From Reactive to Proactive: Revolutionizing Patient-Centric Healthcare with Murray Brozinsky, Chief Strategy Officer at Conversa Health (now part of Amwell)

[00:00:10] Hey, everybody.

[00:00:10] Welcome back to the Health Matters Podcast.

[00:00:13] We have a great episode today recording live from the Las

[00:00:16] Vegas show floor for Health 2023.

[00:00:19] Today we are hosting Murray Brzezinski.

[00:00:22] He's the Chief Strategy Officer at Amwell.

[00:00:26] He joined via the acquisition of Conversa Health, now Amwell

[00:00:29] Automated Care, where he was CEO.

[00:00:32] Under Murray's leadership, Conversa was honored as Best Remote

[00:00:35] Diagnostics Company at the Digital Health Hub Foundation Awards.

[00:00:39] Leading AI chatbot for self-triage by CBI Insights and many other awards.

[00:00:46] Really excited to have Murray here on the podcast with us.

[00:00:49] Welcome.

[00:00:50] It's all great to be here.

[00:00:51] Thank you.

[00:00:51] Yeah, it's such a pleasure to have you here, Murray.

[00:00:53] And look, before we dive into some of the questions that we're going to ask you,

[00:00:57] just for the benefit of the listeners, what is it that inspires your work in healthcare?

[00:01:02] Like many people, it was a personal situation that got me into healthcare.

[00:01:05] I was running a company.

[00:01:07] It was super exciting.

[00:01:08] We were taking it public in a completely different space.

[00:01:11] And my wife was diagnosed with breast cancer.

[00:01:13] This was years ago.

[00:01:14] And by the way, she's healthier than I am now.

[00:01:15] So, years later.

[00:01:17] But I told myself then if I had the opportunity to apply what I was doing,

[00:01:21] which was technology and applying data to improve people's lives, I would do it in

[00:01:25] healthcare and the opportunity arose in 2005.

[00:01:29] So I had the honor of helping to co-found Healthline, which is now one of the largest

[00:01:34] health education companies in the world.

[00:01:36] And from there I became a serial entrepreneur, helping to build and launch

[00:01:40] healthcare companies, culminating with the one that's been most fulfilling for me,

[00:01:45] which has been Conversa, now being part of Amwell.

[00:01:47] What a journey and just great that you were able to take a situation that was

[00:01:52] challenging for you and your wife and your family and turn it into so much

[00:01:56] good for the entire industry.

[00:01:58] Really cool story.

[00:01:59] At Health, you talked about physician executives, about transformational

[00:02:03] leadership.

[00:02:04] How does technology factor into leadership?

[00:02:07] You really can't separate technology from business, from leadership.

[00:02:10] And I think at these conferences in particular, you try to have different

[00:02:13] tracks.

[00:02:13] You talk about technology, you talk about clinical, you talk about business.

[00:02:17] It really loses the power when you separate.

[00:02:19] So I think technology, especially now with AI, it's just, it's part of the fabric

[00:02:23] of life and the fabric of business.

[00:02:25] And I think that's the challenge when you separate it out and the focus and scrutiny

[00:02:28] is on it, it should fade to the back.

[00:02:31] It should be considered magic, right?

[00:02:33] So it's all about experiences.

[00:02:35] And in healthcare, the biggest problem we've had is it's hard to get patients

[00:02:39] engaged.

[00:02:39] We know exactly what patients should do in many cases, and there's a lot of evidence

[00:02:42] out there.

[00:02:43] And healthcare is evidence-based.

[00:02:45] If you follow the evidence, you're likely to get with high conviction, the

[00:02:48] outcomes you're looking for.

[00:02:50] The problem is how do you get people to engage?

[00:02:52] And so how do you use technology?

[00:02:54] And it's, there's a tension, right?

[00:02:56] So if you, if I told you what you need to do to follow the evidence, and we applied

[00:03:00] that to everybody, that's sort of one size fits all, that would work.

[00:03:03] But for virtually nobody's going to do that.

[00:03:05] So how do you use technology to engage patients, meet them where they are, have

[00:03:08] personalized pathways for them to follow?

[00:03:11] And so that's the magic of integrating technology into care delivery.

[00:03:17] And that's to me, the magic and the thing that's exciting about and how it relates

[00:03:21] to leadership is how do you bring all those constituencies that are looking at

[00:03:25] things in a silo together?

[00:03:26] And really it's what I hear you saying is it's making it seamless, right?

[00:03:29] Invisible, just making it work.

[00:03:32] Arthur C.

[00:03:32] Clark talked about the best technologies are technologies that are

[00:03:35] indistinguishable from magic.

[00:03:36] And that's, we're far from that in healthcare, but that's what we should aspire to be.

[00:03:40] That's great.

[00:03:41] I love that.

[00:03:41] And speaking of the traditional pillars of healthcare providers and payers, how will

[00:03:46] technology transform their business?

[00:03:49] Well, providers and payers historically are adults and that's been the case.

[00:03:53] And so there, there's some fundamental things that need to change in terms of the

[00:03:56] way the industry works and policy.

[00:03:59] And again, that needs to work in concert with technology and data.

[00:04:02] But I think we are at the point now where payers and providers are getting together

[00:04:08] at forums like this and trying to figure out how we work together in support of our

[00:04:12] common goals to deliver better care for patients and how do we spread the risk

[00:04:15] appropriately?

[00:04:16] And we talk about value-based care and going at risk and that's now being applied

[00:04:22] across the value chain.

[00:04:22] It's taking some time, but I think there again, technology, payers and providers

[00:04:29] working together on common platforms, doing more data sharing and partnering

[00:04:33] really to figure out how to deliver better care ultimately.

[00:04:36] And it's going to be a rocky road to get there.

[00:04:39] But what I like to do is I look back, are we better now than we were five years ago?

[00:04:43] And the answer is definitely yes.

[00:04:45] Yeah, for sure.

[00:04:46] And one of the things that keeps popping up is just the single digit margins and being

[00:04:51] able to make it all work.

[00:04:53] What advice would you give to some of the providers listening on that front?

[00:04:57] Like how do they make it work?

[00:04:58] Well, I think providers, if they were sitting here and hearing you just say what you

[00:05:02] said would be longing for those halcyon days of single digit margins.

[00:05:06] Right now, they've been negative for the last probably 24 months.

[00:05:09] I think this last quarter they just turned positive on an operating basis, but it's

[00:05:15] likely to go down again.

[00:05:16] So the number one issue on provider CEOs' minds has been cost and inflation.

[00:05:22] And number two are staff shortages.

[00:05:23] And those things don't go well together, right?

[00:05:26] So there's no way out of that dilemma without using technology, right?

[00:05:32] We don't have the ability, the cost structure doesn't work anymore to support

[00:05:35] our business, which is care delivery.

[00:05:37] Right?

[00:05:38] And we have a staff shortage in the critical people that are delivering that care.

[00:05:42] So the only way you can bridge that gap is to invest in technology, but you have to

[00:05:46] do it in a way that you're getting a positive ROI.

[00:05:48] So the thing that's changed even over the last 18 months has been all the innovation

[00:05:53] folks at these hospital systems, either they don't exist anymore or they've been

[00:05:57] fully integrated into the operations.

[00:05:59] And these systems can only make investments in things that work today.

[00:06:03] You can demonstrate outcomes and you have a fast payback and ROI typically less than

[00:06:07] 12 months.

[00:06:08] So those are kind of the criteria that we see as a partner and that's changed very

[00:06:12] quickly.

[00:06:12] It's changed in the last 18 to 24 months.

[00:06:14] That's been a market chain.

[00:06:16] They're certainly spending and they're investing because they recognize it's

[00:06:18] existential and that's why you're seeing consolidation of health systems accelerate.

[00:06:23] But the only way to get back to the health scene is a single digit, hopefully

[00:06:26] higher than that is to invest in technology, but it needs to augment the care

[00:06:29] delivery.

[00:06:30] It needs to be able to leverage the, cause the staff shortage is not a temporal

[00:06:35] thing.

[00:06:35] It's systemic.

[00:06:35] Yeah.

[00:06:36] Yeah.

[00:06:36] No, I love that.

[00:06:37] Thank you.

[00:06:37] Thank you for that.

[00:06:38] That's really great.

[00:06:39] And it sounds like you and the Amwell team are thinking about this critically and

[00:06:43] putting together programs and opportunities that do provide that ROI that health

[00:06:49] systems are looking for.

[00:06:50] Taking this up one level, does the U S need to think about healthcare differently

[00:06:55] now that it can travel over technology?

[00:06:58] Absolutely.

[00:06:59] I mean, I think it's not just the U S I think it's everywhere around the world.

[00:07:02] I think there's a recognition that again, it needs to be done in a way.

[00:07:05] So healthcare is, it needs to be empathetic, right?

[00:07:08] It's all, it all really is about human relationship.

[00:07:10] How do you, it needs to trap Roy uses the term or the co-founder co CEO uses the

[00:07:14] term traveling over technology, but it, it needs to be an extension of the doctor,

[00:07:19] of the nurse, of the care team.

[00:07:20] And so what we've tried to do, and I think the best technologies out there

[00:07:24] are extending that the most trusted relationship in the world in a

[00:07:26] commercial sense is between a patient and a care team provider.

[00:07:30] And if you can take that trust of relationship and instantiate it in

[00:07:33] technology, so it becomes a 24 by seven extension of that relationship, which

[00:07:37] is what we endeavor to do, then I think you're using the best of technology

[00:07:41] because you're leveraging something that's trusted, something that works,

[00:07:43] something where there's evidence-based, but you're augmenting it in a way that

[00:07:46] you can actually deliver the care that the patients and the, and the families need.

[00:07:50] And so that's happening in the U S it's happening internationally.

[00:07:54] It's happening across the stakeholders like payer and provider.

[00:07:58] So they can partner together on common platforms to be able to

[00:08:01] deliver better care for patients.

[00:08:03] You went to the trust component that is at the core of what drives

[00:08:10] healthcare and that you have a tech stack, but at the core of what you're

[00:08:14] sharing is, is trust and that's really exciting to hear from you.

[00:08:19] From your perspective, Murray, what aren't we doing that we should be doing?

[00:08:23] You know, it's not so much what we're not doing, but I'll tell you, so you

[00:08:27] can't walk around this conference or any conference these days without every

[00:08:31] conversation being about AI and in particular gender of AI.

[00:08:33] So I think, and by the way, I'm very excited about it because I think

[00:08:37] it's just, it's been around a long time.

[00:08:38] Obviously it had its Zeitgeist moment with chat GPT and the consumer's mind,

[00:08:42] but it's been around for a long time and there's lots of different types of AI

[00:08:45] gender of AI, just generating language.

[00:08:47] That's akin to human language is one piece of it, but being able to use

[00:08:52] natural language processing to understand what patients are saying and

[00:08:55] then being able to predict using data to predict what might happen next.

[00:09:00] And so I'm excited about all of that.

[00:09:01] I think answering the question that you didn't ask, but I think the danger.

[00:09:06] Is that we implement it incorrectly and or too quickly,

[00:09:10] and then we erode the trust.

[00:09:12] So the whole thing right now is you've got this trusted relationship.

[00:09:14] Everybody here is developing technologies that are, should be

[00:09:17] helping to extend that trust, but it's fragile.

[00:09:20] If all of a sudden you get out there, we have a couple of missteps, you'll

[00:09:23] lose that trust and it'll take years if not decades to bring it back.

[00:09:26] The analogy I like to use is self-driving cars when there's an accident, right?

[00:09:31] There's a huge backlash that says we shouldn't do it.

[00:09:35] Certainly in many cases we should never do it, but a lot of cases

[00:09:38] where it's not ready for prime time.

[00:09:40] But the real bar is a million people die on the roads in the world each year.

[00:09:43] So the bar isn't zero, there's one accident it's being compared to zero.

[00:09:47] It's compared to a million, but there's an enormous amount of education

[00:09:50] to prepare the public to be able to evaluate it and we don't have yet that

[00:09:55] baseline to be able to evaluate AI.

[00:09:57] That's what scares me.

[00:09:58] Yeah, no, for sure.

[00:09:59] And I think that's a really great analogy, right?

[00:10:01] The basis for comparison is zero and fortunately that education is needed

[00:10:09] and so I really do love that.

[00:10:11] Look, this, the work you guys are doing is really making a huge impact for

[00:10:15] everybody listening today, looking for fresh ideas, what call to action would

[00:10:21] you give them?

[00:10:22] It really is starting with the patient.

[00:10:23] So healthcare is very, very provider focused.

[00:10:25] It's very hospital centric and that's why care is reactive.

[00:10:29] You wait for patients to come in and you evaluate them and we're very good at

[00:10:33] evaluating when you come in, but you come in either once a year for a wellness

[00:10:36] visit.

[00:10:36] The only other time you come in is when you've got a problem, so you're already

[00:10:39] sick.

[00:10:40] So by definition, the whole system has been reactive.

[00:10:43] I come to the building and my doctor assesses me based on my current situation,

[00:10:48] which may have been brewing for years and now I'm taking care of someone who's

[00:10:52] sick.

[00:10:52] So if you want to flip that and have proactive care that's focused much more on

[00:10:57] prevention and wellness and everything else, then you need to put the patient at

[00:11:01] the center.

[00:11:01] And this has been a hackneyed kind of phrase people have been talking about that

[00:11:04] for years.

[00:11:04] But the only way you can put the patient at the center is if you actually have

[00:11:08] knowledge of the status of that patient on an ongoing basis and that requires

[00:11:12] data.

[00:11:13] And so that's how we think about it at a very high level.

[00:11:17] Technologies need to support collecting data from patients earlier and earlier.

[00:11:21] And for example, in our case, we've got a platform that starts with an integration

[00:11:24] with the electronic health record.

[00:11:25] So I have all your information and then we enroll you in these programs.

[00:11:29] We provide you with a companion, digital companion that can check on you.

[00:11:34] And if we had enough people and we could pay them, we could send people to your

[00:11:37] house every day if necessary, every week if you're sick and ask you questions and

[00:11:41] take biometric readings.

[00:11:42] And right there, that expert can say, wow, you're doing fine or wow, you're off

[00:11:46] track.

[00:11:47] Here's some change in your diet.

[00:11:49] Here's some exercise plan.

[00:11:51] By the way, you need to actually be on this drug or you need to come in and see a

[00:11:55] physician.

[00:11:56] So we virtualized and automated the ability to do that.

[00:11:59] But then with data, we can actually go one step further and start to predict based on

[00:12:03] that situation.

[00:12:05] We have FFV1 readings from patients that are have advanced COPD or have had a lung

[00:12:10] transplant, for example.

[00:12:11] We have enough of those readings where we can look at it and say you might look OK

[00:12:14] today, but based on other people with those readings, we can predict that your lung

[00:12:17] function is going to decompensate in a week or the likelihood of a readmission to the

[00:12:22] hospital just increased.

[00:12:23] So we can recommend an earlier intervention.

[00:12:25] So the whole idea is how do we pull cost out and use technology to keep people

[00:12:30] marching down this evidence based pathway and keeping them healthy earlier on,

[00:12:34] proactive before it gets bad.

[00:12:36] But at the same time, how do we identify those people that really do need to come

[00:12:39] in and see the doctor?

[00:12:40] And it can be through virtual means through a virtual telehealth visit, for

[00:12:44] example, or an in-person visit.

[00:12:45] And that if you think about that at a high level, you're optimizing the way that

[00:12:48] you're delivering care with these limited people resources.

[00:12:51] So you're getting better outcomes.

[00:12:53] The patients have a better experience.

[00:12:54] The providers are not burning out.

[00:12:56] They're having a better experience.

[00:12:58] And then you're back to the single or double digit on the economics, which bends

[00:13:01] the cost curve and all those things need to work at concert.

[00:13:04] Yeah, no, that's really great call to action there.

[00:13:06] And the data is another thing to actually get the data where it needs to be for the

[00:13:12] particular action.

[00:13:13] And what you're talking about, Murray, is spot on.

[00:13:16] It's helping really kind of understaffed health systems take action when those

[00:13:22] exceptions come up that need action, that need intervention.

[00:13:26] And rather than point of care, you're helping sort of give visibility to how a

[00:13:31] patient's doing.

[00:13:32] But if they need an intervention, they come in.

[00:13:34] Right?

[00:13:34] That's what we're talking about here.

[00:13:35] That is exactly right.

[00:13:36] So you're either waiting for the patient to come in, which doesn't work because

[00:13:39] then it's too late.

[00:13:40] It's costly.

[00:13:41] You're reacting.

[00:13:42] And to do what you just talked about with people, we just don't have enough

[00:13:45] resource and cost.

[00:13:46] So that's exactly where there's lots of uses of technology, but I think that's

[00:13:50] the highest use of technology is how do you identify the patient that needs help

[00:13:55] out and by need it's weeks, months, years potentially before things get really

[00:14:00] bad.

[00:14:00] So it's a better experience.

[00:14:01] They're going to have a better outcome and it saves a ton of downstream medical

[00:14:05] cost.

[00:14:06] And then there's a whole bunch of effort with people coming to visits and getting

[00:14:10] phone calls that are completely unnecessary.

[00:14:12] So if you knew, Hey, this patient's doing totally fine.

[00:14:15] I don't need to waste this visitor, this call.

[00:14:17] Then you would pull not only cost out of the system, but you can redeploy those

[00:14:21] people so they can practice at the top of their license, really care for patients

[00:14:24] that actually do need their attention.

[00:14:26] Totally love that, Murray.

[00:14:27] Well, very promising.

[00:14:29] And I really want to thank you for sharing the work that you guys are up to at

[00:14:32] Amwell and really just some of the thoughts that you have on the matter.

[00:14:36] If people want to learn more about you or about Amwell, where can they reach out?

[00:14:40] So if you reach out to me directly, I actually respond to any communication I get

[00:14:44] from people that are interested.

[00:14:45] I'm very passionate about this.

[00:14:46] Certainly come to our website and there's lots of ways to contact the right folks

[00:14:51] at Amwell.

[00:14:52] But Solves has been a pleasure.

[00:14:54] It's why we do what we do.

[00:14:55] And I'm super excited to have this conversation with you.

[00:14:58] Likewise.

[00:14:58] And folks, remember that you can find all of the details on today's conversation

[00:15:02] with Murray Brzezinski in the show notes, including ways to get in touch with him

[00:15:06] via LinkedIn, ways to get in touch with Amwell and the team over there.

[00:15:10] Health matters.

[00:15:11] And the work that you guys are doing, Murray, is helping elevate that.

[00:15:14] So appreciate all you do.

[00:15:15] Really appreciate that Solve.

[00:15:16] Thank you.