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Toby Cosgrove: What health systems and tech companies can teach each other

Toby Cosgrove: What health systems and tech companies can teach each other
Cadence Team

Cadence Team

30
June 2022

In this week's episode of Cadence Conversations, Chief Medical Officer Dr. Ted Feldman spoke with Dr. Toby Cosgrove, former President and CEO of Cleveland Clinic and currently an Executive Advisor to a number of startups, about how to ensure effective partnerships between health systems and technology companies.

The conversation represents the latest episode of Cadence Conversations, featuring prominent physicians, healthcare leaders, and tech entrepreneurs discussing their experiences driving innovation and progress. Previous episodes include Dr. David Shulkin, 9th Secretary, U.S. Department of Veteran Affairs discussing the future of remote patient monitoring (RPM), healthcare investor and CEO of Rubicon Founders Adam Boehler discussing how to build an impactful healthcare business, and advanced heart failure specialist and cardiologist at the Duke University Medical Center Dr. Marat Fudim discussing how RPM can transform cardiology practices.

Additionally, Cosgrove recently participated in a roundtable conversation held in Nashville about the future of remote patient monitoring, which featured a panel of additional experts including Dr. David Shulkin, David Dill, and Dr. Lynn Simon.

Over the course of the podcast, Cosgrove and Feldman focused their conversation around the major partnership opportunities between tech companies and health systems, along with the role that data plays in healthcare today. According to Cosgrove, improving the delivery and quality of care for patients will require real collaboration and partnership.

"Tech companies basically don't understand healthcare very well," Cosgrove said. "And, we in healthcare are pretty arrogant about the fact that we think we can do it all ourselves and, in fact, we are not technicians and we're not technically as capable or have the resources that can be brought to bear."

"So I think that it's going to take a real partnership between two organizations to learn each other and learn each other's capabilities and respect each other's capabilities and be willing for the tech companies to really jump in and to understand our problems and work with us. And similarly for us to embrace them and bring them in and allow them to teach us how to use all the capabilities that they have."

In terms of evaluating those partnerships and deciding which technology companies to partner with, Cosgrove shared his advice for health system executives about how to set up those relationships for success.


"I think you're going to have to take chances," Cosgrove said. "This is a whole new, great world we're dealing with. But I would be cautionary about putting all your eggs in one basket."

Cosgrove discussed two urgent issues currently facing the U.S. healthcare system that he believes technology can help address: staffing shortages and inflation. According to Cosgrove, in order to keep up with the nursing shortage, the U.S. would have to turn out 200,000 graduates every year. "Absolutely no way we're going to be able to do that with nursing," he said. "So how are we going to deal with that? And my answer to that is it's going to take a rethinking of who delivers care and the use of technology, and we're going to have to employ technology to reduce the amount of effort."

Regarding inflation, Cosgrove noted that the cost per patient in hospitals is skyrocketing, with no end in sight. That, on top of the strain that hospitals were already facing due to COVID-19, has put major stress on healthcare delivery systems across the country. "If we're going to be able to continue to deliver care, we have got to rethink how we're going to get along with fewer people and reduce the cost, and that's going to be technology," he noted.

The conversation concluded with Cosgrove's advice to anyone with medical training who is considering working for a technology startup as opposed to opting for a traditional job in healthcare right now. Cosgrove encouraged practitioners to purse these kinds of new opportunities, saying, "I think the infusion of people who do understand healthcare delivery is an advantage to those companies and those startups and they are going to bring value to the delivery of healthcare over time."


Listen above to the entire conversation and be sure to subscribe to Cadence Conversations wherever you get your podcasts in order to listen to future episodes.

Read the full transcript of the conversation below:

Table of Contents:


Introduction: Welcome to Cadence Conversations, where we're talking with prominent physicians, healthcare leaders, and tech entrepreneurs about their experiences driving innovation and progress.

This week, Ted Feldman, Chief Medical Officer at Cadence, spoke with Dr. Toby Cosgrove, former President and CEO of Cleveland Clinic and currently an executive advisor to a number of startups. They focus their conversation on partnership opportunities between big tech and health systems, along with the role that data plays in healthcare today. Dr. Cosgrove also offers some advice for anyone coming out of medical training right now. So let's get to this week's Cadence Conversation.

Ted Feldman (TF): Thank you, Dr. Cosgrove, for joining us today. I'm excited to discuss the major changes that are taking place across the U.S. healthcare system and how you see new technology companies like Cadence fitting into the future. First off, can you tell us what's been keeping you busy these last several years since you stepped down from over a decade plus of being president and CEO of the Cleveland Clinic?

Toby Cosgrove (TG): Well, thank you very much. It's a pleasure to be here. I spent two years working for Google, because I thought that I could begin to use the technology that Google has to begin to understand and utilize the data that is generated by healthcare. And since that time, I'm on three public boards and an adviser and on boards of a number of startups in healthcare, particularly around the use of technology in healthcare.

Partnerships Between Tech Companies and Health Systems

TF: So for partnerships between technology companies and large health systems, how do you see that going forward? I mean, it seems to me that large healthcare systems recognize they need to embrace technology, and yet technology companies need to get engaged with healthcare systems. But it seems like there's a potential source of friction in terms of how we interact and how we partner.

TC: I believe the future is being able to use the data that is generated in vast amounts in healthcare to improve the delivery and the actual quality of the care and the convenience for the patient. And I think that there are two groups involved that don't know each other very well.

The first is clearly the tech companies basically don't understand healthcare very well. And we in healthcare are pretty arrogant about the fact that we think we can do it all ourselves and, in fact, we are not technicians and we're not technically as capable or have the resources that can be brought to bear.

So I think that it's going to take a real partnership between two organizations to learn each other and learn each other's capabilities and respect each other's capabilities and be willing for the tech companies to really jump in and to understand our problems and work with us. And similarly for us to embrace them and bring them in and allow them to teach us how to use all the capabilities that they have.

TF: So when you were leading the clinic as CEO and new technology companies or partnership opportunities would obviously filter up, how do healthcare systems evaluate these opportunities?

TC: Well, I'm not sure we know how to do this very well yet, and we're learning. But I think we have, like everything we use, whether it's an antibiotic or whether it's an instrument in the operating room, we evaluate a whole lot of different opportunities and try and pick the one that works the best for us. And I don't think that for a second that the healthcare system or any one company can provide all the technology which we need.

You stop and think about whether it's a heart valve that you buy from one company and a different type of heart valve for a different purpose from another. You try to look at the technology as it comes along and evaluate it one at a time and look at a whole slew of things and pick them up. I don't think there's an easy way to do that. It takes a lot of work to evaluate these things. We're going to make some mistakes, pick the wrong ones, but no one company's going to be able to do all this.

TF: It's interesting that you say that because for years and years, we, and certainly in the cardiac surgical space or in the cardiovascular space, have had lots of opportunities to have vendor/vendee relationships with people and evaluate whether it was one pacemaker company over another that had the best product. And it seems as if the health systems now are looking more for partnership opportunities with digital health companies rather than simply vendor/vendee relationships.

How Hospital Leadership Can Evaluate Digital Partnership Opportunities

TF: What type of advice would you give to the hospital leadership about what might be the best type of relationship and how one would embark on taking on these big opportunities with digital health companies?

TC: Well, I think a lot of them have looked for equity as part of the deal that they do, and I think that has been successful sometimes and not successful in others. By committing yourself to equity, you are playing with one company and the effort that you put into it is going to be reflected in the value of the company, and potentially it will be a great value and potentially it'll be a failure. But I think you're going to have to take chances. This is a whole new, great world we're dealing with. But I would be cautionary about putting all your eggs in one basket.

TF: Do you think that the partnership opportunity sort of passes the muster of all of the conflicts we have in terms of disclosures and how we set up? Because it certainly seems as if more and more companies are looking for these partnership opportunities where they can work both the technology and innovation team at the clinic.

But are you comfortable with the partnership opportunities that exist with health systems? Or would you prefer from where you sat as the CEO to keep them as vendor/vendee relationships?

TC: Well, I think one of the things that they want is basically the data, and the data does have value. But I think that takes us in a whole different direction. There is a vast amount of data in healthcare now. The total amount of data is being doubled every 60, 70 days now, and vast amounts of information and healthcare. And from that, you can use your AI and your developed algorithms that will begin to be helpful for us. But our value is in the data.

Now, the interesting issue is who's going to share the data? And the insurance companies have the data, the companies have data, the hospitals have data, and at this point, no one's willing to share it and we are dealing with a very difficult understanding of who owns the data and whether the patient owns it, the company owns it, the hospital owns it. And the HIPAA relationships, these are yet undefined areas that I think once we understand and appreciate the fact that by sharing the data, it's the best thing for the patient, we'll be able to get to a clear understanding of who owns the data and how it can be profitably and shared back and forth.

Methods for Evaluating the Impact of RPM 

TF: So when you look at existing data about RPM thus far, it's sort of mixed. There are no randomized trials that show benefit, but there are lots of individual trials that show we can use remote patient monitoring to clearly improve patient care. What data points personally are you following most closely as it relates to how you best evaluate whether this technology is ultimately impacting on improvement in care? Whether it be a better outcome, a lower economic cost for the same outcome, or preferably a better outcome at a lower cost or cost?

TC: I think it totally depends upon who you are talking to. If, in fact, you're talking to a physician, they're looking for better clinical outcomes. And if you were looking at an administrator or hospital leader, they're looking at the financial savings and the financial implications of it.

So it is really important, I think, that you are going to approach both of those. Clearly without improvement in patient care, nobody's interested. But it's clear you've got to have both the improvement in patient care and you have to have the financial aspects of it make sense.

TF: And certainly we've all in the clinical space have used the randomized clinical trial as the gold standard for evaluating one drug or one therapy over another. But when you come to implementation science, it's hard to do randomized clinical trials. And really oftentimes what you do is you stand up a program, you look at its efficacy and you use sort of controls from historical path to say, "Are we making improvements?"

Using Real-World Data to Evaluate RPM

TF: How do you look at the types of trials that we can do in the implementation science of using RPM for chronic diseases to improve outcomes with heart failure, hypertension, diabetes? Versus a lot of our academic folks say, "Well, there's never been a randomized clinical trial that shows that RPM improves healthcare."

TC: Yeah. And I think the big step forward was taken by the NIH when they began to look at the fact that you could use that real world data. And so we're not going to be doing randomized prospective trials in a lot of things. We're going to be doing, looking at the data and analyzing in real-time. And I think that the potential for collecting this data and analyzing it is going to be self-evident where the opportunities and where the advantages, where the results from this.

And so the main thing is to collect the data, analyze it well and see where it takes us. But we're not going to be doing randomized prospective trials. I think we have limited ourselves in the past by doing that sort of and depending upon that and saying that was the only academic standard. And clearly the national FDA has realized that there are other ways to do this and I think they're setting the pace.

The Role of Digital Healthcare Technology in Practicing Medicine

TF: So I want to turn and ask you more broadly as someone who's been a mentor to many trainees through the years, what type of advice would you give to people coming out of medical training now in terms of entering digital healthcare technology as an alternative to the day-to-day practice of clinical medicine?

TC: Well, I think, as I said at the beginning of our discussion, that the tech companies really do not understand healthcare very well. And I think the infusion of people who do understand healthcare delivery is an advantage to those companies and those startups and they are going to bring value to the delivery of healthcare over time.

Just to give you a brief example of that: Recently it was published that in order to keep up with the nursing shortage, and we only have three million in the United States, we're going to have to turn out 200,000 graduates a year. Absolutely no way we're going to be able to do that with nursing. So we're going to continue to have a nursing shortage, and that shortage continues across all aspects of healthcare.

So how are we going to deal with that? And my answer to that is it's going to take a rethinking of who delivers care and the use of technology, and we're going to have to employ technology to reduce the amount of effort.

The second issue that we're going to deal with, and it is really a crisis at this point, is inflation. And what's happened in the last couple years is the cost per patient in the hospital for goods has gone up 19%. For labor, it's gone up 21%. And for drugs, it's gone up 35%. And when you stop and think about hospitals, for example, they now are running at about a 2% margin and 20% of the hospitals in the United States were running in the red when COVID started, before the pandemic, and the pandemic's only made it worse. And inflation is going to put major stress on healthcare delivery systems across the country. And so if we're going to be able to continue to deliver care, we have got to rethink how we're going to get along with fewer people and reduce the cost, and that's going to be technology.

Now, 60% of the cost of a hospital is people, and we don't have them. So we've got to depend upon technology to begin to figure out how we do it in a more efficient, better way and less costly. This is a burning issue right now, and it's going to depend upon people finding us new solutions to delivering better care.

A Futurist's Outlook on Healthcare

TF: So I want to just close by putting on your futurist hat, if you don't mind. So if we were looking five to 10 years ahead, what would be your biggest moonshot about what gets you most excited in healthcare?

TC: Well, I would say that there's a couple things, and I would take the example of what's happened in cardiac. And in cardiac, we wound up ... By imaging the heart and understanding the structural and physiologic working of the heart, we were able to improve the quality of care fantastically. And I think that neuro is in the same situation right now with a potential, with functional MRIs so we'll be able to understand the function of the brain.

And if you look at the two things that are weighing heavily on the economy and healthcare, it's autism on one end of the spectrum, and it's Alzheimer's on the other end of the spectrum. And I think that there's an opportunity now to begin to understand the functioning of the brain in the next 50 years that will be astounding in the things we're going to be able to do.

The second technology that I would bet on is the use of data and machine learning to begin to analyze that data. And I think we're just touching the beginning of it right now. I think we'll find it as diagnostic. It is predictive, and in many cases, it'll drive our therapies in major ways. But this is going to be a very exciting road for the future, and I think it is going to take partnerships between companies and healthcare providers in order to achieve that sort of potential.

TF: Well, this was incredible, and thank you so much for this great conversation, Dr. Cosgrove, and for spending time with us today. We really appreciate it.

Thanks again to Dr. Cosgrove for chatting with Ted this week. To make sure you get updates on our future conversations, please subscribe to Cadence Conversations wherever you listen to podcasts. And for more information about Cadence and how to get involved, visit Cadence.care.

At Cadence, we believe that everyone deserves to receive the best care possible and we won't stop working until that vision becomes reality.

Author bio

Cadence Team
Cadence Team
Cadence is a pioneering health technology company helping the nation’s most patient-centric health systems deliver world-class care outside of the four walls of the hospital. Cadence’s Care in Sync™ platform couples powerful new technology with clinical excellence, providing its patients a precise and personal level of care through remote patient monitoring and virtual care.