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Jeff Lin
Host of Payment Matters
Payment Matters is a monthly radio show focusing on real issues happening in healthcare payments. Jeff chats with industry experts and thought leaders to bring fresh perspectives on how providers, payers and consumers are all tackling the evolving healthcare payments market. Join the conversation on Twitter with #PaymentMatters.

In this episode, Jeff speaks with Guillaume de Zwirek, CEO of Well Health, a communication platform that connects patients to healthcare organizations via text, phone, email and live-chat. They chat about the importance of coordinated communication in healthcare and how it affects patient engagement.

Jeff Lin: My guest for today’s episode is Guillaume de Zwirek, the CEO of Well Health, a communications platform that connects patients to healthcare organizations via text, phone, email and live chat. Thanks for joining me today. Please tell us about yourself and your background.

Guillaume de Zwirek: Thanks for having me, Jeff. I have a bit of a unique background, as you can tell by my name. I was actually born in Canada, so I’m French Canadian. I moved to the United States in the early nineties, ‘92, and I grew up in Silicon Valley when Silicon Valley was just becoming what it is now. My dad was an engineer at Sun Microsystems and my mom was a physician in the area. Many of the children that I grew up with had parents who ran some of the big companies that we all know of. That formed my thinking as I grew up, and ultimately influenced where I wound up, leading a healthcare company.

I actually started my career in the consumer space. I started at Google in late 2009 where I got to work on initiatives that touch billions of people around the world. That’s where I learned one of my first lessons, which was what success looks like. I always tell people that you were hired or fired at Google based on whether your product reached a billion people who actually used it in a daily fashion.

Fast forward to today. Healthcare is a tremendously important industry and I would say its technology is pretty nascent. To take a step back, I wound up in healthcare because of a personal experience as many of us do. I was running a marathon; I lost my vision; I wound up in the emergency room and they told me I had to see a cardiologist. I was managing my own healthcare and I became really frustrated by that experience. I love my doctors; I love the staff, the health system. I love the facility, but I could not stand all the behind-the-scenes coordination that I had to manage. That’s the genesis of me wanting to form Well Health.

Jeff Lin: It’s interesting that you talk about all the coordination that needs to occur in healthcare. There are many core components out there. From your perspective, who is the real customer in healthcare?

Guillaume de Zwirek: For me, it’s the patient. All that matters is outcomes, and delivering those outcomes in a way that we’re proud of. And when I say we, I mean vendors like InstaMed and Well Health, but also health systems all over the country. The thing that’s tricky about healthcare is that it is a much more complicated industry and you can’t really go direct to consumer the way you might be able to in traditional consumer tech, like working at a Google or a Facebook. You need to consider the needs of the provider. There are regulatory and operational challenges.

When I entered this industry, I was really naive to those challenges and to the considerations that it takes to build something that will actually be adopted by the staff who are driving great outcomes for patients. So, again, to me the answer is the patient, but there’s so much nuance in healthcare because of how complicated it is. I hated it when I walked into the industry and people would tell me that I didn’t understand. Four years later, I think I do understand. It’s a complicated, complicated dilemma we have in this industry.

Jeff Lin: I was at a talk recently where one of the panelists came from a consumer to direct industry. He was saying that joining healthcare was a five-stage process and he called the first stage “despair,” after he realized how difficult it was.

You mentioned that you learned a lot when you came from Google into healthcare. You were really naïve at the start, to think it was easy to solve. Can you share any highlights in terms of how difficult, or how different healthcare was versus those other consumer direct industries you have experience with?

Guillaume de Zwirek: We could probably spend a full hour talking about the nuances in healthcare. I can highlight a couple of the themes that we’ve learned over four years. Things like security. Before you come into healthcare, you really don’t understand the extent to which security is important. And, it really, really is. As a vendor, it’s very expensive to do, and it’s hard to understand. Regulation is a moving target. And above and beyond regulation, there’s also what you, as a company, think is the right thing to do. So, security with a big part of it.

When it comes to the sales process as a whole, healthcare organizations are tremendously complicated and hard to navigate. Sometimes it feels like there are walls between different parts of the organization and to sell a piece of software, you might have to engage 50 different people across the organization who have some sort of say.

In terms of the product itself, the workflow is also tremendously complicated. There are so many solutions in this space. You have an EMR; you have all the different touchpoints with the patient. You have the back office team, the front office team, the care coordinators, the case managers and the insurance companies. Then there’s the whole payment side.

It’s everything from the actual product design and the workflow considerations through to security and infrastructure. The actual sales process makes healthcare tremendously difficult. With direct to consumer, you can build something in two days, put it on the internet, put some ads behind it, put it on Reddit and hopefully have a thousand users a week later. In healthcare, that’s an impossible proposition.

Jeff Lin: We jumped ahead a little bit. I’d love to hear a little bit more about Well Health. You touched briefly on your business, but I would like to understand what solutions you offer and what business problems you solved with Well Health.

Guillaume de Zwirek: I mentioned that my mom was a physician. I was close to healthcare my whole life and I like to think that I had concierge care up until I turned 26 and was off of my parents’ insurance, because my mom was in my pocket and could answer all my questions. It took me being off their insurance in a new city and managing healthcare on my own to get the wakeup call of how healthcare is for the normal person. To see what the status quo is for healthcare.

Again, as I mentioned, our physicians are great. Our facilities tend to be fantastic. The people that choose to work in healthcare are generally genuinely good people who care about patients. They are servants, right? They are doing this because they believe it is so important for the world. Where I found my frustration is that in the process of hiring these great people, building these facilities, managing the regulatory components and all of these other things that we just talked about, the patient was kind of forgotten.

There had been so much innovation in technology, communications and managing processes that had not come to healthcare yet. I literally found myself in this situation and this is where it came to head for me. I booked an appointment with a cardiologist, a specialist, and they weren’t available for three months. And that was me pulling strings with my mother, who’s a physician. I went to see them and when I checked in, they asked me where my requisition was. I didn’t know what a requisition was. They explained to me that I had to get my primary care doctor to write a piece of paper that gave me permission to get this cardiology procedure done. I had to go back and book an appointment and the whole ordeal took over six months. I had no idea that’s how the process worked. When I asked why they didn’t tell me, their answer was that they had left me a voicemail.

I started noticing that throughout my care journey, there were so many of these experiences where it was, well, we told you, we sent you a letter. You were supposed to download that app. We gave you the pamphlet about your diabetes – you didn’t read that? It was clear to me that I had to manage my own care. I had to manage spreadsheets to keep myself on top of my healthcare, and that made no sense to me. And to be honest, healthcare providers don’t like it, either. Health systems don’t like the patient having to navigate this world on their own. They would love for there to be a better way, and that was the inspiration for Well.

I was looking at all of these solutions, all of the experiences you get when you go see a physician. Starting with scheduling and registration, eligibility, transportation maybe. That education material. The prescription that you have to fill. The telemedicine visit. The billing – what InstaMed does after the visit. And having to manage every single one of those on your own. I thought to myself how it would be so much better if I could talk to all of these systems in one place. It would be so great if I could text Stanford and say, hey, I haven’t received my bill yet – I’m doing my year-end taxes and I’m curious what I owe. Wouldn’t it be amazing if somebody from the billing team responded to you within a couple of minutes?

To me – again, this is my naivete – I thought that this really isn’t that hard. This has been done in other industries. This is just creating a common communications protocol that we could install at these organizations, and then work with the vendors to route their communications through. That was the inspiration, that’s what we now do. We’re four years old. We’ve built what we call a unified communications platform. Really, what it is, is a user interface. It’s used typically by administrative staff – think call center, patient service reps, front office, back office. A lot of the system is automated. Administrators can go in and define their patient journey. I want to send a patient a reminder. I want to send them some instructions before their surgery. I want to send them a Press Ganey satisfaction form after their visit, and I want to send them their bill as soon as it’s ready. I want to send all those communications in a seamless, streamlined matter.

I’d say we’re about 10% towards realizing the full vision, but we’ve worked with and partner with folks like InstaMed to deliver a far more integrated experience for patients and staff.

Jeff Lin: Clearly your company, and the story behind your company, addresses the workflow, security, payments – all those things that you’ve had poor experiences with.

We have been hearing discussion around whether if we build it and create these digital tools, will they come? Healthcare organizations of all sizes, from the largest health plans to the smallest providers, are rolling out digital tools. I’d love to hear your thoughts about adoption. Is there a magic bullet that can drive adoption of these digital tools? What are your thoughts and recipe for success?

Guillaume de Zwirek: Healthcare as an industry has been thinking in silos when it comes to their investments, instead of looking at the whole experience. There’s a debate around “best of breed” versus “jack of all trades.” I’m sure you’ve heard this in your conversations, both with health systems and with vendors. I believe that because of how much is on the line with healthcare, we owe it to ourselves to buy best of breed. If I can buy a system that can increase outcomes by X percent, and I’m buying best of breed, it’s worth making that investment. But the problem is that in the process of buying best of breed, which is what a lot of health systems have done, they have forgotten to look at the whole experience.

Let’s talk about a couple of companies that do this well, outside of healthcare. Amazon is a great example. You go back to the late nineties, early two thousands, when ecommerce is really coming into play. The internet was flooded with tens of thousands of merchants who were trying to sell their goods. It became a really daunting problem for folks like you and I who wanted to shop but didn’t have reliability. We didn’t know where to find people. We had to manage everything ourselves. Amazon took a step back and said, hey, let’s build an integrated experience. Let’s get all these merchants. Let’s get the best of breed. Let’s get all the merchants in one place and give consumers the reliability in terms of shipping. Let’s give them phenomenal customer service. Let’s make it a no-brainer to shop online. Let’s make it the easiest thing that anybody ever imagined. Amazon did a really good job of this when you think about ecommerce.

When you think about engagement and adoption and the holy grail, that is why we’re in business. When you look at things holistically, you realize that health systems need to regain control of the relationship. And the relationship is, quite simply, the communication between the health system and the patient.

We don’t do anything else. All we do is make it as easy as possible for the health system to get a message to the patient using whatever modality makes the most sense for the patient. We don’t care what the message is. Every health system is nuanced and has their own needs. They may use a leading billing tool like InstaMed and want to deliver billing messages to their patients that way. What we found is that when you think about this as a holistic experience and you unify communications, patients are far more likely to engage.

We did a test with the patient portal. The patient portal is used a lot for lab results and clinical conversations. We did a test with a health system where we sent the patient the exact same enrollment text message the patient portal was sending, and we processed that message through Well, a unified platform. Enrollment went up 19%.

The difference, when you think about it as a patient, is that now all the conversations are happening in one place. I hate to bring it back to our product, but for us, the solution to engagement, the holy grail, is thinking about the big picture and owning communications and investing in the platform, in the technology, to streamline communications across the board.

Jeff Lin: In thinking about communication barriers, and we see this over and over, it seems many issues are tied to the fact that a lot of communication is being done on paper. It’s being done by phone. With your experiences in the tech industry, especially with Google, you see how they’ve taken that into more of a digital engagement, tech type of platform.

In healthcare, where a lot of people have been there for a while, there’s an echo chamber. There is entrenchment in terms of how to do things. If you had a magic wand, what would you do to reduce the friction in healthcare so there’s more collaboration, better workflow, and so on? What would you like to see to reduce the complexity that you have personally?

Guillaume de Zwirek: There’s a bit of a cognitive dissonance between payers, health systems and vendors. It makes it challenging to navigate healthcare and to have what feels like a fully integrated experience.

I was at a payer summit a couple of weeks ago for one of the big payers and it was interesting to hear them talk about how they think about themselves. They’re also thinking about their members, which are patients as health systems. They’re thinking about their members as their responsibility. But when I think about myself as a consumer of healthcare, because I am, we all are consumers of healthcare, I see myself as buying services from a provider. For me, that’s my primary care provider. My PCP is my sherpa in my healthcare journey.

Sadly, I don’t have the answer here, but I always like thinking about the problems in the eyes of the customer, which I do think is the patient. The good news is, we’re all patients. So, it should be pretty easy for us to put ourselves in those shoes, and think about what we would want to see. Obviously, we would want it to be more integrated. The question is, how do you actually deploy that? That is the hard stuff.

You mentioned a really good point that triggered a memory for me. Which is, this thought of entrenchment. I really like the word complacency. Well, I don’t like it. I think it’s a bad thing. But I’ve recently been thinking a lot about complacency. One of the things I ask all my executives almost once a month is, what would you be doing if this was your first day at Well? Take a step back and forget everything. What would your first day look like? When you look at our business, what are we doing wrong? Where are we being complacent?

We had this experience last week where my CTO and I sat down together; we had a problem with a carrier that was filtering a minority of messages. A tiny, insignificant amount. When you’ve been in healthcare for a long time, you’re building out that complacency. And we asked ourselves those questions. We realized it isn’t acceptable for even one message not to go out. If I were coming straight from Google, I would be very concerned about this and I would be raising tons of red flags.

I would encourage other healthcare leaders, whether you’re at a vendor, at a health system or with a payer, to continually put yourself in the patient’s shoes and ask yourself, if I was new to healthcare, what would I change? What is really important?

Jeff Lin: That’s a tough question. I feel like you go to different parts of the country and people may want different things, right? But I hear you. If the center is that consumer, and their world probably centers around the provider. I call that interaction holy, between those two.

Guillaume De Zwirek: I don’t know if you see this, but it almost seems like there’s a fight brewing between the employers, the payers, the health systems and the vendors. Everybody wanting to own the patient and the relationship with the patient. It’s almost like the final episode of Game of Thrones. Everybody wants to own the patient. My philosophy is that really, it should be the PCP. We’re here to enable health systems to be invisible and deliver a more integrated experience.

As you look at the market, have you seen this as well? How these four different players in healthcare are coming to a head?

Jeff Lin: Absolutely. I equate that to how you go to any conference and there are probably a thousand consumer apps that label everything as a patient engagement opportunity. They say that with their app, I’ll be able to drive engagement.

So, that’s a concern here. I think there is a movement and everyone sees it. When I say everyone, I’m not just talking about the providers and the health systems, the employers, the health plans. Everyone sees how important and critical the consumer is. At the end of the day, that drives this healthcare economy.

In thinking about what you said before, at the dawn of ecommerce there were thousands of sites to buy stuff, and Amazon, eBay and those other companies started aggregating them together to unify the payment experience. Do you think that type of unification could occur in healthcare?

Guillaume de Zwirek: I do, and I think that’s going to happen on a couple of different levels. I think it’s going to happen on the customer experience side. I think it’ll happen on the payment side, which InstaMed fits really nicely into. I think it has to happen with the healthcare supply chain, starting with the payer and going all the way down to the provider and the employer somewhere there in between.

To me, the no brainers that are coming up right now, that healthcare can invest in right now, is the horizontal integration on the customer experience side which is communications and payments.

Jeff Lin: Right. It would be great for everything to be integrated end to end.

We’re starting to see large companies like Google, Amazon and especially with the announcement with J.P. Morgan Chase and Berkshire Hathaway all trying to get to healthcare. We’re hearing more and more about machine learning and AI being deployed in healthcare. What’s your sense of those tools being able to help, and any of the consumer experiences that are out there?

Guillaume de Zwirek: I’m really excited to see what these, call them employer joint ventures, do. I’m excited, because they’re new to healthcare, at least the drivers of these JVs are new to healthcare. They have tremendous leverage, because they can be more integrated, because they can own the payer side, and they can own the patient experience side, and they can own the delivery to those patients, as well.

Now, I do think this is threatening to a lot of people in the space. But if we’re in the space for the right reasons, which is just delivering better healthcare, there’s a lot of promise in what these technology companies could do for healthcare. I think they’re going to hit the same barriers that you and I have, which is all the nuances of healthcare, the security, the workflow, everything that we’ve learned in building companies.

When it comes to AI, machine learning, a new tack that we’re seeing pioneered by these next-stage, tech companies, I just don’t think when it comes to what we do and what you do, that this stuff is anywhere close to passing the Turing test. Companies that say they have bots and smart assistants, but most of them are really just glorified decision trees with yes/no workflows which is not true automation. It’s not true artificial intelligence.

As an industry, we have health systems with phenomenal people, and we should focus on leveraging the people that we have. We shouldn’t sacrifice patient experience or efficiency. We should focus first on improving the experience with the resources we have, and then work towards efficiency.

I do think that the investments should be made in the right order, and we shouldn’t be talking about cutting staff before we’ve fixed some of the current, very real challenges around patient experience.

Jeff Lin: If you were to diagnose the patient experience today within the healthcare ecosystem, if you were the doctor for that experience, what do you think are the three biggest ailments impacting the consumer experience?

Guillaume de Zwirek: Oh, I like this analogy. I never went to med school, so any physicians are going to have to forgive the way I frame this answer. I’ll speak to my personal experience. As a patient, I lack awareness. Awareness of the drivers that’ll help me be healthy. Awareness of the things that I need to do to have the best possible outcomes. I think awareness would be the first one.

The second is that the experience is very uncoordinated. We end up spending a lot of time repeating things with patients and guiding them through their care, and, frankly, losing sight of where they are in their care because the experience is uncoordinated.

The third thing I’d say is that it’s kind of a shame because there’s a huge industry here with a lot of money being spent and a lot of vulnerable people. If we can fix this, it’s going to be really, really good. It’s good for people, it’s going to be good for patients, it’s going to be good for business people and it’s going to be good for the world. I know that’s not a diagnosis, but that would be my potential remediation. If we fix those first two things, there’s a big opportunity to make a big difference. That’s what gets me excited and wakes me up every day. It’s that opportunity.

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