Podcast #90: Digital (Finally) Meets Health

Good day, this is Ken Forster, Executive Director of Momenta Partners & Ventures, with another edition of our Digital Leadership Podcast. Today it’s my great pleasure to welcome Dr. Kal Patel, CEO of BrightInsight, a company fusing digital and health with the leading regulated IoT platform, for biopharma and medtech.

Before joining BrightInsight, Kal was Chief Commercial Officer for Doctor on Demand, founded and led Amgen’s Digital Health Business Unit, and was also the Global Marketing Lead for Amgen’s Enbrel. He also held various commercial leadership roles at Novartis, was a Principal with the Boston Consulting Group, and also served as Senior Adviser in Digital Health to them as well.

Welcome Kal, it’s great to have you on the Momenta Partners podcast.

Great to be here Ken, appreciate the invite.

Absolutely. Tell me a bit about your professional journey, and how it has informed your views of digital industry.

Yes, it’s a good place to start Ken. I think I’ve had a very interesting professional journey, because I started out studying economics, and went into management consulting in Boston Consulting Group for a couple of years. Then did something that very few folks at the time were doing, I went to Medical School and ended up doing an MD-MBA, then went back to consulting for a number of years, before moving over to the pharma industry where I was at Novartis, as you mentioned, for several years. Then for quite a few years at the major biopharma Amgen.

The interesting thing for me from a technology perspective, before shifting into digital health, has been the fact that I’ve always been a user of technology, both as a consumer and as an enterprise user, and for those first two decades of my career I was never really a builder of digital technologies. That really informs my experience on what it takes for something to really be successful, for it to be adopted to really deliver the promise for those end users. I tried to really bring that to bear as I shifted over to the technology side, both at Amgen, at Doctor on Demand, and now at BrightInsight.

Let’s talk a bit about your formal medical education. I like practitioners if you will, and so to go from consulting to taking a formal medical education, and then back into consulting, what inspired you to make that move, and to make the move back?

You know I always had this desire to want to be in medicine, and I would spend all my summers in college working in a basic science lab and doing medical-oriented research. I applied to Medical School, deferred my admissions to go work at Boston Consulting Group, and what was interesting in my decision at the time was I saw BCG as kind of an opportunity to get real world experience, before jumping into Medical School, and to take my economics education, learn it and apply it in the real world.

When I got to BCG what really struck me was the ability to have impact at scale, and I really enjoyed that to say how do we advise executives at companies to make decisions, that will help them and be more successful, hence the beneficiaries of their products really be at scale. So, that’s what really inspired me at BCG around wanting to focus on the business side as more of a career. When I was wrapping up, I had the option to just go to Business School and come back to consulting, or to take upon the opportunity I had to go to Medical School and decided to do that. That was really an amazing privilege, to be able to serve people when they are at such a vulnerable position is really a special opportunity, and I felt that was one that I didn’t want to pass up, that it would really shape how I pursued my business career in healthcare.

So I did that, and I sort of laugh with my friends in college from Medical School, I had the best experience of anybody in Medical School because I was so focused on the long game, and had the luxury of not being caught out by the pending exam, or the pending deliverables that we had to get done. It was really an amazing experience to be able to bring that kind of frontline learning, and then be able to bring that back to the business side.

To specifically answer your question on what brought me back, it was again that desire to do it at scale. I had my experience at Medical School, again it was amazing that you’re serving patients, one patient at a time, and in business and technology you get to really serve people, and obviously massive magnitudes compared to the one-to-one relationship.

I noted at BCG after Medical School you really sat at the boundary of business strategy, and corporate development. What were some of the early trends you saw in digital healthcare at the time?

It’s interesting to reflect back on that, because at the time I think we weren’t even really talking about this kind of digital technology with our healthcare clients, and frankly they weren’t really talking about it either. There are so many things I reflect back on, one was this massive uneven adoption of technology, within companies that are literally spending billions of dollars pursuing the unknown, from a core science and medical perspective. Yet, they were very hesitant and very slow at adopting technologies that were getting proven out in many other industries. So that really struck me as the dichotomy of being at the forefront of innovation on certain parts of their business, and very risk averse or slow on other parts.

The second thing I would say is, there was a real desire, especially when you moved away from the big companies and started seeing what the smaller ones, and the start-ups would be getting to do when they started recognizing the potential power of what we now call digital health. What I noted was, early-on folks really focused on how do we stay out of the regulated world? There was this notion of, ‘Hey, I’m doing digital health, but I’ve found a way to build a product, or a business that’s going to keep me away from FDA, or keep me away from other types of regulations, or EMA’, in the case of Europe etc.

I think although that allowed for some innovations to obviously move faster, I think much of that really missed the bar in terms of how to drive the most impact from digital health. I think we’re finally beginning to see digital health now focus on leveraging, and really embracing the power of what you can do within the regulated area of healthcare.

And as we’re recording this of course we’re somewhere between week 6 and week 8 of the lockdown, due to the COVID pandemic. So, this whole idea of acceleration of medical scientists and technologies to meet this pandemic is certainly relevant to this, and we’ll talk about that in a few minutes. But I think it’s interesting this idea that on the regulated side, that digital wasn’t moving as quickly in that space, all the way down to health records, is usually what you hear about quite a bit in the US, is the commonization and sharing of those.

I saw you started formally using the term ‘digital health’ in 2013 as the Founder and Head of Amgen’s Digital Health business. What was the specific offering at the time, and what made it truly digital?

Our focus there was, how do we leverage technology to improve the real-world performance of our drugs. What really inspired me to want to do that and focus on that is, as I looked at what pharma and medtech could be doing with technology, it became really obvious to me that technology had changed virtually every aspect of our lives; if you think about how we bank, how we figure out directions, how we communicate, technology literally had changed virtually every aspect of our lives. But it had largely in my opinion anyway, skipped over healthcare, education, and government. It’s hard to find three more important areas of all our lives as global citizens, than healthcare, education, and government. What I saw was there was a lot of value that proven technologies could bring to healthcare, and so at Amgen being one of the first really dedicated units in a big pharma, medtech and we focus on digital, we set a focus to say, how can we leverage technology to improve the real-world performance of our drugs.

What that meant were things like improving identification of patients that were appropriate for our therapies, or improving adherence to our therapy, so for patients already using our therapies by helping them be adherent to the right regiment or protocol of taking the medication. So what we did were things that solved those types of problems as specific examples, one of the things we did was we put Bluetooth into whatever our main drug delivery device is for one of our main drugs, and at this time it’s still pretty early, there’s a lot of companies beginning to do this now, but at the time this program was very early, and I think ultimately led to the second-ever what the FDA calls a connected culmination product, so drug, plus drug delivery device, plus IoT platform, algorithm, app, all as a regulated medical product. So, the second one of those Amgen actually got approved by FDA.

Other things we were doing is we we’re building algorithms, some extremely simple, some very complex, but the purpose was how we build these, commercialize them again through regulatory bodies, and then embed them into electronic medical records, and to patient registries, into medical devices, with the purpose of finding patients that were undiagnosed, misdiagnosed, or under-treated where Amgen had a leading drug position. It was the early days of what I call regulated digital health, but where I think there’s just a tremendous amount of value by finding these opportunities of care optimization, and being able to close those gaps and really improve clinical outcomes, which then leads obviously to raw cost savings, as well as often a much better experience for patients and practitioners.

I’d noted going from Amgen, and perhaps it falls under this idea of impact at scale that you served as Chief Commercial Officer, at Doctor on Demand. Tell me a little bit about what inspired you to make that move, and what were some of your key learnings during your time there.

It was a personal decision and to your point, impact at scale. I recall my wife sat me down as I was preparing to leave Amgen, and she said, ‘Look, you always tell everybody you had the best job at Amgen, so what problem are you trying to solve?’ and I said to her, ‘You’re right, I do have the best job at Amgen, Amgen have been nothing but great to me’, it was a great opportunity to learn and have great impact, but I told her I felt like we were steering a big ship that had a focus on drug innovation, and I really wanted to be at the equivalent of trying to build an Amazon in the early days of the dot-com revolution. So, I finally felt like digital health was hitting this point of inflection, and I wanted to be at the forefront of that, really trying to shape, drive and deliver that. It really became to a degree a personal motivator for me to be in that environment, and so that’s what took me to therein joining Doctor on Demand, which for some of your listeners that are outside the US and may not be as familiar with it, it’s one of the United States largest tele medicine/video medicine providers.

It’s still at that point where we’re that much early in the journey of being a startup. It was an amazing learning experience, and so first of all I would say the startup environment is like dog years, so I feel like I learn 7 years’ worth of output and learning within startups because you’re just doing so much, and you’re doing it all so fast that you don’t really have the luxury of a necessary debate, or alignment, you’re really making decisions and executing at a rapid pace. That was an amazing experience, but from a medical perspective what was really interesting to me, and I learned the hard way as I really dug in, was how hard it is to drive behavior change.

We at Doctor on Demand had an experience, we had a product that our users absolutely loved, our ratings in the app store for IOS and android were 4.9 out of 5. Our net promoters scores were in line with how much people love their iPhone or their Amazon services, so people loved our experience, yet it was really hard to get folks to change behaviors. So they would use our services for let’s say the flu, and then that same user wouldn’t think about us for another medical issue they had that we would be perfectly suitable for, because I think as humans we’re so wired to be habitual, we form these habits and we literally don’t think, we just do. So, to get folks to change behaviors even with an experience they loved was extremely hard.

So now when we think about healthcare, you think about the behavior changes that are not so fun and enjoyable, for example eating healthier, exercising more, losing weight etc., just having a whole new appreciation for the kind of support and challenge that is to drive those kinds of behavior changes.

Behavior change can be driven by positives, and as you say sometimes negative things, certainly again the current events going on now could be an accelerator for just such digital health innovation, which again we’ll talk about in a few minutes. So, you went from Doctor on Demand to Flex, a company that’s well-known in the Bay area, and quite well thought of as well. What led you to go to Flex, and also tell me a little bit about the work you did there that ultimately ended up in BrightInsight.

So Flex, very innovative leadership that sits across many initiatives. Flex is the largest manufacturer of regulated in medical devices in the world, they have a lot of other industries where they generate a billion dollars or more revenue. So, there’s this massive company that’s seen innovation in all these various industries, and they were seeing what digital was doing to many other business segments, and they saw that it was going to come to healthcare and to pharma and medtech who Flex specifically serves. So they were really looking for somebody who could help them think through what are the opportunities as digital come to pharma and medtech, and given my background, having worked in major pharma companies, having done the entrepreneurial side was a nice fit to help them think through that, and to execute around opportunities. For me, the attraction in the pitch was, ‘Essentially, you’ll be an entrepreneur within our company. We’re going to stay out of your way, and let you innovate the way you’re used to innovating as a start-up, but we’ll also give you the resources and support that you need’.

It was a really good match, and came in and looked across what was happening, Flex is the best customer base across pharma and medtech, and I saw that digital was finally moving from something that was really a lesser priority to one that was quickly moving up to becoming a C-level priority, and even on board level discussion. As folks were elevating the opportunity set for digital within pharma and medtech, so companies were really starting to now explore building regulated digital health products, rates of funding really taking pharma and medtech products and digitizing them, or digitizing around them, and they were going to have the same challenges that we experience and solved at Amgen. Some of those challenges really should not be solved at the level of individual companies, but should really be solved by a company that can really play that path where infrastructure play in. That’s the opportunity we focused in on, and ultimately led to what we now call BrightInsight.

BrightInsight is a Flex company, and we’ve talked a little bit about how that’s worked in terms of the setup of this and everything else. But what really drove your thesis about building BrightInsight, especially thinking about an IoT platform for biopharma and medtech? My background of course, ThingWorx, PLAT.ONE a company that we invested in, SAP acquired, so we know the IoT platform space. What makes BrightInsight unique and differentiated in that, in terms of the clients as well?

Great question. The only reason BrightInsight exists as an IoT company is because we solve the very specific and important problems of moving data from the edge, from the patient, or from the user, or the device, to the cloud and back in the context of healthcare. So, when you’re in regulated healthcare there is a set of requirements that are very important from data privacy and security, as well as from a regulatory and quality perspective that you have to meet. When I was at Amgen we built that connected combination product that I was talking about, connected delivery device; we ended up spending more time, money, and effort on figuring out the IoT piece than we did on putting Bluetooth into our injector pen and building the user app. So, there was really that plumbing, that infrastructure that’s extremely complex because of the requirements of regulated healthcare, that it becomes really a high mountain to climb to be able to do this kind of innovation.

What we said is, each company shouldn’t be building, trying to home-grow this, and literally spending many-many tens of millions of dollars to build a sub-par home grown IoT platform, and then many tens of million dollars to maintain, run, and expand that platform globally. So, what we said is we should be solving that problem and be really focused and really-really good at doing that, and then let other companies, pharma and medtech use our infrastructure to build their innovation on top. So, what we did is, we first put in place a robust quality management system, one that is very important when you think about regulated healthcare, so the ones that are defined by the FDA, defined by EMX etc.

We put in a quality management system that governs all the way up to the highest level of risk from a regulatory perspective. So, in the FDA that’s called Class 3 combination product intended use, so very high-risk use cases of the data. So we built our infrastructure under that QMS, we sort of say internally from our culture, everything we do at BrightInsight is under that QMS, every single piece of code we write is governed by that, and what we do in terms of designing the code, doing the code, documenting, doing the unit level testing, doing the traceability, doing the verification validation, creating what’s called the design history file. Everything is done under this QMS, which fundamentally lets us be a part of the medical product that our customers are building.

Hence, we take on that burden of doing this part of the end solution on their behalf, so they can then use our infrastructure really as plug and play to build their innovation on top of this infrastructure, and we’re doing this at a global level. So, we have built it and launched the platform, gone through the requirements from a US perspective, from a European Union perspective, and now we’re on the next wave of countries that we’re close to being live in, which will be places like Japan, Canada, and Australia. We’ll continue to expand across the globe providing on a turnkey level the IoT infrastructure, but infrastructure that’s compliant at each region or country’s requirements from a privacy, security, regulatory and quality perspective.

You know, it’s funny, we do a lot of work in Digital Industry, and so we think about the health of machines, predicting if there’s a failure of rotating equipment. It’s been arguably easier to determine the health of machines than people, and yet we seem to have all of the sensing systems in place, and as you say behavior change is moving in that direction. What do you think has held back the adoption of true digital health in that regard?

That’s a great question. The first thing I’ll say, the shortfall hasn’t been the technology, and that’s again coming back to your point around why I focused on technology, to Doctor on Demand, it was so obvious to me that of course underlying technology will continue to improve, but that wasn’t the reason why we don’t have adoption of that in healthcare. I think there’s a few key reasons that had held it back, the first sadly is lack of align incentives, certainly it’s a little bit different in each country, but there aren’t the incentives for the patient and the provider to drive adoption of this kind of technology. When I say incentives, I mean financial incentive, in fact oftentimes they’re disincentivized to spend the time and effort to understand, adopt, and deploy these types of technologies.

The second has been the privacy concern, so understandably it’s one thing to have the data of a GE jet engine being real-time stream, to a monitoring center to manage performance and intervene. It’s another thing to have your clinical data be streaming to a backend, and have those natural privacy concerns, and so I think those have been two of the main reasons that it’s been held back, and certainly we really try to make a big difference in the privacy side with what we do at BrightInsight. But I think the incentive side, there’s progress for sure that’s happening with concepts like value-based care, but there’s still a way to go in terms of aligning incentives, so that both users of the technology, i.e. patients, consumers, as well as the folk paying the bills are aligned to adopt these.

Actually, similar to what has held back the digitization of other industries as well, privacy could be interchangeable with data security in some sense, and those concerns. Especially talking about the cloud, and businesses that are used to having everything on premise, and so I suspect there’s some common patterns there as well. I know we’ve hinted about it a couple of times during the discussion but what do you think the impact will be of the current COVID-19 crisis on digital health adoption, across both on the consumer side certainly, on the healthcare and business side as well?

We’re all hoping that this virus and its impact both from a clinical perspective, and obviously people’s mental and broader livelihood perspective comes under control and passes soon. I hope the learnings that were forced upon us through this experience are ones that as a society, and as governments, and large employers’ step back and reflect on, and really make some changes around it, and I think there’s several layers of that.

So, first what we’re seeing is that folks that had never tried or adopted digital health, as well as other technologies, are rapidly experiencing and adopting that. So, things like doing tele-visits with your physician or provider, versus going in person, and I’m talking folks I know both in the business and in my personal life, they’re saying, ‘Gosh, I don’t see why I need to go back to see my doctor in person, or at least not as many visits. I can do, the majority of them at a tele perspective.’ So, I think we’ll get people to have experience and adopt it, which is usually the first part of behavior change, and hopefully people will have the kind of experience that they want to keep using, these types of solutions. What we need to hope for is that the economic incentives that have held back some of these adoptions, that have either been addressed in a temporary basis, or now on a permanent basis, so for example you can get reimbursed as a provider to do tele-visits, just as well as you would for an in-person visit, that those types of changes will hopefully will come.

The second big piece is, there’s a growing recognition I think at all levels of digital health, particularly around things like remote diagnostic monitoring, being able to see how somebody is doing from the comfort of their homes, versus having to have them come into clinic. From things like wearables, things like putting in how they’re feeling etc., can really be game-changing in the context of a pandemic, but could also yield tremendous efficiency and improvement in how we monitor our health, and how the health system works. So, again hopefully we will continue to keep adapting and using the type of digital solutions that go beyond the tele-visit, as we continue hopefully going back to otherwise a normal life.

Then the third piece, which I haven’t heard as much about, but I really hope to realize is the gaps that we have, not just in our healthcare infrastructure, but in our digital health infrastructure. In the US for example there’s a lot of talk, there’s been talk actually going for a years, if not a decade or more around the massive infrastructure investment that the US needs in fixing our roads and bridges, and airports, and so-forth. That’s also needed in our core technology infrastructure, in our broadband, in fiber optics etc. The same thing is needed on the digital health side, if we’re going to really have robust digital health offerings, not just in times of crises but also for the improvements of general health, the level of our governments who when you think about what’s the infrastructure that we’re investing in, how do we ensure as you mentioned things like cyber security? How do you ensure the ability for critical data to come in at a real-time? How do you ensure the privacy requirements are clear, and can be met and monitored?

So, there’s a real opportunity I think at the level of individuals, to systems, to governments, to step back and say digital health kind of helped us through this crisis, but how do we now get ahead of it, so that digital health can fundamentally change the trajectory the next time something like this comes along?

Earlier you mentioned that digitization effectively had been unevenly employed, you mentioned healthcare, education, and government just a moment ago, have largely been skipped over from a digital perspective; what’s your predictions on when you think these industries will truly be digitized?

I think before COVID I would have said it’s going to be in the sort of 5 to 10-year timeframe where we’re going to start really living in a world where we’re thinking digital first, when it comes to healthcare. Just based on what I’m seeing at the front lines of innovation, both within biopharma, medtech, but also at the level of startups, the level of what’s going on in hospitals, and the care delivery side. But just coming back to my previous comment, I think with the COVID-19 crisis I would bet that that’s going to drive some real acceleration, and so instead of 5 to 10, my prediction, and it’s just that, a prediction, would be I think in the next 3 to 7 years we’re going to see innovation come out and scale in a way that will be very meaningful to changing the lives of many patients.

It won’t be for everybody at once, but I think you will see it at the level of certain aspects of your healthcare, meaning tele-visits versus in person, or the level of disease areas, being as a diabetes patient for example, they might become much more of a digital-based support system/healthcare system than maybe other disease areas that will trail. So, I think we’re living in a world where that tipping point was coming, and was accelerating, and I think the crisis my guess is, will really put more fuel behind the speed of that innovation, and that adoption.

Excellent. So, we always like to finish up these discussions with a discussion of any recommended books or resources that inspire you, to share with our audience.

Yeah, maybe I’ll share one on the personal side, and one on the professional side. Personal side, there’s a book that I read a long time ago, I think it was written 20 years ago or more, that just always leaves me grounded every time I reflect back on it, and it’s called, ‘A Fine Balance’, by Rohinton Mistry. It takes you through the lives of Indians at the time of Indira Gandhi, as she was coming to power as leading in India. It just strikes you around how much on the one hand influence and control that people have of their lives, and at the same time how little we all have. And again I think sadly COVID is an example of that, that in the blink of an eye governments, institutions, and individuals went from feeling that they had an immense amount of control over their day-to-day lives, to recognizing how little they actually can have in certain circumstances, and, ‘A Fine Balance’ I think is one of those timeless books for me, that gives me pause for good reflection and conversation.

I think on the professional side, a book that I reflect back on a lot, and often give to folks that I promote into management roles is one written by Marshall Goldsmith called, ‘What Got You Here Won’t Get You There’. This is one of those things that I’ve seen when I was at BCG from a healthcare perspective, from a pharma perspective, and then a startup perspective, this common theme across folks and their careers, which is that people who are really good at their job are the ones that get promoted to management.

The common mistake that I’ve seen folks make over and over when they become managers is, they continue to rely on the same technical skills that got them to that job, or that helped them to really excel as individual contributors. They rely on that skill to try to be great managers. Fundamentally it’s just a very different skill to be a great manager, than it is to be great at a technical level, and you really need to pause and realize that those great technical skills are not what is going to make you a great manager, but there’s fundamentally a  different set of skills you need to focus on building that’s going to make you a great manager.

I think it’s an inflection point in people’s careers, there’s people who are stars that really see a fundamental change in the trajectory of their career in the direction they didn’t want, when they get promoted to manager. There’s others who actually are pretty good, maybe not even stars on the technical side, but really take off when they hit that management level, and I think this book does a great job of capturing what you need to focus on and learn, to really be a great manager and continue to evolve as a manager in your career.

Two great suggestions, especially, ‘What Got You Here Won’t Get You There’, it’s been a favorite of mine as well.

It’s been my great pleasure to interview Dr. Kal Patel, CEO of BrightInsight, and if I may, practitioner of impact at scale, because I think it clearly describes both your digital journey, and the difference that you’re making as part of BrightInsight now. It’s been a real pleasure Kal, thank you so much for taking the time.

Ken thank you, best of luck in these coming weeks, and I look forward to connecting in the future.

Absolutely, great. Thank you very much.

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