5 Things We Must Do To Improve the US Healthcare System: With Limor Weinstein & Kyruus CEO, Graham Gardner

I think we have done a terrible job as a society in understanding mental health and integrating treatment into clinical care. While we are making some progress toward destigmatizing various conditions, we have to view mood disorders like we do hypertension — they affect large swaths of the population to different degrees at different times in people’s lives. […]

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I think we have done a terrible job as a society in understanding mental health and integrating treatment into clinical care. While we are making some progress toward destigmatizing various conditions, we have to view mood disorders like we do hypertension — they affect large swaths of the population to different degrees at different times in people’s lives.

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Graham Gardner, CEO and Co-Founder of Kyruus. As CEO, Graham has led the development and commercialization of the company’s market-leading patient access platform that now serves over 225,000 providers across 500 hospitals. Prior to Kyruus, Graham was a Venture Executive at Highland Capital Partners where he co-founded Generation Health, a genetic benefit management company that facilitates optimal utilization of genetic testing, and served as the company’s Chief Medical Officer through its acquisition by CVS Caremark.

Graham completed his clinical training in internal medicine and cardiology at Beth Israel Deaconess Medical Center and Harvard Medical School, where he also served as Chief Medical Resident. Graham completed his BA and MD degrees at Brown University and earned an MBA from Harvard Business School.

He currently serves as a board member at Sigma Surgical, an advisor to the Innovation & Digital Health Accelerator at Boston Children’s Hospital, and as a member of the Digital Health Council of the Massachusetts eHealth Institute.

Thank you so much for doing this with us Graham! Can you tell us a story about what brought you to this specific career path?

I wanted to be a physician for as long as I can remember. At the same time, I grew up with the pharmaceutical industry around the dinner table, and learned from my father’s work at Merck that there were many ways to serve patients and make the world a better place. I always suspected that I was going to wander out of clinical practice at some point, but it wasn’t until I had the opportunity to witness my father launch a start-up company late in his career that I realized the incredible opportunity that exists at the intersection of healthcare and entrepreneurship. I discovered that I was someone who enjoyed thinking about brand new ideas and decided to leave clinical practice so that I could have an impact in a different way.

I was fortunate to have mentors in business school and during my first years in venture capital that helped me begin to understand how to build and fund companies. I went on to co-found and serve as the Chief Medical Officer for Generation Health, a genetic benefit-management company that helped patients and providers understand how to best incorporate genetic testing into their care. After we sold Generation Health to CVS Caremark and I had hired my own replacement, I left to start Kyruus in order to help bring a data-driven approach to care coordination.

Kyruus is the embodiment of the world view with which I was raised — a belief that we are all different, all beautiful in our way, and we all have our relative strengths and weaknesses. I became fascinated by how Billy Beane and the Oakland Athletics used statistics about baseball players to understand their relative competencies and use the information to leverage players’ strengths by putting them up to bat in situations where they were more likely to do better. Having previously practiced with many different kinds of physicians, I was convinced that we could similarly use information about providers to inform how to best match them to patients they were uniquely suited to treat. “Moneyball for Doctors” became the inspiration for Kyruus.

Can you share the most interesting story that happened to you since you began leading your company?

So much of entrepreneurship is luck — you try to be in the right place so that when the right time comes along, you are fortunate enough to get a chance to do something meaningful. One of our big breaks came during a presentation to what would become our first enterprise customer. Up until that point, we had done three small pilots, getting valuable feedback on the product UI and potential use cases but failing to garner the widespread organizational attention that would be necessary to precipitate a full-scale deployment at a health system. There is a saying in healthcare that you can die by a thousand pilots, so we were eager to get someone who would partner with us at scale.

During our pitch, the key executive asked us to go off-script by searching for a condition that we usually didn’t demonstrate. I still remember the name of the physician who came up because the executive immediately shouted “That’s right — she is the best in the world. Ok, we are buying this. And if we’re going to do it, we aren’t doing a pilot, we are going all in.” That institution became our first full roll-out and the results we generated there helped to convince several other organizations that our solution could help deliver the impact they were also seeking.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

I’ve made so many mistakes along the way that it’s hard to remember them all. The most embarrassing ones were the same mistakes I made twice! The funniest one I remember was during our early days. iPads had just launched and we were thinking of deploying our software on these devices. I stood up in several prospect demonstrations to explain how we envisioned searching for the right provider on the iPad and then calling them directly from there — not realizing that they weren’t actually phones… I tell the story now to our team to drive home the point that if the CEO can barely turn on a computer, then it’s ok for people not to know everything and to seek out help when they need it. It helps foster a culture of learning that I think drives collaboration and bonding.

What do you think makes your company stand out? Can you share a story?

Without question it is our people. When you are creating an entirely new industry vertical, you are by definition, selling a vision for how to solve an important problem. Early adopters recognize this and accept that the product and/or delivery may have hiccups and may need to evolve. However, they have to trust that you will have the ability and the grit to iterate and problem-solve.

Because no one had ever developed a solution like ours before, we very explicitly hired people from different industries (inside and outside of healthcare) and created a culture that facilitated learning and cross-collaboration so that we could develop some of the first experts in patient-provider matching software. Similarly, we recruited people who put patient and customer first — empowering them to advocate for the customer and work tirelessly to deliver on their expectations.

What I recognize now is that we will always be evolving our product as the market demands new capabilities. Fortunately, we have developed a team of thought leaders across clinical operations, product development, and customer management that can truly guide health systems on how to optimize their care coordination platform.

What advice would you give to other healthcare leaders to help their team to thrive?

I wouldn’t pretend to know how to manage anyone’s team better than them. Every team is different. The approach we have taken is to embrace that heterogeneity and create an environment that attracts and supports diversity. I believe each member of our team has their own unique gifts. The key to helping people maximize their impact and professional satisfaction is understanding those strengths and cultivating them — putting people in a position to contribute and grow by aligning their unique talents with the company’s needs.

What I began to appreciate over time was the role that I had to play in repeatedly articulating our vision, mission statement, and core values as part of that process. We ask our team members to care (about our customers our product standards, and each other), to own (their work and performance), to respect (each other and our individual differences) and to empower (our customers through our product and each other through our leadership). These principles help a diverse team come together around a common set of principles that I hope helps each of them appreciate their role in our success.

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

I think the first important point to make is that our performance is not the same for everyone in this country. For many people with resources, the system might serve them quite well. At the same time, lack of access and education means that many of our vulnerable citizens can’t benefit from the incredible scientific advancements or even basic best-practices that we have developed. One of the things that I am most proud of at Kyruus, is that we help provide access to the right care at the right time. This is where it has to start.

The evolution of clinical practice has also handicapped our ability to engage and consult our peers. Medicine is a team sport and caring for a patient often requires experts from different specialties to consult together in order to determine the best treatment path. However, as healthcare networks have gotten larger and individual specialties more siloed, patients are often tasked with trying to coordinate their care by themselves.

A third challenge is the complexity of our technical scaffolding. I recently heard Eric Schmidt from Google characterize healthcare data as “incarcerated.” It is far too difficult for patients, providers, and even administrators to have access to the right data in order to make the right decisions because it is locked up in proprietary systems. One of the things we have been successful in accomplishing at Kyruus is providing interoperability of scheduling data so that patients can be matched to the right provider across clinical, demographic, insurance, and geographic necessity regardless of which systems originally held that information.

Kyruus Co-Founders Julie Yoo and Graham Gardner

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

The first change I would institute is around data standards. Data liquidity is essential for proper decision making in healthcare and standards would help provide interoperability between different systems. This would also help innovators better integrate new solutions on top of existing platforms.

Secondly (and somewhat selfishly), I would demand that data be used to inform patient-provider matching. By understanding both the patient’s needs as well as the characteristics of individual providers, we can steer patients to the “right” caregiver based on their unique condition. This would not only make care more convenient and accessible, but also better from a clinical perspective.

Third, I would simplify billing processes and procedures — both between provider and insurer as well as what the consumer sees. There is far too much overhead consumed dealing with claims rules and far too much confusion for patients about what they are responsible for paying.

Finally, and perhaps most delicate, I would love to see more honest, data-driven conversations about end-of-life care. I was fortunate to have practiced cardiology earlier in my career — a field where we can sometimes intervene and have an enormous impact in someone’s life. At the same time, we were often consulted very late in the care of someone with end-stage disease where no one had addressed the inevitability of their demise. I have never forgotten the words that a medical school dean once said to us: “Sometimes, don’t just do something…stand there.” I believe that part of our responsibility as physicians is to help people understand when just doing something is not always the right answer.

Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

Realizing these changes would obviously require modifications to policy, technology, and perhaps even societal norms. While these don’t occur overnight, I do think it starts with data-driven conversations. For example, we know that a surgeon’s volume and focus around certain cases translates into better clinical outcomes. To put it bluntly, providers who are not doing a sufficient volume of cases are statistically harming patients. And yet, we continue to refer patients to colleagues without knowing their volumes and/or clinical outcomes.

Once we realize that situations like this are irresponsible and must be addressed, technology can play an important role. Our mission at Kyruus is to help organizations understand the heterogeneity within their provider networks by having access to the necessary information. Once you can understand and measure differences, you can use that data to inform optimal pairings, helping ensure that patients see the right provider for their unique condition. Over time, I would hope that the evidence and technology are so clear, that policy can be set to institutionalize best practices like this.

As a mental health professional myself, I’m particularly interested in the interplay between the general healthcare system and the mental health system. Right now we have two parallel tracks mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

I think we have done a terrible job as a society in understanding mental health and integrating treatment into clinical care. While we are making some progress toward destigmatizing various conditions, we have to view mood disorders like we do hypertension — they affect large swaths of the population to different degrees at different times in people’s lives. The data also suggests that struggles with mental health can have a compounding effect on other health conditions, complicating adherence with therapy and even access to care. Again, the solution must be multifactorial through ongoing dialogue at the societal level, screening at the patient-provider level, and the introduction of technology where appropriate.

How would you define an “excellent healthcare provider”?

That is a great question! First and foremost, providers must be coaches and advocates for their patients. To me, that can only happen if a provider understands and internalizes the priorities of each individual patient. What one patient might want upon hearing a cancer diagnosis might be very different from another patient. Providers must be willing to listen and help translate options based on the needs of each patient. At the same time, they have to balance the inevitable information asymmetry that comes from years (if not decades) of medical knowledge and practice. I believe that it is not only ok but sometimes also responsible for providers to share their opinions of different options when they have built a trusting relationship with the patient and understand how best to advocate for their desires.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

I recently saw a quote — attributed to an African proverb — that really resonated with the journey that Kyruus has been on over the last couple of years: “If you want to go fast, go alone. If you want to go far, go together.”

While we had always set out to build a meaningful company that would one day transform how care is delivered, our early years were characterized by the prototypical search for product-market fit. Success at this stage often correlates with flexibility and iteration — testing products, business models, and overall strategies quickly. Often individual team members could move the company forward through heroic efforts and small teams were necessary for us to respond quickly to evolving opportunities.

After our initial success enabled us to begin scaling our platform and company, I realized that this behavior was actually disruptive to our ability to build sustainable processes and efficient operations though. Moving the company forward now required the careful orchestration of different functions and teams that depended upon one another to deliver a coordinated solution. We looked for leaders that could empower their teams to work together — stressing open communication and even introducing cultural things like our “moneyball” award that rewards cross-functional collaboration as opposed to individual accomplishments.

Are you working on any exciting new projects now? How do you think that will help people?

We’re at an exciting point in our evolution where we’re increasing our impact by broadening our engagement in the digital health ecosystem through partnerships with other best-of-breed companies. In 2018, we launched ProviderMatch for Salesforce in the Salesforce App Exchange and earlier this year, announced a partnership with Microsoft. Both partnerships are aimed at delivering win-wins for health systems and patients by integrating our provider search and scheduling solutions with top CRM solutions. The integrations enable a better call center experience for patients by facilitating personalized service and allowing patients to leave their call with a booked appointment in hand, which also drives demand conversion and efficiency for the health systems.

We’ve also partnered with companies like IBM and Binary Fountain to help health systems modernize the digital experience they offer to consumers — meeting consumer demand for the self-service they’ve grown accustomed to in other industries and empowering them to make more informed healthcare decisions.

Just as we need to empower our team members to work together, we recognized that we can’t have the impact we want to have if we just go it alone and try to do everything ourselves. By partnering with other organizations, we can focus on what we do best while collaborating with leaders in other areas to maximize our collective impact on patient experience and healthcare more broadly.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

I’m pretty selective about what I read. Part of that is managing the demands of life with two active boys and a spouse who works even harder than I do as Chief Medical Officer for a large software company. But part of it is also a degree of skepticism about applying every fad to my leadership philosophy. While the lessons I have learned and could expound upon might provide wonderful guidance for someone starting Kyruus eight years ago, it is not always clear to me that those same lessons are the right ones if you were starting Kyruus today. So much is contextual and I often encourage other entrepreneurs to go with their gut as much as they listen and incorporate advice from others.

That being said, I have read several books over the last few months from which I have drawn inspiration. Works like Grit by Angela Duckworth have helped me not only think about how we best raise our children, but also provide some degree of encouragement for the challenges that must be endured when building a company. When Breath Becomes Air by Paul Kalanithi was an important opportunity for me to remember the calling that medicine represents as we seek to empower both patients and providers through our work at Kyruus. While on vacation last month, I also read Bad Blood by John Carreyrou. I saw this as a powerful reminder that “fake it til you make it” can be a dangerous philosophy when caring for the lives of patients. In fact, an important part of scaling our company over the last year has been transparency about what we do and don’t do. You have to be confident that you deliver an important service without pretending to be something you aren’t.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

As parents, my wife and I talk a lot about what success and happiness means. We are both the children of immigrants — my parents are Scottish while my wife’s family is Indian by heritage. Both sets of parents worked hard to guide us through college, medical school, and business school, putting us in a position to give back to the world and also provide for our own families. They also embraced us for who we were — reminding us that, while we were far from perfect, we (and everyone else on this planet) were special and unique.

That philosophy has served as the foundation for my life. It means that we all have a different set of gifts that we can offer the world. Everyone has something to contribute. I ache when I watch people wrestle with feelings of inadequacy or stress about not being good at something. So if I could inspire a movement, it would be one that accepted everyone for who they are and positions them to play to their strengths — acknowledging the journey that they are on and respecting the decisions that they make along the way. A movement that gets the best from everyone because it recognizes that this only happens when we embrace people for who they are.

How can our readers follow you on social media?

Readers can follow Kyruus on LinkedIn and/or Twitter (@kyruus).

Thank you so much for these insights! This was so inspiring!

About the Author:

Originally from Israel, Limor Weinstein has been anorexic and bulimic, a “nanny spy” to the rich and famous and a Commander in the Israeli Army. Her personal recovery from an eating disorder led her to commit herself to a life of helping others, and along the way she picked up two Master’s Degrees in Psychology from Columbia University and City College as well as a Post-Graduate Certificate in Eating Disorder Treatment from the Institute for Contemporary Psychotherapy.

Upon settling in New York, Limor quickly became known as the “go to” person for families struggling with mental health issues, in part because her openness about her own mental health challenges paved the way for open exchanges. She understood the difficulties many have in finding the right treatment, as well as the stigma that remains so prevalent towards those who are struggling with mental health issues. She realized that most families are quietly struggling with a problem they’re not comfortable talking about, and that discomfort makes it much less likely that they will get the help they need for their loved ones. She discovered that being open and honest about her own mental health challenges took the fear out of the conversations. Her mission became to research and guide those families to the highest-quality treatment available. Helping others became part of her DNA, as has a commitment to supporting and assisting organizations that perform research and treatment in the mental health arena.

After years of helping families by helping connect them to the right treatment and wellness services, Limor realized that the only way to ensure that they are receiving appropriate, coordinated and evidence-based care would be to stay in control of the entire treatment process. That realization led her to create Bespoke Wellness Partners, which employs over 100 of the best clinicians and wellness providers in New York and provides confidential treatment and wellness services throughout the city. Bespoke has built its reputation on strong relationships, personalized, confidential service and a commitment to ensuring that all clients find the right treatment for their particular issues.

In addition to her role at Bespoke Wellness Partners, Limor is the Co-Chair of the Academy of Eating Disorders. She lives with her husband, three daughters and their dog Rex in Manhattan.

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