Bryan Arkwright, Sumit Nagpal and Khan Siddiqui at Converge2Xcelerate Conference (Boston, MA)
- HIGI has a nationwide network of 10,000 FDA cleared ‘Smart health’ stations
- Comcast is developing in-home device to monitor people’s health
- Comcast and Independence Health partnered on a new healthcare reform
Bryan Arkwright – VP of Innovation, SCP Health: 00:00
Well, thank you so much for continuing to stay in the telehealth track. I’m very excited about this next panel. Really two pioneers and just two titans in the industry really. I’m so very excited to have these individual here. Both of my prep calls with both of them. It was just incredible to learn their backgrounds experience. We of course don’t have a ton of time so we can’t go into all that, but this should be a very engaging panel and very excited to have the guests here. So this one is capturing the consumer health zeitgeists with remote health technology which I think is very exciting. As we move forward. And again, I’m Bryan Arkwright, VP of SCP health innovation. Also chief research officer Chrome for health and adjunct faculty at wake forest. And I will let Sumit introduce himself first.
Great. good afternoon. I’m Sumit Nagpal, I’m the GM for health innovation at Comcast. Prior to which I’ve been in the healthcare industry for 25 years. I’ve built five companies. Two of which are still in flight. And then I spent a year as the global lead for digital health at Accenture before joining my customer at Comcast.
Khan Siddiqui – Founder/CMO, HIGI: 01:35
I’m Khan Siddiqui the founder and chief medical officer of HIGI also adjunct faculty at Johns Hopkins. Like to me that I’ve also had a various career in healthcare undersea for a long time, having had the companies part of my time spent at Microsoft running their engineering teams for the health solutions group. I’m a practicing radiologist also.
Bryan Arkwright – VP of Innovation, SCP Health: 01:57
Excellent. And so with the focus being remote health technology, you know, they, both previous company’s founder and with HIGI as well as is to make your role with compounds, you know, a major, you know, media producer. I think that’s what I was really excited to talk about remote health technology. You know, what are kind of some of the obstacles you’ve encountered as a go to market strategy for consumerism and, and do you in fact see consumerism and remote health technology linked in what you’re currently doing at your companies?
Sumit Nagpal – SVP/GM Health Innovation, Comcast NBC Universal: 02:39
So now we’re coming at this entire challenge of rightsizing healthcare and bringing healthcare to the right menus for the right things, for the right reasons, at the right cost, with the right experience where we’re looking at this problem from a what happens in the home perspective and what happens where we live, work, play perspective and we’re convinced that even though it’s early days, that over time, more and more care is going to be delivered closer to where we live. A lot of care is going to get delivered in the home and a lot of early warning and you know, a check engine light kind of scenario where finding out that something’s going wrong before an ambulance ride, before an emergency admission is going to happen in the home. And so without going into too much detail around, you know, unannounced and on launched products, what I can say is that the home is going to become a nexus for care. People are going to want more and more care to be delivered in their homes when they’re healthy. Just the way we want our groceries delivered there, we’re going to want care to be delivered there as well. We’re already seeing, you know, pharmacy and medications being delivered into the home on a larger and larger scale.
Sumit Nagpal – SVP/GM Health Innovation, Comcast NBC Universal: 04:10
And that’s going to extend to other elements of what we define as healthcare. While we’re well and over time we’re going to see a change in, you know, the role that hospitals play in our communities. Because some of the things that we go into hospitals in Virginia emergency rooms to get done, we will be able to know in the home. That’s what we find exciting. And we believe that the biggest impact beyond convenience, beyond efficiency, the biggest impact that this transition can have is on the cost of care.
Khan Siddiqui – Founder/CMO, HIGI: 04:50
No, I agree with what somebody is saying. Right? Do you mean for healthcare to really scale, it needs to be where you are all the time. So, the way we think about is that, you know, the healthcare network really started with physician offices at hole. It consolidate into hospitals and emergency rooms, which end up being costly, which led to creation of your third network. So doctor’s offices, first network hospital, second network, urgent care facilities, third network. Now we’re looking at the fourth network, which is everywhere. Home, school, work, grocery store, pharmacy, gym. You think about it wherever you are, it needs to be. So there’s applications of healthcare at home, the applications in healthcare, you’re walking around with your mobile devices. But then there’s a whole area of elderly in under served communities and low income individuals. How do they interact? What the bridge between that? That’s where HIGI comes in place where we provide this gigantic footprint of a healthcare access through a retail and network channel.
Bryan Arkwright – VP of Innovation, SCP Health: 05:52
And I know, you know, when we’re talking about more into the home consumerism is important. Consumerism, you know, can be defined in a variety of ways. And you know, hospitals, you know, a particular have maybe struggled with it and are just now turning to, you know, say, Oh, we need to be like more of these big tech companies, these big companies that understand consumer as well from organizations like yourselves. You know, how have you matured along, you know, with consumerism and has always been a part of your companies versus just now. Whereas hospitals may seem to have just started.
Sumit Nagpal – SVP/GM Health Innovation, Comcast NBC Universal: 06:40
Well for Comcast, you know, consumers are our lifeblood. We’re in 30 million homes and that represents about 83 million user relationships, consumer relationships. And so we live and breathe in, you know get judged on that particular our ability to deliver value in the home every single day. We think that healthcare just happens to be other service on that continuum, especially as our populations age, especially as people will end up wanting to continue living in their own homes as we live longer with chronic conditions, with long-term conditions. And we want to continue living in our own homes surrounded by our companionships, around by our possessions. We think that that becomes even more important as a nexus for care. And so bringing what we have learned over a very long time about how to deliver service in the home to healthcare with a very engaging empowering consumer experience that brings joy is really how we’re thinking about.
Khan Siddiqui – Founder/CMO, HIGI: 08:09
So when we think about how our talk crosses wall with consumer health Is when we started HIGI about seven and a half, almost eight years ago the idea really was how do you bring data into clinical workflows or anybody taking risk on a population. So data that is more valuable for assessing outcomes in a value based care system. How do you bring that in, especially focused on elderly and the underserved communities and low income folks? That was a kind of whole idea behind it. And we realized variables immediately in 2012 when we started. We’re not the way to scale. And that’s when we thought we be, we need to think about how banking has done it through an ATM. And can we do that? And that’s all we came up with, this idea of our kiosks in retail locations. The first thing we learned was that we thought we were building an ATM to decrease human interaction.
Khan Siddiqui – Founder/CMO, HIGI: 08:51
And it was completely opposite of that. So one of the patients in one of our consumers, you know, research experience doesn’t mean doc. It’s like I show up at ATM and as I’m supposed to a hundred thousand or five 50,000, my bank, and now my balance is showing zero. I don’t want to talk with ATM anymore. I want to go grab somebody’s neck. And so that’s when I first time find out I’m hypertensive. That’s the emotional reaction I get. We’ve actually seen increased communication happening with retail in pharmacy, in nutrition services and physician communication because of that reason. And to completely change the thought process that we need to do more interoperability, more connectivity to the local health systems. And we’ve done a lot of partnerships with local health systems, local payers and other networks, the whole ecosystem to really improve that interaction between the patient.
Khan Siddiqui – Founder/CMO, HIGI: 09:37
And whoever’s taking a risk on that population. The other thing we learned was very interesting was that because we tried to focus on existing habits, right? So a typical adult goes to a grocery store, bought 1.8 times a week, and that’s exactly how we see our frequency of usage. And what we’ve learned now is that by focusing on that existing habit, we’ve been able to be arriving at a grocery store or pharmacy as a trigger to get your health assessment done on HIGI. So if you’re 55% of users are using HIGI actually using it before they do shopping. So now we have now ability to influence the shopping behavior and other habits that are around, you know the recording disease or whatever they’re managing.
Bryan Arkwright – VP of Innovation, SCP Health: 10:18
That’s a fantastic example of really scaling consumerism and following that trait, following that cycle. I had heard some similar studies years ago around voting and tapping into people’s behaviors that day. What, don’t just ask them if they’re going to vote that day. What did they plan to do before voting, you know, after voting, where did they plan to vote? So really associating those traits and details into their daily patterns. That’s a great example of scaling consumerism. Is there a business model for consumerism?
Sumit Nagpal – SVP/GM Health Innovation, Comcast NBC Universal: 11:32
Well, I think the business models are really rooted in the notion of cost takeout. I think, and one of the foundation thesis for us is that change doesn’t happen in healthcare just to improve outcomes or just to improve efficiency or just to improve the experience. Change happens at scale when there’s major shift in cost. All the other things are vital to cause adoption. But scale doesn’t happen unless there’s a benefit in managing to take cost out. If you can accomplish that, then you’re actually getting somewhere. And so our business models are a rooted in that concept. How can we bring about a fundamental large-scale shift in cost from the places where we spend money today on healthcare, to spending less in places where we should be spending money. That’s what are our foundation premise is. And we think that the home happens to be one of those places where if we spend some there, we can wind up spending a lot less elsewhere.
Khan Siddiqui – Founder/CMO, HIGI: 12:31
It’s a very complex, complex question. So especially for us, you know, when you start thinking about hypertension, that’s our primary disease, they’d be focused on you think everything is known. But we get surprised when you find out that the clinical evidence only shows when to start medication therapy on hypertension. There is no evidence how to manage it, change your medication doses and there is no good evidence on vendor discontinue then hibernation medication. Right? So when I sit down with people from NIH and who are experts in hibernation management, you know, who’ve been studying this for decades, you know, they struggle with those concepts. A lot of these ended up being expert opinions rather than evidence-based rules. And how do you handle some of these aspects of our care management. So it becomes pretty challenging how you actually do that aspect of it.
Khan Siddiqui – Founder/CMO, HIGI: 13:28
If you think of it you know, when we think about you know, how do you scale likes I’ll give you an example. And American heart station every year does some kind of target on in the word hibernation month, which is February to hit a certain targets of hypertension screening. This year they wanted to hit 4 million target and they did, you know, we had 4.3 million target in the US to screen individuals. And what they do is they collect data from all connected devices. So anybody, any blood pressure device that is connected, any kiosk, anything that is out there, even their own primary care clinics, they do a screening for hypertension. They all submitted it back to EMJ and that’s how the global number comes in. So they looked at all connected blood pressure devices, total 180,000 screenings were done in February on all kinds of health devices all combined.
Khan Siddiqui – Founder/CMO, HIGI: 14:25
Our other kiosk manufacturer that did 700,000 screenings in their clinics did 200,000 screenings. 3.2 million were done on 4 million, 3.2 million were done on HIGI. So we were, it was such a dominant aspect of how much training were you able to do? Just the focus on the consumer and how do you do that though? Right? So, as you think about, you know, business model as your question was, it’s really hard to keep building clinics, brick and mortar to scale hypertension management or disease management for those who are not multi morbid disease, right? Who are sick and who need continuous care. But, but majority of patients who are hypertensive, diabetes, obesity are walkie-talkie. They’re nothing’s happening to them right now. There is no cost effective scalable manner. If you can afford devices, yes you can do it, but majority of population in the US makes less than $2,000 of income.
Khan Siddiqui – Founder/CMO, HIGI: 15:27
They’re not in that category to do this stuff. So to really come up with innovative ways, how do you engage those communities digitally, electronically at home? Everybody has a TV, right? Everybody’s using a mobile device or what would it is to check them? That gives Comcast his opportunity to be in that and take that moment and capture with it. One of the things I talk about is that what do we compete with in consumer health? We don’t compete with other healthcare companies are Amazon, Google, all the stuff we compete with the McDonald ad that is showing up. Right? Because there’s so many, if you look at sit down and watch TV and just start counting how many bad habits are being advertised and how much your eyeballs are on that, that’s what we competing with and how much marketing dollars are spent on those on those things make a huge difference. Yeah.
Bryan Arkwright – VP of Innovation, SCP Health: 16:13
I’ve got a couple of other questions. I’m trying to be picky here. You know, we talk about cost are there like, are you, you know, for HIGI, are you focused on that cost of the lack of research and that’s driving the cost cause there’s no clear stops and starts and best practices or, you know, I guess the question is, are you raising in on a specific cost? What you know, or what are those top or most interesting costs to you?
Khan Siddiqui – Founder/CMO, HIGI: 16:58
Well, I’ll give you a unique example. And we’ve seen a lot of innovation coming out from our customers. We think of the idea, but then they completely take it to the next level. So Rush Health system in Chicago came to us that, you know, we are at risk for a cardiac, MI and stroke for homeless population that show up in the ER and what 3.5 million annually are homeless people that show up in a stroke or acute MIS scenario. Right? And you say, you know, most common reason is these habitual, probably hypertensive and you know, can we do something about it and do it? And so they can, what if we put these stations HIGI stations in homeless shelters in Chicago? Would that make a difference? So it’s like, well, the station doesn’t do anything, right? Doesn’t treat anybody. Just identifying somebody.
Khan Siddiqui – Founder/CMO, HIGI: 17:44
What do you do? So they decided to create a resident rotation in with the residents at night, be there. So because there’s so many people come in, so many, so quickly, the you think you did screened the population of anybody’s that is in dire need for access. Then residents do the evaluation and send them to the catchman a clinic or something else where they actually take care of this patient. So they reduce their ER homeless cost from 3.5 million to 500,000 in one year. Right? So that’s kind of how innovative ideas are coming out from our customers. We’re looking at what’s our risk, where’s our risk stuck at and how do we reduce the risk? How do you engage the consumer in the pipeline before they show up? And high cost and high cost is going to happen.
Bryan Arkwright – VP of Innovation, SCP Health: 18:34
That was a great example was that the city of Chicago’s cost or the Rush health system?
Khan Siddiqui – Founder/CMO, HIGI: 18:34
Rush health system.
Bryan Arkwright – VP of Innovation, SCP Health: 18:36
So Rush health was bearing that cost appropriately. Wow, that’s powerful. And it’s great to see HIGI focus on kind of the poor and under.
Khan Siddiqui – Founder/CMO, HIGI: 18:43
I mean, they forced it to think about that. We weren’t thinking of, you didn’t know how that would work, but they kind of proved out that you actually can do that.
Bryan Arkwright – VP of Innovation, SCP Health: 18:50
That’s awesome guys. Well, we actually share that customer and we’re doing some very interesting work with them as well. No, a part of what we’re doing is putting a device in the home that census things. And again, without going into too much detail you know, listening to our customers, listening to some of the largest health plans in the country, they’re the ones bringing use cases to us by POS takeout. And they’re coming to us and saying, Hey, if we could just listen in at night to breathing noises for little kids who are on asthma meds for taking inhalers, if we just listened in and measured their respiratory rate at night while they’re asleep, without them having to wear anything special without them having to remember to wear a wearable we could make a massive dent in our 2.4 million admissions a year because kids aren’t either taking their meds on time or they’re not using their inhaler properly. If you could just find out when that happens that the next morning, either a parent is informed or retrained or a nurse reaches into the home through telehealth, telemedicine and re-coaches retrains somebody in the home, we could take a massive piece of that cost out.
Sumit Nagpal – SVP/GM Health Innovation, Comcast NBC Universal: 20:02
In those kinds of use cases that we’re focused on. We’re innovating, you know, with Rush and others exactly this way with the participation of payers. We’re saying, if we can do this, then there is so much savings to be enjoyed that we’ll share. Some of the savings. That’s how we’re focused on this Mark.
Bryan Arkwright – VP of Innovation, SCP Health: 20:47
So exciting. And if you are here in the morning, a share an example of some cost savings that they achieve through pediatric asthma programs as well. So it’s interesting to hear that. And just so great. Kind of see two different types of companies that are, that are working to, you know, cut healthcare costs. Last question and towards making me ask this to everybody. So what are your predictions for healthcare over the next two years and what are the barriers and can you give us one to two strategies to overcome them?
Sumit Nagpal – SVP/GM Health Innovation, Comcast NBC Universal: 21:21
Well since you said two years in healthcare, that’s a really short time. And so I’ll stretch it a bit there. I think that we’re starting to see the early shades of more and more care moving into community settings closer to where we are. And with us, where we go, we’re starting to see technology, not for technology’s sake, but for cost takeout sake. As I said, with the prerequisites of, you know, easy to adopt and a great experience with those prerequisites when nothing works without that. If people don’t use it, you know, nothing happens. But technology that has those, that meets those prerequisites, that is now all about helping us get on with our lives without thinking too much technology and taking cost out. That’s what we see happening over the next few years. And that we believe is going to five years from now actually wind up becoming the foundation on top of which the new health economy’s going to March.
Khan Siddiqui – Founder/CMO, HIGI: 22:42
So, when we always overestimate what we can do in two years and underestimate what we can do in five years. It’s a famous quote that everybody talks about. I think we will be, I agree with our representative to said, I’m just going to add a little bit more to that. I think we will always be surprised where innovation comes from. I’ll give you an example in medical imaging, some part of my other focus of my work. So the bread and butter when I train and the early days of my career, even in like 2010, our bread and butter ultrasound examination used to be what is called trisomy 13, the third trisomy screening, you know, triple screening. And so you look for to Dyson down syndrome and related things that we did every single day. If you ask the radiologists today, how many trisomy ultrasounds do you do?
Khan Siddiqui – Founder/CMO, HIGI: 23:32
They won’t remember. They know what it is, but they won’t remember when the last time they did it because nobody’s done it since 2013. What happened in 2010? Everybody was doing it in 2013, three years. Completely out the whole imaging study we used to do routinely multiple times a day. 2010 first cell free DNA test came out that detected it in a two CC blood in a lab in the office, and by 2013 peers were reimbursing for it, right? So now the OB can do blood draw in the clinic while the patients are I and within seven minutes have a result with 90% accuracy, 90% specific much better than ultrasound and completely, and everybody talks about AI is going to remove radiologist. Like, Hey, I have an example of this. Imagine if tomorrow some same thing comes out from breast screening, your whole mammography screening industry will disappear overnight, right?
Khan Siddiqui – Founder/CMO, HIGI: 24:26
So, those are transformational changes that happen that just change completely something that doesn’t happen anymore. Right? AI will incrementally do it. Something like that will disrupt it that nobody even know exists. And there are a bunch of different companies that have different stages. They’ll sell for DNA for different one collage diseases that we, you know, now it’s going to be, you know, do imaging to find where the cancer is and measured it for me. You can take it out because you already know what it is. Well guess what, machines are much better to do that than humans are, right? So, it’s not because of AI, it’s because of other things that will enable AI related applications be much more effective to do things that will make a difference in what is happening. So you never know. You’ll be surprised. We’ll all be surprised and year from now what actually disrupted healthcare.
Bryan Arkwright – VP of Innovation, SCP Health: 25:15
Very good example. Very good to answer both of yours. Well, it has been an absolute honor to meet both of you in person and collaborate with you over the last couple of months and thank you so much for attending. Thank you.