Sterling Lanier, CEO of patient data collection and analytics provider Tonic Health, gets real about the four pain points that an effective patient experience can solve for clinicians. Sometimes the strategy isn’t rocket science, but execution is a challenge. Sometimes data shows reasons for lack of engagement that you wouldn’t expect, like patients needing a ride home or not being able to afford medications. And sometimes, we just need a reminder about what makes a difference for the ones in the trenches.

Show notes

Air Date: April 6, 2016
Guest: Sterling Lanier, CEO of patient data collection and analytics provider Tonic Health

3:12	Introducing Sterling Lanier
6:41	What is the current environment for digital health tools?
10:48	What can patient engagement do to affect outcomes?
13:48	Factors that affect engagement may not be what you expect
14:44	What are the keys to patient engagement?
19:34	How do you market to clinicians? What pain points do you solve for them?
23:58	Bonus question: If you could join a rock band or music artist for a day, who would it be?

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Full transcript

Jared Johnson: Hello, my friends, and welcome again to the Health IT Marketer podcast, the podcast where we tell the story of innovation in health IT. I am your host, Jared Johnson, of Ultera Digital, health IT influencer and content marketing. This is the first and only podcast dedicated to the health IT marketing community. Welcome aboard.

If you want to keep up with the trends, voices, and marketing tools involved in health IT and healthcare technology, you are in the right place. This program is on iTunes, so you can subscribe and leave a review there. We are also on Stitcher Radio and on Podbean. You can subscribe for free on either of those services if you prefer.

I keep saying that this program has gained its voice thanks to the rock star guests who have appeared here on the program. It’s like the Lollapalooza of health IT marketing, at least back in the day when everyone who was anyone was on that festival lineup. My upcoming guests in that vein include Mandi Bishop from Dell, industry veteran John Glaser talking about his new, recent role as VP for population health at Cerner, well-known CIO consultants David Chow and Sue Schade, and Dr. Matt Patterson, the CEO of Airstrip. Keep tuning in each week.

All new episodes in 2016 now have a full transcript posted at UlteraBlog.com. This was the number one request from you, our listeners, at the end of last year. Transcripts can be useful. You might want to go back and read through some of the comments, or find a quote from a guest who will help you socialize the message of one of those episodes to your team back in your organization.

I post the full transcript typically about a week, maybe a week and a half after I publish the episode. The link is also included in the description for each episode. As always, tweet me and let me know if that was helpful for you to have those transcripts, and if so which ones you enjoyed in particular. Also, you can help me improve this program by taking our listener survey at bit.ly/hitpodcastsurvey2. That’s bit.ly/hitpodcastsurvey2.

I frequently say keep building your audience one gig at a time. That was the case for me this week. This last week I had the opportunity to attend the Connective DX healthcare forum in Boston, as well as host the Kareo chat on the topic of cyber security, and then just a few days later to host the Healthcare Podcasters Blab also on cyber security. We had great participation in each of those events. They each left me with a reminder of the many conversations that are out there taking place.

Don’t think that building an audience is going to come all at once. Don’t wait for opportunities to come to you. Go out there and find them, or make them if they don’t exist yet. We need more people talking about innovation in health IT. We need you to talk about it in new ways that people care about, not the old school marketing jargon and a marketing voiceover that nobody cares about. Please, for the love, that doesn’t mean blogging more often about why providers should use your solution or how you are going to singlehandedly revolutionize healthcare. The hype meter is at an all-time high. Please do humanity a favor and don’t. Just don’t. Choose to rise above the noise and find a new voice.

My guest this week is Sterling Lanier. He’s the CEO of patient data collection and analytics provider Tonic Health. Sterling, how’s life?

Sterling Lanier: Pretty good. Just working hard and playing hard, so I guess no major complaints.

Jared Johnson: Right on. The most important question is, are there ever any bad weather days there in the Bay Area?

Sterling Lanier: This year, it depends on how you describe bad weather. Only because we’ve been in such a drought, when it’s pouring rain here people have been calling that good weather. I guess it just depends on your perspective, like everything in life.

Jared Johnson: Awesome. For our listeners here, I’d love to give you a chance to tell a little bit more about your background, where you are now, what you’ve done in the past, and what you’re doing here in your current role with Tonic.

Sterling Lanier: Prior to founding Tonic, I had started a market research company called Chatter. That was and still is one of the leading consultancies in a number of industries, the most prominent being television, video games, and hospitality, theme parks, etc. If you need to know anything about a reality show star, I could probably tell you, although my information is a little dated now. Nonetheless, I started that. We positioned ourselves as being experts on the consumer engagement front.

One day about six years ago we got a call from some breast cancer researchers at UCSF who asked us to do a pro bono project for them in which they were trying to figure out how to get participants in their breast cancer program to fill out a lengthy questionnaire. They said, “What are the principles that we can use from the consumer engagement world, entertainment, video games, hospitality, theme parks, etc. and port those over into patient engagement? What are those types of principles that we can leverage for our own behalf?”

That’s where Tonic was born. Tonic is a story of no good deed goes unpunished. We had done this pro bono project for them and said, “If UCSF has this problem, perhaps others do as well.” Fast forward six years. We’ve built a fully broad based patient data collection and CRM software platform that is deployed in 15 of the top 30 health systems in this country.

Some of our customers are folks like MedStar Health, Partners Healthcare up in Boston, Providence Health and Services, New York Presbyterian, UCLA, UC Irvine, Shriner, Seattle Children’s, and a bunch more. Some of our customers are listening. I didn’t mention you. It’s not because I don’t love you. In the interest of not boring the audience, I love the customers as well as payers and pharma in that mix as well. We’re dedicated to doing one thing. That’s helping health systems unleash the power, at least what we found, the power of the most underutilized resource in healthcare, which is the patient. That’s a very abridged version spanning six years of where we are right now.

Jared Johnson: Right on. Using that background in patient engagement we want to dive into what you’re seeing and what you hear as you engage with, like you said, many of the top health systems in the country and many others of all shapes and sizes who are engaging with your platform, who have given you feedback.

That’s where I’d love to start is your take on what the current environment is for digital health tools in general, if we are focusing on patient engagement tools. What functions specifically are providers saying, “Hey, we need this”? What functions are patients saying, “We’ve got to have this”? What’s that environment these days?

Sterling Lanier: The environment has never been better for all types of digital health tools. We’re certainly really excited about the broader push towards patient centricity and using technology to improve patient care and outcomes. I think the environment has shifted.

A good example is six years ago, cloud based systems were still a significant concern for a lot of providers and payers. The idea that you were a cloud was still somewhat exotic. It was definitely, sometimes it was a significant barrier to a trial and certainly purchase. We just don’t hear that as much anymore. Certainly security is always an issue. I’ve certainly seen a willingness amongst our customers.

We primarily focus on large enterprise health systems and payers. I’ve certainly noticed a willingness to adopt these new tools and start to see technology as not something that’s scary but something that could really drive their business forward. I think the overall idea of the cloud right now is being seen as moving from something that can hurt us to something that can really help us.

From that, from a macro point of view, I think the current environment is great. You certainly see it . . . I live out here in Palo Alto. Boy, it feels like there’s another digital health company doing something, finding some important vertical or niche in healthcare to tackle. Certainly lots of activity on the startup side as well.

The second part of your question is really what functions folks are looking for. I think there are a couple of things. One, at least to us, data point one here, certainly our folks’ providers are requesting ways to know their patients better. When they know their patients better they can treat them better at a lower cost, which ultimately is what Tonic does for a living. We help people, people here being providers, to get to know their patients at a much deeper level of detail so that they can then act upon that data to provide better care at that lower cost.

This is especially important in this brave new world of value based care, which goes to the second piece that we’re certainly seeing lots and lots of activity primarily inbound from our customers and prospects saying, “Hey, can you help with this?” is really the move towards patient reported outcomes. It seems like you can’t pick up a trade journal or any type of healthcare IT commentary without talking about PROs here being a super-hot button issue for two main reasons.

One is it’s currently cumbersome to collect these patient reported outcomes from patients. Again, for those of you who don’t know, patient reported outcomes didn’t work. It’s not paying you for the hip surgery. Let’s give you hip surgery and then six weeks later, six months later, let’s say, “Do you feel better?” I’ll pay you for that answer rather than just the procedure. It’s currently cumbersome to collect those outcomes from the patient, except for, we like to believe, us at Tonic.

Number two, outcomes, at least we believe, are the new currency of this value based payment system. For most providers and payers, this isn’t a nice-to-have, which it might have been 10 years ago, which is to say, “How are we doing on outcomes? Let’s track that.” All clinicians are in it for better care. The idea to track it and measure it perhaps isn’t as acute as it is today where it’s really a need to have for these providers and payers alike.

Jared Johnson: Can you walk us through, can you think of any use case off the top of your head when you’re talking about what a patient engagement platform can do in that case when you’re talking about how it can affect outcomes or help a provider get to know their patients better?

Sterling Lanier: Certainly. What Tonic, what we specialize in is getting patients to both give us more information about themselves, and we do that by pushing out surveys, forms, and questionnaires electronically on a tablet, on a phone, on the web. We’re really agnostic on pushing that out and doing it in a super fun and friendly way. That’s kind of what we specialize in.

Secondly is also pushing out data. It could be a video. We really try to build that last pipe to the patient so we can collect data from them via surveys, forms, questionnaires, and then push out relevant data to them right at the spot. Let’s say you come in. You are filling out an intake form in a hospital or a clinic setting. It turns out that you screen in as high risk for diabetes, or you screen in as high risk for depression.

We immediately send in a note either through an alert or by putting it at the top of a report that then gets integrated with the EHR. We immediately send an alert that says, “Go outside right now. When you see this patient right now, you need to focus on this depression. You need to focus on this diabetes.”

Again, giving the tools to the provider to do something about it. We also heavily use a less heartening example. We used a lot for distress screening in waiting rooms. If someone screens in by answering questions within Tonic on an iPad, by answering questions a certain way they may screen in as suicidal. Tonic will send an alert, “Go outside right now.”

Another couple examples, if I give you one more without boring you and the audience is pre-surgical triage. We have another customer who is sending out surveys 15 days in advance of a surgery. Their problem was people show up having surgery the day of the surgery having no business having surgery. They didn’t follow the rules they were supposed to take. The reason they wanted to track this is if they show up prepared for surgery, we’re going to have better outcomes.

What they’ll do is they’ll use Tonic to push out a survey 15 days before surgery, 10 days, 5 days, 4 days, 3 days, etc. If you answer questions a certain way and screen out, if you will, Tonic will fire an alert to the surgical nurse to say, “Pick up the phone. Call Jim Smith. He seems to be having something going on here that we may need to address before surgery.”

The reason I love this example is it has an outcome that nobody perhaps was expecting in that what they found was the physical things they were trying to screen out for, such as, did you stop taking your anti-clotting medication before surgery, were not the things that impacted outcomes.

What impacted outcomes, were social and environmental factors that they were never even asking in the first place. Such as, do you have a ride home? Can you afford your medications post-surgery? These elements that weren’t even being tracked or asked before turned out having the biggest impact on outcomes, certainly the biggest impact on readmission rates.

Again, hospitals get penalized if that surgery patient comes back within 30 days of being discharged. Not being able to afford your medications is going to be one reason they come right back. It’s been interesting to see how outcomes can be greatly influenced or impacted by things that perhaps aren’t necessarily intuitive to us at the start.

Jared Johnson: I know. In fact, a couple of our recent guests here on the podcast, Dr. Wendy Sue Swanson and Dr. Justin Smith, they both use your platform to engage with patients. I’d love to hear from your standpoint what you think are the keys to patient engagement.

Sterling Lanier: Dr. Swanson and Dr. Smith, from a clinician point of view you’re not going to find two sharper folks than them on patient engagement. Again, they’re in the trenches. They’re in the clinics dealing with patients. I would certainly defer to their clinical expertise. From my third party perspective, we have a number of key things, none of which are rocket science, by the way, but they’re hard to execute against, which is why many struggle to do so. For us it’s three things that we think about as it relates to the keys to patient engagement.

The first one is about providing a great digital experience whether that’s through a super fun and friendly user interface we’ve tried to build, or finding other ways to surprise and delight patients. It’s like common sense. It’s just hard to do. How do you create a simple and intuitive process when you are oftentimes dealing with patient populations that are either uncomfortable with technology or stressful situations? Let’s talk about the diagnosed oncology patients. Your mind is in a lot of different areas. How do we engage them in a way that gets them to focus on the information that matters most to them and their care? It’s easier said than done.

You’ve got to stand out through the noise of everything else going on in their life. That’s not just within healthcare. How do I stand apart from the noise of Facebook, from all these other cool apps they’re using, Instagram, the recipe apps? How do we provide an experience that can compete with those? I think people are obsessed with trying to compete with other apps within healthcare. That’s not really the way the real world works. You’re competing for attention from that patient by all the other things in their life, healthcare related or otherwise. That’s number one.

Number two, it’s really about making it convenient overall. Again, not rocket science here, but how do you do that? You’ve got to make it convenient for patients to either fill out the information or consume the information you’re giving them, and you have to make it convenient for staff to receive and analyze the results, not having two separate systems they have to log into, for example.

For patients, what we ended up doing was building native apps across the iPhone, iPad, and web that really allowed patients to interact in the medium and in the time that was most convenient or relevant for them. It’s really about let’s build our workflow, I hate that word, let’s build or information needs or make it flexible enough so that it can be personalized to the patient rather than having the patient follow some rules of engagement that we’ve somehow dictated from above.

Third, for us it was about making that data actionable. You hear about patient engagement. You engage the patient, but if you’re not providing feedback or giving them something in exchange for that engagement, you’re eventually the boy who cried wolf. People are going to say, why am I engaging if I’m not seeing any type of return? We really see that as, we said we’re going to make that data actual. If you tell us one thing, we’re going to instantly return some type of information back to you whether it be, “You took an atrial fibrillation screener. We’re going to automatically return results to you and say here’s how you compare versus all the other 50 year old African American men living in this zip code,” for example.

You can start to see, “I get this information. I get some good feedback.” There are some cases where you don’t want to show how people compare when you give them back the results, but that’s just an example of how we provide meaningful feedback. Hey, you screened in a certain way. Watch this video right now. You may be at risk for obstructive sleep apnea. Check out this video. You might learn some tips. Here are some things you should go to your doctor and be sure to ask him or her about that when you go in.

It’s really about how we use that data in real time to both improve care on the clinician side and return something back to that patient for their engagement. We’re always focused at Tonic on how to get the right content to the right patient on the right device at the right time. It’s not a rocket science idea, but it’s hard to execute against. They say ideas, idea generation is 1%, 99% perspiration. We’re certainly focused on the perspiration part.

Jared Johnson: I’m curious how you market this platform to clinicians, specifically what pain points you let them know you are helping them overcome.

Sterling Lanier: I think anybody, whether you’re a provider or a payer, if you work in the health system you are there to provide great care. You’re certainly going to do that. That’s your main motivation. Everyone wants a great patient experience. The question given the payment models, the question then becomes, what can we afford to pay for? Oftentimes just providing a great patient experience is maybe not enough to make that line item in the budget. It’s a pain point. People are absolutely focused on it. I think it has to come with teeth, if you will. The teeth we define four ways, cost, revenue, outcomes, and competitive advantage. Let me take each of those in turn.

First of all is cost. What we try to say is while you’re providing a better patient experience, we’re also going to streamline those operations so that we’re going to save money at every patient interaction. Right now, every intake experience from labor savings, time savings, to the patient, you’re looking at roughly $300 to $400 every encounter just in labor time of entering that data, not having the data at the right time within the record. Tonic is going to say we’re going to provide a much better patient experience, but we’re also going to save you cost.

Hey, I’ve got this patient satisfaction survey I’m doing, but I can’t get the data back in real time. I certainly can’t customize anything with the standard patient satisfaction tools. That’s costing us real money and not being able to understand why folks aren’t coming to our clinic. What we try to say is great patient experience. We’re also going to save you cost by streamlining operations.

Second thing is we’re going to provide a great patient experience and we’re going to drive more revenue for you. We’re going to allow providers, for example, to provide those services that have been historically challenging to provide but now I can bill for, such as the new chronic care management code from CMS, the chronic care joint replacement model from CMS, even simpler stuff like annual wellness visits. We’re saying those things are tough from a requirements perspective.

Tonic will just automate that whole process for you so that you can make more money while providing a better patient experience and ultimately providing better care because we’re doing all these things together. That’s the first piece. We also have a full patient’s payment platform that allows hospitals and providers to collect more payments from patients than they otherwise could get on their own because they’re primarily using paper billing. The second main piece is you can make money doing this as well.

The third one is certainly outcomes. Again, the more we know about a patient, the better the care at a lower cost, or the better we can treat them at a lower cost. That’s what Tonic does. We can do all this preventative care. We can screen your population on an ongoing track so we can track and trend those patients over time. We can get you the outcome data without it being a complete pain in the rear to collect all that information and make it very easily accessible.

The fourth big pain point we say is we can use that patient experience as the competitive advantage in terms of, as we all know, we’re now in a period of mass consolidation among providers and payers. Both really need to offer and experience that patients can’t get at the competing provider down the street. One of the things that has been what we call a halo effect with Tonic is what you’ll hear from patients is those folks who use Tonic will tend to say that provider offers more advanced or innovative care than they can find elsewhere.

Again, when we talk about how we make our patients . . . particularly a value based model, I don’t want them to go somewhere else. I get a fixed fee for their health. If they go somewhere else, I can’t track it. I can’t control that. We want to keep them in the network here. How do we make it an experience that people want to stay? It’s really those four things. Yes, it’s about providing a better patient experience, but it’s got to have teeth. Less cost, more revenue, better outcomes, increased competitive advantage.

Jared Johnson: We’ve got time for one more question, which is our little bonus here. If you could join any rock band or music group for a day, who would that be?

Sterling Lanier: I think I would probably join the Dave Matthews band. One, I’m a product of that environment. I went to college when he was just starting out and playing in the local college bars. I guess I have an emotional connection to my youth. I think he’s got a true focus on quality. He really cares about every performance. He cares about every song that he puts out. Again, this is my perception. I’m not sure if this is true or not. I don’t know. I’ve never met the guy. I don’t think I’ve even read much about him. I don’t know. I think that’s why I like the guy. I’d say if I were to dissect why that would be, I say those would be the reasons I’d pick him.

Jared Johnson: Sterling, I appreciate your time here on the podcast. Our listeners have a lot to think about and hopefully a lot to take back to their practices and to the vendors that they work with and say, “Hey, we’ve got some new insights here.” For anyone who wants to get a hold of you or get in touch with you, what’s the best way for them to do that?

Sterling Lanier: I’d say shoot me an email, sterling [at] tonicforhealth.com. Always happy to chat. Feel free to email me at any time.

Jared Johnson: Hopefully we’ll have you again on the program soon. Thanks again for taking the time.

Sterling Lanier: Thank you. I appreciate the invitation.

Jared Johnson: That wraps up our program this week. What did you think this time? Let me know what you thought. Tweet me @JaredPiano. That’s J-A-R-E-D-P-I-A-N-O, JaredPiano. Let me know what you thought. You can leave a review and subscribe on iTunes also. I’d love a few more reviews there on iTunes. You can also subscribe on Stitcher Radio or on Podbean or on your favorite podcasting app. My friend Joe Lovell loves the app Overcast. Check that out if that helps you out.

Ladies and gentlemen, remember it is up to us to tell the story of innovation in health IT. Remember to build that audience one gig at a time. Until next time, I’m Jared Johnson. You have been listening to the Health IT Marketer podcast. This program is sponsored by Ultera Digital, influencer and content marketing. For a full archive, go to healthitmarketer.com. That’s healthitmarketer.com. Thanks again for tuning in. I’ll talk to you again next week.