Indu Subaiya Interviews Chuck Saunders of Aetna

Chuck Saunders, Head of Strategic Diversification at Aetna, will join us on stage at Health 2.0 Spring Fling: Matchpoint Boston on the Customers Panel. He will discuss Aetna’s scaling, partnering, and commercializing activities alongside other leading Health 2.0 companies. This interview is part of Spring Fling: Matchpoint Boston series.

Indu Subaiya: Hello Chuck, we’re excited to have you on the Customers Panel at the upcoming conference. You’ll be speaking on behalf of Aetna, and its role in the Health 2.0 company ecosystem. So, let’s dive right in:

Clearly one of the biggest news items in the last few months has been the acquisition of iTriage, a company that we have been following since the early days of the Health Data Initiative movement and things like that. What have you learned from the acquisition and perhaps what has most surprised about collaborating with them?

Chuck Saunders: Well I think it was our realization early on that while we had developed tools for consumers, those were developed from the perspective of the consumer being an Aetna member or as an employee.

As employers begin shifting to defined contributions and some employees start to migrate to the exchanges, we need to really re-think experiences that the individual has with health care system.

Our system today is not a very effective experience–it’s complicated and confusing to individuals.

I think increasingly consumers that use the system episodically are starting to define quality as convenience, the ability to have easy access with transparent information that’s relatively effortless to navigate. They’re much more into the e-commerce retail experiences rather than the traditional health care experience, which is really designed around the providers and the convenience of the hospital more so than it is around the individual.

So taking that lesson to heart, we believe that it’s all about the consumer, it’s all about the individual longitudinally over time where the quality of their experience and the convenience is equally important to their being engaged and the outcome of the health care.

We decided take our vast tools and assets such as Aetna Navigator, our secure patient portal, our payment estimator tools, provider directory, and all of the care management and the wellness services that we have and try to meet the consumer where they are with technology — much more mobile — that is more convenient. It’s more human; it involves a social element.

It is about the ability to engage with the consumers of our large health plan, develop the kind of applications to meet them where they are with the tools that they are going to actually use…

So, we looked around the marketplace to see where some of that creativity and advanced technique was occurring. iTriage really has amplified a lot of that very forward-thinking view about how consumers interact with the health care system.

I got to know Pete Hudson and Wayne Guerra, both emergency physicians, and they have really done some elegant things there, so we got together and tried looking in terms of tackling this problem together.

Indu Subaiya: So thinking about accountable care, which sort of assumes that there is a medical home, and a physician is accountable for the health of his or her population, how does a mobile app like iTriage that allows the consumer to go to any physician, fit into an accountable care world?

Chuck Saunders: Well I think when accountability shifts to the provider, patient engagement becomes far more important.

When Aetna thinks about engaging a member, we think about things like health and wellness care management, case management and fees management. But when you think about it as a provider you think much more in terms of navigating the health care system, working together to create operational efficiencies and workflow.

If you’re accountable, you want to embrace that patient, have them interact with your care coordinators and care managers so you can keep them healthy and out of the ER and prevent the unnecessary admissions. Doing so just gives them a better experience. You also want to increase your capacity as a delivery system or a patient centered medical home so that if somebody needs to get in to see the doctor today, they can. This is made possible because you’re leveraging technology to expand your ability to take care of a large population and get them immediate access if they want.

So this means a much greater operational focus and a focus more on navigation and interaction with the caregiver on a day-to-day, hour–to-hour, minute-to-minute basis, and if that’s the case the reality is people are not always sitting across their browser.

They’re dealing with technology integrated into their lifestyle, which means mobile. They’re also taking their cues from the loved ones and caregivers and everyone else that they interact with on a daily basis to help them to manage their health…so these kinds of technologies become far more relevant in an environment where the provider is accountable and highly engaged with the individual.

Indu Subaiya: But I think it also begs the question of provider engagement and kind of how these applications fit into existing ways of doing business and there will certainly be a transition ahead I would imagine.

Chuck Saunders: There will; there are–in some cases you walk before you crawl, but I can give you examples of the evolution.

With iTriage we talk about the symptom-to-provider pathway. It starts with the first notion that you have a problem, and then it goes to helping you find a solution, so you know which kind of provider that you need, and the kind of urgency that matters, and then it goes next to finding the right provider based both on the appropriateness to condition that you have, the geo-proximity to where you are and certain types of preferences that you might have, perhaps your health plan and your benefit design, and then finally looks at your out-of-pocket cost, deductible, etc.

And then the next great leap is actually being able to register for that visit or schedule an appointment directly with your handheld device and with the convenience of sitting in your car, park, or home, or what have you. And so you can start layering on additional functions that are very robust in a handheld type of experience.

For example, as technology evolves, it might suggest options, for example, for whether you really need to physically show up at all or make it possible for you to engage in an e-visit right through your device. Perhaps chat with your care coordinator and have the care coordinator suggest an alternative or the right type of service, solution, advice.

You start to build this robust experience in which your entire micro-network of supports–caregivers, providers–are all engaged in helping in real-time to solve that problem.

This completely changes the experience that we have, which is three out of four have been clearly paternalistic and that if you want to make a visit, you make a phone call and maybe there is something in a week or two available for you. If you don’t have that, you just go to the ER.

Indu Subaiya: And if you call between noon and one, they are away for lunch which is —

Chuck Saunders: That’s right. And when you complete the visit, you should be able to look up the results right on your handheld device. You should be able to give the discharge instructions, you should be reminded of what the kinds of medications you were given and that you haven’t gotten it filled yet. And then if you are referred to get a diagnostic test or to see a specialist, you can actually schedule that directly.

This sequence of activities–information follows you into the next stage. And all of that actually are doable with the technology that we have.

Indu Subaiya: You know we did our first Health 2.0 India Conference in January, and now we are doing a hackathon in Shanghai, and then Tokyo. So it’s an amazing kind of a segue to my next question which is, this whole developer community that we are now seeing engaged in health care.

At Aetna, you guys are definitely doing a lot of outreach. We’re seeing similar a similar movement by GE, AT&T, and Verizon, and some of the EMR companies like Allscripts. When Matthew and I first started Health 2.0, we used to think well the two competing platforms in Health IT are Google versus Microsoft–the whole conversation was about those two being the two competing platforms.

But now with these other players, including Aetna, kind of inviting developers to build out of their own platforms, do you think we are going to kind of see the platform wars of 2012, or do you think all these systems will be able to co-exist in harmony?

Chuck Saunders: Well I think that they will co-exist. We are creating the API, the open APIs and the software development kits and pushing those out for free to third party developers so they can just very quickly write applications that either leverage iTriage or leverage our iNexx platform which is part of Medicy,, the health information exchange company that we acquired.

The third parties can develop those applications and have nothing to do with Aetna. We’re just making these applications available to providers, for whatever business model works for them.

What we’re really trying to do is let the market grow on what the standards will ultimately be, and it’s all based on the value of the product and defined by the users.

There is an enormous amount of creativity and flexibility that is occurring in the marketplace and the approach that we are taking is to let it happen. It doesn’t have to be Aetna, it doesn’t have to manage us or control it.

If other health plans and health systems want to contribute applications to this platform then let it occur because it’s all about a different way of providing health care in which everybody is engaged.

Indu Subaiya: I would say in the last couple of years we have seen this surge, and the kind of the young developers coming into health care and building an app and suddenly it has potential, whereas before you have to come from an established (maybe an EMR company, etc.) to be able to credibly develop in this space so that’s something that’s really interesting.

Well, finally you are going to be speaking at the conference in Boston, at an event where we are going to be talking a lot about partnerships and collaborations such as the one between iTriage and Aetna. What do you think kind of the health technology entrepreneur of today needs to hear about what it takes to work with an organization at the scale of at Aetna for example?

Chuck Saunders: Well I think the mindset that we have taken is all about embracing entrepreneur and rapid cycles of creativity, so that we can innovate and do it quickly and inexpensively without the kinds of bureaucracies and the heavy iron that have been part of the last 40 or 50 years in health care.

We’re very open. We invest and build at any stage of the business life cycle. This means if there is an up-and-coming company that’s got a better mouse trap and a creative idea, we’d love to work with them. In many cases, we’ll put capital behind that company or that individual like we did with iTriage.

In some cases, it just involves a new capability. If we see that the future needs to be paved by a couple of stepping stones, and it’s something that’s key to making that world come about, we’ll put capital behind that. The changes can be sometimes more incremental while adding enormous value. So we’re really open for working with the collaborators at any stage in the idea cycle or the business life cycle.

Indu Subaiya: That’s a great message for folks to hear. I know you guys will be at Matchpoint specifically companies in the nutrition, fitness and wellness space that might integrate with CarePass. I guess your day job now focuses a lot around meeting new companies. How do you kind of keep abreast of all the developments out there, in order to stay current with these innovative companies?

Chuck Saunders: Well, we’ve got teams that are looking at incubating new business ideas. We’ve got an ideation group that’s constantly putting new ideas into the pipeline. We have an incubation group that’s developing new company concepts, we have an M&A, and an acquisition group that are constantly looking at the marketplace and seeing what the up-and-coming companies are, and we have a tremendous amount of ideas coming into us from both entrepreneurs and from established companies.

And then we are out there constantly speaking with folks like you, and groups where we get a chance to hear who has got great ideas, and meet companies that are doing greater things.

We spend an awful lot of time just listening to our customers. We’re out there listening to our members and working with health systems and hearing where the unmet needs are and where somebody has got a great idea. It’s just all about keeping your ears and eyes open and thinking outside the company rather than inside the company.

Indu Subaiya: Sounds like an exciting time to be working for Aetna! Congratulations on all the latest developments. Actually, we are potentially going to work with your folks down in Colorado to do some type of Hackathon at the new center in Colorado that might be fun.

Chuck Saunders: Yes I look forward to that.

Indu Subaiya: Great, thanks so much for your time Chuck and we’ll see you in Boston.

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