Deep Dive into AI & FinTech with Nuno Sebastiao, CEO, Feedzai

By Patricia Kemp, General Partner, Oak HC/FT

What role does artificial intelligence (AI) play in Feedzai’s business?

Despite the fact that AI has been around for 50 years, our customers continually tell us that they need AI, but that it is too hard or expensive to wire on and takes too long to start working.

But, we at Feedzai, know AI. AI is our business, in fact, it is in our name. We use this technology to help make sense of commerce omni-data to identify trends and patterns that help predict – in real time – whether a transaction is good or bad, fraudulent or not. With AI, we have creating the world’s most robust risk management platforms, that solve our customers’ most challenging problems.

How do you see AI affecting the financial services industry in the short term?

We’re witnessing AI, this “cognitive revolution,” sweep through every sector, and taking financial services by storm. What is happening at Money20/20 this year with AI Deep Dive is indicative of the effects of AI and the potential it provides for companies across financial services to modernize and create remarkable customer experiences.

Let’s put it this way. Every one of the AI Deep Dive speakers – from the “bare-metal” leaders at Stripe, Square, Intel, Amazon, HSBC, and others, as well as technology visionaries like Steve Wozniak, Ray Kurzweil and Dr. Michio Kaku – are presenting on how important AI is in financial services now. This shows how critically important it is to be strategizing towards AI now, for your business to be effective in the years to come.

And in the long term? Do you think there are any areas of banking or financial services that can be completely replaced with AI?

Rather than thinking in terms of “AI replacing humans,” we think of AI as an important tool to augment humans and make their work more powerful and intelligent. Machine learning systems being built now are only an intermediary step. Our vision is to evolve machine learning to something we call Machine Teaching – where the insights gained by the machines are not locked away in a “blackbox” but instead begin to explain and show human operators what is happening underneath, to demystify the machine logic.

At Feedzai, we do this by making machine models that do their core job — managing risk for banks and merchants — and we have secondary models that explain and teach us what the machine model is doing. Machines actually teaching people, now that’s a breakthrough!

What are your plans for Money20/20 this year?

We’ve been big supporters of all the Money20/20 events because, as the name implies, it brings together people who can see clearly “what’s next.” Feedzai was one of the first to sign up as Money20/20 expanded to Copenhagen, then Singapore, and we’ll be one of the first supporters as they move into China. But this year, we have an additional and unique focus.

We are proud to be the first of its kind partner to Money20/20 by creating an “event within an event” with the AI Deep Dive. We will serve as hosts of the event, empowering the content and conversation driven around the topic at an event with so many important leaders. We like to call it “the Davos of AI.”

Aside from the AI Deep Dive Track, which panel discussion or Money20/20 event are you most excited to attend?

The Startup Pitches and Hackathon are important for us, the next disruptors will come from here so we stay close to these events. I think Max Levchin’s talk on Reinventing Credit will be enlightening as he’s always been at the unique intersection of technology and money. Thorsten Wölfe’s Emotional E-Commerce panel is another good one, another example of the knock-on effects from rewiring of the payments ecosystem. Also inspiring is Ezequiel Szafir of Santander’s How a 20-Year-Old Bank Was Reborn promises to reveal how their use of machine learning and artificial intelligence enabled them to deliver an entirely cloud-based bank.

What do you think of your caricature this year? Who has the best caricature that you have seen?

I love the caricatures, it is such a uniquely Money20/20 thing. The caricature version of me keeps looking younger and younger, although I feel like I’ve lived a dozen lives in only the last 12 months. My favorite caricature is of course Steve Wozniak, it looks just like him!


In Conversation with Brad Smith, CEO of Aspire

By Annie Lamont, Managing Partner, Oak HC/FT 

What is Aspire?

Aspire is the nation’s largest home-based provider of care to patients facing a serious and life-limiting illness. We employ interdisciplinary teams of palliative care physicians, nurse practitioners, nurses, social workers, and chaplains who use our data-driven and technology-enabled workflows to provide 24/7 care to our patients and their families. Today, we are working with patients in 23 states across the country.


Why palliative care? How did you first recognize a need or opportunity to focus on that area of healthcare?

I was introduced to palliative care by my brother, who was studying to be a physician at Harvard. He had decided to take a year off to work with Atul Guwande and Susan Block, who was the leading palliative care physician at Dana Farber. We were home for Christmas and my brother was sharing articles about his work. I became fascinated by the research, which focused on the health implications of palliative care.

The studies demonstrated consistently high patient and family satisfaction; rates of hospitalization coming down by about 50% in the last year of life; and costs coming down by 20 to 25% for patients. I thought, “Wow, this works so well, why is it not happening everywhere?”

About six months later, my grandmother became sick and ended up going into the hospital unfortunately without the benefits of ever receiving hospice care. It was a very challenging and personal experience, and I decided there had to be a better way.


How are you leveraging data analytics and IT within your business?

Data is an important part of our operations and we use it in two main ways. First, we use it to identify patients. We work with our partner health plans to collect information from claims and clinical records, and then we project how likely patients are to pass away and have high spend in the coming months.

The second way we use data is after patients are enrolled on Aspire’s service, where we use data to help support our clinicians’ decision-making and ensuring patients get the right resources they need at the right times.

In palliative care, no two patients are the same, so there’s never a definitive right answer. For individual patients, it is more about presenting them with a set of options that they might want to consider.


In serving patients across the United States, what are some notable differences you’ve seen in the way you manage the business or work with stakeholders?

When we started the company, we suspected there would be a good chance that outcomes would be different because we serve patients in places that are so diverse.

For example, we serve patients in the Rio Grande Valley, where 90% of our patients prefer to speak Spanish.  We are also in the South Side of Chicago, where many of our patients and their families experience adverse socioeconomic conditions.

But what we have been surprised to learn is, across all those different locations, the outcomes are all remarkably similar – both in terms of patient satisfaction and in terms of the reduction in hospitalizations and transition rates to hospice. I think what that speaks to is people, at the end of the day and no matter their background or socioeconomic status, really want the same thing, which is to be with family members they care about as they near those difficult times.

One big difference is how we engage with those different patients, however. Reaching out to patients in the Rio Grande Valley is very different than reaching out to patients in downtown Chicago.


You previously worked in state government. What lessons or experiences have been most valuable as an entrepreneur and CEO?

When I started the company, I had no idea if anything I had done before would be relevant. It turns out it was very helpful. For one thing, when I led nonprofits and worked in government, I had to bring together people with different perspectives to tackle a common problem. It turns out this is actually very similar to the work we are doing at Aspire.

For example, you have patients and families that really care about the kind of care they are getting. You have health plans that care a lot about cost and quality factors they are held accountable for. And you have investors who are interested in both the underlying mission as well as the financial aspects of the company. In many ways, this is like running a campaign. You need to understand divergent stakeholders and where those different groups are coming from. And, then you need to find the common ground and align all those people. This is far more like politics and leading non-profits than I ever anticipated.


Aspire is featured in Dr. Ezekiel Emanuel’s recent book, “Prescription for the Future”. How did that come about? What’s been the response?

Zeke had heard about us from various people and had reached out to us, so we arranged an opportunity for him to shadow one of our clinicians in Philadelphia for a day. Based on that experience, what he saw was a company that was really making a difference in the lives of patients and families. At the end of the day, what we do is all about serving patients and families, and it is important that stakeholders know about what we do so that we can do more of it. His book has been very helpful in raising the profile of a healthcare issue we care so much about, and highlighting the work we do.


Lightening Round:

If I weren’t a CEO I would be… running a nonprofit.

What’s on your desk right now? Nothing. I keep my desk completely clean; it makes it easier for me to concentrate that way.

What is your favorite source for news? Politico. I am fascinated by everything that is happening in DC right now.

What’s a great piece of professional advice you’ve received? The best advice I received was from Senator Bill Frist, who co-founded Aspire with me. About six years ago, I brought him two ideas to consider: one in education and one in healthcare. He knew a lot about both markets and strongly suggested we pursue the palliative care opportunity given the vast amount of patient need. Without his guidance, I may never have launched Aspire.

What one piece of advice would you offer to an entrepreneur? Focus on the biggest problems. When you’re starting out and leading a company, it’s often tempting to do the things that are easiest first. But all too often, there are only one or two things you must really figure out to make the business successful. Focusing your time on the one or two most important things is critical.


In Conversation with Andrew Robinson

By Tricia Kemp, General Partner, Oak HC/FT

What is an Executive in Residence?

As the first Executive in Residence (EIR) at Oak HC/FT, my role will be to develop new insurance tech businesses through a combination of building from scratch and investing in early- and growth-stage companies. The role would evolve into me overseeing one of the new companies on an operating basis.


What attracted you to the opportunity to work with Oak HC/FT?

The Oak HC/FT team, first and foremost. Besides having a terrific track record in the industry, they’re wonderful people; very smart and down to earth, which makes for a dynamic working environment.

We also share a view on big opportunities within the insurance tech space and a common philosophy around how to pursue those opportunities. My background and Oak HC/FT’s deep capabilities and insurance tech expertise make for a powerful combination. I am confident we will pursue some big ideas together.


What are you most excited to do in your role as Oak HC/FT’s first EIR?

While the Oak HC/FT team has already made smart investments in insurance tech, there are many more attractive opportunities to pursue. Within the US property and casualty market, for example, carriers have only returned cost of capital in aggregate once over the last 12 years. Products remain extremely complex to understand—even to a sophisticated corporate buyer—and efficiency gains and improvements in reducing loss costs over the past 10 years have done very little to reduce end-customer cost. Services and service quality are generally poor when measured against nearly any other industry of comparable size.

The opportunity to build a business that meaningfully addresses these factors is what gives me and the team at Oak HC/FT a lot of energy and excitement.


What are some of the initiatives you will be focusing on at Oak HC/FT?

We see abundant opportunities across the entire value chain: how capital is sourced for a specific risk type; how products are constructed; how risk is selected and priced; and how loss events are managed and adjudicated. While we don’t want to be specific on the core ideas, using commercial lines as an example, it is easy to envisage how new categories of data can be harnessed in combination with new approaches that better leverage existing information for competitive advantage. This concept cuts across nearly all product lines and risk types and will be central to product construction, driving down loss costs, and improving risk selection and pricing.


How have you leveraged your corporate experience and background in your entrepreneurial roles?

I am passionate about working with entrepreneurs and have years of experience serving on the boards of VC-back insurance tech companies. I can leverage my corporate experience within the VC community to add credibility, context, and perspective around the power of the ideas of each of these companies. My understanding of the insurance market and where and how value is created (or destroyed) is often helpful to the design of the solutions these early-stage companies are creating. I have also been a cheerleader and door-opener for business development and relationship building with carriers, brokers, and service providers.


You have strong experience in both financial services and insurance. Compared with other financial services, do you think insurance has been slower to innovate and digitize?

Yes and no. The insurance industry is composed of many smaller markets, so you need to look at them independently. Commercial insurance accounts for about half of the industry, and it is more akin to commercial banking, which has been slow to innovate, as well. But if you look at other segments—such as personal auto insurance, which is more consumer-driven—you would find more evidence of innovation. For example, a company like Progressive has been innovative on pricing, customer experience, and, recently, telematics, where they have been leading the way in product design and driving adoption. So, I don’t think you can paint the industry with broad brush strokes.

That said, there are a handful of challenges that have hampered the speed of innovation and digitization. The US insurance market is regulated at the state level, making changes costlier and more time consuming. International insurers have also been focused on Solvency II compliance over the past several years, which has been an intense process and consumed resources that otherwise might have been deployed toward innovation.

Talent is another root cause. Historically, the industry has not been perceived as “cool” by the next generation “A” talent, and the industry hasn’t paid for top tech talent like many banks and other industries have.

Lastly, the commercial insurance industry is unique in that prices are effectively “set at the checkout line” yet the cost of goods sold (COGS) isn’t known until a future point in time. The combination of these factors makes innovation a challenge but also an attractive opportunity for the future.


What do you think will be the biggest upcoming trends in insurance tech?

Big data, artificial intelligence, robotic process automation, blockchain, and chat-bot technologies will all have an important role in shaping the insurance industry’s future. I think the sharing and gig economy will also play an important role in enabling development of new products and markets, and attracting talent to the industry.

One specific area is sensor technology, which could have a profound impact and accelerate the elimination of some categories of risk and the creation of others. These changes will impact every step of the value chain.


You’ve worked extensively overseas. Are there any notable lessons or experiences you’ve carried back with you?

Whether they are in London, Mumbai, or Chicago, many early-stage, emerging and growth technology companies share a similar ethos, determination, and frequently, values. That’s unique to the entrepreneurial mindset and start-up culture, which makes working across borders relatively easier than what you might experience within an older, established company.

Specific to the insurance industry, the London market, where I spent many years, demonstrates that concentration of talent can make a huge difference to building real expertise and distinguishing a market. While technology has the potential to make talent concentration less relevant, I would not underestimate this historical advantage and how this concentration of talent may be foundational to innovation.



In Conversation with Scott Walchek, CEO of Trov

By Tricia Kemp, General Partner, Oak HC/FT


What is Trov?

Trov is a technology company providing on-demand insurance for single items. We enable people to insure the things they want, when they want, for the duration they want – entirely from an app on a smartphone.

Trov is the largest emerging insurance company that takes no balance-sheet risk – much like Uber is the largest taxi company but owns no cars, and Airbnb is the largest hospitality company but owns no property. We are a full-stack reinvention of the insurance value chain.


What was the genesis of Trov?

We created Trov by applying technology to the intersection of people and their possessions.

Along the “arc of possession”, Trov exists between the poles of acquisition and dispossession, where there’s a whole lifecycle of utility that nobody has applied technology. We believe that is where Trov’s opportunity exists.

For decades, enormous investment and technology has been poured into the acquisition and dispossession of goods, with companies like Amazon, eBay, Alibaba, Craigslist, etc. But Trōv is designed to help people benefit from the information about the things in their lives – after acquisition and before dispossession. We imagine a time when everyone will have a Trōv – populated with the information about the things they own – and will uniquely benefit from that information. Our first unique benefit is on-demand insurance for single items.


How is Trov changing the way consumers think about property insurance?

A great analogy is iTunes. When Apple launched the service, they changed the way people acquired and consumed music by disassembling the album into separate parts, allowing people to buy individual songs. Not only did they invent the technology to do that, but they also created an entirely new marketplace – all while serving an emerging generation of consumer seeking greater control through technology.

Trov is attempting to do the same thing by disassembling the insurance policy covering all their contents and enabling individuals instead to cover a single or select few assets. If you only care about your camera, laptop, or bicycle, you can use Trov to protect just those items, rather than buying a blanket policy that encompasses all your possessions. It’s like buying that single song instead of the complete album.

Traditional insurance policies are typically rigid and the policy is always active, which extends the time and increases the cost of coverage. Trov’s insurance platform offers a solution for those who want to choose when to protect single items and keep costs low.


What is the most common item people are insuring through Trov?

Because we’re focused on millennials, we’ve figured that the things our consumers care most about are the possessions that connect them to their world. That starts with consumer electronics: smartphones, laptops, tablets, headphones, and gaming consoles. Photography gear is also an important category.
Soon, we’ll support other categories in response to user demand. For example, jewelry and unique watches.
The average consumer covers two items, usually their smartphone and laptop. Smartphones are the number one item because they are automatically added to Trov and serve as a digital repository for all the information about your possessions – including metadata around the purchase, retailer, retail replacement value, etc. One of our current development tasks is focused around removing the category limits so that users can cover more types of items.


Trov first launched in Australia and the UK, and is now expanding rapidly across Asia and Europe. How are you able to enter so many different markets?

Our objective has always been to find strong local partners to help us navigate the market-entry process and overcome geographic or cultural hurdles.

We initially partnered with primary insurers to launch in Australia, the UK, and Japan – via Suncorp, AXA, and Sompo, respectively. The model of launching individual partnerships in each market – and with primary insurers that have their own consumer-facing brands to protect and promote – brings with it massive hurdles that are more protective than expansive. So, we more recently formed a partnership with MunichRe to enable growth globally across Europe and Asia.

Because MunichRe is a global reinsurer without a direct-to-consumer brand, we can drive our expansion more efficiently by leveraging their footprint, balance-sheet strength, and regulatory relationships. This can all occur more quickly than growing one market or one partnership at a time.

One of our core advantages is the ability to enter a market relatively quickly and inexpensively. Since we’ve built the complete stack of technology required to support all aspects of the insurance value-chain, and our tech is entirely cloud-hosted (AWS specifically), we have a time-to-market advantage that, compared to incumbents, is more cost effective.


What are your future ambitions for Trov? What features are you launching?

We are pursuing two additional, complementary lines of business. The first is a private-label (B2B2C) product line that is leveraging our platform to support on-demand, micro-duration, unbundled opportunities for auto, home, and small business insurance. This will be a white-labeled or co-labeled offering for existing insurers and financial institutions to brand applications that we build for them.

The second opportunity we are pursuing is what might be called insurance-as-a-service, through which our unique proposition and technology can be embedded in other companies’ apps or operating systems to benefit their service offering or user experience. We’re excited about both these opportunities.


Compared with banking, insurance has been relatively slow to innovate and digitize. Why is that so?

There are many reasons why insurance is slow to embrace transformative technologies. But specifically comparing banking and insurance, I think the frequency with which we engage with insurers plays a role.

Banking is a daily engagement, and banking products – from loans to checking to savings – involve daily or frequent transactions. Companies and consumers are reminded regularly of the benefits and potential for technology within those banking interactions. There are also several early innovators who jumpstarted banking technology, like PayPal.

Conversely, consumer touchpoints for insurance are opaque and infrequent – more typically on a yearly basis. But now that the world is going the direction of the smartphone, and consumers are living their lives and consuming services digitally, it’s logical to apply the same banking engagement model – unbundled, digital, and on-demand – to insurance.


If I weren’t a CEO I would be…

Traveling and in the water more frequently….


What’s on your desk right now?

I don’t have a desk.


What is your favorite source for news?

My kids


What’s a great piece of professional advice you’ve received?

The most important job for a CEO is to create an environment where employees can feel safe and thrive professionally.


What one piece of advice would you offer to an entrepreneur?

Be comfortable with change. Where you think you’re going directionally is unlikely to be where you ultimately end up. So, embrace optimism and resilience. The optimism enables you to believe in what you’re doing every day; the resilience is there when the optimism gives out.


Interview with Dr. Ezekiel Emanuel, Venture Partner, Oak HC/FT

By Annie Lamont, Managing Partner, and Andrew Adams, General Partner, Oak HC/FT

Why did you decide to expand your medical and academic career into the private sector?

Being at the forefront of change in health care in the U.S. means engaging with venture capital and the startups that are driving that change.

Academic research and public policy development have a tremendous impact, but we are now at a moment when the private sector is responding quickly and leading significant health care changes. The sector is at an inflection point, driven by recognition of the importance of chronic illness and the inefficiency and low value of much of health care, combined with important changes in payment.

The private sector is leading that response, and to be engaged and help shape change requires working in the private sector—specifically in venture funds. That’s what attracted me to Oak HC/FT, which has been at the forefront of innovation in health care for over 15 years and has a peerless team under the leadership of Annie Lamont and Andrew Adams.


What areas of healthcare are generating the brightest opportunities currently?

Fully 84% of all health care spending in the U.S. goes toward chronic illnesses. Within that, some of the most important areas of spending include behavioral health and end-of-life care.

For instance, behavioral health—care for patients with depression, anxiety, and serious mental health problems such as schizophrenia or bipolar disorder—is the fourth largest area of health care spending. Chronic care, behavioral health, and end-of-life care have traditionally been ignored by medicine, but they are among the most important areas of opportunity. So, the areas with the best opportunities happen to be the same areas that have been at the margins for the last 70 years, yet command some of the most health care resources.


What are some of the companies you are working with?

I work closely with Annie, Andrew, and the Oak HC/FT team across several areas, especially advising existing portfolio companies as well as opining on prospective investment opportunities.

Chronic care, behavioral health, and end-of-life care are the areas where I am particularly active, so I tend to spend the most time with Oak HC/FT portfolio companies within these areas.

Village MD, which provides primary care solutions, is a company I have profiled in my book, “Prescription for the Future,” and I serve on its Board. It has some important innovative practices other physician groups can learn from, such as its programs on rooming patients and home care.

Similarly, I am working with Quartet, a mental health company that is trying to develop what I think of as a virtual collaborative care model to link physicians and their patients with behavioral health specialists. Interestingly, it is also trying to bring performance evaluation to mental health, which has not happened previously.

I am also working with Aspire, a palliative-care company that is trying to put into place all the recommendations on improved end-of-life care that the medical establishment has never been able to implement. I started my career working on end-of-life care when it was not fashionable; not even a recognized area of research. Over the years, the field has developed important ideas on how to improve care for patient likely to die. For instance, focusing care on patients not just in the last days of life but beginning palliative care earlier to elicit preferences for end-of-life care and handling symptoms months, if not a year, before they die. This makes the transitions to the dying process much less abrupt and gives time for the patient to adjust and acclimate to dying at home. But such recommendations have rarely been widely implemented. Aspire is dedicated to bringing these optimal end-of-life care practices to patients. We are working with them to analyze and publish their data on quality and on cost savings.

These are a few of the interesting companies I am involved with through Oak HC/FT.


What is “Prescription for the Future” about?

The subtitle for the book gives a clear picture of the book’s subject: The 12 transformational practices of highly effective medical organizations.

The premise of the book is that the U.S. health care system is going to have to change to deliver higher-quality and lower-cost care consistently. So, I went about examining outstanding medical organizations—from smaller physician practices to larger multi-specialty groups to Medicare Advantage plans to whole-health systems—to elucidate what they did to deliver high quality and reduce cost.

We identified 12 different practices ranging from changing scheduling to chronic care coordinators to community health workers, which are key to transforming care delivery to consistently higher quality and lower cost. In the book, I delineate the specific steps medical organizations can take to implement these practices successfully. For instance, I found all groups that achieved successful chronic care management followed the same five basic steps. This leads me to be optimistic that over the next decade the U.S. can achieve much better care, especially for patients with chronic illnesses.

Importantly, we found that no single medical organization did all 12 transformational practices. So, even among the very best practices in the U.S. there is still room for significant improvement.


If you were to triage the industry, what would you prescribe as the most urgent and critical care priorities?

The single most important pre-requisite for transformation is payment change. Physicians, hospitals, health systems, and all the other providers need to be incentivized to change how they deliver care–to focus on higher quality and lower cost. This requires moving away from fee-for-service payment toward what are called alternative payment models, such as bundled payments for an episode of care or capitation. Fortunately, this is happening—especially through MACRA, the new health care bill that changes how physicians are paid, and through payment changes being implemented by private insurers.

A second important prerequisite is data on where physicians are using resources and the outcomes of their patients. One of the biggest changes since the managed care efforts of the 1990s is that the U.S. system has a lot more data on the performance of the system and physicians to guide transformation.

I lay out several other important pre-requisites in the book, such as leadership and governance. I note that no medical organization can implement 12 transformational practices all at once. So, I indicate a few tiers of practices.

The top priorities and most urgent transformational practices to implement are: 1) open-access scheduling; 2) chronic care management and co-locating chronic care coordinators with physicians; 3) performance measurement and improvement, so physicians and other providers can see how they are performing relative to national benchmarks and their local peers from whom they can learn; and 4) site of service to create referral relationships with other higher value specialists and hospitals.


Can transformation occur despite the current political impasse and efforts to repeal the ACA?

As I note in the book, almost everyone in the health care system thinks transformation is inevitable. For one thing, private payors and the public are demanding more affordable care regardless of the status of the ACA. This will drive transformation.

Much of the drive or pre-requisites also go beyond the ACA in terms of changes in government payment to physicians through MACRA, the Medical Advancement, and CHIP Reauthorization Act. MACRA abolished the failed Sustainable Growth Rate (SGR) formula for adjusting Medicare payments to physicians. It was replaced with payment that incentivizes physicians to shift off fee-for-service payment to more alternative models. Regardless of what happens to the ACA, MACRA will stay and push the transformation I described.


What is high value care and how do we achieve it?

High value care is composed of two parts: higher quality of care and lower costs. We achieve it by improving the health care delivered to patients and lowering the costs of delivery.

As I mentioned, 84% of all health care spending is devoted to chronic illness. In addition, 10% of patients with chronic illness account for nearly two-thirds of all spending. So, if we want to improve quality and lower the cost of care we need to improve the care of patients with chronic illnesses. That means we must prevent the exacerbations of chronic illness: prevent patients with congestive heart disease from gaining too much fluid and developing extreme shortness of breath; patients with chronic obstructive pulmonary disease—emphysema—from becoming short of breath; patients with diabetes from developing infections and gangrene; mitigating the side effects cancer patients develop from chemotherapy.

This is the key, and the key to achieving this is identifying the high risk 10% of patients, having chronic care coordinators co-located with physicians actively reaching out, and managing these patients by ensuring they are taking their medicines and following other recommended interventions. It also requires standardizing care so patients are receiving the best care as defined by the best physician experts on these diseases.

Medical organizations that follow these and other care practices can achieve high value care, typically by lowering visits to the emergency room and hospitalization rates by up to 40%.


What are some of the most notable advances you are seeing around care delivery and patient experience?

What makes me optimistic is that there are so many advances being tried and constantly improved by different medical organizations.

One critical improvement is open-access scheduling. This means physicians start every day with between 20% and 50% of their appointment slots open—i.e. unscheduled. So, if a patient develops a problem they can be seen in the office that same day and treated by someone who knows them and their entire medical condition, instead of being sent to an emergency room where they are treated by someone who does not know them or their medical problems. This also enhances patient satisfaction.

Another important advance is for patients with high social needs and few social supports–poorer patients often on Medicaid. Having effective community health care workers is a huge advance. These health care workers find out what these patients need and want, and then help them obtain services and social connections. They help patients get housing, food, job training and jobs, or just find activities, like bowling and sports, that connect them and bring them some joy and happiness. These community health workers become social supports for the patients. And this frequently reduces use of the health care system for what are otherwise social support problems—lowering hospitalization rates and other uses of the system.

Similarly, adding behavioral health to regular medical care is a fundamental advance we will see more of in the next few years. Patients with chronic illness who have co-morbid depression or anxiety are so much more expensive to care for. Important advances are efforts to provide these patients mental health services that are integrated with their regular care. When done well, this helps patients overcome their depression or anxiety and thereby lowers their use of health care services and costs. It is a classic win-win situation.

I could go on and on because the book is filled with scores of these advances being implemented by different medical organizations.


How do you escape work and clear your mind?

I don’t know about escaping work and clearing my mind. I find that when I am relaxing I am often thinking about work on another level.

I love to run, bike, and kayak. Recently, I spent three days navigating 50 kilometers by kayak in the Norwegian fjords around Alesund. The area has some of the most magnificent scenery in the world. Two weeks later, I biked 65 miles from Harper’s Ferry to Washington D.C. I learned a lot about the John Brown raid of 1859 on that trip.

I am about to embark on another fun project: making a world-class chocolate bar. I am partnering with a chocolatier and we are traveling to Madagascar to procure beans, and then will go into the lab and make a fantastic chocolate bar. That will be super fun.

I also love to cook. A few years ago, I was a chef at a pop-up brunch restaurant. That is hard work but fun. I love to throw dinner parties and make new dishes.

I am also an avid reader. My brother, Rahm, and I trade titles we have read. We both love history books as well as great novels. I just finished “The Good Lord Bird” by James McBride about the John Brown raid. I am reading John Steinbeck’s “East of Eden”, and just started the book about Winston Churchill, “Hero of the Empire”.

One day I want to write a history book of a great, but forgotten American physician and revolutionary war hero, Joseph Warren.


Conferences + Events
Meet us


J.P. Morgan Healthcare Conference

January 8-10, 2018

San Francisco, CA