The healthcare industry has to treat patient-centricity as a north star, not a check box. That includes consumers having ready access to their health information. That includes communicating in ways that patients can understand and use. No one cares more about an individual’s health more than themselves and their families. I have encountered many doctors whose attitude is, “if patients just did what I say, they’d be healthier.” Well, if a doctor can’t build a relationship of trust with a patient, why would a patient follow the doctor’s advice? Remember, I am living proof that doctors can be wrong. My mother lived for 28 YEARS after doctors told her she had six months to live.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview David S. Williams III. David is a three-time digital health entrepreneur and thought leader in consumer healthcare communications. David’s latest venture, Care3, is transforming the interactions between patients, families and physicians by using mobile technology to move from episodic verbal exchanges of information in doctors’ offices to ongoing care conversations available anywhere and everywhere. David received his BS in Economics and Entrepreneurial Management from The Wharton School of the University of Pennsylvania and his MBA in Digital Strategy from UCLA Anderson. David is also a member of the 2013 Class of Henry Crown Fellows with The Aspen Institute and a member of the Aspen Global Leadership Network.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
Everything good in me came from my mother. She almost died having me; and when I was 11, she was told she had terminal liver cancer and only had six months to live. Rather than giving up, my mother wanted to live for her children, and she did. I grew up as a caregiver for her with her numerous health issues, thankful that she was even alive. She ended up living until just before my 39th birthday. Once I graduated from college, I started management consulting to the healthcare industry with Deloitte. The light went on in my head that the challenges we had faced with aligning her care among providers and getting support wasn’t isolated to just her. It was a systemic problem in the industry based on a paternalistic culture of “doctor knows best.” In order for this to change, the culture had to change. And the most effective change agent is data — the right information delivered at the right time to the right person who can make the right decisions. Healthcare, believe it or not, is mediocre in that process.
Can you share the most interesting story that happened to you since you began leading your company?
My son has severe autism. My wife and I used Care3 to track symptoms and vitals for three months. We learned that our son’s aggressiveness (biting, scratching, etc.) and head-banging seemed to be related to elevated heart rate. We shared this information with our doctor who prescribed medicine to try to regulate our son’s heart rate. The result was less aggressiveness and head-banging which saved family, teachers, and aides many bites, scrapes, scratches and our son from self-injurious behavior. We gave our doctor information to make effective treatment decisions. It is amazing. The overall problem, however, is that doctors can’t get this type of information from an electronic health record. They have to work with patients and families to make these types of breakthroughs.
Can you tell our readers a bit about why you are an authority in the healthcare field?
Care3 is my third digital health venture, the first became a digital health unicorn (PatientsLikeMe) and the second was a mobile app acquired into health insurer Aetna’s enterprise suite. Each venture has focused on how to get consumers (patients and families) to take more control over their health information so they, and their care providers, can make better health decisions. The industry, remember, is mediocre so we have to be strong for ourselves. I’m a published author in two peer-reviewed journals, Nature Biotechnologyand The Journal of Communication in Healthcare, my work has been cited in leading publications including The Wall Street Journal, Wired, Fast Company, Businessweekand others, and I’ve helped hundreds of thousands of patients live their best lives by making their personal health information actionable. More importantly, I was a caregiver for my mother prior to her passing and I have a child with severe autism. I live this every single day.
What makes your company stand out? Can you share a story?
Care3 focuses on using technology to make the people caring for patients better at what they do, and patients better at caring for themselves and loved ones. We’re not trying to replace people with machines or deploy chatbots to avoid human interactions. Care3 wants to make the existing human interactions better, more productive, more informative, so that people give and receive the highest level of care possible at every given time.
There are numerous success stories. There’s the story of the elderly woman with heart failure and COPD who lives at home and is part of a senior care program. Even though she went to the day center to receive medical care and recreational activities twice a week, her family still needed to make sure she could take care of herself to avoid going into a nursing home. Her family used Care3 to track the housekeeping and fluid intake to avoid falls and over-hydration. Over the course of three months, her falls reduced and she stayed out of the hospital.
Or there’s the story of an elderly Chinese woman in a senior care program who went to the adult day center three times a week and needed home-based therapy to complement the care in the center. The problem was that the doctor couldn’t make contact with the woman’s family, mostly for scheduling reasons. The elderly woman took a flyer home about Care3 (we offer Chinese as one of our languages) to connect with her doctor and the care team. The woman’s family began using Care3 to send messages and indicate completion with home-based care tasks and therapies. Care3 was the conduit for helping optimize the home environment for the patient and gave insight about care in the home that the doctor and other care team members were blind to and would eventually lead to problems.
Or there’s the story of the 70 year-old man with Parkinson’s and onset of dementia who had been hospitalized twice in the last two months because of falls. His 74 year-old brother was his caregiver and needed an app to manage the home care aide he had hired for his brother. He found Care3 and started a conversation with the aide to track the care tasks to be completed. His brother was reluctant to allow his aide to use a mobile app while taking care of him. After 60 days on the app, there were no more falls and the brother began using the app himself to connect with his brother and other family members about his care. Care3 helped bring the family together, improve the brother’s care, and help the home care worker track her work.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
Care3 is transforming the interactions between patients, families and physicians by using technology to move from episodic verbal exchanges of information in doctors’ offices to ongoing conversations about care delivered in the home and community. These new conversations use text messaging, media, and data to paint a digital picture of patient experience between visits. Because data are generated on an ongoing basis, the healthcare team can intervene immediately if a care plan is not being followed, thus avoiding costly emergency visits and hospitalizations. Care3 provides greater access to care providers, more complete care, and improved outcomes.
Care3 has demonstrated significant impact in number of interactions, clinical data points generated, and care plan adherence through the use of Conversations. In three separate case studies with hundreds of participants, Care3 resulted in the capture of more than 360 clinically relevant data points per patient per quarter and increased care plan adherence by 68% during the three-month period. When including text messages, photos, videos, and audio shared between family and providers, Care3 Conversations drove more than 450 quarterly interactions per patient and led directly to an average of two intra-quarter adjustments in care plans. This means patients received better care because of the information they shared on Care3.
Are you working on any exciting new projects now? How do you think that will help people?
Absolutely. We have two groundbreaking new initiatives underway.
For industry, we are currently working on a machine learning predictive algorithm that will alert doctors and other interdisciplinary care professionals when frail elderly patients need an intervention to avoid emergency visits and hospitalizations. These alerts will give community care providers information on how likely someone is to have an emergency episode given similar paths captured on Care3. Because Care3 data can’t be found in EHRs, the predictive algorithm will be based on longitudinal real-time data from real world experiences that have led to hospitalizations — not claims data, incomplete or irrelevant medical evidence, and/or the unstructured recollections captured in physician notes.
What are your “5 Things I Wish Someone Told Me Before I Started” and why.
1. “Sales cycles are going to be even longer than you think.” Why? Time is money and startups need cash to survive.
2. “Be wary of political agendas.” Your technology may prove other initiatives are failures rather than purported successes. Sidestepping the politics can mean a faster sale — not doing so can result in no sale even when your product would perfectly serve their needs.
3. “Take care of your mental and physical health.” Building a company is an emotional rollercoaster ride. It impacts you and everyone you love so you have to take care of yourself to maintain a healthy life.
4. “OK is not good enough.” There is a myth of getting a tech platform “out there” even before it’s ready for primetime just to begin the process of getting feedback. Getting a bad product out there can have lasting negative impacts that can be difficult, if not impossible, to dig out of.
5. “The rules are not the same for you.” As a person of color, everything will be more difficult in a startup — especially fund-raising. Regardless whether you have strong entrepreneurial background with multiple exits and a great educational pedigree, it will still be hard to raise money.
Let’s jump to the main focus of our interview. According to this studycited 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?
1. Healthcare access as measured by coverage is still very poor in the US as compared to other high-income nations. Until we embrace a system that provides basic coverage for everyone, overall outcomes will be poor. It doesn’t have to be a “single payer” system, but the new system would have to provide basic coverage for everyone to have outcomes more aligned with other wealthy nations.
2. Healthcare in the US is reserved for those who can afford it. Naturally then, people who can’t receive poor outcomes which drags statistics lower. The natural progression is, of course, that the population as a whole gets sicker, not healthier. With the spread of income inequality, we can expect aggregate health outcomes to worsen. When I hear politicians say that the US healthcare system is the best in the world, their goal is not for everyone to have access. In their eyes, the US healthcare system is working just how it’s supposed to — only for those who can afford it.
3. The healthcare industry has to treat patient-centricity as a north star, not a check box. That includes consumers having ready access to their health information. That includes communicating in ways that patients can understand and use. No one cares more about an individual’s health more than themselves and their families. I have encountered many doctors whose attitude is, “if patients just did what I say, they’d be healthier.” Well, if a doctor can’t build a relationship of trust with a patient, why would a patient follow the doctor’s advice? Remember, I am living proof that doctors can be wrong. My mother lived for 28 YEARS after doctors told her she had six months to live.
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.
1. There is zero price transparency throughout the industry, which undermines a true capitalistic healthcare model. The only result can be oligopoly under current market conditions. If pricing were truly transparent, consumers could shop for better care by price AND outcome as a ratio. Who wouldn’t do that?
2. The culture needs to change. The “doctor as hero” complex is a bug, not a feature. Physicians need to be more collaborative and use their powers for the good of patients and not their egos. The non-cynical response is that doctors need actionable information because that’s where they can be their best — analyzing issues and designing care plans to solve them.
3. Healthcare leaders must advocate for better interoperability between healthcare systems with government entities allocating funds, much like meaningful use did for EHRs. This has to be done at the community level rather than for healthcare facilities. 95% of care is delivered outside of healthcare facilities. Imagine how much data is lost on care and what that translates to in poor outcomes.
4. As I mentioned previously, care programs have to truly be consumer-centric.
5. STOP TRYING TO TAKE AWAY HEALTHCARE FROM PEOPLE. There’s a start. While that seems obvious, there are cascading impacts from the uncertainty introduced in the market when current laws are threatened. Companies refrain from making medium and long-term investments because of uncertainty. Venture capital and private equity investors reduce their investments or prematurely sell their stakes in companies because of fear that the underlying market assumptions will deteriorate their portfolio companies’ economic models and valuations. Uncertainty kills investment, innovation, and meaningful progress.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
· Policy — Basic insurance coverage for everyone. This is possible, feasible, and economically viable. The other wealthy nations in the ranking have proven it.
· Corporate — Investment in technology platforms that capture the patient experience outside of health facilities for rapid intervention, if needed, to avoid costly outcomes.
· Individuals have to take control of their own health information. This is NOT easy. It takes commitment of a community movement towards people having control of information that the healthcare industry doesn’t trust consumers to have.
o Children: There would have to be a concerted effort from an early age in health education courses to talk about health data. There is already infrastructure for delivery of this type of information to children. We simply need the curriculum.
o Adults: Adults should treat meetings with doctors like they approach meetings at work. At work, there is an expectation that the presenter will have a verbal discussion, media (like a slide show or video) for context, and data to validate their points. But in the most important meetings we have, those with our doctors concerning our health or that of our loved ones, we only have a verbal exchange of information. What if adults came to doctor visits prepared to talk through their problems, have media for context, and data on their experience? Doctors would immediately be able to give us better care. This change can happen.
· The model of health can change from sick care to healthy care if policy leaders start rewarding individuals for making good health decisions. For example, some self-insured employers offer incentives for healthy lifestyles and exercise. Why can’t that be done at the government scale?
· Governing boards have to hold the industry accountable for errors. Hidden in health data are clear incidents of medical malpractice especially as medical errors are the third highest cause of death in the US. Doctors should be leading the way in this charge rather than shying away from it.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
· Kaiser Health News website. They always give data on how the industry is performing for everyone, including those most vulnerable.
· Kaiser Health News Podcast, “What The Health.” This podcast makes it easy for non-healthcare experts to understand policy decision impacts on peoples’ lives without being too “wonky”. As a leader, I have to always keep patients and families in mind and this podcast is a constant reminder not to get caught up in the industry jargon.
· Vox, Sarah Kliff’s series on Emergency Room bills: This is a MUST READ for everyone to understand how ER bills are created, why they’re so (arbitrarily) high, and how you can resolve them without going bankrupt or paying exorbitant legal bills.
· Good To Great by Jim Collins. While not a healthcare book, this book taught me one very valuable lesson: keep doing the right things and eventually the market catches up and you will be rewarded. I don’t follow fads or gimmicks in my businesses. I focus on what will help people live their best lives and in all of my endeavors, staying on course and focused on the mission has yielded success — for me and for those I’m trying to help.
How can our readers follow you on social media?
Twitter: @DSWIII, @care3app
LinkedIn: linkedin.com/in/davidswilliamsiii, linkedin.com/in/care3app
Thank you so much for these insights! This was so inspiring!