mHealth Israel_Bright and Dark Sides: Working with US Hospital Systems_Jim LeBret, MD
•Download as PPTX, PDF•
1 like•423 views
Presentation by Jim LeBret, MD for the mHealth Israel community, Nov 8, 2016 in Tel Aviv: "Bright and Dark Sides: Startups and US Hospital Systems". Jim is Assistant Professor, New York University School of Medicine and Associate Director, NYU Technology, Innovation and Entrepreneurship.
Recommended
Recommended
More Related Content
Similar to mHealth Israel_Bright and Dark Sides: Working with US Hospital Systems_Jim LeBret, MD
Similar to mHealth Israel_Bright and Dark Sides: Working with US Hospital Systems_Jim LeBret, MD (20)
More from Levi Shapiro
More from Levi Shapiro (20)
Recently uploaded
Recently uploaded (20)
mHealth Israel_Bright and Dark Sides: Working with US Hospital Systems_Jim LeBret, MD
- 1. Bright and Dark Sides: Startups and US Hospital Systems Jim Lebret, MD Assistant Professor, New York University School of Medicine Associate Director, NYU Technology, Innovation and Entrepreneurship President, Lebret Consulting
- 2. AGENDA ● Hospital Systems in context ● Providers: building networks, advisory boards and more ● Pilots and Partners: Who should I seek and who will waste my time? ● Raising funds: Who should I ask and who should I ignore?
- 3. WHAT JIM DOES... ● for Healthcare players: vetting later stage startups and due diligence, IT strategy, influencing partnerships ● for State Government: match early stage startups with medical centers for pilots ● for Startups everywhere: product (ideation, creation, refining, testing, feedback), biz dev, introductions,
- 4. AGENDA ● Hospital Systems in context ● Providers: building networks, advisory boards and more ● Pilots and Partners: Who should I seek and who will waste my time? ● Raising funds: Who should I ask and who should I ignore?
- 6. US HEALTHCARE SYSTEM: Hospital systems
- 7. AGENDA ● Hospital Systems in context ● Providers: building networks, advisory boards + ● Pilots and Partners: Who should I seek and who will waste my time? ● Raising funds: Who should I ask and who should I ignore?
- 8. PROVIDERS ● Physicians, nurses, physical therapists, etc ● Currently on the front line? ● Do you need a social worker or a chairman? ● Know the language AND culture ● Inpatient vs Outpatient
- 9. AGENDA ● Hospital Systems in context ● Providers: building networks, advisory boards and more ● Pilots and Partners: Who should I seek and who will waste my time? ● Raising funds: Who should I ask and who should I ignore?
- 10. PILOTS AND PARTNERS ● Who should I seek? Who will waste my time? ● Cultures change sloooowly ● Consider big and small systems and clinics ● Innovative payment model = innovative practice? ● A rare find: paid pilots
- 12. AGENDA ● Hospital Systems in context ● Providers: building networks, advisory boards and more ● Pilots and Partners: Who should I seek and who will waste my time? ● Raising funds: Who should I ask and who should I ignore?
- 13. RAISING FUNDS ● Who should I ask? Who will waste my time? ● Angels, VCs, crowdfunding, corporate venture, equity for service, accelerator, incubator, grants (nondilutive), friends, bootstrap... ● NY or California style investor?
- 14. AGENDA ● Hospital Systems in context ● Providers: building networks, advisory boards and more ● Pilots and Partners: Who should I seek and who will waste my time? ● Raising funds: Who should I ask and who should I ignore?
- 15. REGULATIONS ● Alphabet soup: HIPAA, ACA, MACRA ● What’s your strategy? ● Turning obstruction into opportunity
- 16. CONTACT ME ● Product (ideation, creation, refining, testing, feedback) ● Business Development ● Introductions ● Partnerships and Pilots ● Fundraising
Editor's Notes
- Hi, my name is Jim Lebret and I’m professor and director of innovation at NYU. I also run a consulting practice that is scaling up. My goal is twofold tonight: FIRST its to give your information about the US healthcare system that will make you think and ask questions and that will ultimately generate business for my consulting arm.
- We will cover: …. Hospital systems Providers How to pilot How to raise funds Regulations These are the areas I think are important to you and theyre the areas I work in.... IMPORTANT: this will seem like I’m jumping from subject to subject and youre only getting a taste before I move on. Thats because thats what will be happening. Its a huge area and we have 20 minutes. My goal is to whet your appetite and help generate questions in your mind. When that happens remember it and we can address it in the QA or after the talk.
- I wear 3 different hats in NYC, NYU and government. My recomendations tonight are based on my role as a consultant not as an NYU employee. For NYU, I vet later stage startups and work with IT to see what we will look externally for. For NY State I match early stage startups with medical centers for research pilots For startups I perform a number of functions and have more work than I can handle, so I’ve expanded to take on other physicians who join me for larger projects. Under Lebret Consulting we help with product, biz dev, intros, partnerships, pilots, fundraising and overall strategy. I know of about 5-10 other doctors who have a foot in startups, hospital systems and tech in a similar way. I work best as a guide and interpreter. I’ll discuss most things in the abstract, feel free to reach out to me with specific questions--either tonight or via email. I’m in Israel until November 21st and am here for a month each year. My wife is from Tel Aviv and we have a 3 year old son. My interests in speaking to you are to generate consulting engagements and to generate deal flow for the investor groups I work with.
- Lets start with hospital systems and where they fit into healthcare.
- This looks like a mess because it is. 3 trillion dollar behemoth, 10K dollars per person per year and 17.5 % of the GDP. With about 30-50% waste.
- We will focus here on hospital systems and providers, not on insurance or pharma.
- There are more providers than just doctors. Optomitrists, NPs, podiatrists, patient advocates, adminsitrators galore, cooks, janitors. Those working currently know more than those who stopped practicing years ago. If you need specific knowledge of current practices (2 midnight rule for medicare, for instance OR how eprescriptions work) you’ll need someone who’s practiced in the last year. More changes coming with ACA--more on that soon. / Also: beware of the ‘yes’ said in excitement. Most folks are squeezed so hard in the name of ‘efficiency’ that they have little time for anything else. That is the drawback of having someone currently practicing: timely information but inconsistent availability. Big differences in the advice you get from a social worker or the chairman of medicine. Depends on what youre working on. If it is readmission avoidance, you may want a social worker initially and then move to the chairman later in the hospital relationship. Take a moment to read a bit of the area youre working in. If it is machine learning, which can be applied to clinical decision support or behavioral change, you should be familiar with what docs know and dont know. (contrary to their opinion, there are things they dont know). The state of the art CDS is usually an app, if that, which uses small data to help with a clinical desion model. Also: know the two things you will be asked by providers: What is the LIABILITY? (docs are risk averse) and is there an EVIDENCE BASE for your product? Dont speak markety market, theyll tune out. Also know if youre dealing with an inpatient problem, outpatient problem or both. For instance, heart failure is both but when you drill down has inpatient and outpatient specific issues (compliance is outpatint issue and IV lasix delivery is inpatient, for example). And if you receive criticism, try to frame it in a welcome way. It is customer feedback. And take it with a grain of salt--they may be threatened by realizing they dont know something about their domain. Its often not you theyre upset with but the system. And thats a business opportunity. Do you need a provider with decision making capacity? Just ask. If they dont know, they dont have it. For example, you may talk with a junior doctor who is excited about your EHR product but who may have no way of bringing you in the door. Of course, they may be an influencer--especially in smaller hospital systems and practices. More on that soon. A final note that applies both to providers and hospital systems: how to get an in? With both, relationships are key and leveraging those you have through family or friends are well worth it. If you don’t have connections, social networking, conferences (that said, some cater more to vendors, providers or others and can be hard to discern) and direct emails work if you keep at them. Once you’re in the door, many opportunities will come.
- There are 5,600 hospitals in the US. We will see many of them close in the next decade. They’re often overworked and close to the edge of a financial cliff. It may mean that they need you desperately or that you’re a discraction. Your peers, trusted advisors and consultants will know which systems are and arent receptive to innovation. We’ve worked with these systems and know who is truly innovative and who uses their innovation team as marketers instead of pioneers. We tend to hear about the biggest and best (mayo, mass general, stanford) in terms of innovation. While them may have their own internal innovation team, the smartest systems know what balance of internal and external innovation to seek. (ex DHBN) ACOs, mixed payor/provider organizations (like Kaiser Permanante) are important to consider if you help provide value rather than cut costs--theyre interested in the long term and have the ability to see the eventual upside of saving money. Pilots arent free for hospitals: have to go through legal, finance offices, meetings. Theyre not good at having a standardized intake system. And there is no standardized method of gaining approval for digital health pilots--most hospitals are just learning the ropes and have thorough due diligence. Certain accelerators and infleuncers can shorten the process. I consider myself a guide and translator for this realm which looks like…
- mail.
- Another ecosystem that changes all the time is startup financing. I know the US system very well, having recently helped 3 startups raise over 32 million dollars. Which method did they use? They all used most of the options. For example, one startup I worked with started bootstrapping, got into Y combinator (an accelerator--it was great fun, we met with Paul Bucheit, the inventor of gmail) then took Angel money and VC money in a seed round and are raising the next round. Another startup started bootstrapped, recieved 2 grants, then raised a VC round. Be careful who you take money from: If you are focused on health, you’ll need someone familiar with not only experience but others who have had good experiences. NY or California was the choice a few years ago: with California investors focused on growth first then monitization and NYC wanting a fast return on investment--however that is blurring both geographically as well as in terms of deal structuring.
- A final note: regulations. The US is filled with them. The Affordable Care Act (ACA), also known as obamacare, is 11.5 million words long. But within all the talk are tons of opportunities that smart businesses can take advantage of. You’ll need to decide, as leaders of your business, what you will and won’t do. Whether or not you do business in america is decision one. Decision two is just how for to follow the rules. At the end of the day, obsessively following every rule to the letter of the law is not the best strategy. But which ones are vital and which ones can be dealt with later? Plus, which rules are so new that knowing them may offer a competitive advantage? For example, knowing the CCM (chronic care management) is the only area of the ACA that allows for non-face to face interactions that can be billed for--basically the only reimbursible digital health area active so far. One might build a business for auditing those interactions or enabling them. Or knowing about telehealth state rules. Better, who owns the patient data? This is a question posed to me by Oded Kraft, who is here. It turns out that it varies by the state: New Hampsire is the only state where the patient owns the data. Most of the rest have no regulations surrounding this and its left to the BAA that EHR vendors sign. The bottom line is that if you work in the US, you need a strategy and the smartest one changes monthly lately. Its not as complex as it looks when you have good advice.