadmap. Like they don't care. They're like, they're like, I have a commission to hit and I'm not going to have my job if I don't hit this commission.

[01:17:16] Dhruv: And so like, I understand what you're saying, but that has, you know, nothing to do with me. And a lot of around like, you know, talking about. Navigating thorny stakeholder issues is just kind of aligning on what your goal is that overlaps with that person's goal and kind of like anchoring on that shared goal and, and, you know, like trying to like, like work around that I'm kind of like, again, you know, like talking about it at a high level, but, you know, these are the things that, um, As you could probably tell, right?

[01:17:44] Dhruv: Like this, like, thing, thing one and thing two, like question one and question two are really good, they kind of like, line to that native digital health product management. Thing one is like, how do you get access to buyers? And, you know, like, that allow you to have deep domain expertise for your market.

[01:17:59] Dhruv: And thing two is just good product management. How do you handle Like complex stakeholder needs and, you know, generating buy in or trust or credibility with stakeholders. And so it's like, it's those types of things where that's the purpose of the course, like really blending a lot of the healthcare specific nuances for both sides of what makes a good product manager.

[01:18:19] Omar: True. You mentioned like what the, the digital native product health tech product manager should look like, uh, you've mentioned some key skills. These are going to be the very important skills that are going to allow you to win in the space. You talked about a lot, like you mentioned stakeholder management a little briefly or a moment ago and like how frustrating can be and kind of strategies to deploy their, I'd be remiss to say, like, or to not ask, but I think each of us on this on this episode or this podcast here, right?

[01:18:50] Omar: Like, have interacted or know someone who is a senior leader in product and health tech, who is either leaving or have quit their job abruptly. Like there's something going on right now in this moment in time. And I'm wondering if you have any insight around that.

[01:19:07] Dhruv: Yeah, you know, okay. I do. I, and, and honestly, I I've said this because as, as you both know, I, I run a private product leaders community and this is a very common conversation in that community, even in like one on ones.

[01:19:20] Dhruv: And I don't think that it is just product leaders. I think it's truly like any executive that leads a given function at a startup. And I think that the challenge is that broadly speaking, I think that if you are in early stage, And, and you have this, you know, risk tolerance or, you know, you, you have the opportunity and one of the challenges is that one, a lot of folks are burnt out, like, like, look, like, let's just acknowledge it.

[01:19:48] Dhruv: Right. We've gone through a massive, like a massive pandemic. And, you know, especially for those of us that are, you know, Working remotely, you know, like, and I can speak for myself, it's a very become very difficult to kind of separate and compartmentalize like time thinking about work and time, you know, being able to like work and coordinate with your co workers and home time.

[01:20:08] Dhruv: And so I think that. There's a massive amount of burnout that folks are trying to like recover and recharge from and, you know, startups are grinds like startups are, you know, multi year marathons. And so I think that there's a little bit going on there. But something that I'm hearing a lot, especially from product folks, is that the math is not mathing on risk adjusted rewards in early stage right now.

[01:20:32] Dhruv: And what I mean by that is, I think for a lot of growth stage companies, The there's a genuine question that a, you know, the, the job is a grind right now because the, the later stage private markets are really tough and you know, is it worth like working on a grind where for many companies, you're not going to grow into your evaluation.

[01:20:53] Dhruv: And like, like, you know, your, your options or your, your upside is really underwater. And so, you know, you may want to re like re roll the dice. Similarly, I think that especially in tech enabled services where you need more capital, you need to raise more capital, which means you're going to be diluting your employees more and the time to exit as much longer.

[01:21:16] Dhruv: I've definitely heard this from a few product folks, which is they're like, look, the math is not mathing in terms of the, you know, like. Equity ownership and upside that I'll get and the amount of risk that I'll be taking on relative to, you know, like the, like co founders and the, you know, likelihood of success.

[01:21:33] Dhruv: And honestly, like I was talking to a product leader this morning where it was just like, look like, and the fact that, you know. My function is just always riffable and we're still in a place where, you know, you can join a company and then be in a riff, you know, three, six, 12 months later. And so interestingly, what I'm seeing a lot is a lot of folks that are in any, you know, like startup function, but I think product is interesting in particular because there's, there was some like, Recent more kind of descriptive analysis that a friend of mine, Rebecca Mitchell did, which kind of just showed that product is most likely as, as, as the, as a function historically, most likely to then found their own company.

[01:22:10] Dhruv: I'm just talking to a lot of product leaders who are like, look, the risk adjusted reward, the math is mapping. If I start my own thing and, and I know that there's plenty of co founders and I've been a founder myself. It was just like, look, it is different when you're an exec versus when you're a co founder.

[01:22:24] Dhruv: And I'm like, I get it. I acknowledge it. I understand it. But I think what these product leaders are saying is they're like, look, I'm willing to take that, you know, like hit and that effort after taking some time to rest, taking some time to recharge because my comp may not be much like my, my comp will be lower.

[01:22:44] Dhruv: And in fact, it might now even be like near zero for a little bit. But if I am a career healthcare operator, who's led the product function that has a lot of the same skills needed to launch an MVP or a new business. Uh, from the product side, I think that I have a good shot at fundraising. And my equity upside will be 10 to a hundred X higher.

[01:23:07] Dhruv: And that for that, I'm willing to work and take, like, take on the work and the stress of a co founder or a founder. And so I just think that like, that's the direction that things are headed. I've just seen multiple product leaders start their own companies recently, or join as co founders of companies that, that hasn't been announced yet.

[01:23:25] Dhruv: And so I think that like, that is the trend that we're going to see again, you with all the caveats of, it totally depends on like. Macro tailwinds and like, you know, whether there's a correction in the early stage environment and your individual like risk tolerance. And I probably have a selection bias of people that are far more risky and risk tolerant than the average, you know, like startup person or like, you know, digital health person, but at least like anecdotally, that is what I'm seeing around people leaving and then taking a break to honestly start their own thing.

[01:23:59] Angela: All right, Drew, we have reached the concept closing call, so we're going to wrap with five questions. All right. The first one is, are there any concepts in healthcare that really excite you?

[01:24:12] Dhruv: So one that, one that I'm super excited about because I, I've always been excited about this. I think it's just a timing thing of when the rest of the industry and payers in particular, like are also excited about this is empowering the family caregiver.

[01:24:26] Dhruv: I, like, I'm a, I'm a caregiver for my father. I'm on the board of the Caregiver Action Network. My grad school research was on supporting caregivers with technology. This is something that, you know, like, I've really been caring about for a while. And, and I currently advise a company in the space called Ionicare that is a, you know, like, basically tech enabled services platform, digital platform that allows the family care team in the home to become extensions of the clinical care team.

[01:24:52] Dhruv: Ionicare. com And I'm super excited about that because, you know, I think that they're, I think CMS announcing this guide model, which is a model really to support dementia caregivers is groundbreaking. And it's like first of its kind to really finance wraparound services and supports for family caregivers.

[01:25:11] Dhruv: And so I'm just super excited about that concept in, in many different like incarnations, whether that is supporting family caregivers of dementia patients of individuals. that are going through a cancer journey, individuals at end of life and that are experiencing a serious illness, or even like hospital at home and home based care models.

[01:25:30] Dhruv: Like I just think that caregivers are so critical, like such critical parts of this that the healthcare system is going to have to figure out how to properly Empower them and bring them into being formal members of the care team.

[01:25:44] Omar: I love that. I think it's like, there's the buyer of healthcare. There's the actual consumer.

[01:25:48] Omar: And then there's the, the other consumer that's not really loved very much. And that's definitely the caregiver. Um, Drew, who's someone in healthcare or health tech that you admire and why?

[01:26:02] Dhruv: I've got a couple. Oh man. I need to, I need to think about this. Oh, you know what? I admire the hell out of Laura Stratt, who is a cancer survivor that works at Electra Health and just got a awesome and very well deserved promotion at Electra.

[01:26:23] Dhruv: And I admire the hell out of her because she's a multiple cancer survivor. She's a mom. She's a cancer, like she's a cancer nurse. And she has like made this like very successful pivot into being a digital health operator, but you know, like she just she just authored this post about time toxicity, where she was just talking about the, you know, burden, the time burden on her or her family around just coordinating a lot of her cancer care.

[01:26:49] Dhruv: And I remember talking to her and she was just talking about how, you know, one, like she was, I think she was like, Oh, I wasn't sure if I should write that and I was like, what are you talking about? Like, I'm so like, like everybody would want to hear from you and kind of like, you know, like shout about your experience from the rooftops.

[01:27:04] Dhruv: But the reason why I admire the hell out of her is that she posted this piece on time toxicity. I think multiple organizations reached out to her as like employers or payers or providers who were just like, Hey, You know, we'd love to understand how we can solve this and we, you know, like, like, and I think that what I really appreciate about it is she's, she's, you know, there's, there are these people and she's one of them that have the lived experience of a very difficult patient journey who also, you know, have the like audience or the ability to also translate that into like why the legacy health system should care about And, and I love that you did that and I hope more people that have gone through their own patient or caregiver journey kind of like share that with enterprises to be like, You know, this is the human experience of what our current system makes people go through, and there's a like real face about it.

[01:28:02] Dhruv: And by the way, that person is like your colleague or somebody, you know, and I know a lot of like advocacy organizations do it. And I'm just saying that we should do more of it. But I think especially in digital health as like folks who are in it. You know, digital health insiders, the more that we can kind of highlight those stories and person like humanize them and personalize them.

[01:28:19] Dhruv: Like, I think in many ways that that really does accelerate change in a way that gets underestimated.

[01:28:26] Angela: Thanks for sharing that. And we'll, so Laura,

[01:28:28] Dhruv: Laura, you're the best.

[01:28:29] Angela: We'll link her article. What is something that not many people know about you?

[01:28:37] Dhruv: I. I really like anime and manga and, or Manwa, which is Korean, Korean comics. And truthfully, you know, like I, I really love them because I, like, when I moved to America, I kind of grew up on like Toonami and, you know, Dragon Ball Z and Yu Hakusho, but in particular, like, this is, this is a bit of a cop out because so I'm just going to like be upfront.

[01:28:56] Dhruv: I love this stuff, but also I have an 18 month old. And so I don't get that much like downtime to really like watch a TV show or consume content. And so. Nice like 18 minute anime episodes or like a, you know, like anime, like a manga that I can read on my phone is amazing. Like downtime, kind of like something that I can do that's like very quick that then allows me to kind of like, like, you know, leverage my free time.

[01:29:23] Dhruv: Then I can kind of go back to making sure that my son is not doing something highly dangerous, which he loves to do.

[01:29:30] Angela: They're definitely a hazard to them.

[01:29:34] Dhruv: Angela sounds like she speaks from experience.

[01:29:37] Angela: I have two boys.

[01:29:38] Omar: I was a kid as well. So that that's, that's really cool. Do you have any shameless plugs you want to share with the audience here?

[01:29:47] Dhruv: Uh, yeah, no, several. Well, so, you know, I mentioned this to you both before we started the podcast, but I am. And, and I'll figure out where people can like follow along for this, but, you know, if you're interested in this, follow me on Twitter at dvishishta, or just, you know, follow me on LinkedIn, but I am going to announce, like, by the time this episode is posted, I will probably have announced it, but I will be announcing soon that I am going to Restart an innovation and caregiving conference that I hosted in 2018.

[01:30:18] Dhruv: I just think that the time is now like, like it's, it's very funny, you know, that that conference was in 2018, it had a hundred people, but like a lot of, a lot of the people that were there either speaking or in the audience were like Dirk Sorenson at ESI and the, and Jessica and Steven, who were the iCare founders and Helen Adio, son of Care Academy and Marcy Cardi, who's the Chief Medical Officer at Laurel and the folks at Alta or.

[01:30:42] Dhruv: You know, just like Ali from T Care, there's just like a lot of entrepreneurs that have been grinding over the last five, six years, building compelling, venture backed, caregiver oriented businesses. And I just feel like with the guide model and so much more attention kind of being placed, both from a capital and a customer perspective on caregiving, that the time is now to restart that conference and kind of convene this.

[01:31:06] Dhruv: Small but mighty group of people again, and hopefully widen the umbrella of folks that would be interested in learning. So I'll be sharing more about how you can sign up or be involved with that conference in the coming weeks. And then honestly, like right now, if you are interested, I'll shamelessly plug all the different companies that I'm currently advising, but if you are a health system and interested in Gen AI, talk to me about Elion.

[01:31:29] Dhruv: If you are doing stuff in the, you know, like. Cardiology enablement, like cardiology value based care space, reach out to me if you are doing anything in the guide model and caregiving, you know, hit up me and Ionicare.

[01:31:41] Angela: And um, I think you already hit this, but where can people get in contact with you if they want to reach you?

[01:31:47] Dhruv: You can follow me on Twitter at Divashishta, D and then my last name. You can follow me or add me on LinkedIn. And then I will, I should say this just because it's kind of going to be forcing me to be accountable, but my, my wife keeps on reminding me that I said I would start a newsletter or a stub stack or something with my, with my musings on a lot of the topics that we discussed.

[01:32:12] Dhruv: And so hopefully by the time that this, Podcast is up. I will have done that and you will have a newsletter that you can sign up on or sign up for.

[01:32:21] Angela: That's awesome. Love it. Well, thank you so much.

[01:32:24] Dhruv: Thank you for having me. This is awesome. I, you know, I think that this is so necessary in a lot. I mean, you probably just heard this, but I'm working with several companies right now, which is a lot of fun.

[01:32:36] Dhruv: But some of the most common things that we talk about is basically like, how do you build a care model? And how do you, you know, it's literally like, If our care model and clinical and, you know, quality outcomes is capital P product, you know, how do you get there? And then what is lowercase p product that the tech and the tech stack and the data stack that enables it.

[01:32:52] Dhruv: And so many folks are trying to figure out the same thing. So I'm just so glad that you've started this podcast to start allowing people to share their lessons and, you know, hopefully accelerate innovation and patient impact in our ecosystem. So really appreciate you guys having me on and doing this.

[01:33:08] Omar: That's Drew Fashista. Thanks so much for joining the podcast, Drew. Thanks.

[01:33:14] Omar: Hey, thanks so much for listening to the show. If you liked this episode, don't forget to leave us a rating and a review on your podcast app of choice, and make sure to click the follow button. So you never miss a new episode. This episode was produced and edited by Marvin Yue with research help from Aditi Atreya or Angeline Omar.

[01:33:32] Omar: And you've been listening to concept to care.

 

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