Improving Healthcare Outcomes for Our Military: Partnering and Funding Opportunities With the VA and MTEC | LSI USA '24

This panel highlights the opportunities for healthcare innovation in the U.S. Department of Veteran Affairs and through MTEC.
Speakers
Shawn Green
Shawn Green
, MTEC
Christopher Parker
Christopher Parker
, U.S. Department of Veterans Affairs
Kristopher Teague
Kristopher Teague
, U.S. Department of Veterans Affairs
Michael Parrish
Michael Parrish
, U.S. Department of Veterans Affairs

Shawn Green  0:04  
Hopefully it'll resonate with many of the players here, both in terms of folks that are building diagnostics as well as the service providers, we think we create an interesting ecosystem to advance that we'll come back to it in a minute. But I'm going to move over to Michael Michael    Parrish. He's, he's the chief of acquisition. For the VA. He's the big thinker. And we're going to come back to Michael, and he's going to share a little bit about his experiences, and how we can best engage the VA in terms of your innovation. Next to him is kit tag, and kits, the discovery, he's out searching for those innovations for the VA, and how we keep our veterans active. And going forward. And of course, we have here, Christopher Christopher    Parker. He's the one that actually executes on this, he's the one that deploys some of the big picture visions that Michael presents on the table. So we're gonna, we're gonna allow each of these individuals to again, introduce themselves, and their mission and what they want to accomplish in context of you, and how you can best play and engage both MTEC, which I'll explain in a moment, as well as the VA MTEC is funded by the DOD, specifically the US Army Research and Development command, we focus on trying to accelerate and create efficiencies for our primary sponsor, and that's the DOD, specifically the army over the past half a dozen to almost a decade. And we focus on all the therapeutic areas, infectious disease diagnostics, and which we work with our counterparts in the DOD, of what are their needs, what's best for our soldiers? How do we keep our soldiers engaged? How do we keep them healthy? How do we create high performers, and we put these solicitations together and identify the best of breed players to come in and work with us. We provide non dilutive funding, with particular focus on prototype development, going into phase one, phase two, a very crucial time, a time which sometimes it's hard to raise money, but these non diluted of dollars will hopefully not only advance your cause, but then begins to tee you up for the private sector, because we want your innovation not only to impact upon our needs to protect and help our troopers remain engaged and healthy. But we want your products to spill over into the private sector and benefit the taxpayers directly. So MTEC, over the past half a dozen plus years, we think we've done an okay job for every dollar of the taxpayers money to the blessing of the DOD, that we helped to invest in biotech companies, the private sector came in and gave a buck and a half to upwards to $4, depending on how you cut the metrics, in validating, are quote unquote, non diluted of investment. So we think we're doing an okay job at being good stewards of the DL DS money. That's point one, two, our membership has about 700 members today. And of that membership, about half of them are the small companies, the nascent companies, the ones that are at the kind of cutting edge of new innovation. Another subset is the universities, and of course, the large players. And within that group, we have another set of players. And those players are service players. So the service players do pay attention, because these folks need you the back office, whether it be IP support, whether it be accounting, whatever it may take to advance why they're focusing on the science, you're helping them get through that bridge to the next level of maturity. And so that's the MTEC model. In short, we welcome you to reach out my colleague here is Rick, who runs commercialization, to reach out to us take a look at the site, we can walk you through the mechanics. So let me turn you over to our VA partners, Michael, as I mentioned, he's, he thinks big, he's the creative guy that is looking and create and how do we take care of our vets? So I'm going to turn it over to Michael, Michael. Please.

Michael Parrish  4:28  
Thanks, John. So I'm Mike Parrish. I'm president duly appointed as our Chief Acquisition Officer for the VA. And that's a nice way of saying I'm the temp for VA and I'm also the, you know, the troublemaker that comes up with crazy ideas and needs to have to take that along with the rest of the team. But before I start, let me ask, Do we have any veterans in here? Awesome. We all sign up for your benefits. Of all of you here because I know I've come from your world. I used to work in GE and I am a retired Army aviator. And so I've done a lot of r&d work on the on the weapons side, and it played on the research side of trying to trying to get business with the government is that how many of you have worked with government before, we're actually trying to get contracts with government before. So we know it's a painful process. So, and on the DoD side, there's a phrase called the Valley of Death. And then we say that's where good ideas go to die. And so I've grown up there, and I've and the reason I'm in this role is trying to help break that cycle of new ideas and just kind of they're going to die. So the main mission, my big effort is trying to do that fusion of acquisition and innovation and be able to scale your new ideas to be able to go to become a mainstream product. So talking innovation of VA, we are the largest integrated healthcare system, probably in the world. So we have 9 million plus patients out of 22 million of us veterans. And, you know, we've been doing a really good job for all those veterans who know the pain and suffering of some of the old VA problems, as I say, it's not our parents VA anymore, because we are now giving more benefits and more health care to more veterans than ever before. And so we're really about pushing the envelope on doing a lot of innovative ideas. And so our challenge is to be able to take those ideas and move forward. So you may or may not have known that VA back in the 50s, we were the inventors of the pacemaker. We were the first telehealth appointment back in 1967, you know, lung transplants, all these things were done at the VA. But in federal government, we're we're government used to be the lead investor, if you will, for new innovations, we've lost that edge and government and we've gotten to the, you know, the $200 toilet seats in the over engineering of things. And so I'm one that's inside trying to break that mold and saying, we in government can no longer afford to do that. And we need all of you as the innovators and the new, new ideas, especially in the medical space and life sciences space, to tell us what that's all about. And, and so we're pushing the envelope to to help you all either incubate or grow or get to scale into the VA. The first thing that and I'll have to get talk more in detail about that is, is the idea of of a of a product that I invented, it's called pathfinder.va.gov. Anybody heard of that or seen it? So we've been really good. And that's what I actually call it the fusion of acquisition and innovation, we do a really good job on the acquisition side, on the sales side, we're getting better right on the innovation side. So I encourage you all, if you've not looked at that, it also helps those who've never done business with with government, it's an easy to use intelligent and integrated system to be able to learn how challenging it is in government acquisition. So I'll end with just a story of my observations. I used to work at DARPA and other places of government research. So there's everybody watching the movie, Indiana Jones, call the scene in Indiana Jones effect. Remember, at the very end of Indiana Jones, that Ark of the Covenant, pretty big deal for us Christians got rolled into a warehouse, right. And that that, to me is a good, a good cliche for how government electoral property is done, because currently people spend more time doing the publishing are perishing. And they just do r&d For r&d sake. And I'm here to tell you that we're breaking that valley of death mold to be able to do what I call strategic innovation. And what that does, it starts with with these guys and teams from the very new idea from that, that breadboarding. And that prototyping, to think strategically how something as a new product can actually grow into a scalable product, the mainstream product for all of VA, and we'll go into more details later. But I really don't want to sound that Indiana Jones effect anymore, especially with the VA. So I'll pass it to Kitt.

Kristopher Teague  8:30  
Good afternoon, everybody. I'm Kip Teague. I'm executive director for Veterans Health Administration innovation ecosystem. I'm not a veteran, but I got the bad haircut. And, you know, I've been with VA for like 20 years 11 of those years have been spent in innovation. And I always like to tell the people, you know, the story of you know, I've worked at every level of the organization, I've worked at the local level, the medical center level, I've worked at the regional level, and I've worked with the national level. So I've basically seen it all. And part of that time I've spent in the Bermuda Triangle, a va which we call human resources it and contracting, which contracted you guys, right. Okay. But, you know, with innovation ecosystem, we have a number of different programs and portfolios that are designed to help facilitate healthcare innovation across VHA, all the way from early stage ideas of our frontline employees, to scaling across the enterprise. And one of the other big things that we do is community building. We do a lot of external collaborations and partnerships. And what Mike was talking about as far as Pathfinder is it's it's a tool, it's like a digital concierge front door for folks externally that want to either sell the VA on the acquisition side, or they want to innovate with the VA on our side. And what happens is, as you go on the site, it asks you a few leading questions about you know, it tells you a little bit about VA what we have available, we have a number of suite of assets that It can be utilized by companies that are early stage, pre commercial. And then also, you know, companies that have come to commercialization and are trying to get their foot into a medical center, or a healthcare system. And, you know, we've got, let's see, SMEs, from all walks of every clinical subspecialty, you can think of is in the VA, we've got data, some of the best data in the world, we've got a research infrastructure that's funded at $1 billion a year, we've got veterans that are more than happy to provide feedback on different products. We've got 172 medical centers that you can pilot some of this technology. And so those assets are what VA has to offer. All of you that may be interested in taking advantage those but you need to go to Pathfinder, answer a few questions. It doesn't intake, what happens, it comes to my team. And we have folks that triage it. And we have a community of about 400 SMEs throughout the country, that are clinical, that are technical, they're administrative, that depending on what your submission is, we say these are the folks that you know, we need to get feedback from. So we send them your submission to them. They provide feedback, and then it's either a go or no go decision from us. If it's if it's a go decision, we reach out to you and say, Hey, let's figure out how to do a collaboration together, we'll help walk you through the process. If it's a no go, we're going to provide that feedback to you of why it's a no go. And so you can recalibrate. And so we work with I think right now we've got 60 Something craters with different companies, or is there anybody in this room that has a crater with us? Okay, we got some. So, you know, we, we were looking for any technologies that can benefit our veterans, we cast a wide net, but it's, you know, we have finite resources on what we can do. But if you have something that's going to meet the needs of our VA veterans, you know, we're all about it. So.

Christopher Parker  11:54  
Alright, Chris Parker here, so, so unlike, so I've been with VA for about three years about the same amount of time is, as Mike, I've been, I'm currently the Executive Director of the strategic acquisition center, and just recently took on the acting duties over at the National Acquisition Center. So I've got two out of the three strategic acquisition centers at the VA right now, which is proving to be kind of interesting, from the sense of overlap and programs, things like prosthetics are bought by multiple activities. My job, the way I look at it is, you know, hey, I came from DOD 30 year Navy vet, bought any kind of system you can imagine on the Navy side, aircraft platforms, surface platforms, Intel's platforms and the like. Most of those on cutting edge technology sorts of things and trying to get them into market for competition as quickly as possible. So good fit sort of with the VA had never bought any health care stuff, you know, but I knew the innovation side. So coming to the VA massive ecosystem, across several ecosystems, innovation is one of the interests spots in every single one of our product lines, right, everyone's got the latest and greatest technologies out there. The challenge is how to buy them. The programmatics typically don't exist in the innovation space inside a lot of the government spots, you know, the DARPA is out there, things like that. And the VA, we're having a hard time kind of piecing all that together. We're really good at buying things where there's a demand signal out of clinicians, things that are on formularies things that, you know, all the orthopedist want a specific thing, great, we can go by that at the enterprise level. So as we're looking at some of our ecosystem of acquisitions out there, things like community care, telehealth, you know, we bilateral prosthetics and the like is what are the similarities and how we buy stuff across this? How do we kind of tie in to where a kid is coming from and some of the ideas that Mike is coming up with? How do you turn that into an acquisition? So my organization has program management folks, financial folks to try to turn something that typically is a bright idea coming out of somewhere, and I'll call the bright idea tree from Mike sometimes is how do you turn that into a demand signal that turns into an acquisition? So we try to negotiate government contracting is very complicated, right? So we try to work with the programs to establish an acquisition, that makes sense that's competed typically, or we use unique authorities that are granted to the VA from Congress to buy specific items. We have specific prosthetics authorities that a lot of folks just don't know exist. But the whole idea is we have authorities to be able to look for those unique, tailored solutions to end up with the best outcome for our veterans. And so we're always trying to find the best way to kind of create that mix. So that's kind of my job in this space, is how do I turn it from great idea to great interest from certain communities inside the clinician space into now we're buying it and getting it to the frontline as soon as possible. So I think that covers the whole range of that ecosystem. So yeah.

Shawn Green  14:47  
I'm gonna go right to the audience. You kind of got a primary or you got a primary here. Questions? Yes, sir.

Kristopher Teague  14:57  
Coming in, speak to the screen. Chris, you mentioned demand signals from clinicians. How do the entrepreneurs know what those demand signals are?

Christopher Parker  15:05  
That's what ket is trying to solve right now. Right? So because if you ask, you know, 30, heart surgeon surgeons what the best product is gonna get 30 opinions like lawyers, right? That's what I'm finding. So you need some sort of a central management of some of those clinical demand signals. What I find is that of the programs that VA probably the prosthetics folks are the most developed in that space, is they typically they hold Industry Days, they all get together, they make determinations on what product lines they want to pursue, if they're interested in pursuing it, we get it on contract really rapidly, and we're able to get that out into the field. So having things like procurement ready companies, we can talk a little bit about that if anyone's really interested things like you have FDA approval, you have a DUNS number, you have all these, you know, you're registered in SAM, all that neat stuff. You know, those are the sorts of things that help speed the process. And if the company has gone about getting onto a Federal Supply Schedule or something like that, in the meantime, that speeds our ability to move to a strategic contract across VA. So in in those unique cases, where it's something that's not on that formulary that a specific clinician wants, sometimes we can even reach in and use special authorities in that space. So there's no easy answer to this, I think what we're trying to figure out is how do you cut away from the idea of you have 172 medical centers? How do you go to one point to introduce your innovation as opposed to trying to market to 172 different medical centers?

Michael Parrish  16:21  
Yeah, and I was gonna reinforce exactly the last part that Chris had mentioned is I've seen horror stories that your peers and Patriots are trying to sell, and try to find 172 different champions. And that's, that makes no sense. And that's what I'm here to, like, say we're trying to stop that. So if you're doing that, I recommend strongly talking to us to help you get that get that worked out, because the scale bar and just add to the leverages, you know, we we buy $56 billion annually of stuff. So we know it's it's looks good, but it's hard getting there to that point. And that's where we want to try to help work with you to figure that out to a single enterprise wide solution. Good. Perfect.

Speaker 1  17:02  
Yes, ma'am. Sydney, CEO and co founder of vessel prosthetics. Sydney, CEO and co founder of vessel prosthetics, and I have the Pathfinder is fantastic, very easy to navigate, really enjoy that. And then we're working on a crater as well. So it's spectacular to see the support that is existing at each of the stages of a company's lifecycle, which I think is fantastic. Are there pathways to get from one of these to the next? So once we've started a credo, is there a way to move kind of easily to what that next stage would be? And then, and then to acquisition after that?

Kristopher Teague  17:37  
Yeah, I'll cover that. So the credit is the first step, it helps to get you in the door of the VA, I mean, you can go out and try to sell the VA. And as Mike was talking about going to like 172, VA medical centers, because we're not doing centralized buying as effective as we could. But I think what actually get you in the door with the VA is doing some kind of collaboration, or partnership, what it gets your product introduced into VA gets it in the hands of the folks that are going to be using it not only the providers, but also the veterans that can see that can touch they can feel they can get to know it. And if if the collaboration is fruitful, that means that at the end of it, we validated the efficacy of the approach and the product, there's going to be a demand signal to Chris's point, that's going to come to him and say, Hey, we tried this under credo we really liked this, what can we do to get this in the hands of our providers and veterans? And then that's when the real conversation starts strategically about how to scale it not only for those providers, but the rest of the enterprise. Yeah.

Michael Parrish  18:46  
Let me just add, just to clarify, for those who know credo is a cooperative research and development agreement. So that's a deal where, you know, you come in and you'll provide your wares. We write sweat, equity or feedback for you and help you help you commercialize your product.

Speaker 2  19:02  
David hired a co founder and CEO of Vine Medical, we are working pretty closely with DOD and active duty medical providers. And I guess I have two questions. One, how does VA think about helping support the implementation of products that will ultimately help the warfighter the active warfighter, and to do craters in one vertical of the DoD or the military apparatus apply to other verticals in the military apparatus.

Michael Parrish  19:31  
So I'll put my chip on my shoulder general DoD guy, the mission of department defense is to fight when our nation's wars so from a medical space, that's a third tier combat service support level effort. The mission of VA is to care for those those who bore the brunt of battle. So, you know, when you come to a scalable space that encouraged VA first, but one of the things we're also trying to fix is that government wide collaboration, not just with DoD and VA, but also with HHS and this ARPA h new group and some of that stuff, so We're working through that. And it's still a work in progress. But you know, these kinds of things to know about is it's, you know, it's important that that with awareness with these kinds of events and go through Pathfinder will know what you're doing. And we can also work together, so we're not duplicating or competing with each other, if you will.

Christopher Parker  20:16  
And we're congressionally mandated actually to do more cooperative buying. So in some cases, things like HTV, high tech medical equipments, we have partnering contracts where we write part of the portfolio of contracts, DOD does the other report part of the portfolio? So a lot of coordination meetings between the two, some of the places where you'd like to see it as a retiring vet, you know, so say I had a CPAP machine is active duty, as I rolled into VA, should I have the same machine? Should I have the same information, all the informatics that I had as a, you know, someone indeed, everyone in DOD ends up in the VA, right? So So wouldn't it wouldn't make sense for all that stuff to be able to communicate with so all that passes over automatically into the VA space? That's we're trying to fix? Because those systems are not the same. You know, some of the medical devices I had on active duty when I retired, I had to throw them away and get new ones issued by the VA because they were different, supported differently. And that's a shame. So yep.

Speaker 3  21:10  
Rick    Satcher with Sean and MTEC. I'm curious to know how you're prioritizing innovation that you need to hear about, of course, the prosthetics you mentioned, but mental health is huge. So I'm curious to know if you can comment on how you're prioritizing. There's a lot of competing priorities, right?

Kristopher Teague  21:31  
No, there absolutely is. And, you know, what, you know, the, the veteran health conditions are a lot of the same health conditions as the general public. However, there's some things that the veteran populations experiences more than VA focuses in on more mental health and suicide prevention, TBI, polytrauma, PTSD, spinal cord injury, prosthetics. Those are the six that we're like, that's that's our big priorities. Everything else is kind of gravy after that. But if we focus on those, that's, that's the big picture for us. I mean, there's there's a lot of things that we have that are more prevalent in the veteran population like diabetes, some heart issues, cancer, all of those things are also important, but the six that I just told you are probably the big ones for us.

Manny Villafana  22:32  
I Mani villafana Medical 21. We are developing products in which we are approaching the Mayo Clinic's Cleveland clinic's Minneapolis Heart Institute at variety of hospitals to participate in a clinical trial on class three devices, implantable devices, does the VA system have a means by which they to participate? Number one? And the second question is, do we have an advantage in going to the VA versus going to another standard institution? Not that any of these are standard? But you know what I mean? In other words, we have an advantage going through you as it relates to the long timetables of the the FDA.

Kristopher Teague  23:26  
FDA? Yeah. So I'll take this. Yes, we can be a clinical trial partner. And yes, there is advantage going through the VA we have special relationships being a federal agency. We have special relationships with other federal agencies, for instance, we have a office that's its sister offices is called Office of advanced manufacturing. And they do a lot of 3d printing and prototyping and medical device design. And they're the hub is up in Seattle. Well, the FDA has folks that are embedded there at the Seattle facility. And they helped kind of traverse kind of the the regulatory hurdles that the FDA has. And it's it's it's a very collaborative relationship. And so I would say that, you know, there is advantage coming to VA and we do a lot of clinical trials, not only on products, but also pharmaceuticals. So it's it's a good place to be for clinical trials.

Manny Villafana  24:26  
Don't hide, I'm going to find you.

Michael Parrish  24:31  
In being a user of implants, all most veterans have a lot of stuff we always encourage the better kind of equipment. So.

Shawn Green  24:40  
Other questions? Kit, I'm going to come back to you. You mentioned the pilot. I'm going to keep coming back to the clinical because we encounter this all the time at MTEC that we're going through that transitional phase for prototyping. Walk us through a site from the portal and A template us, walk us through the economics of that, who's who's paying for what some of these companies are, as we know, we're all fragile in some of our early stages and growing these companies, help us understand aside from the clinical, walk us through with some granularity, how do we collaborate and share that cost? Yeah.

Kristopher Teague  25:24  
So basically, when we do a cooperative research and development agreement, we're both sharing the cost, VA sees value in whatever product it is we decide to do a cooperative research and development agreement on, they see the value for the VA, they see the value for the veteran. So they're willing to put in resources, sweat, equity, all those things to help move this product or this company along in the lifecycle to see if it's, you know, efficacious. What we're asking for the companies is bring your business development dollars, bring, you know, the product to be available for the pilots, and work with us in the trenches, to get the insights that we need to be able to validate whatever we're doing. And so, you know, we're bringing things you're bringing things, we're bringing them together for a common purpose. So yes, there's investment from the companies, we expect you to either, you know, bring that from your VCs bring that from whatever capital you've raised, other means, but it's, you know, it's something we're doing together collaborate for the greater good.

Michael Parrish  26:32  
And I'll and I'll just add, you know, coming from my old GE days, when we did this work for Jack Welch and we had had a phrase that you know, said we want to acquire, you know, the leading edge, not the bleeding edge, like you all work through all the all the pain and suffering of the breadboards. And all the development work. And then we GE would scale that. And that's, that's my talking, I think what gives us a unique advantage on the VA side is we also have funds, we want to get more obviously, but But you know, we want to commit funds to help you do that, that r&d effort and CO develop a product would be CO CO owners, if you will, with whatever system you're doing, depending on what phase of development you are in, in the in the system. And that's how we want to kind of do that. So there's a phrase, if you're not familiar government that DOD has better than us that we're working on is small business, innovative research, and there's different little levels of funding. We're doing a bunch of tech sprints. That kid alluded to earlier. And there's places that you can you can find these things through what's called challenge.gov or sam.gov. You know, by law, every contract government does, in guarantee you'll need a like a full time person, I had a couple of I had a team doing this when I was CEO, but sam.gov Every contract and every note is contractually has to go into sam.gov challenge.gov. And I think he's also@grants.gov, our side sister websites for for government funding of different types of efforts. And we're trying to still work through that. So it's still a labor of love and a process to be able to get better. But there is there are funds available to help with that could development.

Kristopher Teague  28:08  
Partners again, I'm wondering about if you have any plans for like focus groups or clinicians, let's say that we had a group of cardiologists are their focus group plans kind of coming along, where we could get some of these folks in front of them?

Michael Parrish  28:23  
You're, you're preaching my gospel, because we have we talked, we talked about a thing called Mike speed, you know, Mike's like I'm in the business possible. But one thing we want to do more of which we do and have done before, is called reverse Industry Days. And that's where you all can come. And we're actually talking about setting this up through Christmas. See, my Christmas is having these reverse image days on specific areas like like prosthetics, or like pharmaceuticals, or like, high tech equipment, but it's it's having you all come and show us your wares like Industry Days would be like we're preaching to you all, like, here's what we need, but reverse Industry Days you come. It's almost like the speed dating things you're doing here, but it's focused on us and the VA. So you come in those ideas. So we want to do more of that. And we're going to start aggressively doing it in summer. Right, Chris?

Christopher Parker  29:03  
Hopefully, even sooner than that, depending on the topic. So So we've done a few of them for things like community health, community care, things like that telehealth we did one last year and, and the hard spot is, of course, on the acquisition side, that helps me tremendously because it kind of helps the program's formulate their, their approach, right, they get an idea of what's out there on the market, helps them make the points of contact, they're going to need trying to determine, hey, how does the industry procure this sort of stuff. And that's the sort of communication that we're looking for is when we hold these events, it really is pretty broad. They're announced typically on Sam. And the whole idea is to come with your, you know, some crazy ideas to as far as hey, if you could revolutionize this, you know, here's the way to do it. Here's a better way to buy. Why do you divide your regions in a specific way? Why do you you know, we ended those sorts of discussions with industry, just to kind of try to figure out hey, are we buying this the right way? If you got a suggestion, bring it up at one of those events. We have pretty thick skin I do at least I don't know. But, but you know, We want to be told, Hey, you're buying this wrong, you can save millions, billions in some cases. Okay, well, tell me how that really works out showing the math and you know, we're willing to have those sort of conversations. But the whole, really the best idea that comes out of those is what is the latest and greatest thing? How should we buy it? And then how do we kind of position the VA to actually use the authorities that we have turned into programmatics? And then go field it quickly so we can get some veteran outcomes we're looking for? So that's the magic in it. So but it's the how do you get it? Which cardiologists you're gonna invite that first one, right? That's the real question, right? Prosthetics? Has it figured out some of the other ones we're working on right now? Who's invited to the show? And can they speak for the whole community. And, you know, we're still trying to figure that out in some some commodity areas.

Shawn Green  30:47  
Just to add to that, at M Tech, we put our solicitations, we don't always have it right. Even though we're working hand in glove with our primary sponsor, recent one just came out yesterday on oral health, the genesis of that came about maybe six, seven months ago. And the requirements weren't necessarily aligned with many of the players that could meaningfully contribute. So we push that out there, which they become the co authors, bring it back in under a white paper, repackage, bring it back out to as a solicitation. And in doing that, you bring up the best of breed players to yes, they're authors of the requirements. But they're already in the space. And so we're already thought leaders in that particular space. And so it's, it's a different way of approaching it. But how do we bring some of these technologies in, that we may not have really articulated in these solicitations. So we're trying to be a little bit more dynamic, and reach out to the players here, pick up the phone, call us, we don't have the right idea, or we're not prioritizing correctly, give us a call, we take all the phone calls, we take the meetings, we listen to our biotech partners, because at the end of the day, this innovation is coming from this community here, and how it helps our troopers. So just a thought to consider.

Michael Parrish  32:14  
And that's actually important for any anyone doing business with government, don't hesitate to reach out to whoever it is that you're, you're talking to one of the things we're trying to change the mode and VA is the dictatorial like, you know, we're government, we're doing something over the fence. So we want to do exactly that do do draft RFPs do do request for information. If you see those, they'll send sending your information. And we obviously were We were sensitive to to any of your your secret sauce or any of your intellectual property or competitive advantages. But that's where you can schedule a one on one meetings with us and to be able to do that, and we'll keep things in confidence. But if we don't hear from you, then we don't know what you have to offer. And that's the big takeaway, so don't be afraid to to talk to Big Brother, if you will. So it's great, Michael, we're like you guys.

Shawn Green  32:58  
Yes, sir. Thanks.

Speaker 2  32:59  
Thanks for a great session. Could you talk a little bit about the department's approach to remote patient monitoring status of telehealth development, wearables outside of the facility? And as as you're thinking about, and people are thinking about chronic management of patients and so forth. So it's a little bit of a broad question. I'm sorry, but it's a pretty broad topic. I

Christopher Parker  33:28  
can take a partial stab, then I'll turn it over to kick it for the for the CIO. So one of the contracts that we support, and, of course, the telehealth telehealth program, there's a element of telehealth as far as sharing expertise inside the VA. For patients that may be in Spokane, Washington and getting seen by someone who's in Bethesda, Maryland. Right? So so there's some of that going on, as far as you know, you know, sharing inside the VA network, and what devices long term measurements and stuff like that there's a lot of existing technology in that space. Then there's the home wearables, which is a whole new set and really a new field, I guess. But some of the weird things you said, the rings that can measure all sorts of weird things for you, right? I mean, there's there's amazing technology that's out there. They're struggling right now to try to figure out which of those devices are the right things to put out there for veterans? And do they really connect in in the same way? Are they additive to the overall ecosystem of things you're trying to monitor and measure? And so they're going through a process where the telehealth group meets periodically to try to figure out do I have the right mix of home monitoring devices? Do they all have to connect to an IoT device? Which is kind of the the model right now? Is that the right model for the future? That's a great question. I don't know. I don't I won't say one way or the other. I have an opinion yet. But but you know, that is the there are people looking at this continuously. And so the telehealth space because I refer these things all the time you probably do to get right is is the idea. There's a group of clinicians to try to figure out what's that supposed to look like? Isn't there a lot more that can be done? Yes. answers, of course, you know, because the big challenge we have with the VA is with all the legislation that's come over across the last few years about drive times and availability. What about rural health? I mean, the veteran can't always get, especially if you're talking a 90 year old World War Two that they can't get to the clinic every two weeks for this monitoring thing, this blood test, or whatever the thing is, how do you monitor them better? How do you decrease that need for in person visits? So that, you know, you can actually do an entire health check? What are all those devices? And how do they stay? interconnected? And what do you do that through? So yeah, huge challenge. I mean, so So the aperture is wide open, looking for what's that next great device? What's that next thing that will do multiple things and connect into? You know, and of course, there's always the it, how does it all connected to the bigger the Borg? You know, but but I think that's the, you know, the I would say the aperture is wide open in that space. And you probably know more about it from the ecosystem, as far as what some of the new Tech's are. Yeah,

Kristopher Teague  35:57  
we've been working on this for a number of years, it got really accelerated during COVID. And, you know, one of the areas that we really focus pretty hard on is remote temperature monitoring for diabetics with, you know, potential for foot ulcers and downstream amputations. And we found a number of different solutions, during COVID. That can help reduce that, you know, the problems that we experienced were, you know, figuring out just how many patients we have with potential issues or risks they're finding out, you're trying to figure out exactly what level of risk do we prescribe the intervention for? The other issue that we kind of dealt with was trying to figure out, what are the best care models to surround those types of solutions. Another thing was is, is the VA going to actually do the monitoring, or we're going to outsource the monitoring to the company. And that was, that was a really interesting one, and then to Chris's point, the integration piece, that data coming back, and it's it coming back into the medical record, as opposed to some standalone portal that you've got to check. And providers are just getting inundated with these one off solutions and the lack of integration into their workflow. And so those are all challenges that we've kind of faced. There, somebody's going to say, but it's not public yet. So I'm gonna say it. But there's a lot of still discovering to be had here. And we're still working through it. And you know, like Chris said, the aperture is wide open on what we're looking at. So if you've got some, please bring it to us. And I'd also say for Chris, you know, for the last five years, innovation has done a lot of good things on the front end. But we would never be able to deliver those solutions to our veterans without the acquisition partners, they have been tremendous help for us in moving these things along across the enterprise. One of the solutions that we found during COVID, is now at like 130 medical centers because of the partnership with Chris. So

Shawn Green  38:04  
just to add to that, you know, historically, M Tech is, you think in terms of priorities, and where the money's had been spent, usually always infectious disease regenitive wound healing, you're gonna see under the M Tech 2.0, since we just been renewed, you're gonna see that pie chart, radically change with a focus on healthcare it even though you're not seeing solicitations coming over the wall yet, we already anticipate forward front kind of thinking meaning to have that Chatbot. Ai, Assistant nurse that anyone on the field can deploy. So we're spending a great deal of energy thinking through these issues, and beginning to identify you. When that day happens. We hope to have a stable of thoughtful companies and players that can help us implement and help our troopers in that capacity. So important question, important area, and we plan on investing in that area. Good question. Yes. Yes, sir.

Speaker 3  39:13  
I don't think I need a microphone. Yeah. I'm Peter    Doyle. I'm the president, CEO of first precision, precision contract manufacturing company, and I'm a veteran. I wonder, just broadly, if you could talk about how you look at the art return on investment at the VA for this program, to streamline and helps you measure it with patient outcomes with agility with contractual spend, what an over what timeline do you expect in aggregate to see some of these programs

Michael Parrish  39:57  
I guess I'll take that one. So So we part of our challenges, and this is changing the game inside of VA is, is, you know, we never really understood what success look like. And so part of our lifecycle management, not just contract management is to understand the business need, understand what the problem is we're trying to solve are you all are helping us try to solve, and then understand what success looks like, and whatever measures they may be, you know, OKRs, or service level agreements, whatever it is, but something that's measurable and actionable traditional metrics, you know, one on one, but for the end of the day, it's really, are you increasing outcomes of veteran health? And are you increasing access to veterans health, you know, health care, whatever the the issue is, so it's really veteran centric, it's, I was going to close enough for a little bit later, but around the idea of human centered design and making sure that everything you do is around what I am mandating called the EI doctrine, easy to use integrated intelligent, the system, you don't, you shouldn't need a PhD or an advanced degree to figure out how to use whatever widget or tool you're you're you're offering to us, you should be integrated, it should be something that that is like consider shouldn't be a one off solution. But it should be something that can be scalable across the enterprise. And then finally, in today's day and age, it should be intelligent, you know, have some AI component in it, not AI only, but an AI enabled component that allows predictive methodologies, some advanced intelligence with it. So those, those are the measures, and it's really unit specific, but at the end of the day, how it improves access and outcomes, the veterans is really our ROI, if you will, financially, you know, coming on from the other side, you know, free is always the best thing for me, but in reality, it's, it's, you know, whatever the cost is we're we're we're, we're not driven necessarily by cost, unless it's compared to if you have a competitor of something, new new efforts, which you offer, it's really about the access outcomes of veterans.

Christopher Parker  41:42  
And we're looking at that with every program, each one's unique, you know, some are just playing cost centers, I mean, they're, it's gonna cost money to do this thing to get the veteran, you know, the veteran outcomes you're looking for. So we just tried to get that thing at the best price we possibly can so that it's balancing against the rest of the VA portfolio priorities, right. So so but in other cases, there is an ROI. So in some case, some of the innovations that come to us is in a way of buying or a way of approaching something. So when it comes to the strategic acquisition center, you know, when when when kids looking at that, that's not a question yet. Like, that's the hey, here's the whiz bang, cool thing. How do I turn that into a product line? But if by the time it comes into the programmatics, and the strategic acquisition part, now we're looking at, what's the ROI going to look like? Is it patient outcomes, funding? You know, savings, those sort of things? Acquisition times? Yeah, whole. But we determine that at that point,

Kristopher Teague  42:32  
those are the three things that we look at access outcomes, quality life, is a value based care system. That's what we're concerned about our veteran population cost, it's important to be efficient and save money. But that's, that's not our primary concern. We're not we don't have the same kind of guardrails as the commercial world. And I'm glad because our veterans deserve the best.

Michael Parrish  42:53  
We had a question over here. Hello.

Speaker 4  42:56  
My name is Suzanne. My question is about doing business companies outside the US? And is there any restrictions on where devices are manufactured?

Michael Parrish  43:06  
There are since I'm the senior accountable official for VA, you know, there's big Made in America push and especially on BP and some medical device. And so the rule is, we have to buy American and so, you know, if you're a foreign resource, it's really about do we have trade agreements, you know, a trade agreement, or BA or TA kind of effort? And I think it's really driven on can you manufacture in the US with American materials, American goods, I think the rule is 55% of the system product needs to be American made, I think it's moving up to 75 85%. So, you know, there's an idea with Congress all the time. And also another closing thought is, is around, you know, the law of unintended consequences, good ideas, but sometimes we just really can't get there today. So sort of like the chips act like we're, there's a law that's coming in place, saying that we can't have for meat chips in our laptops, and then other stuff. And it's like, that's physically impossible today, but in the future, it is, you know, we'll we'll get there. So if you're in the development stage, and then kind of consider that there is indeed limitations to, to what we're allowed to buy. So, so just

Christopher Parker  44:10  
to clarify, because it's really important to note if it kit is not manufactured in the United States right now. But if it's trade agreements at compatible, that aids and our ability to obtain it, so when you start certain dollar values, it goes from Buy American Act to Trade Agreements Act. So it does complicate it if we're drunk going looking for something from foreign sources, but we have certain authorities if it results in a better a better an outcome to still obtain it. But if you can manufacture United States that clears the path a little bit, it makes it much easier. Yep.

Michael Parrish  44:46  
That's coming next foci for no controlled interest. So we can't have the front companies that are that are you know, go back to the mothership and certain foreign countries that we will remain nameless, that are based in America that actually are you know, that dimension, I think tick tock or some of those kinds of companies.

Christopher Parker  44:59  
Yeah. But again, it kind of comes down to the trade agreements countries with countries is that that makes that a glint again clears the path a little bit. So. And if you look at the Trade Agreements Act webpage, you can see all the countries that are trade agreement and Act compliant and those that are

Shawn Green  45:14  
from a protocol type standpoint, not acquisition, less restrictive. So we've invested in European, Israeli, and so forth, radically different. We're not at that acquisition stage. So there was a question back over here. Yes, sir. Two of them in the back please.

Kristopher Teague  45:38  
specific programs focused on value based outcomes based pricing when dealing with acquisition.

Christopher Parker  45:47  
In the prescriptions world, yeah, for pharmaceuticals in particular. I'm sorry, device. Now, not that I know of now.

Speaker 5  46:03  
Hi, this is Jonathan Maniar. With Solage. We are instance sleep apnea detection company. And you have mentioned that I like the six priorities. Has outside of those if there are other things like how does that stack rank or process for

Kristopher Teague  46:22  
sleep apnea is definitely a big one. I those those six that I told you, those are like, those are VA specific priorities that we focus on. But there's other you know, issues like, you know, like I said, diabetes is a big one, sleep apnea, and a lot of our veterans have sleep apnea. It's high on the list. It's probably in the top 10. If I had to say, I mean, we're the largest, largest single purchaser of sleep apnea devices.

Christopher Parker  46:46  
And let's face it, even though there's priorities out there, yeah, you have to keep all the plates spinning. Honestly, I mean, that's the that's kind of my challenge is that, you know, I've got the priority list. And then I've got the basic business that still has to continue. And you still want to introduce innovation and better ways of buying things as you go. So So of course, when you've got the priority programs like that aren't suicide and things like that, that we're trying to get after? Yeah, we turn the needle a little bit and do a couple more industry events kind of speed up things, you know, in that space, wherever we can. But but we're still spinning the plates. Nothing is going on. Done. Yeah, that's that's the challenge. That's why the gray hair

Shawn Green  47:23  
round of applause for our distinguished, Michael, Chris.

Thank you again and again, to echo what Michael has conveyed. If you see alignment, or you have a question, please reach out whether it be the VA or our our initiative in the area of prototyping. We're all ears. What's best for our troopers. Thank you.

 

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