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October 30, 2020: What does it look like to navigate a cool digital start up as a CEO during a pandemic? Carina Edwards joins us from Quil Health. Their joint venture with Comcast and IBC looks to grab a piece of the multibillion-dollar care at home industry. How do you accelerate the adoption of care at home solutions? What devices should you use? How do you make it simple and easy? How do you scale remote monitoring? Where does the funding come from? And more importantly how do you integrate it into the workflow of doctors and nurses?

Key Points:

  • The beauty of a digital health platform comes into play when the world changes overnight [00:04:30
  • Where does the Business to Consumer funding come from? [00:10:10
  • Ambient voice’s role in “I've fallen and I can't get up” [00:12:10
  • What does it look like for a provider to partner with Quil Health on a solution? [00:13:50
  • How do I look after my parents who live in a different city? [00:19:14
  • The primary care physician was always the quarterback but in the home care model the nurse really is the quarterback [00:21:35
  • Are health leaders engaging as much at the virtual health conferences as they were at the face-to-face? [00:23:20

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

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Welcome to this weekend Health It, where we amplify great thinking to Propel Healthcare Forward. My name is Bill Russell, former healthcare, C-I-O-C-I-O, coach, consultant, and creator of this week in health. It a set of podcast videos and collaboration events. Dedicated to developing the next generation of health leaders.

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I have Karina Edwards on the show. If you aren't familiar with Karina, she's been on the show before. She's the CEO of a really cool hot startup, uh, called Quill Health. And, uh, it is a partnership between Independence Blue Cross. Comcast based in Philadelphia. They're doing some really cool stuff and I'm looking forward to sharing this show with you.

Alright, today I am joined by Karina Edwards, the CEO of Quill, and we are gonna have a great conversation about supporting care in the home. Welcome back. Welcome back to the show, Karina. Thank you. Great to be here. Yeah, it's, it's, it's been too long, but a lot of things have been happening. . A little bit. A little bit.

You're, you're headquartered in Philadelphia, Comcast isn't coming back to work until July. What does, what does that mean for you? We are headquartered in Philadelphia. We made this transition to virtual pretty, pretty quickly because we already had a pretty remote team, and so we are staying remote until sometime in 2021, and we'll figure it out as we go.

But right now it has not impacted business and the team's been doing really well. It, it hasn't, it doesn't appear to have slowed you down at all. I, I, I've seen you, you're at the health conference and, and you pop up on my feed quite often, either in in, in conferences or, or some, some facsimile of, of, of conversations that you're having with industry leaders.

So you're, you're staying pretty busy having those conversations. We are. It, it's been an interesting year for us because we're as, as we're only two years old. For us, we were just taking off as, as Covid hit, and we had one of those big like moments where we were selling to provider organizations and we were going live with provider organizations.

Right. We launched the Quill platform in April, 2019 and March comes and all of our patients go off the platform. All of our customers. Shut procedures down. And so we had this like, okay, we have this amazing platform. We can do some pretty great things. And so in five days we launched a Covid journey to 1.3 million Independence Blue Cross members.

And so we just showed the power of the platform of digital engagement. Digital connectivity. So it's, it was a, it was, it's been a wild ride. And that's the beauty of a, of a digital platform like that. The, the world changes overnight. Five days later, you're sitting there going, Hey, we can, we can take these same workflows, the same training, this same content, and we can deliver it in a different way to address the needs of the market.

And that's the, that, that really is the, the promise of digital agree. I, I think it's been, it's a testament too to also like how you think about scaling in all of these different startups.

All right. Did you, did you lose my camera there for a minute? For a quick minute, I did. But you're back. I'm back. All right. And we're back. This, this, I don't know if you remember this, but this happened, we had technical difficulties in the last time we tried to have a, tried to do a podcast together. We were in your office and the automatic lights kept going off.

That is right. We had to wave our hands a lot. We had to wave our hands in the air. , like, like, like, we just don't care. So you, you . You, you were the CEO for how long before March? Came around for about a year, is that right? For about a year. Yeah. I joined March, 2019. I, I'm gonna ask you, we'll, we'll go back and, and cover what Quill is in a minute, but I, there's just a question.

What does it look like to navigate a pandemic during a a, a cool digital health startup? During a pandemic, did I get that question right? What does it look like to navigate, uh, a pandemic at, in, in your role as ACEO? That was a new role for you and it it was quite the curve ball. You know, for us it was all about staying focused on delivering for clients.

And that's why when March 11th hit March 12th and, and procedures started going. Getting shut down and elective procedures got put on hold and, and hospitals started, furloughing employees, all of us just stayed true to how can we help. And so it gave us a purpose. And this notion of, of transitioning to help with Covid was great.

IBC was having challenges. It was misinformation Nation, uh, as Kevin Mahoney likes to, to call it, and. We were able to work with NBC and the Today Show and really curate down like these are the facts. And it wasn't about the symptom tracker and the testing that was part of the journey, but it was really about staying focused on getting people to, how do you transition to home?

How do you homeschool your kids? What's grocery shopping like? Where all those things that we've now gotten used to. In the beginning of the pandemic, it was really hard to navigate. And as the year then went on and things started to open back up, clients started coming back on, we started selling more. So just, we've gotten to a natural rhythm, but the, the pandemic gave us a purpose on how to help.

Interesting. So for those who didn't listen to our interview over a year ago, give us a little intro into Quill and what you guys are doing. Sure. So we are the joint venture between Comcast NBCUniversal and Independence Blue Cross. We have a consumer engagement platform that is on your television if you're a Comcast subscriber, on your tablet, on the web, on your phone.

And what we do is we help consumers. The caregivers that support them, organize and navigate their health life. But we do it in partnership with provider organizations and payers. And so our clients include large health systems, uh, and large payer organizations. And we're putting the platform to use in bringing turn by turn directions to the consumer as they're navigating different episodes of care in their health life.

So I wanna go in a bunch of different directions with you. First of all, I, I, I titled this episode Supporting Care in the Home, and I've been following this pretty closely. There's an awful lot of things going on. There's internet, internet of things. There's, I, I keep making a note of the fact that Best Buy is now a healthcare company and they're being valued as a healthcare company.

Utilizing their Geek Squad, actually, they're making investments in, uh, device companies that they're going to be taking into the home. And, and that seems to be the, the, the next frontier of, of where, uh, care is going to happen. And, and. And people keep reminding me, home healthcare is not a new thing and it's not, but what's, what's changed to really accelerate the, the, the potential adoption of care at Home Solutions?

So I think it's the combination that what one we were forced to, right? When you can't go in and see your loved one because you might infect them or they just don't feel comfortable going into the institution because they're at risk, then you have to look at different ways. And so I think Covid accelerated

The use of digital technology beyond the virtual visit, like the virtual visit is nice. We all zoom. This is easy to do. This isn't rocket science. It's how does it actually integrate to the workflow? And then how do you monitor populations at scale? And so what devices, how do you make it simple? How do you make it easy to use?

And so I think you're gonna see a continued, we, we ourselves are going there. We announced at health that we are doing a consumer play together with Comcast in 2021 to connect people in the home with . Just great voice speakers and, and hubs for you and your caregiver to connect. So I think there's the consumer side of this, and then there's also, uh, the B two, B two C side and remote monitoring and shoot, you guys had it in your, in your last institution, right?

We've all been able to monitor populations when needed. But now how do you do it in scale and how do you more importantly integrate it to the workflow of the doctors and the nurses and the patients that sup, uh, the patient care coordinators that support patients. Yeah. You know what the, so B two c, B two B two C, the question always comes back to you're, you're a health tech startups, where, where's the funding come from?

AB two B two C? Makes sense, right? Yep. So it's essentially you're, you're getting paid by the providers to give them a platform that they can, they can, uh, interact with their patients in a, in a new way through the home. B two C, am I gonna pay for this? If, if. If, or, or is insured gonna cover it for me?

That's interesting. So on the B two, B two C side, we're selling to provider organizations and we're selling to payer organizations independently. We do think there's an opportunity for them to converge, and so I do think as you're thinking about navigating, I'll use Philadelphia. We're in partnership with large academic medical center there.

And now they're having patients go on these journeys. Isn't it great? Now, if I'm an IBC subscriber and a Comcast employee, can I have a differentiated experience on the health journey? Because now in my health journey, if I'm doing a heart surgery or a hip replacement or having a baby, can I also see.

What my benefits are, what's reimbursed, what, what facilities I should go to, and what my corporate benefits are. How many weeks off do I get once I have the, the, the child successfully? If, if, if all goes well. So I feel like there's this great convergence on the B two, B two C side, direct to consumer. I think what that looks like differently, you will pay, I think what we're seeing in the marketplace today, even just from the old school, help by fallen that I can't get up.

Consumer products, you're right, people are willing to pay $40 to $50 a month. For those subscriptions just to know mom and dad are safe at home, they have that, that extra layer. And so when we thought about naming our solution and branding it, we called it Quill Assure for Assurance in the home. Thinking about how do we make sure that as a caregiver, here I am in Park City, Utah, and my parents who are aging in home and have health challenges are in Boston.

And so how do I make sure that we're connected beyond just a FaceTime visit every now and again. Yeah. How has the technology played a role in, in changing how we're looking at this? Is the technology land landscape changing as a result of Covid or during this past year? I guess? I think it's rapidly changing.

I think we've seen new technologies come into the home that people are getting more comfortable with. The question there is the business model and the security. So voice, right? We've all love our voice speakers and our ambient voice and, and things that are around us. But now let's be clear in the offering, when you're connected to that voice, who has access to that data?

And so I think there's that privacy concern. Nobody wants cameras in their home per se, right? But you do want ambient sensors. And there there's been a lot of great technology advances. We're using these pucks that literally can detect patterns. They can detect falls, they can detect . If you, if you name a room a bathroom, they'll know that if you're laying down, you didn't fall probably, you're probably in the bathtub.

They can sense water. So there's just different things with new technologies that you can bring to bear in health in a really unique way. Interesting. So I've fallen and I can't get up, has changed to pucks that, that understand the context of the room they're in and they understand that, hey, I'm in the living room.

I'm probably gonna sit down. I may lay down on the couch. Those kinds of things. So you just get, you get a different level of things. So is that something that you guys have announced you're, you're taking out into the market at this point? Yep. We're gonna, we're gonna be trialing the solution with Comcast employees and they, they have this great, um, way that they trial new tech In December.

We're gonna work through the, the, the, the quirks , make sure it works all well. And then we're looking to launch in Q three next year. So coming soon to an Xfinity story near you, maybe

So it's, it, it's interesting. So if I'm with a provider at this point, you are working with, I love the fact you say Academic medical center in Philadelphia, that just narrows it down to about four or five candidates. 5, 6, 7. Yeah, exactly. , it's one of the most overpopulated academic medical center locations in the country.

But, but what does it look like for a, a provider to partner with, with Quill on a solution? How are they, how are they putting it out there? Yeah, it's, it's, it's really been fun. We, we, we are doing is, we're, we're looking at the things in the areas . That are not served by the core infrastructure vendors.

Right. Listen, you're not going to displace your EMR, you're not gonna displace your patient portal. How does Aquill work in con in connection with that, and how do you really integrate to the digital care plan being prescribed by the doctor? And so what we've done, um, is we've literally gone and, uh, we're launching, we're live in one service line, launching four more.

So thinking about oncology and women's health and orthopedics and . And as we think through those, think about the, the massive procedure volume on that. And it's not so much the. What's my appointment and when do I get scheduled? It's okay. How do I prepare for the appointment? Who do I bring with me? What questions do I have to ask?

How do I navigate and get my surgery date? How do I prepare for the surgery itself? How do I recover at home? How do I check in remotely and do my remote patient monitoring and my patient reported outcomes on a digital platform? So it's been really fun reinventing the patient education and navigation.

The service lines because you're getting to bring consumer grade videos and explainers and, um, other things to bear beyond just, um. The, the, the content that I think in healthcare is a little bit dated. I, I know that, I know of some health systems that are trying to build what you just described, build it all out, and it's, that's, that's an awful, that's an awful heavy lift for them.

They're trying to, uh, bring it into their, their digital front door, whatever that happens to be. It could be sure. Could be a portal, but a lot of 'em are breaking apart the portal. And then, and then bringing it is, can your solution be delivered that way too? Can it be as, as, as they break apart the portal and bring things in, can they bring Quill in and and plug it in?

Yep. That's exactly how it works. So basically we work in, in connection on the front end side with the patient. You can navigate from it, from your portal, uh, and navigate to it, and also from the app . We get you to the relevant sites. It might be the portal, it might be a website, it might be a, a piece of resource for that single department.

And then on the backend, all of that data for patient reported outcomes and remote monitoring gets put back in the EMR. Uh, so you can actually have the clinicians look at their, uh, populations at risk, that 30, 60, 90 day readmission rates. Who's trending, who's on track, who's not on track? Where, where should I do proactive, uh, outreach?

Do you get that goofy question of can I white box this? Uh, . Yeah. Or white label, whatever the, so right now, yeah, it, it's, it's the white label, uh, thing. And yes. Right now, the way that we sell is the, although you are downloading the Quill app, everything in the app is then white labeled from the brand that you've been prescribed, the journey.

So if you go into Quill and you have . A Penn medicine hip replacement journey, and then you have an IVC, uh, C Ovid 19 journey. You'll see both of those journeys in your Quill experience, but all of that content is branded by the organization that brought that journey to you. And all of that data uniquely goes back individually to those organizations.

We don't commingle, so like no one's getting provider data at the IBC side and I BBC's not getting. So it's really clean from that perspective. Interesting. I I'm gonna ask you one last question on the, on the platform, and then we're just gonna go, we're gonna go offroading with, with some questions. And so I, I wanna talk through two scenarios right now.

We, we take care of my 88 year old father-in-Law in our house. We happen to be a Xfinity Comcast sub subscriber at this point. I don't know if our health system down here is or not, u utilizes your platform or not, but give us an idea. I I'm gonna start with this scenario of we live in the house with.

With him and then I'm gonna go back to your scenario where you live across the country from talk about gi, give me an idea of how you're gonna support me and my wife as we try to care for, for her father in our house. Sure. So two things. So first we're we've launched a caregiver journey, and so literally it's a journey for you.

You can actually go to your TV tonight. You can say Quill, or you can say what happens next? And the Quill app comes up on the tv. There's core videos there. But when you pair a journey, like a caregiver journey, we're gonna give you the tools to understand. What's an advanced directive? How do you talk to your dad about living independently?

Like what are the best practices to bring him into the conversation? So this isn't happening to him, it's happening with him. And so it's also some education content that you could put on the TV for him. How do you talk to your kids about this? How do you let your wishes be known so you don't feel like you're being a burden on them, et cetera?

So there's a lot of it that comes down to consumer grade . Conversations if something happens to your dad. So say he has a fall, he does have a hip injury, and now they've decided that they're going to. Do a new hip or, or do hip surgery, you can actually, as a caregiver, get all of that surgical information on the Quill op.

You can follow him along on that journey. You can also show him how to do really basic exercises on the tv. So it goes back to we're gonna give you a platform and, and partner with your healthcare organization to bring that home for the patient and the caregiver in this circle. Uh, is it similar caring for your par parents cross country?

Yeah. I. Yeah, I think that the, the, the challenge of the parents cross country thing, it more, it's more the checking in piece. You can only do so much on a virtual check-in, and so that's where we're starting to support caregivers with the ambient sensing because we think nobody, my, my parents don't wanna be monitored, right?

They, they feel like they're completely independent. Like my dad who's got, I, I love him and he's fine that I talk about him. Publicly, but he, he has some, some underlying uh, issues and he is got some, some, some chronic health issues. And literally I asked him at the beginning of the pandemic, so do you think you're at risk?

No, no, I'm not at risk. We're fine. Like, okay. So it's those things that we just had to have a more direct conversation. So instead I pointed into some like basic websites. He's a, he is a Fortune 60 exec and it is, it's funny to watch him as he is, as he is aging now, how invincible he still thinks he is. So it, it's, it's been a good conversation and we've gotten to a really good place, but it's hard to do it remotely.

Yeah, we're utilizing, we're utilizing things like Amazon Echo in his room so he can, he can call us and whatnot, and it's gotten to the point where he gets, he's not really good with the echo, so he, he, we actually got him in monitor. Now there's usually a word that goes in front of that monitor, which we don't call it that, otherwise he would be really annoyed.

But the, the monitor gives 'em the ability to just, you know, just tell it, tell us what's going on, and that kind of stuff. It, it just, it just gets to the point where. You, you want to keep him in the home as long as you possibly can. And that's because that's where he is comfortable. And, and, and that's what we want to do for him.

But it, it does require some, some additional technology that you can trust, some neighbors you can trust, obviously. 'cause otherwise you're never leaving your house. And that plus other services. Right. I, I think it goes back to . Medicare provides so many services that people just don't have the full understanding and benefit around, and they don't understand how to navigate.

It's a complex process and so we start thinking about third party caregivers and when do you engage them and how do you engage them and how do you talk to your dad about that? Especially now in C-O-V-I-D, A lot of education, I think to rise up the, the literacy on how to navigate all of this. Yeah, I've been really impressed with the home nursing, uh, program They have amazing here.

It's really, I used to think primary care physician is the quarterback, and I've now seen a model where the home care nurse is really a quarterback. She's calling all sorts of, uh, different physicians for us and checking meds through those doctors, and, and she, she just comes over once or twice a week and, and just does a great job.

S So I wanted to bounce off of the, off of that conversation and just talk to you about the industry a little bit. So Sure. I'm not gonna talk to you about the election, that that could get crazy. Thank you. Thank you. Thank you. Go in direction. I'm not really gonna talk about Covid per se. In terms of what's going on and, and those kind of things.

But I, I'm curious, the, the landscape has changed. So we didn't do HIMSS this year. We didn't do CHIME meeting. The health conference was remote. You've participated in a lot of remote conferences. How much do you think going forward that that whole landscape is gonna change? How we interact with each other?

How we, uh, market, how we connect with other people, how we, uh, connect with ? Fundraising, some of these conferences were great to connect with money, with ideas and those kind of things. How is that gonna change going forward? Have you seen anything that you're like, yeah, this, this looks like it could work going forward?

I, I think there can be a really good mix of virtual and in . In person virtual, which I'll say differently, right? Because it's one thing to watch a bunch of recorded announcements or I, I feel like everybody that went into some of these virtual conferences, they, they went in with a, Hey, I'm still gonna work, and then this is gonna run in parallel and I'll catch up at night and see what, what happened in the industry.

That I think has to be the fundamental shift for this to really work. Like if you're going to sign up for health, then . Pretend that you're going to the conference and engage in all of the mediums that they have available. Like those little 30 minute chats were great. The connection points were wonderful if you took the time to set up your schedule.

I found a lot of those people weren't available. I. You tried to connect with somebody and they just, they, they either didn't update their profile, they really weren't participating in the conference like that. So it just goes back to how do you get these new normals that will be, Hey, just like you were at the conference, you're open to 15 minute networking sessions.

Yeah. And that's you, you talk about the health conference. And I was signed up for that and I wanted to, what I'd done in the past is I'd gone to the health conference, I took a mobile, uh, podcasting. Set up with me and I, I would meet with people and do 15, 10, 15 minute conversations. Yeah. You know, what are you trying to do here?

That kind of stuff. And so I thought, all right, here's what I'll do. I'll, I'll go onto the app, I'll make these requests of all these different people and see, but you know, almost, actually, I will tell you flat out no one. Got back to me through, through the app, and I was a little, I was wondering, I'm like, you know, is that an indication of, of how people are engaging in these things?

And to be honest with you, I was able to attend the first day and I thought, okay, I'll, I'll go in between meetings on the second day. My, my second day got so booked up with stuff, uh, stuff outside of the conference that I, I didn't really attend any of the stuff. Now I still have access to all those sessions because I was an attendee, but I didn't really attend that second day.

I think it goes back to how do we, how do we change the new normal if we, because I think everybody's just waiting to go back in person and maybe waiting to go back in person isn't gonna happen until December, 2022. Who knows? I. I, I, if we are, 'cause I had a similar experience, I was able to do five of those, like 15 minute connect sessions.

But that was it. And so literally at the conference I would've had like 50 meetings. And so it's just a different pace because I think people are still trying to do both. And I don't know if people have accepted that it's okay to take off from work to go to a virtual conference. So I think that's another new normal for the employers.

How do you give your employees the permission? Because they would've been on a plane, they would've been in Vegas or Chicago or wherever. Chime is gonna do, it's a chime, fall forum, digital 2020. In November, it's gonna be three and a half days. Right? So same thing. Is everybody taking off those three and a half days or is it going to be like, Hey, I'm participating when I can jump in.

I'm finding the metric everyone talks about is we had this many people sign up. But you know, we're, we're not hearing much in terms of engagement and watching the events and, but the numbers are through the roof. So the potential for virtual is that you could have maybe three times as many people participate in the content.

So this is where I think your idea of the, the physical and virtual, we're gonna learn a lot about virtual this year, and hopefully we can. Almost out of three to four times as many people engage in the conference material by, by doing a combination of both, I think there's a new metric that needs to be shared because I, I, I, I'm with you.

It's not just about the number of registrations, especially as, as a. As a technology supplier and vendor on this side of the equation for to get my sponsorship dollars, I'm gonna wanna see conferences. Now tell me what is my digital engagement index? How do I actually think about this population? How much did they engage?

When did they engage? What times of day did they engage? You have to give me a digital persona of your attendees that's going to be very different than the people that physically were on site in pick a city. Yeah, it's interesting. I, I did wanna talk to you about are, are we back to, you know, normal sales process?

Are people taking meetings? You have, you find it hard to, to get people to get on a, a Zoom call and talk about I. Putting, putting your product in or is, is it, is it still a little slow? 'cause people have, we still have a surge going on in some parts of the country. Yeah. I would imagine it would be hard to call on those health systems.

Um, yeah, we've seen, we've seen a delay in pipeline, I think like everybody else in as the different areas surges. And we had opportunities early stages in the March timeframe in the Connecticut region. Right. Forget it. Like you weren't getting them on the phone until at least I think we got them on the phone finally.

It was like October , early October, like 26 days ago, which is fine. I think what I'll say is it goes back to what are the core focus areas as people come out of this Will will providers, . We know they're probably gonna have limited budgets. What will their top one, two, or three priorities be? How will they think about the digital front door?

'cause everybody has now used that term. And I think in the, in the new construction space, you still see a lot of sales happening because you still need to open up these facilities. And so your core infrastructure, your tapping goes, your, your, your, your, your bedside monitors, et cetera, those are all going in.

It's where does digital health now play in concert with this and, and how does it get accelerated? Interesting. Karina, it is always wonderful to, to catch up with you. I, I'm, I'm really excited about what you're doing at Quilt mostly 'cause I can be a client now that I'm a, uh, Comcast, uh, Comcast customer.

Although I would like to do away with the set top boxes. I, I, it, as a technologist, it just drives me nuts that I have to have that box there. Is there, is there something on the horizon where I can just get rid of it? I, I do believe there are things in the works. I think you might have seen something with a peacock streaming service.

There's a new flex stick. So there's, there's things that they're moving towards that are a little bit lower footprint and less, uh, monolithic that's less, less a Linux box that's about this to figure out where to put behind my. Couple thousand dollars sleek, new. Oh no, they actually have the, they have the little boxes now too.

They're, they're honestly, they're about the size of a mobile phone and they slide right behind the flat screen. Ah, yeah. Those are great. . This, this, I, I, I learned so much when we, when we look together, . Well, I'll be your Comcast tech support . Well, thanks again and really appreciate your time. Oh, thanks Bill.

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