Megan Zweig (00:00):
That thread you can pull through across med device, across payers, providers, and also pharma, in that, they want a relationship that is more continuous, longitudinal because if you can own that patient relationship, you're also going to own the data, the ongoing engagement, and ultimately, the next intervention, which is something that is really valuable to these companies.

Abby Burns (00:25):
From Advisory Board, we are bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. I'm Abby Burns. A few weeks ago, we released an episode on Radio Advisory all about digital health funding featuring president and CEO of Rock Health Advisory, Megan Zweig. It's a conversation that Megan and I originally had on stage at Advisory Board's Research Summit in Carlsbad, California. If you haven't listened to that conversation yet, I highly recommend going back and giving it a listen. Megan breaks down what's happening with digital health funding, where money is coming from, where it's flowing into, and how health systems should think about engaging in digital innovation looking forward. We covered a lot of ground clearly, but we didn't cover everything. In fact, there were some questions that came in via Q&A from the audience that Megan didn't get a chance to answer live in the moment, but that we think are a really important part of the broader conversation about AI, digital health, and the future of the healthcare landscape.

(01:22):
So today, Megan has generously agreed to come back and answer a short list of questions from listeners. I'll read the questions off as they came in. Although by now you can also probably guess I won't be able to hold myself back from asking Megan a few follow-up questions myself. Without further ado, Megan Zweig, welcome back to Radio Advisory.

Megan Zweig (01:42):
Thanks. So good to be here again.

Abby Burns (01:44):
Slightly different environment from last time. Hopefully, a little bit more comfortable, no bright lights shining down on either of us.

Megan Zweig (01:52):
Totally. I loved being at the conference though. It was really fun.

Abby Burns (01:56):
Megan, today, we are rounding out essentially our conversation from California. And I say rounding out, but really this is a topic that we could continue to talk about ad nauseum. So instead, we are going to scope the conversation a little bit, specifically during our live conversation, there were some questions from the audience that we didn't get a chance to get to live, so I want to bring those to you today.

Megan Zweig (02:19):
Perfect. That sounds great. Happy to answer whatever follow-up comes our way.

Abby Burns (02:24):
Awesome. The first question that we're going to get to is in this intersection between direct-to-consumer solutions and health system strategy. I will say, personally, Megan, one of the things that you said during our conversation that has been sticking with me was, yes, we need to have a conversation about are these tools safe? Are they really connecting patients with the resources and the care that they need? But I'll quote you, these front doors are open and people are going through them. It'll really be incumbent on provider and plan leaders to think about, where do I start plugging into these digital ecosystems that are attracting patients and where there's a tremendous amount of engagement? With that, understandably, here's the question we got. How should incumbents think about their role in engaging with wearables and other consumer-generated data?

Megan Zweig (03:13):
Yeah, it's a great question. And I really do think that what we're seeing in the wearable space is one of the clearest paths that we have to, more proactive preventative care, which has always been a north star, but is something that I think we collectively as a system have struggled to deliver. So to contextualize the space a little bit and remind folks from the Rock Health data, we see that over half of people own a wearable today. Of wearable owners, almost 60% have said that they have talked about their wearable data with a provider. And it's good that we're having the conversation right now because the American Medical Association you may have seen just came out with their own survey data of clinicians and they found that 86% of US physicians have, at some point, reviewed their patient's wearable data. So you have appetite, right?

(04:07):
You have consumers who are using these tools and you have physicians, who are engaging with that data and trying to make sense of it and make it contextualized and clinically relevant for the conversations that they're having with patients. But I think what was really interesting from that AMA survey was those same physicians who are talking about wearable data said that in only 6% of cases is that data integrated into the EHR, integrated into their clinical workflow, right?

Abby Burns (04:38):
In other words, it's data that is coming in and influencing the care experience, but it's coming in a really analog and maybe in the least user-friendly way.

Megan Zweig (04:46):
Yeah. It's probably like somebody coming in with their smartphone, opening their ŌURA app and showing their clinician or showing them some readout from the Apple Watch. It's a conversation. It's constructive, I'm sure, but it's not being captured and structured and acted upon in a more systematic way. And when you think about the challenges on the health system side, it's not just workflow integration, it's also reimbursement. It's also, is this data clinically validated? Once you've decided to ingest a bunch of patient generated data, there is some real liability that health systems have to take on in figuring out how do you ingest this patient generated data? How do you understand it? How do you act on it?

Abby Burns (05:31):
Yeah. Megan, can you talk through a couple different maybe avenues that you see health systems going down or flavors of what this looks like in practice?

Megan Zweig (05:39):
Yeah. I think one is some providers are really building right now and building their own version of wearable ecosystems. I think the way that we've thought about that more traditionally is remote patient monitoring, its chronic condition management. Sutter Health's Sutter Sync is a great example of that, where they have built out the infrastructure, they've built out the continuous monitoring capabilities. They're deploying Sutter Sync for at-risk populations to ultimately help manage chronic conditions at home. In that instance, and I know there are other systems doing that work as well, where you're able to focus on a particular population, where clinically and financially the outcomes make sense for that proactive continuous management. I think, second, there is some broader infrastructure work that is happening to get the data more integrated into the EHR.

Abby Burns (06:35):
Megan, when you say the data, my interpretation is we're looking outside of health system's own data.

Megan Zweig (06:40):
Exactly. An example that comes to mind is Xealth. They were acquired by Samsung. Xealth will actually bring patient-generated data from wearables directly into a health system's EHR and clinical workflows. And so, they are working with health system leaders to figure out which data points are actually meaningful, which ones are actionable, because of course, you don't want to have every data point that a wearable is capturing being put into the EHR.

Abby Burns (07:13):
And Megan, this sounds like an evolution for Xealth as a company.

Megan Zweig (07:18):
Yeah, that's definitely correct. They really made a name for themselves in helping health systems to integrate digital health programs into the EHR, so that it was almost easier to "prescribe" certain digital health programs or solutions. And so, when they were purchased by Samsung, it became clear Samsung, obviously being in the hardware and wearable space, that some of the expectation would be that Xealth would integrate that wearable data, so that you're not just using the clinical data already in the health record, but also patient-generated data. It's early. This acquisition I think went through last year and they're having conversations with health systems about which wearable data is going to be the most clinically relevant, the most actionable so that not only can the clinician make better decisions about the go forward for that patient, but it also makes the Xealth platform more powerful, because it gives them more inputs to guide the clinician to which of the digital health supports that the health system has invested in might be relevant for any particular patient that they're seeing.

Abby Burns (08:31):
So Megan, you've given us examples of health systems that are actively building here. You talked about others that are building out the infrastructure to be able to use wearables data. Any other flavors of what this looks like that we should be tracking?

Megan Zweig (08:43):
Yeah. I think it's also important for us to track and understand what wearable companies are building out themselves and how they are moving into care delivery. And this is something that we talked about in our last conversation, but WHOOP and ŌURA recently announced telemedicine offerings being integrated into their platforms. And so, they're not waiting to be integrated with the health systems. They are building care relationships directly with their users.

(09:12):
What was interesting was earlier this year, WHOOP raised a very large Series G funding. I think it was $575 million, and the Mayo Clinic was one of the strategic investors, who put capital into that round. And so to me, that was a telling signal that some health systems are recognizing that new care delivery models are really being stood up around these wearable platforms and they're wanting to be at the table, be investors rather than just ultimately being downstream of that.

(09:44):
Because I think as an incumbent, as a health system, you've always been in competition for the patient relationship. And now, wearable manufacturers are in a lot of ways also competing for that. If we assume, which I do, that the future is going to offer patients a more continuous, data-rich, proactive experience, health systems need to figure out how they offer that themselves in a Sutter Sync type context, how they are building the connective infrastructure to get that data into the hands of clinicians, not just because their patient brought them their ŌURA app, but because it's intentional and integrated into the EHR, and how they're not just on the sidelines watching these innovators, but they're actually partnering with them, investing in them. I think that's what's going to help incumbents be relevant, be competitive in this next chapter of wearable-driven care, which is really cool.

Abby Burns (12:02):
Megan, a lot of our first conversation focused pretty squarely on providers and health systems in particular, thinking about their strategy and the ways that they engage, should engage in the digital health innovation landscape. In the next question, I want to bring in another perspective. Here's the listener question. I work at a fairly well-penetrated medical device vendor. How important are strategic investors and/or partners in today's venture markets? The way I interpreted this question, Megan, I'm curious if you interpret it differently, again, we talk a lot about payers and providers, how important are the other parts of the incumbent ecosystem in this wave of AI innovation?

Megan Zweig (12:42):
I'll answer the question directly and quickly first, but then want to broaden it to talk a little bit more about how we're seeing med tech, med device, pharma play in this digital health innovation space. Yes, strategic investment continues to be critically important for startups raising venture capital. Strategic investors often will offer clinical validation. They offer partnership in product development, like what is actually usable and valuable. They can offer distribution channels, et cetera. Oftentimes, that investor on the cap table does give a startup a lot of credibility if it's a meaningful strategic partner. We've talked a lot about the provider space, but every healthcare incumbent right now, including med device, including pharma, are really thinking about, how do we leverage innovation AI to do what we do better, but also how does it open up new transformative opportunities? I can chat through what we're seeing on the med device side and then on the pharma side.

Abby Burns (13:49):
Yeah, and maybe let's start on the med device side.

Megan Zweig (13:52):
On med device, there continues to be a lot of momentum when it comes to AI-powered clinical decision support. They are still trying to equip providers with tools that are going to help with diagnosis, that are going to help with care pathway planning with ongoing disease management, and there's a lot more of a regulatory paradigm. The FDA is clearing AI algorithms as standalone software products, not just embedded in hardware, which does open up new opportunities for med device companies to play in.

Abby Burns (14:27):
So essentially, playing the same role that they have played for a long time, but almost supercharged.

Megan Zweig (14:32):
Yes. Supercharged, because now, we have a lot more data. So using both real world data, patient-generated data, along with clinical data to surface who are the patients that need to do diagnosis or are misdiagnosed, and then getting them onto the appropriate care pathway, which may or may not include an implant or a device that is relevant to the med device company that is helping to build not just the devices and the hardware, but starting to get into software infrastructure, which is a big change for these med device companies, and some are building themselves, but a lot of them are looking for digital health partners, who have that DNA of building, deploying, updating software. That's pretty interesting. I think the other interesting piece when it comes to med device is the intersection that it's having with consumer health. Think of continuous glucose monitors, where traditionally, that's a clinical device, but CGMs are increasingly going over the counter, and they're really repositioning themselves for wellness audiences.

Abby Burns (15:39):
You can buy them at CVS.

Megan Zweig (15:41):
Exactly. You have medical device manufacturers, like Dexcom and Abbott, who are marketing to consumers. Like you said, you can get it at CVS. If you want to better understand your metabolism, you don't need a prescription. Those big manufacturers are partnering with digital health companies to build out the consumer experience on the device. At Rock Health, we publish a quarterly insights report. We actually just dropped our H1 report. One thing that we highlight there is that a company called Signos, they just raised $20 million and they partner with Dexcom. So Dexcom offers the CGM and then Signos offering this FDA cleared patient app to help make sense of the data and help with things, like insights for weight management. And so, that's pretty interesting. There's this interesting crossover that's happening between incumbents and devices with the consumer space and wellness. And not to mention, we talked about how the Mayo Clinic participated as a strategic investor in WHOOP's latest funding round and Abbott, the medical device company also participated in that round as well, so they're also kind of buying this investor front row view into the care models with wearables at the center.

Abby Burns (17:01):
There's almost a parallel between what we're talking about on the payer and provider side of leverage digital innovation, leverage AI enablement to do what you do more effectively and to enable you or to open up new avenues to engage with call them patients, call them members, call them consumers differently as well.

Megan Zweig (17:18):
Yeah. And I think that that thread you can pull through across med device, across payers, providers, and also pharma in that they're all trying to extend the relationship that they have with the patient beyond an episodic touchpoint. They want a relationship that is more continuous, longitudinal, because if you can own that patient relationship, you're also going to own the data associated. You're also going to own the ongoing engagement and ultimately, the next intervention, which is something that is really valuable to these companies.

Abby Burns (17:56):
Yeah. Own or orchestrate, depending on where and how you play. You mentioned pharma, let's go there next.

Megan Zweig (18:03):
On the pharma side, it's interesting because a lot has changed, but I think the overall mandate hasn't, where pharma companies are still very much interested in, how do we get patients accurately diagnosed at the right time? How do we get them on the right therapy? And how do we support them to stay on that appropriate therapy? But the channels for doing that and the orchestration, as you said, are changing a lot. Patients are increasingly using AI chatbots, for example, to understand and research their health and medications. They're going to telehealth platforms to access prescriptions and the GLP-1 kind of onset wave has really catalyzed pharma to build direct-to-patient infrastructure at a very rapid clip. Eli Lilly really started that race with LillyDirect. And so, they are not just orchestrating connecting patients with telehealth providers, but also insurance navigation, also home delivery for drugs, also just ongoing behavioral management.

(19:09):
And so now, most pharma companies are building their own direct-to-patient infrastructure or plan to do so. And again, this isn't channels for advertising. This is channels for orchestrating that care for the patient in a more longitudinal way that's far beyond just the prescription. That's, I think, to tie that back to what we were talking about, that's what it looks like when pharma is trying to get closer to the patient and more central in orchestrating what that care looks like in an ongoing way.

Abby Burns (19:43):
Megan, you used the word competition earlier when talking about the patient relationship, and just as we talk about each one of these players, it strikes me that rather than maybe clarifying role delineation, there's very much a world in which this greater tech enablement actually makes role delineation across these players more unclear or blurs the line between what parts of a patient pathway does pharma own versus does the health system own versus another player?

Megan Zweig (20:14):
Yeah, no, I think that's a really good point. How much of that does potentially create fragmentation in the patient experience? I think the impetus of these channels is accessibility and meeting consumers where they are. But at the same time, if you are going to a telemedicine provider offered by the wearable that you have for something related to your heart rate, if you're then going to a different direct-to-patient platform to see if you're a candidate for a GLP-1, there is still an onus on the patient to orchestrate, where they are going and for what. And so, I think it's really important that there are players like Be.Well, like HealthX, which I think I mentioned in our last conversation, who are trying to bring the additional contextual layer into these platforms of what is this patient's historical health data? What do we know about them, so that these decisions aren't just being made in isolation, but with a comprehensive and longitudinal view of the patient? Because I think access is amazing, but access that is incredibly fragmented just creates more burden for patients.

Abby Burns (21:39):
Our last question is actually one that I asked Megan live, but I thought her answer was an important part of the conversation that we weren't able to fit into the original episode, so I'm including it here. I'll pivot the last question. What is your favorite trend that you have been watching or are going to be watching for the rest of the year?

Megan Zweig (22:00):
Let's see. There's a lot. I think I am going to go with what are these ecosystems that are being built around wearables? I think some of you are probably smirking at that comment, because I think wearables have been put in such a class of wellness and fitness, but we see such greater clinical capability with these solutions. ŌURA just put out some data that people are on average wearing their ŌURA ring 23.5 hours a day, which is basically all of the time. And people who own wearables on average, according to our data, are wearing them five days a week. I'm just excited by the idea that we have always thought that care is too episodic in nature. It's not keeping us healthy. It's not proactive. And I know there are so many risks associated with how we all are trying to use AI, but it is always on, it is always personalized.

(22:56):
We are generating so much data for ourselves that if you can bring that together with the health record, with the analytical layer, my gosh, is that a key to behavior change that we have all been looking for for so incredibly long? And, find a little fun factoid from our data, when you look at who is adopting wearables and who is adopting telemedicine, it's probably who you would expect. It's affluent people who have the means to do so. When we look at who is using AI chatbots, that is not the case. It does tend to be younger folks, but when we look at health status, when we look at things like income, there's actually no difference in who's using it. And so, when I was kind of gasping at the statistics about the uninsured rates around the billions in uncompensated care, people know that they aren't able to access the healthcare system.

(23:45):
And if that gets worse, they're going to look to these alternative methods. And so, I'm actually very excited that I think a lot of these companies are building with the intention of offering healthcare experiences with the right context in a personalized way that hook into true care delivery when and if that is needed. And we just need to make sure that those journeys become really intentionally built out and safe for people. I'm excited and I hope that we all figure out the right role to play in that because I think that health systems need to figure out how they are partnering and plugging into that because you all are so incredibly needed in many ways that these tools are not going to be sufficient.

Abby Burns (24:29):
Well, Megan, thank you so much for coming back on Radio Advisory.

Megan Zweig (24:33):
Thank you so much, Abby. I love chatting with you and just really appreciate the thoughtful questions that we got.

Abby Burns (24:43):
Here's what's sticking with me from that follow-up conversation with Megan. Megan named a number of different ways that stakeholders are leveraging AI and digital enablement to play a bigger role in the patient journey. She posed a question that's probably pretty scary to providers in particular. Who is it in the next phase of care delivery that owns the patient relationship? Now, the actual answer to that question is probably not that it's one sector or even one provider in particular. Here's how I think about it. Each stakeholder is opening up new lanes on the highway to engage patients. Our collective challenge moving forward is not how to get patients exclusively into my lane or even into one lane in particular, but how to keep traffic moving forward towards shared goals. That's easier said than done. But remember, as always, we're here to help.

(25:56):
New episodes drop every Tuesday. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board. This episode was produced by Rae Woods, Chloe Bakst, Atticus Raasch, and me, Abby Burns. The episode was edited by Katy Anderson with technical support provided by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Dominique Del Gaudio. We'll see you next week.