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5 Things I Learned from the MidAmerica Healthcare Venture Forum 2015 (for Fitting into the Marketplace)

Steve Carbonara
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5 Things I Learned from the MidAmerica Healthcare Venture Forum 2015 (for Fitting into the Marketplace)

Continuing the lessons (you can find them here and here) I learned from the MidAmerica Healthcare Venture Forum (MHVF), in this post I will be focusing on fitting into the marketplace. How do you affect the organization that you are calling on? Let’s assume hospitals – what is your talk track with the CEO, the CFO, the COO, the CNO, the CIO, etc.? Do you understand how you modify the workflow of the user or users, and in what way does your product/service affect the relationship the hospital has with the patient?

  1. Everything you say and do must be audience-appropriate. Why would you present heavy financial information to a CNO? Save that for the CFO.  Confusion is your worst nightmare; make your points concise, clear, and appropriate, or you will lose the attention and interest of the person before you have the chance to win his or her business.
  2. Make sure that you’re presenting documentation to your contacts that allows them to educate the rest of their team. If people are asking for more information, then you haven’t done enough yet.  They won’t move forward until you do more work. Your early pilot accounts don’t mind helping you figure it out. Just don’t make them figure it out on their own.
  3. One of the biggest issues with startups is in trying to save the world from itself. The end result is that the patient’s relationship to the hospital is changed. You cannot win in a world where you modify the patient relationship to the hospital; make sure that this is heavily discussed in your strategic-planning process.
  4. If you’re going to change the relationship between hospital and patient, make sure that it’s creating more value and longer-term trust. This may be easy to see with educational products but not so easy in supply-chain products. Many times the benefit is there, and it is ignored. It’s not the job of the buyer to figure out your value propositions, so always look at the patient side for time and cost saving, improved quality or safety, and higher satisfaction.
  5. Tie yourself to workflow; make sure that your product/service assists the hospital in not only creating value (revenue) or savings, but also in time saving through potentially shifting workload and alleviating pain. This is a great article on that topic. The author focuses on services to CIOs that can be packaged in a manner that understands the restraints on a CIO’s time and alleviates workload.

In the end, the above five topics are a baseline to how you not only need to think through building your company and your product, but also how to fund your company. If you aren’t presenting the information clearly, then an investor, just like a buyer, will not understand the long-term value of your product/service and will thus not fund you.

Thanks again to MHVF for all of this great information. It will be interesting to see how the market shakes out while moving to a value-based model these next five years. I look forward to being a part of the process with you all. Good luck with your endeavors. I appreciate your time here today. As always, take care and have a great day.

4 Takeaways from the MidAmerica Healthcare Venture Forum 2015 (for Innovators and Entrepreneurs)

Steve Carbonara
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4 Takeaways from the MidAmerica Healthcare Venture Forum 2015 (for Innovators and Entrepreneurs)

What a great two-day conference in Chicago – the MidAmerica Healthcare Venture Forum (MHVF) hosted by MedCity News and Mid-America Healthcare Investors Network.  The combination of angel investors, venture capitalists, healthcare information technology specialists, and biotech and medical-device organizations was truly inspiring. One could sit and hear all the different perspectives on each topic presented.  Some quick takeaway points for all of you innovators/entrepreneurs out there:

  1.  Stop building products and stop talking about solutions. A common theme was to identify the problem and understand how healthcare workflows are set up today to ensure that you bake these existing constraints into your business model and planning. Having the best product that can’t fit within a delivery system or having the solution to a problem no one asked for won’t lead to long-term success.
  2.  Everyone’s getting into accelerators and incubators. How does that affect you and your new business? The short answer is that it all depends on the group you’re talking with and what your expectations are. Not one incubator will make your company – you need to do that. So make sure you walk into the relationship with the appropriate expectations about how they will help you plan, network, and learn about your business. If you don’t need those three functions, then don’t go that route. Thinking that they are a fundraising group is not accurate, so don’t expect that as your main reason for applying to one.
  3.  It’s scary that people helping to run healthcare nationally deem it as misaligned and confusing as we lay people do. Transparency is a huge concern for patients. Not knowing what is being done to us, how we’re being billed, and why insurance will or won’t cover something seem to be problems for every patient, even those who create policy! Innovators need to work on solutions that align the system, create transparency, and give credibility back to the system. Companies coming to market are trying to alleviate some of these issues, while hospitals and insurers only care about ROI over the next 12 months. This misalignment leads to progress being slow and confusion reigning.
  4. Shifting from fee-for-service to fee-for-value is still a long way off. The business models aren’t defined yet, and the players aren’t able to move forward yet, so how does an innovator create around an ecosystem that has no definition? In one word, carefully. We need to build companies today that can create value in the fee-for-service model, but then can help shift the market to fee-for-value. This is not easy, which is why there are so many failures. The driving force behind each of our companies must be to bridge the gap during this time of unbelievable turmoil in the market. Once the gaps are filled, we can focus on building value based on solutions, but that day is not here yet and may take five to 10 years to reach. I remember launching EMRs 16 years ago; we thought we would revolutionize the market and be paperless in five to 10 years – we’re only 60 percent of the way there and it’s been 16 years! Change takes time.

I appreciate the time of Chris Seper and others who hosted the conference this past week. Thanks for those of you reading today, and let me know if I can help with any questions you may have on leveraging the lessons learned for your business.  As always, take care and have a great day.

The No Wait Emergency Room

Paul Rosen
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The No Wait Emergency Room

The other day, I was asked, “What is your definition of a no wait ER?” I did not mean to be sarcastic, but I think my answer sounded that way: “It is when you go to the ER in a hospital and you don’t have to wait.”  Let me explain. A no wait ER means that when you go to the ER, there is no waiting in the waiting room. You get taken straight back to a treatment area. After that, you do not wait for care (i.e. urgent care). The care team enters the room with you. Instead of telling your medical history multiple times: first to the nurse, then to the resident, and then to the senior physician, the whole care team enters at once and you tell your story just one time. Now, you may have to wait for test results (EKG, blood work, X-rays), but waiting is minimized because those tests are performed in a coordinated fashion and the results are delivered as soon as they are ready. You are informed in advance of the duration of tests and when you will receive results. If you need to be admitted to the hospital, you are transferred to your hospital room in less than half an hour. If you are discharged home, it takes a few minutes, rather than 45 minutes. Is this a fantasy?  Is this even possible?

A no wait ER is possible. You just need 2 ingredients: belief and commitment. You need a belief that it can be done. You need commitment to make it happen. The belief stems from the examples from around the country and around the world where eliminating unnecessary delays is a focus. The commitment comes from knowing that making patients wait in an ER is not good medicine and can be dangerous.

Eugene Litvak, an industrial engineer from the Institute of Healthcare Optimization and Harvard University, has written and spoken extensively about flow in hospitals. Dr.Litvak points to the differences in natural variability (i.e. most ED patients across the country arrive between 4 PM and 12 midnight) and artificial variability (i.e. surgeons do more surgeries on Mondays than on Fridays). Litvak argues that diminishing the impact of the artificial variability will allow a smoother patient flow in the ER and throughout the hospital.

The ER is a great place to examine bottlenecks as ER flow is typically an outcome of patient flow in the rest of the hospital. If your discharge process from the inpatient ward is inefficient, it can be felt in the ER. If the hospital is full, the ER gets backed up with patients waiting for admission. If elective surgeries are scheduled unevenly, then the intensive care units and wards get filled unevenly. Some organizations decide building more rooms is the answer. However, Litvak and others have proven redesigning processes is the key to minimizing peaks and valleys in patient volume and flow in hospitals.

The Emergency Nurses Association recommends the following solutions:

  1. Immediate bedding
  2. Bedside registration
  3. Advanced triage protocols
  4. Physician/practitioner at triage
  5. Kiosk check-in
  6. Patient tracking systems
  7. Robust hospital surge capacity plans
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