Dr. Jeff Wessler (MD MPhil FACC) is a virtual cardiologist, the Founder of Heartbeat Health, and on clinical faculty at Northwell Health.
Like a lot of startups, my company is meant to disrupt the problems that exist with the status quo. Indeed, it’s harder to think of a more entrenched foe than the industry we are facing: The United States healthcare system.
It hasn’t been easy, but we’ve made good progress. And I’ve distilled the playbook that has worked for us in hopes that other startups might find it useful.
The Resistance We Faced
Some background is useful. My company is focused on one small but important part of healthcare: preventing and treating cardiac disease. Today, most people discover that they have cardiovascular disease when they experience heart attacks, strokes or other issues. Our approach uses telehealth and remote diagnostics to identify people with heart issues long before an ER visit is needed.
The logic of this is clear: Catching heart disease early can save lives and money. Medicating someone with high blood pressure, for example, is far less costly than treating a stroke patient. But for this model to be adopted, many deeply entrenched healthcare practices must change:
• Primary care providers need to refer more at-risk patients for appropriate cardiac screenings. In-office EKGs in isolation miss too many signs of serious conditions.
• Cardiology practices need to embrace telemedicine. Office visits take weeks to get and aren’t efficient for frequent monitoring of treatment. And it’s sometimes difficult for patients who live in far-flung locations or only have access to public transit to make in-person visits work for them.
• Insurance companies and other payors must incentivize preventive care. Now providers earn more treating diseases than preventing them.
The Way Forward: A Disruption Playbook
There are lots of initiatives attempting to improve the U.S. healthcare system. Payors, especially Medicare, are experimenting with reimbursement arrangements that incent providers to keep patients healthy. And the U.S. Preventive Services Task Force, which recommends standards for testing and prevention, has looked at screening for atrial fibrillation but wants more evidence in support of it. Yet as a startup, we can’t wait for all this to play out, even though we would like to speed them along where we can.
So we’ve had to work within the system as it exists, even as we try to foment change. Our experience strongly suggests three tacks:
Find a community of innovators.
Even if most of the industry is stuck in its old ways, there are doubtless some that are trying new things. They are your natural partners. For us, two groups are particularly important:
• Accountable care organizations. These are group medical providers who serve patients in Medicare programs with reimbursement tied to the quality and cost-effectiveness of care. We can provide cardiac care to their members.
• Medical device and consumer health device makers. The same trends in miniaturization and wireless connectivity that have driven the smartphone revolution are creating many new devices, such as smartwatches and miniature EKG patches, that can monitor cardiac functions. We work with manufacturers to interpret the results for their users.
You’ll probably run into potential allies as you attend events and read trade publications in your industry. Look for companies that are in different parts of the value chain, such as those that might distribute what you make (or make what you distribute). Anyone that could benefit from shaking up the established order may be a valuable partner.
Move fast and be prepared to pivot.
When you are David fighting Goliath, speed and agility are your advantages. Use them. As I wrote in Forbes in May, my company is on its third business model in six years. Our first idea was to serve individual consumers who can afford to pay for their own care without insurance reimbursements. Then we worked with employers who would offer our screening and care as an employee benefit in their offices. The third time, as they say, is a charm. We partnered with accountable care organizations that need us to help meet the goals set by Medicare. And their members—who are by definition elderly—have a high concentration of people with undiagnosed cardiac conditions who we can help.
What’s important is to keep your eye on your ultimate goal. Treat everything else in your company—products, marketing, distribution—as experiments about how to reach the goal. Regularly evaluate the results. Double down on what’s working, and change the rest, even if it means throwing out projects you’ve worked hard on.
Collect data as you go to prove the benefit of your model.
Research may seem like a waste of scarce startup resources, but big players will want to see hard facts before they commit to something new. Sometimes that takes some finesse. The most important outcome of our approach, increasing the life span of patients, will take many years to determine. Instead, we’ve used surrogate markers like blood pressure improvements. We also track symptoms because quality of life is just as important as the quantity of life. Each proof point helps us convince more partners to work with us, expanding the available data for our research.
Think through what information you will need to validate the most important hypotheses in your business and to prove your value to partners. Make sure your systems capture and keep all this data, even if you haven’t built out all the analytics to use it. Start as early as possible; it’s much harder to change the way your data is organized later on.
These three strategies work together and offer a basic road map for how a startup can disrupt even the most entrenched industry. First, find the rebels who share your goal of challenging the empire. Second, take advantage of your small size to adjust your tactics whenever it will help you reach your goal. And finally, collect accurate data on all you do. It will help you make smarter choices. It will let you attract allies. And it just might be the catalyst you’ll need to cause the disruption you’ve been working for.
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