Digital Transformation: Increasing Value Across Products, Services, and Operations | LSI USA '23

Transcription

Kelly Williams  0:05  

I'd like to introduce you to our moderator Vaughn Schouten. Vaughn is a global lead med tech advisory and Innovation at Salesforce. He's a driven sales leader known for passion, energy growth, development, continuous improvement and results within the medtech world. So he's going to come up and introduce your lovely panel.

Vaughn Schouten  0:32  

We're excited to be here. What a fun week. I want to thank LSI for the opportunity. I think this will be a fun, interesting panel. So let me introduce them my name, I'll let them to go into more detail with their organizations and as much background as they want to give. But here to my left to start, we have Peter Stebbins, he's the executive chair of Nurami Medical and has 30 plus years experience prior to that with Johnson and Johnson and several other ventures. Next, we have Dr. Aklog and he's the executive chairman of PAVmed and heart surgeon. And last but certainly not least, we have Mrigasha Patel, who's worked in the cardiovascular space for several years and then found herself into the medtech investment banking. She's the vice president for med tech for HSBC Securities. So with that, why don't we go down the row Peter, and I'll let you introduce yourself a little bit more.

Peter Stebbins  1:30  

So as he said, I'm Peter Stebbins, I spent a good amount of time at Johnson and Johnson across the surgery business, and then also on the ortho and neuro side commercial and an L&A. So I had a pretty decent exposure across a lot of these issues. I think one of the things I thought about in a while, back in the day in 2000, I was in Europe and, that was kind of the internet thing we're like, had to come up with like, like, what's the strategy actually, you know, use the internet. And it was, we'll talk about later but it was a big decision to actually do that, because we weren't lined up to do it very well. And I can think even when even to today, some of the some of the questions and challenges that we overcame and that had through are still applying just in a much higher bit rate in terms of the use of looking forward to the session.

Lishan Aklog  2:16  

Great, thank you. It's great to be here. I'm Lishan Aklog has won mentioned, I'm a former heart surgeon and now I run medtech enterprise and PAVmed Inc. I think it's the first panel where I've been the second tallest person on the panel. So this is a it's a memorable as a memorable day. But I'm looking forward to this. There's a lot of you know, I've been I mentioned that my talk earlier today. This is my fourth LSI emerging med tech summit. And it's just remarkable how each year the whole area of digital digital health digital transformation, what that even means defining it, how it touches on on numerous aspects of, of what we do is, is an area of real interest for me and looking forward to very robust conversation about

Mrigasha Patel  2:57  

Mrigasha Patel coming up on 12 plus years in med tech only, very much like Peter started my career at J&J can't seem to get away from it, for some reason, have worked on a lot of different areas, but mostly in the cardiovascular space. And after business school, I found myself med tech investment banking, worked on some very notable transactions that you guys have probably seen in the press releases with some of those, you know, few strategics that are left. But kind of looking forward to this digital transformation era we're living in. I still don't know what that means, but we'll find out.

Vaughn Schouten  3:35  

Fantastic. Well, we're excited to be here. So the actual title of this panel is digital transformation. So if anyone in the audience can define that, shoot us a text or an email and let us know exactly what it is now, but that's what we're going to talk about today. Increasing value across products, services and operations. So as I've participated in sessions in different panels throughout the week, I wrote down a few key topics that I think we'll discuss today. I've heard more than my fair share about data, digital transformation, remote care, wearables hospital at home, patient monitoring, personalized care, AI, VR, AR, how do you make sense of all this? So what now what are we going to do with it all. So just having more data is probably not the right direction. So I'm going to fire a few statistics and then I'm gonna let the experts to my left take over and share their expertise with you. So I want to start backwards as far as the title of the presentation from an operation standpoint. So I spent the last 20 years in the medtech space. I started in pharmaceutical, then I went to big fortune 100 device. And then I landed at a biotech company which had one pharmaceutical and two devices. So I've lived through some of this over the last 20 years. So there's a staggering statistic out there that in this age of data should be pretty simplistic to solve. So $25 billion in medtech sales will be lost this year through revenue, revenue leakage. So there's a 25 billion with a B, just simply in revenue leakage. So in this age of data, every single person in this room, whether you're a startup, whether you're a banker, whether you're the biggest med tech company in the world has more than enough data. Why is there $25 billion in revenue leakage, leakage? And how do we solve that? So I'll let you guys take it from here.

Peter Stebbins  5:48  

Yeah, so I can think of, you know, sales leakage. And one of the opportunities is just to have better, you know, better CRM better better information for the organization for reps for marketing, to be able to analyze, you know, what's going on in those territories and not have, you know, competitive loss that you don't know of, because it's just beyond, you're just beyond where your your rep is, and what your knowledge is, as a organization. And I think that, that is kind of at the pointy end right out at the surgeon level. And then it can go through the organization, that type of information and other tools, make sure that people all the way through the r&d chain, the supply chain, have the right information. And it's structured in such a way that it's useful, again, to the point about not too much data, you actually want to have operational information coming through, you know, help you with those issues.

Lishan Aklog  6:44  

I think, you know, that you said we have we have all this data, but at the end of the day, it's not quantitative, its qualitative, what is what type of data and how useful it is? And how do we have the appropriate mechanisms to utilize it in a useful fashion, I think you're honing in on the kind of the operational sales side, I can give you a concrete example that with one of our subsidiaries Lucid Diagnostics, which is a lab where we have a laboratory, we have reps in the field who are calling on primary care physicians, they're ordering tests, there's the results of the test. And we're just getting started understanding exactly how to get, you know, even PHI information properly processed through standard compliance mechanisms, so that our reps in the field can engage with their physicians and give them feedback on your order this test came back positive, how did it you know, how did you respond to that and all that. And it is just not it's an it's a non trivial exercise? Because it relates to the flow of data, how do you know who goes through their compliance issues as it relates to PHI, and so it's, it's not just simply the quantity, it's utilizing it in the appropriate ways. And Salesforce is very helpful for us.

Vaughn Schouten  7:46  

Oh, thank you for the shout out.

Mrigasha Patel  7:48  

I beg to differ. I think from my perspective, so you know, I've, I think there's just so much data, as you mentioned, right? But we always forget that the healthcare has a very human aspect to it. And we're kind of fault. We're watching history sort of repeat itself. Right now, in front of our eyes, we're talking about taking healthcare back home, into the home, right, we're talking about house calls, again, in 2023. And that's because, you know, we've tried to customize every patient, every sort of provider, every sort of hospitals data, and now we're here, we're sitting here with all this data. So the big question is, you know, how do we kind of work our way backwards and make this data actionable? And it doesn't have to be customized, right? It can be sort of very basic, starting at workflow efficiency, hospital infrastructure, and things like that. So that's sort of my two cents on that.

Lishan Aklog  8:47  

Can I say something about that? Because you touched on one aspect of it, which is that we have so much data now it's, we can actually have personalized data, right? So we actually can No, not talking to certain populations, where we can talk about individual patients and how and what we know about them or categorize them in certain ways. There's all sorts of privacy and and other factors that come into play. But to me, that's one of the exciting things about about this focus on on just generally more data is that we can actually provide more personalized, personalized care a CME Group, then

Mrigasha Patel  9:17  

I can, you know, from a finance standpoint, I'll use one transaction as a as an example. Right? So when Boston Scientific acquired Preventus, so the valuation on that transaction was really hinged on the smart data, the Holter monitors were collecting the way they saw this from a strategic standpoint, they were like, we want to, we want to build capabilities. Right. And so, to your point, I think there's a place for that, and it's at sort of the industry level, right? Not at the hospital level. So let's sort of look at that as you know, let the Medtronic, Boston Scientific, J&J sort of take that work on right become the smart data Warehouse's while physicians and patients can sort of continue to go through the continuum of care.

Vaughn Schouten  10:08  

Fantastic. So Peter, fire away

Peter Stebbins  10:10  

Yeah, just to add on both of those comments, someone's relative to like, putting a really gonna follow money. So even like whether with a Boston example, the key is okay, are they going to get revenue from from from having that data? Who is going to, you know, fund that how it's going to be paid for is it just, you know, stepping up the level of care in hospitals that are already losing, you know, billions of dollars. So how do you it's information can be useful, but unless someone is actually going to get paid for it, it can very easily get squeezed out of the system. And that's where I think it's very important to really look at each of these spaces, you know, that everything from the operational side, certainly to the customer, facing sides to say like, how is this really going to play out over time, who's going to make money in the future, who's not going to make money in the future and therefore becomes, you know, everyone who wants to be, you know, great for the patient. But if some other stakeholder group is going to be, you know, losing that revenue, or something set in place for them, it's like, whoa, hold on, let me attack this thing over here. Because I was counting on that, regardless of how good it is for patients. So

Lishan Aklog  11:22  

I think what you're touching on is an area that maybe this is not exactly where we're heading with this just reminded me, there's an opportunity to talk about this, which is, I'm on the board of AdvaMed, which is a great honor and privilege, because I get to see a little bit of what's going on behind the scenes and some of how some of the sausage is made. And what I think one of the things that you're hinting at is that the infrastructure always lags as it relates to regulatory compliance, payment, you know, all of those elements, FDA has actually been remarkably more forward thinking than you might then you might assume in terms of other they're behind, but they're, but at least they know that there's that they have to get more on top of how to regulate data and digital digital health side of things, the payment side is going to be much more complicated. So as an industry as opposed to individual companies, there is a prerogative that's necessary there. But I will point that there are some aspects that are already there as the in terms of opportunities, where the financial centers are actually aligned with the collection of data and the specific area that I'm assuming I'm referring to as remote patient monitoring where there are, in fact, very robust codes. There, they're crystal clear exactly what a patient needs to do in terms of the transmission of data, what the criteria are at 16 days a month of have at least one parameter that's from an FDA approved technology. And the the and what the physician has to do in terms of the time spent to, to review that information. And there is reimbursement just one clear clarification is separate from telehealth. And it's not part of COVID. There's more attention to it, but it precedes COVID. And that, and so it's not subject to everything is subject to, to the Congressional whims and so forth. But it's not subject to some kind of a sunsetting. Period.

Peter Stebbins  13:02  

So it's actually I saw your presentation before. And so if I understand, right, it's $45, for 20 minutes,

Lishan Aklog  13:09  

that's for additional 20 minutes, and then there's further out further opportunities

Peter Stebbins  13:13  

to I do but it was your math, right, that means that that physician, if it's, it's whatever for that, like, you know, 180 bucks per hour for them. And for the follow ons, it's $25. So it's,

Lishan Aklog  13:23  

Yeah, it doesn't have to be the physician. So it can be it can be, it could be a physician extender. And really, if you're doing it right, what it all boils down to, it's about $200 a month per patient, which, you know, on the industry side, that's a nice margin that accompanies that facade for it. But facility system is really key. There are other elements to it as well, that their value based their value based projects out there that that in addition to that, you know, the RPM codes provide additional financial incentives for the collection of data. If it results in, if you can validate that it results in improved care.

Vaughn Schouten  14:01  

So to tie a loop on this particular topic, kind of commercial operations and data, I'll share one kind of use case from our seat. And I'm just a year into Salesforce. Like I said, I've been in in medtech for 20 years. And I think the VP of Business Development for this organization is in the room. So I won't mention the company by name. But I have several friends that are general managers of business units. And it's interesting because you talked about data, you talked about the amount of data, but then trying to access that data and make a strategic business decision. With that is harder said than done. So I engaged a couple of general managers and it was as simplistic as your service team that's out servicing these million dollar pieces of equipment. Do they know what your commercial sales team is doing? And if they don't, why don't we migrate? that data together so the service team knows what the sales team is doing. And vice versa. So question for our investment banker, if I said, Give me $2 million, right, someone from on the stage said they needed $2 million to finish up one of their clinical trials yesterday. So if I said, Give me $2 million, and I give you $40 million back in 12 months, would you do that deal? 

Mrigasha Patel  15:26  

No 

Vaughn Schouten  15:27  

You would not?

Mrigasha Patel  15:29  

Because where's that $40 million coming from? Right? The one of the one of the things we see in diligence, so often is a lot of hoax, see numbers thrown out, and no one can roll up to that $40 million. Clearly in healthcare IT, we see, you know, recurring revenue, we see this, we see that and, but there's no clear line of sight to those $40 million. And unless I have that clear line of sight, there's no way, you know, even a growth equity partner is gonna put $2 million into it or a seed person, right. So to answer your question, you know, the monetization opportunity and data is so big, if there's a clear line of sight into who's paying for it to Peter's point, but it's not there today, right. And on the industry side, you know, if I were a Boston or Medtronic or a J&J, I'm sort of quietly building these data warehouses just to make my devices, my therapeutic devices smart, because that's where the monetization opportunity still continues to be in healthcare. And then again, you know, I won't even touch on the hospital infrastructure opportunity, because that's, you know, that's where you're seeing the consolidation efforts on the PE side today, right? Like, you hear us watch the news, Blackstone, Premier, all these guys are just buying up hospitals left and right. That's not to, you know, that's not for in, like, inpatient transformation. It's for infrastructure transformation. You know, when Doc, I'll let Dr. Aklog talk, but I'm sure you know, workflow is not efficient, even now, right? When you practice lots of inefficiencies, you're running from wing A to wing B to like, you know, look, find a patient. I mean, things are just so outdated from that standpoint, that we have so much more opportunity to kind of use that data to monetize certain aspects of the systemic, 

Lishan Aklog  17:29  

You're entirely right. I think this the idea, the word data, monetization is something that certainly within within the med tech industry, there's a broader, you know, healthcare, it side of things that weren't even greater is a word we should probably maybe throw out, because it just has too much of, you know, there's gold in the Hills sort of feel to it, I registered to say, hey, we're collecting data, and you know, we're gonna make a ton of money doing it. And it's just like you said, there's not a clear path as to where that value is, there's an enormous amount of value in wrangling, the use of data with regard to making healthcare facilities work more efficiently and for practitioners to do so, the collection of physiologic data or patient symptom reporting is great, and it's going to transform, I believe it's going to transform how we deliver care. But there's, you know, to be in a situation where now we can provide at home, effectively sending the physicians the equivalent of if the patient was in the ICU, you know, minute by minute heart rates and respiratory rates and oxygen saturations and all this data now, with wearables that we can provide on on a second by second basis? Who's going to interpret that? Where's that? How is that going to impact on care and so forth? And, and at the end of the day, if it doesn't have that, like, like Peter said, if it doesn't have a clear value, connection to real value, it there's nothing to monetize. So, you know, it's probably worth and I'm guilty of that. I think I had a slide that was entitled by my presentation, but as your as we're talking about it, you know, we should we need to do it in a stepwise fashion and be much more concrete about what is the data and how is it going to add value?

Vaughn Schouten  19:07  

So let me reframe my question. If I did a risk share deal with you. And I said, Give me $2 million. And if we deliver these KPIs, and we guarantee you $40 million back and I provided a plan to you, would you do that deal?

Mrigasha Patel  19:22  

So, you know, providing a plan again, if so, people talk about forecasts all day, right? I don't even know what's going to happen five minutes from now. So the plan has to be sort of realistic, it has to be conservative, it has to be, again, going back to it. Where are the dollars rolling up from right and now the risk sharing thing, it's a great word, but what risk, you know, are we talking about here, right? It's, that's very subjective. And then on the other side, you know, risk sharing is I call it a punch word, right? Someone's losing in this in this deal. So going back to it, I can't stress enough unless there's a clear line of sight that rolls up to whatever revenue forecast you have, right? And kind of walks through the business plan with the investors like, you know, this is where I plan on targeting. This is where, you know, my accounts are going to be, this is where you know, my customers are going to be, and this is sort of the demographics of my xy&z customer, it really becomes just a number and even risk sharing won't make any difference. At that point.

Vaughn Schouten  20:40  

You're You're really good, tough crowd. So I'm going to answer my own question. I'm just kidding. I'm not, I'm just going to share the use case. So the point I was trying to get across was the amount of data and simply a risk sharing totally agree with all the comments, right, someone's losing. The risk share portion would be okay, medtech company, startup or big company, let's determine collectively what KPIs that you want to measure, define everything have a crystal clear plan. So they simply did a $2 million data integration project on one of our cloud platforms. Therefore, their commercial sales team, their service team was able to go out equipment was end of life, right? They were able to upsell, they were able to cross sell, they were able to mitigate some of that $25 billion of revenue leakage that was occurring. And it also resulted in where the 40 million came from was service contracts and new capital sales. So risk share would be we define the KPIs together. If we don't meet those, your two, we give you your $2 million dollar investment back if we do meet those, you know, well, yeah, in one fiscal year, in 12 months, it generated $40 million in new revenue for that organization. So but I'm coming to you to evaluate deals, because you're telling me

Peter Stebbins  22:04  

That's actually an error we talked about before about the before the panel, when we say transformation, that's a major thing, right, then there's also just this notion of digital improvements and things go, I think if you look at things over a 10 year period, there's going to be a lot of small changes that get to like, Oh, my goodness, it's transformed since then. Whereas there are some projects and some initiatives you have to take on. And I'm not sure the details that particular one, but I could just imagine, you can improve that that operational system and in lots of ways and improving user with a system as a people, but then the other is a notion of Okay, now we're really doing things very differently, which becomes a cultural shift. And you have to change how you do SOPs and and all these different things where it really it's more than just a, I don't know, a better iPhone, but it was, it's the notion of now we all need to figure out how we're going to do this. And it needs to be cultural, and you need to really have that, that that buy in and go through the effort to get there and ensure you don't have a situation where you have fatigue on that digital transformation or any type of transformation. So I think that's a on the operational side, it's important to kind of recognize that you're making changes. But if you do something big, really understand you can't just throw money at it from the guy from the IT department without everybody buying in,

Lishan Aklog  23:33  

are we talking about two different things, maybe maybe just to, to throw out there that there is I think, maybe on both of my sides, I think what you're you're you're talking about a lot is about that, you know, a, you know, a company, you know, using data internally to improve their commercial operations and so forth. But on the other side, there's, you know, as an industry, can we facilitate? Think that's what you're referring to, can we facilitate the collection and the use of data by our clients, the hospitals, the physicians and so forth, in order to add value to the system, both clinically and obviously, at the end of the day, bottom line, value in terms of the healthcare economics, are those mean? I'm sure they're related. They're both data, but are they? Are they fundamentally distinct things that we should be talking about? Really, quite a bit separately?

Vaughn Schouten  24:26  

I would say yes, absolutely. And it comes down to what is the single source of truth? What are you considering your quote unquote, intelligent data source? So you guys mentioned something that I think is a really interesting shift in the way things are being done. I don't want to say globally, but let's take the United States so we're sitting in a state that typically has sunshine but it has its it has the second most amount of hospitals behind the state that's its own country, which is Texas, Texas has about 900 hospitals. The state we're sitting in right now has nearly 600 hospitals. So I want to go to kind of this shift in healthcare. And we've mentioned wearables, we've mentioned hospital at home. So this year, there's 631 hospitals in the United States that are at risk, immediate risk of closing. comments, thoughts from a physician's perspective, investment banking, someone who's been in the industry and a CEO? How do we evolve in the medtech space on this digital transformation journey? Like, you can open the news, as Peter said, hospitals are operating in the red. Right? The to the ER and L&D operate in the red sometimes on purpose? And there's a reason behind that. But how do we shift this? And you mentioned some of the answers, but 631 hospitals are projected to close in the United States this year. So thoughts, comments from your backgrounds, and

Lishan Aklog  26:08  

Let me just maybe I'll start because there's a bit of a paradox here, right, they're, they're closing, but they're not closing because of over, you know, over capacity. They're closing, while ers are filled to the brim, and there's, you know, 8 hour wait times, and, and, you know, highly inefficient ways which which patients are flowing through the system, they're closed, because they're hemorrhaging money. And so, so it's not a self correction, it's, it's, you know, an impending catastrophe. And just to highlight one other aspect of that, which is that, that, that that acute crisis is particularly, it's particularly acute in the rural areas, and in areas that have limited services, there are plenty hospitals, and, you know, within 10 miles of San Francisco, but but but not in, in sort of the Inland Empire. And, you know, there are lots of really a lots of things that go beyond the scope of, of what, you know, we're certainly within the medtech industry, or med tech companies can do to, to facilitate that. But I think, you know, a lot of it is political, a lot of it is policy based, and so forth. We can go into that, that's fine. But I do think maybe from a med tech point of view, we can see that as an opportunity to use technology to facilitate to help distressed facilities stay open. And you know, just I won't go into all details, but you touched on one I think hospital at home, as a as a as a useful paradigm that still has to be sorted out. But it gives a hospital that capacity in an instant, my old alma mater, Brigham plans on opening 200 Hospital and home beds over the coming years. That would be 25% capacity with wide laying a single brick or digging a single ditch and, and so far, the payers and Medicare in particular are pricing that service at a at a price point that that would make that viable and would help with the help with the with the bottom line. We have tools I go, I'll give you a concrete example with Varis, our our cancer care platform that I talked about in my earlier presentation, one of the our early clients has a hospital in in Pennsylvania that caters to a rural Amish community. And so you can imagine that if you have cancer, and you're an Amish community, and you literally I'm not being a saracastic, so you're have to take your your horse and buggy to, you know, an hour to go to get your chemotherapy check or to make sure that you have that you can get your chemotherapy, you don't have a fever, having the ability, things that we can provide as an industry to provide the technology so that the physicians are are effectively virtually there, the care team and understand what's going on with them clinically, can can facilitate facilitate that. So I think technology is the solution on the rural side. There are lots of other policy, you know, things that need to be addressed more broadly, I'm sure.

Mrigasha Patel  28:54  

So I'll throw a question out there, right. What do you guys think is the most expensive asset and healthcare or I should say the most costly asset and healthcare,

Lishan Aklog  29:03  

Labor, nurses.

Mrigasha Patel  29:04  

Thank you. And so if you look at these public filings, right for these hospitals on a financial standpoint, it's the workflow inefficiency, aka labor inefficiency is what's driving these negative margins. These, you know, physicians are frustrated, they can't really treat patients the way they want to, you know, staff is frustrated that they can't really, you know, do what they were trained to. And so, you know, I go back to my alma mater, Medtronic, they had a really unique model that they had developed called the CVG sort of work, workflow business unit. It was a small unit within the cardiovascular group, and I thought it was brilliant because what they were essentially doing, or they were helping physicians and hospitals map, sort of their workflow using time driven activity based costing, right and that's an accounting term that you know, I don't know who, who's familiar Are with it. But you know Toyota uses it right? manufacturing firms all over the world use time driven activity based costing it's been around since the 80s. But what they're trying to do is quantify where are the inefficiencies in any given workflow. Now, the problem we have is we were still using a stopwatch within hospitals to do this, right? So they're there in and of itself is a huge opportunity to kind of become more efficient. And on a financial standpoint, right? People are sort of seeing that opportunity. They're saying, Okay, where do we reduce overhead on the billing side? Where do we reduce, you know, where Labour has to sort of spend time inputting data, right, so that sort of the opportunity we see on the financial side for these for for these hospitals like GPOs, and ideas to become profitable.

Peter Stebbins  30:51  

Now, I'm just gonna build on something he said, did take a minute to give you just a shout out to the notion of the work you do with AdvaMed, when I think about, you know, all these costs. And the fact that I mean, potentially in the next little while here, there could be a bit of a of a like a, GE Healthcare is too expensive, we need to do something about this again, right type of thing. And it's going to be important for for AdvaMed, and what we do at mathematic in Boston, and to really be able to bring that to our, to our local legislative elected officials, because they need to understand, and we know sometimes, like, they don't really understand technology, sometimes, like we're doing with TikTok reviews, they need to understand and be able to fight to say yeah, okay, this is a, you know, this type of, first of all, medtech is important, but also some in the audience is to be going to your, your local industry group to make sure that if your story is about saving time and effort in and or in the hospital, then you should be there with that Congressman, you know, with a Medtronic or whatever, and they actually want to listen to you more than they do Medtronic. And just, just, for people in that space, if you're a digital, you tell that story, because it's important, because we don't, then they'll just be, you know, continued kind of like mismatch on like, hey, we need to cut costs. And you know, there's no way we're going to add something, we're gonna pay for something new. Because they don't see the value unless we explain it to our elected officials.

Lishan Aklog  32:14  

Can I just add one thing, so a bit of a thanks for the shout out there, because one thing I'd like to do is encourage, you know, we think small companies, you know, the Medtronic and the Edwards of the world are the ones who should be lobbying Congress for policies that serve them. And that is about two thirds small companies. I'm a small company, I'm, you know, I've ever made active and it is super important for smaller med tech companies to be involved because the work that they're doing actually, in fact, impacts us perhaps greater but you know, Medtronic on their own, they don't need they don't need advocate in some sense to, to do so. And like one key example here is to get the message across that innovation, and the hurdles and the friction that's required to bring innovative technologies, whether it's just hard devices or innovative approaches to processing data is ultimately necessary. They're there the hurdles are too high, the right the payment pathways are too are too complex that doesn't facilitate the capital formation and investments because of these the risks and timelines associated with that. And there are, there are some really key initiatives, one of them is called T set, if you haven't, if you don't, that doesn't ring a bell, look that up. It's translational coverage for emerging technologies, which would basically have Medicare provide transitional coverage for new innovative technologies and allow them to garner the data and the evidence base while they're actually covered, as opposed to having to have to essentially subsidize subsidized economics during some unknown period of time before you can get coverage. So those are extremely important. I'd encourage everybody, small companies in particular, to know what's going on at a minimum and get involved.

Peter Stebbins  33:43  

Those Those, those Hill flights, they really liked the startup talking about it, they don't need to hear J&J Say it, they want to hear, you know, PubMed, and these companies do it. And that's, nice job.

Vaughn Schouten  33:53  

So 86% of C suite, and med tech execs agree that their future success is dependent on targeting the entire care pathway. thoughts, comments? And as far as the entire care pathway, there's been so many panels, you start talking about, when people start to look for care, right? My daughter gets sick, I'm not running to the ER, unless it's emergent, right? What do I do? I pull out one of my two iPhones, and I go on WebMD or I get on telemedicine, right? She's got a virus or whatever the case may be, unless it's a broken arm, and we know it's a broken arm, then we go. So patients, physicians, site of care, payers, even so how do we use data to kind of improve efficiencies throughout this entire continuum of care?

Peter Stebbins  34:48  

So two things I think it's not just data as this digital right. So that data is going to build up digital is kind of in a more real time, and I would say the important thing to be successful was, when you think about continuum of care, just be really careful about if the decision makers are changing. Realistically, I mean, j&j has done it lots of different times. So we have this continuum of care from smoking cessation through to lung cancer. And it's really hard because like, you're, you're really not going to build any in real life, you're really not going to build any synergy in terms of affecting that patient. Now, if it's a situation where it's in orthopedics, or something where you're can get early on with with a physician who is largely going to be in that flow, and also the rehab after if they're going to be involved in that, and you can, you can make that work. But to some extent, the patient continuum is so far that you just from a commercial perspective, you just kind of lose your way, because you're trying to do something that you don't have a good call pattern for.

Mrigasha Patel  35:52  

So I'll throw it out there, I think the big opportunity is really kind of, you know, it's what is the continuum of care? Let's first define it. I mean, let's use technology to even define what the continuum of care is, right? I don't I hear all these buzzwords all the time value based healthcare continuum of care, like, you know, Lee, and efficiency, but let's start defining these things first. And then we could probably have some answers on how to go about sort of solving for it right. Now, I don't know, to Peter's point, right, like how many continuum of care they are, because they vary by individuals. We could have, I don't know how many. But once you start defining it, you start seeing trends to be able to standardize a few things. And I think that's probably a good place to start and my mind,

Lishan Aklog  36:43  

Can I just add one thing, which is, that's why I lean to you first, because I think there's sort of broader, you know, a lot of broader questions, even defining it, and so forth. That that we have to focus on that doesn't get to that involves lots of stakeholders and players that have to contribute to that. But maybe I'd like to, I'd like to bring it down to maybe the audience here, which is what can smaller med tech companies? How should they look at that data, and if they're trying to develop tools, you end up as a high risk, particularly on the digital and the data side to sort of join entering a tower of Babel where everybody has their own custom platform and, and you're walking into the dock, you know, to a practice and saying, Hey, look at our cool technology, it's going to help you do X, Y, and Z and, and they're like, Well, I have five other things, and how do you how does it all work together and the and it is critical for smaller companies of trying to get in on that and trying to be part of at least making that making a contributing to the continuum of care that you have to learn about things like redox, and other, you know, fire and these these buzzwords that I've just learned about in the last year around how do you how do you integrate with their existing EHR? And how do you make it seamless? And how do you facilitate the their own internal IT department so you're not just kind of throwing out another, another platform that is just sort of operating in a thing you have to even as a small emerging med tech company, you have to operate within this, this ecosystem that's already there. It's not very good. It's all jumbled, doesn't doesn't work very well. But that's what you that's what you're coming in on. And I would implore people to consider that at the early stages of the design.

Peter Stebbins  38:12  

And I, it reminds me, enjoy, I think there there will be in some areas, a need for, for industry groups to work in different players in Asia to work together and be much more open. You know, open architecture and API based and then in the past, we hate it. It's an oligopoly. We don't want to do it. I go back to being in Europe, we tried to figure out our system for doing ordering electronically. And we were saying we're gonna have our J&J approach. And then someone said, why don't we like do it with like, the other other industry players? I remember laughing I laughed at him. I went No, no way. And then like three months later, we announced GHX, which pretty much allowed us to avoid having somebody else disintermediate our supply chain, and the industry kind of came up with a system that worked and went forward and I really do feel I'm not sure which space it's going to be in. But there will be opportunities for patients that only by working together will they get enough traction to work and there will have to give up a little bit of of that in their own uniqueness and differentiation to make the whole thing happen I look forward to that is don't know what space is going to be but it's going to be almost forced because we won't get there otherwise. 

Vaughn Schouten  39:27  

All right, rapid fire 10 seconds each one key takeaway from the week not defining digital transformation or continuing care but from the conference or what anyone can do to add value startup or big device company one key takeaway that you would give the audience

Mrigasha Patel  39:47  

well, it's NBA season there needs to be more NBA happening here. But anyway, I don't I think you know, like people are way smarter than I am on, like working on these deals with small deal teams but like for companies that have just emerged and started, just have a clear line of sight again, right to your revenue. And then when you're talking to investors don't throw spaghetti at the wall more doesn't mean you're gonna get the money. There are strategies, ways and things of doing these, we you know, private placement processes that we execute on are extremely tailored, sometimes well designed depending on which bank you talk to which banker you talk to. But you know, more is not necessarily better.

Lishan Aklog  40:32  

This is an emerging medtech conference, I think I would encourage people to focus on the emerging part. I'm not one prone to hyperbole, I think people who know me, but I do think we're in the middle of a revolution in how and how patient care is going to be delivered. You know, Marcus Welby is, is coming back, he's going to be in the home that as a person, but as as technology that we can offer to facilitate the improvement of care into personalized care. And, and there are lots of opportunities for emerging med tech companies to try to figure out how to wrangle that and participate in that revolution.

Peter Stebbins  41:05  

One thing I'd say relative to the sum of startups is to understand if your business model as a standalone startup, you may have certain ways you want to have things paid for. But think about in the hands of a acquirer, if you end up being acquired, is that the way to go? You know, is it in a lot it's going to down to is a subscription or not? Are they using that because they can sell an implant with it? I really think that through from the other side of the table, because that not that one needs to be right and the other is wrong. You just need to figure out can they actually pivot to that? Because it may make sense of a different a different financial model. Again, it's available, follow the money, and there's some really great technology here that needs to make sure it gets paid for.

Vaughn Schouten  41:45  

Well thank you for your time and expertise and we're gonna get yelled at if we don't get off the stage. So thanks so much.

Lishan Aklog  41:50  

Thank you, everyone. Thank you