Elliott Green (00:00):
It's not just about, "Can I build the best shiny tool?" It's, "Can I build the best shiny tool that integrates into the workflow or integrates into the healthcare dynamic of those systems?"

John League (00:12):
From Advisory Board, we're bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. I'm John League, managing director of Digital Health Research. I'm about to go on stage at Advisory Board's Revolutions in Specialty Care Summit here in Chicago as guest host of Radio Advisory Live. We're wrapping up this week's sessions here, and what we're really working on right now is how to make innovation a reality. To do that, I'm joined on stage by two healthcare leaders who can speak to both sides of innovation, the vendors who create solutions and those who purchase and implement those solutions.

(00:56):
Those two leaders are Elliot Green, co-founder and CEO of Dandelion Health, and Dr. Ayo Ajaiyeoba, who serves as department vice president of employer health solutions at Blue Cross Blue Shield of Kansas City. Now, I've talked to both of these guys before, and they have genuine insight when it comes to creating stronger vendor-client partnerships, envisioning and executing solutions that create value for key stakeholders and, ultimately, driving innovation in the healthcare industry. Here we go. Welcome to Radio Advisory Live here in Chicago. Dr. Ayo, I'm going to start with you. When we talked previously, you mentioned two qualities of innovation that were very important to you and I thought were exceptionally important. Thoughtful and intentional. Tell me what that looks like.

Dr. Ayo Ajaiyeoba (01:47):
As healthcare leaders, we're very inundated. A lot is coming at us on a daily basis. Many times, I think about my day and just getting through my meetings is a win. And on the other side of that, we have this other innovation agenda to modernize something, to ideate around something, or figure out the next shiny object to take to the market. And I find myself, and we all do find ourselves just innovating for innovation's sake. When I think about thoughtful or intentional innovation, I think about what keeps me up at night. What are the strategic priorities across our enterprise? What new opportunities have presented to us, and how do we make the most of that? So I think about an alignment component. I think about how do I align the problems I'm trying to solve with the solutions or the innovations that are presenting to me?

(02:38):
So that really fuels just how I approach vendor conversations and really see through all of the noise, all of the dust, whatever you call it. I offer clinical leadership to our sales organization, and I get to stand in front of our largest employer groups, our health plan sponsors who pay for healthcare. And I will tell you, they're not easy conversations. Many times we're telling them, "You're going to get this rate increases on your premiums or administrative fees," and they just tell me, "I can't afford another 10%. I can't afford another 20%." But I mean, this dilemma of figuring out healthcare costs are increasing, we have to pass them onto the health plan sponsors. And so, I go back to how do I take all of this back and innovate around that? I'll give you an example of some of the things we've done. You must be living under a rock to not know of the GLP-1 crisis.

(03:35):
So to give you context. Of our 300 or so large group clients, we have a small percentage, less than 10% of groups or employers that offer the benefit. It's an optional benefit. And so in the last two or three years in looking at the data, when I've gone out to these clients, we have seen skyrocketing cost increases for this specific drug class alone. And most recently, some of those employer groups have decided to rescind the benefit offering. They say, "Hey, Ayo, I know this is good, but I cannot afford this cost exposure long term. The risk-benefit. I'm not even sure I'm going to keep this employee for two years, so why make the investment?" So that has fueled just a lot of my meetings in the last six to 12 months, including this week. I've been on multiple meetings trying to figure out what a comprehensive obesity management program might look like.

(04:28):
And so, everything from benefit designs to just wraparound lifestyle programs to cost share opportunities. So I try to look through that lens to say what are our biggest challenges? What are the things that keep me up at night? And how can I go to the market really thinking about solutions to address them?

John League (04:47):
The thing I pull out of that, Ayo, is necessity. We can't innovate unless we have a need. We have to identify that, as opposed to innovation for innovation's sake. Elliot, I think Dandelion sort of represents at its core what that thoughtful approach is. Can you tell me about your validation tool and how that came to be?

Elliott Green (05:08):
So Dandelion is a data consortium of a number of health systems around the US. What we do is we pull all of the clinical information out of these health systems, we structure it, we de-identify it, we tokenize it, and then we make it available to various third parties to go out... To Ayo's point, build innovative tools. You quickly realize that if you're at the front of that chain, you need to ensure that what people are building actually has a purpose, or else you'll find your customers run out fairly quickly while they all try and sell to people that don't want what they're buying, or building rather. And so, actually, it's in that context, John, that we looked at validation. So after we had initially pulled the data out and we started looking at it, we thought to ourselves, "Wait a second, the market's in this really interesting moment," where I imagine lots of people in this room are having similar conversations.

(05:57):
Someone will approach, "I've got an amazing AI tool. It will solve this problem. It will predict your patients going off to various cardiometabolic diseases. We can stop it happening," et cetera, et cetera. And it sounds wonderful. But then you have this moment of, "How do I know what I'm buying? Does it work? Well, they've got this data set that they said they ran it through. I had no idea N equals 1,000. Is that a lot? Is it not? How do I make the decision?" So at Dandelion, what we thought what we really need on this nascent industry is the rules of the road, the parameters. And that's what validation is. So validation is taking an algorithm or series of algorithms and assessing them against a comprehensive data set that is representative of a population.

(06:42):
We have three health systems already, and we have five coming, that you can say, "How does this algorithm perform against various gender breakdown, race and ethnicity, inpatient, outpatient, and on a far broader impact?" So that first of all, you can say, "Well good, I'd like to see its performance, but then I'd also like to know..." And HHS is on this as well recently, "I'd also like to know if it's biased. Am I accidentally bringing something into my system that is now going to discriminate against various members of our patient community?" So all of this stops innovation. It just halts, because no one has the confidence to go and implement something they don't understand. And that's the problem we're really trying to solve, is how can we give people like Ayo the confidence to be able to say, "I get what this solution is. I get what it does. I understand what the impact's going to be on my community. And I'm ready to start playing around lightly, in this new world of innovation"?

John League (07:46):
One of the things that I hear in there is a way to get over that first step, that hesitation of resistance. As you said, there's a lot of ambiguity, there's a lot of, "I'm not sure if I'm actually doing the right thing here." Does that resonate with you when you talk to folks?

Elliott Green (08:07):
Oh, yeah. I mean, with the best will in the world, when people invent these algorithms, healthcare is an interesting industry. You're meant to start or you'd like to ideally start with patient benefit as your north star. But ultimately, what you realize through various reasons is that what you have to start with is who's going to pay for this? So one of the big things about what we're trying to solve for is it's not just that validation. It's also... We did another tool alongside that does exactly the same thing, but for health economics outcomes research. Which then at least says, "Okay, good. Now I know that I'm not just benefiting my patient community, but I'm not going to put us out of business at the same time."

John League (08:53):
Right. I want to advance that just a little more. Ayo, when we talked, you mentioned some challenges you have with potential partners who maybe don't share that same sort of thoughtful approach, that concern with your up-at-night issues when folks approach you to pitch or to partner.

Dr. Ayo Ajaiyeoba (09:13):
Well, I think the responsibility's on me as a business leader to think through first, what are the strategic priorities, what are the things that keep me up at night? What will help members lead better outcomes with regards to their health? And how do I really come to a decision with that? So a couple things. Our product team at Blue KC does a fantastic job preparing us business leaders when we interact with vendors. They actually do a screening call. And we actually craft a problem statement, thinking through what are we trying to get out of this call? And we have some kind of rubric to assess the vendor and come to a decision. Because I will tell you, this last week, I was on back-to-back vendor calls. I was talking to three potential vendors for GLP-1 management. So I had to think through, "Okay, what am I trying to get out of this call? How do we make the best use of everyone's time?"

(10:06):
So I'll go through a couple pointers. If in the first 10 to 15 minutes of the call I'm not clear on the value prop of the product or service you're trying to sell me, you've lost me. These calls are usually about an hour. So I find that in the majority of cases, they all beat about the bush for the first 45 minutes. And somehow they get there, but at that time you've lost a lot of the attention of your decision makers. So please, make that very clear, make it succinct, and really stick to why whatever it is you're offering is a differentiator in the marketplace. Why you're different from the four other calls I'm going to have to listen to and make a decision on. So that's number one. Number two is there has to be some kind of clear delineation of value in that how much am I going to invest in this shiny object or this product or service, and how much value is going to be returned to me?

(11:03):
That has to be very clear. Several panelists yesterday went into just how expensive some of these platforms or offerings are. We spent millions and millions of dollars, as you can imagine, investing in several of these tools, programs and all. And if during the call I'm not clear as to, "Okay, I'm putting down $10 million for this service. How much am I going to get in return over time?" that's a problem. And I think that segues into really clear accountabilities around that. What are the metrics of success? I'm personally over service line agreements and performance guarantees that mean nothing. Many of the standard templates are very generic. They don't really speak to relevant metrics of success. So I'm usually that person in the room saying, "Okay, I don't quite agree with this. How is this really going to deliver on value?" And I think the vendor partner should really be clear on they're going to put down this. You're going to get this in return.

(12:00):
And beyond just the total cost of care. Because I think we on the dark side, aka insurance companies, people look at us as, "You guys just pay claims. You don't want to spend all this money." But we really want to quantify cost outcomes in ways that we build a viable financial situation for the healthcare system, but also some non-financial metrics of success. What are the clinical benefits of this service or product, and how can we also talk through experience for the member? Because ultimately, that's who we're serving. We call them members. Providers call them patients. How does this make this a little more easy? I'm the first to say that the healthcare system is very complex, as we know it. One other point I will say is we want to be clear on just what are the challenges... And this is a trust component for me.

(12:51):
What are some of the challenges, limitations of the product or service? And a lot of vendor partners don't do that. They tell me all the great things about it. And I know it goes against just sales principles. You don't out yourself or say those things that you struggle with. But really, for me, that resonates in my books. It's scores a really high point in that I feel I can build trust with this partner. If the going goes south, I trust that they will alert me, they'll let me know, and we can collaboratively figure out a solution. So I will say really having a clear problem statement, accountabilities, clear delineation of value, and really speaking to how you assess success long term, those are huge.

John League (13:34):
Elliot, you come at this from the other side, obviously. You're a vendor. You mentioned to me in passing in our previous conversation that the hardest thing was actually not getting the data out of the system. What was it?

Elliott Green (13:46):
Yeah. I probably shouldn't say that because trust me, getting the data out of health systems is plenty hard. I think what's so interesting about healthcare in general... We can have a broader conversation, not for now... is the alignment of incentives has to be so strong to embolden people to achieve what you need. And so the classic way is you get C-suite buy-in and you hope it trickles down. I mean, in a wonderful world, everyone's got the KPI that lines up with exactly what you want to do, but that never happens. So that's the bit that we had to start with, was just that alignment of incentives. And then after that, one of the biggest problems is you have a gap, just be transparent, between the technical capability of the people that are buying the solution and the technical capability of the people that are selling it.

(14:32):
And that gap is getting ever, ever bigger. So the translation mechanism that you need between those two things becomes more complicated. And I think that's the challenge that we're on now, is how do we take phenomenal, super interesting, whether it's a foundation model, whether it's an LLM, whether it's a computer vision model and imaging, and translate that simply into terms that the purchaser, whether that's a payer or a provider, digital health company, can really understand in the context of their own work? And the reality is that most vendors aren't skilled at doing that translation. Now, we're not placed in that world. But because we're a platform that helps people build solutions, we find ourselves dragged into it.

Dr. Ayo Ajaiyeoba (15:15):
Many times we walk into vendor meetings thinking, "What is the problem I'm trying to solve?" And sometimes we're very myopic or short-sighted. I'm very wowed by vendors who come to me with insights I did not think about. Vendors who say, "Hey, you're thinking about this one little problem, but here are five other things that you should be thinking about." What is the science? What is your fact base? How are you thinking about the future? Because it tells me that I can have an evolving relationship with that vendor partner. And I think about times... We invested in this tool at Blue KC many years ago. It was bright and shiny at the time, but they've stayed stagnant over the last 10 years. Healthcare has changed quite a bit. So in my mind, we've challenged them in how do you keep up? How do you meet these evolving needs? And so when vendors don't come with that futuristic additional insight, I'm often disappointed. I'll say definitely thinking ahead, telling us things we don't know, I think really, really, really helps. That blows my mind.

Elliott Green (16:21):
I was in a session on cardiometabolic care earlier today, and I rather cheekily asked a self-serving question about data. And one of the reasons is I think what's so fascinating is we live in this world of GLP-1s and no one actually... Everyone said, "Well, I don't know what's happening or..." And it is happening. It's happening right now with all of your patients. The historic world, that autoimmune disease was expanded in terms of labels, was clinical trials. But that takes decades and billions of dollars. And we don't have that time because Novo ran a five-year trial and is slowly but surely giving you all the information on liver disease and Alzheimer's and all of these other conditions that GLP-1s can solve. So I would challenge the people in this room and more broadly of the data that you need to inform the decisions you have to make now is sitting in your system, if you're a provider.

(17:10):
Some of it's sitting in your system if you're a payer as well. This data should be coming out. You should be finding ways to take a resource that you already have. Because if you want to know whether or not a GLP-1 is affecting chronic kidney disease, the answer is in your imaging system and in your EMR. And the ability to extract that information lies in the new computational capabilities of AI. It is a lot simpler than it sounds to combine those two things, once you've built the pipes, to get the answer. And I feel like we have a duty to try and do that because there are millions. I mean, these things are likely to have 30 million people on them by 2030. There are millions of people in the US and more broadly that could benefit. So that, I think, is a really key element, to Ayo's point, of expanding what people think is possible.

Dr. Ayo Ajaiyeoba (18:06):
Elliot keeps making me think about more, so I'm going to keep sharing. I think the pricing model has to be very clear too. And I think I'm over vendor programs where there isn't skin in the game. I'm the one giving. If this works out, great. If it doesn't, I'm all at risk. You want to find vendor partners who have skin in the game, stating shared risk savings arrangements. And I have to give kudos to a vendor partner I have thoroughly enjoyed working with over the years who is in the room, Avalon Lab Solutions. I see Julie and Mike sitting there. They have been phenomenal partners. And they're thinking ahead of our problems. So when we meet, they're saying, "Hey, have you thought about these two or three other things that you will have to deal with down the line?" So thank you for being phenomenal partners.

John League (20:30):
In a world where the partners are coming to you with pitches that are not clear or not differentiated or not actually compelling in terms of the problem that you're facing. And from your side, when you see folks who have a clear boundary between their understanding of what is possible and what is to hand, my question to you two is how do we move forward? What is the step that bridges this gap? One of the things, I mean, you just pointed to is let's all get aligned on incentives. My perspec is that I find often when I talk to vendors, they feel that that's just another way for a client to say no. It's just another hurdle to jump over. Maybe fair, maybe not, but it is a real perception. So as we think about what are the ways that we can close the gap and actually make partnership valuable, to your point, patient value again, what do we need to be doing here?

Elliott Green (21:28):
It reminds me of a great Charlie Munger quote, by the way, which is, "Show me an incentive and I'll show you an outcome." It's pretty true. I would also challenge that anyone who says that that isn't actually accurate, they're being pushed back, it's just they're not solving the right problem at the right time for the right person. But anyway, the reality of what Dandelion is doing is putting ourselves, to what you were saying, John, as firm partners with health systems. And the reason we've done that is we believe that if we have that alignment, that long-term partnership... And we have three great partners thus far, as I was saying. Sharp in San Diego, Sanford in the Dakotas, and Texas Health in Dallas, and we're adding more systems soon. What we can do is actually work out how do you put it back into care? Because all of this doesn't mean anything unless that happens.

John League (22:21):
Right.

Elliott Green (22:21):
It's just nonsense pontification. The reality is that people ask me, "Well, wow, when do you think you'll define success?" And I'd say the first person that can actually benefit from a product that is implemented and get better care, that will be the beginning of success. Not did someone build an amazing foundation model that will sit on the side and no one can work out how to implement. So that's the point, is it's not just about, "Can I build the best shiny tool?" It's, "Can I build the best shiny tool that integrates into the workflow or integrates into the healthcare dynamic of those systems?"

(22:56):
Some of that will be generic. The majority of it'll be idiosyncratic. There's nothing we can do about that. People have lots of different tech stacks in the way they built it. But if you can show proof points... And that's what we are planning to do with our partner systems. Careful if I say this in the room, but I'm going to anyway. Hospital systems don't like being first, but they really don't like being last. And so you manage to prove it out, you're going to start getting some momentum.

Dr. Ayo Ajaiyeoba (23:26):
We in health insurance realize our limitation when it comes to care delivery. We look to our provider partners to deliver affordable, high quality care. But on the back end of that, I have to make sure that this is sustainable long term. I'm accountable to the health plan sponsor, the employer group, to make sure that I'm not slamming them with those year-over-year rate increases because we're not managing costs well. So really, I think if we can align incentives and really make sure that the things we're looking out for align... And I'm using this word a million times... with those things that I consider high priority from a strategic standpoint, I think we can lead really good conversations and partnerships.

John League (24:13):
You mentioned bringing that back into care, bringing the data back into care. And you were talking about relying on provider partners. We can talk about relationships with vendors and we can talk about building pipes and connecting data, connecting information. Eventually, all of this has to get to the point of care. And I stop as I say that because the next question in my head before I can think anything else is like, "That's really, really hard." The question I want to ask is what is the limitation? What is the hard part there? But I just want to let you guys talk about that for a minute.

Dr. Ayo Ajaiyeoba (24:48):
Being a physician myself and a lot of the roles or a lot of the things I've done at Blue KC have given me the opportunity to interact directly with our provider networks. And doctors, I think I have permission to say this, are hard to deal with. Getting buy-in on a bunch of things can be very challenging. I remember when we were building out our value-based programs with primary care way back when I joined Blue KC, almost 10 years ago. It took us one to two years to even get those physician champions to agree to the measures that we were presenting to them. Because at Blue KC, we have to put the needs of our members, your patients first. That really should drive all of our investments and decisions. But also, as a physician, I'm thinking how do I make the physician's life easier? So I've not been in practice for several years. I'm on the managed care side. I'm married to a physician in practice, so you can imagine how evening conversations go.

John League (25:45):
I can't, actually. I can't.

Dr. Ayo Ajaiyeoba (25:46):
She's like, "Why won't you all ever pay for X, Y, Z? You guys just pay this claims?" And I'm like, "We actually have to make sure this is manageable." And so really, I'm thinking through the lens of how do I make this physician... the physician who is on the front line of care delivery, how do I make their life easier? How do I think through their challenges, their inefficiencies, and really offering value to them so we might lead a win-win situation? I cannot tell you how many times I've walked away from vendor services or products just because I couldn't see that provider adoption. And to me, if I'm buying something that will impact the provider's workflow and they haven't bought into it or the vendor hasn't done their homework to show me how they hope to engage with providers, I have walked away from a ton of those opportunities. Because a day in the life of a provider is complex enough.

(26:44):
I really want to make that easier as I think about innovation. So please reach out. I tell people all the time, reach out to your health plan representatives because we really want to have those conversations. I prioritize those meetings with providers over several other meetings I have in my workday because if they're not doing the work they do, if they're not on the front lines of care delivery, I don't think I'll have a job. I don't think I'll be in managed care. So we really look to them as good partners. And we want to be trusted advisors to them. So I really think we can meet in the middle and really have good collaborative conversations and partnerships.

Elliott Green (27:26):
So I'm going to say a bunch of really contradictory things.

John League (27:30):
Okay.

Dr. Ayo Ajaiyeoba (27:31):
It's okay.

Elliott Green (27:34):
So I used to be at Oscar, and have some feeling of the insurance and provide a dynamic. And it was a wonderful learning experience for me. And on that, I agree with Ayo, it was very much like how do you make things easy? You would start with incredibly small touch points and you try and grow. It was the classic kind of kernel to a tree story. And I think that's still very valid. But actually, I think we've got to the point now where it's really hard to do because the problem is it's too multifactorial. So even if you prove something over here, you have a bunch of other things over here that counteract them. So value-based care is a perfect example, "I'm going to take your diabetes patients. Well, did you really manage all of those perfectly, or was it done over here? I'm going to take the PCPs and did you really," et cetera, et cetera.

(28:21):
And what you find is that the best arrangements, to some degree, take more responsibility. Whether that's full cap in the context of insurance and providers or in the context of AI and innovation, this was one of the things we looked at. We looked at lots of point solutions. And people say, "Well, point solutions are great, that we can implement, that we can get them into the radiology workflow, and we can diagnose accurately, let's say, emphysema from a chest CT. Fantastic." But it's not big enough. It's not going to make the C-suite say, "We got to pivot the system and this is what we're going to do." Because people aren't yet at the point where they're taking the value from a single example and saying, "We could also do this for biopsies. We could also do this for cardiac conditions using ECGs."

(29:10):
There's not that level of education. So you have to show it. And so this is the contradictory bit where it's, well, I'd love to do the small project. But actually, that's why we just spent three, four years building pipes. Because I actually think that the best way to do this is to show the big impact, because that's where we're at now.

John League (29:31):
Solomon Banjo, our vice president for life science and health tech innovation at Advisory Board is casting a long shadow here over this presentation. Because what you said made me think of something that Solomon has talked a lot about in terms of value. And it's the tension between value at the population level and value at the individual patient level. I've never thought about this. And this is how this is a good panel because I had a thought I've never had before. But this is the impact of innovation at that macro level versus at that individual level. How do we do this big project? How do we achieve a scale that will then have an impact at the individual level?

Elliott Green (30:09):
Right. It's completely contradictory to what we have done before. But I think on something as big as AI, for example, I think to prove out its value, you have to go big. I'm also talking my own book, so you have to be very careful. But we've watched the point solutions over the last few years, and we've watched them not gain traction. And the simple fact is that there are lots of little things you could do. Like one of the CMOs on one of our systems emailed me and said, "I'd really love to know which GLP-1 my patients should be on. It's Epitide versus semaglutide. How does it work on different genders, different age groups?"

(30:51):
And of course the information's there, but it's not really accessible. So by ripping out all of that data, by trying to access it... And there are other examples of similar things that people will do. What we then start to do is show all of these proof points, quickly. And at that point, the people who really make the decisions in healthcare think, "Well, one second. We actually really could affect value-based care. We really could bend the cost curve. We really could." And now I see the investment that we need to do to get there. But I think you need to make that impact at such a high level that it starts to get people's attention.

John League (31:28):
I'm very interested to hear your take on this. Because from your seat, you have a much more longitudinal view than I think a lot of folks potentially do in healthcare, which is still, despite our best efforts, so very episodic.

Dr. Ayo Ajaiyeoba (31:41):
I think we're going to walk away with a few buzzwords from this podcast. The first being alignment. We want to align incentives. But value prop is one of my favorite expressions in life in general. And I think in any kind of interaction, there has to be some kind of value proposition. And I think it's really on the receiver or the perceived target audience to perceive what value is at that point in time. So we have to look through different lenses. And to providers... Again, this is my personal struggle. Sometimes the doctor is just thinking, "What do I need to give my patients so they're well?" I'm thinking that script is going to cost us $300,000 a year. And that is a school district client who doesn't make that. They don't get as much money. At one time, I was presenting to a school district client. And throughout the presentation, I could see that the superintendent was a little uneasy.

(32:35):
He just wasn't engaged. I'm trying to ask him questions. I wasn't getting the right engagement. And towards the end I'm like, "Do you have questions? Do you have comments?" And he told me. He said, Ayo. Dr. A, if you keep giving me this rate increases, I'm going to have to start cutting down on teaching staff." And in that moment, I had to pause and say, "Okay, I got to do better in healthcare." If I have the opportunity to make decisions that impact the long-term sustainability of healthcare, I think it's a very near and dear responsibility or expectation for me.

John League (33:12):
Elliot.

Elliott Green (33:13):
As I was just listening to Ayo, I had that, "What's the essence of all of this?" I think we've all had very high-level conversations about how to do this. The reason AI is so exciting is I think it will go a long way to solve a very fundamental issue, which is taking aside patient benefit, which everyone in this room and many beyond this all take as the thing they most want. What's the thing that's going to enable it? And it's understanding where the value accretion lies. And that's the only way that this is ultimately going to be solved. So one of the things, one of the great benefits about artificial intelligence is that ability to accrete value very precisely.

(33:56):
I'll give you an example. We're running an algorithm at the moment on chest CTs and emphysema. And what it's doing is it's looking at whether or not a diagnosis was initially correct, and then it's using the algorithm to predict what it would see. And it compares it to what happened in real life. So somewhat of a A/B test, let's call it. What you'll understand from running that A/B test and using this particular model is you'll understand the value accretion of the model. How many people did it find that had emphysema that weren't diagnosed? How many people did it find that did indeed get diagnosed with emphysema, but it found it six months earlier in a chest CT? Soon we might be able to do it in an ECG. We may be able to do it in an MRI. Whoever knows? The whole point is it changes. But now, what you're starting to do is you're starting to also understand, "Well, who does that benefit?"

(34:47):
Does it benefit fee-for-service arrangement? Does it benefit a value-based care arrangement? Okay, so where's the value accretion? Is it the provider or is it the payer? Because this is where everyone is scared. But now at this point, you start to... Once you understand that, you understand who you are from a vendor point of view, you actually understand who your customer is. So you can go to the appropriate person. You can say, "I have a solution for your problem. I have a solution for your problem. And I have the numbers to back it up." That's the only way, at that level of detail, that this stuff is going to start getting implemented.

Dr. Ayo Ajaiyeoba (35:21):
So Elliot, I'm going to ask you a question, and I don't think I'm allowed to-

John League (35:25):
Go for it.

Dr. Ayo Ajaiyeoba (35:25):
... but I'm going to.

John League (35:27):
Go for it. I've been waiting 40 minutes for this.

Dr. Ayo Ajaiyeoba (35:29):
Do you believe in the concept of win-win outcomes? Because I think this is very controversial. All of us in healthcare, I think we're all trying to serve our patients, our members ultimately. If somehow the end consumer benefits from whatever the innovation is, do you think we can find correlations with how all the other players may benefit?

Elliott Green (35:51):
So I live in my little reality distortion field where I indeed do believe in win-win outcomes. I don't think they present themselves very often. I think when they're there, you need to grab them and run with them. I personally feel incredibly fortunate to be in a position where I have that kind of holy trinity, as it were, of the different actors. Whereas one of my team members said, "AI and value-based care go together like peanut butter and jelly." We will find out, but it is definitely, since I've been in healthcare, the greatest opportunity we have had to really bend the cost curve. Not just to do fancy things and be able to do... But to really be able to bend the cost curve, because the level of detail that we can get into, and like I said, that value accretion has not been present previously.

Dr. Ayo Ajaiyeoba (36:43):
Good answer.

John League (36:46):
Outstanding. Well, that I think is where I will leave it for today. Dr. A, Elliot, thank you so much for your time. Thank you all for being with us today. One of the things that stands out to me about that conversation was the emphasis on alignment as a key to making innovation a reality. Both in terms of aligning incentives, but also making sure that everybody can understand what problem are we trying to solve? What is the actual value proposition of the work we're going to do together and the solutions that we're offering each other? That really stood out to me from the conversation, and I think is something that is within the power of all of us to actually make a difference. Remember, as always, we're here to help.

Abby Burns (37:42):
For the next two weeks, we're going to be encoring two of our most listened to episodes from the past year. Then we'll come back in August with an update on an episode from earlier this year before returning to regularly scheduled programming in the run-up to Advisory Board's September Strategy Summit, Pivots for a Sustainable Future. Radio Advisory is a production of Advisory Board. This episode was produced by John League, with support from me, Abby Burns, as well as Kristin Myers, Atticus Raasch, and Chloe Bakst. The episode was edited by Katy Anderson, with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Carson Sisk, Leanne Elston, Erin Collins, and Solomon Banjo. We'll see you next week.