Q&A with Aaron Martin, Part 2: “We Can Extend Our Reach Beyond Our Clinical Footprint.”

When Aaron Martin told his boss that he was leaving Amazon to pursue the role of SVP of Strategy and Innovation for a health system, the reaction was pure confusion. In fact, it took a good half-hour for Martin to convince his boss of the opportunity healthcare offered. By the time he was done talking, he had made his point.

And although this was seven years ago — before Amazon had any interest in healthcare — the draw remains the same: to leverage digital technology to improve consumer engagement, and to help realize the promise of AI. Recently, healthsystemCIO spoke with Martin about what he believes healthcare can learn from other industries, how he is able to marry the dual roles of Chief Digital Officer of Providence and Managing General Partner at Providence Ventures, and the benefits of having digital and marketing under the same umbrella. Martin also discusses the “rigorous process” Providence utilizes to identify the right digital opportunities and purse them, the keys to developing a consistent online relationship with consumers, and the three stages technologists go through when entering healthcare.

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Key Takeaways

• The decision to move to a single platform — rather than individual hospitals having their own websites — has streamlined Providence’s ability to “attract new patients and invest in our ability to capture digital transactions.”
• Providence was able to leverage tools from spinoff companies like DexCare to enable patients to do self-assessments and save on PPE during the pandemic.
• Health systems can learn a lot from Mayo Clinic, which has greatly improved engagement by investing in clinical digital content.
• Martin’s decision to come back to healthcare after a 15-year hiatus was mostly due to the rise of AI and wearables, and the infrastructure that was in place to enable digital health.

Q&A with Aaron Martin, Part 2 [Click here to read Part 1]

Gamble:  So much of the focus is on making the consumer experience more seamless. Can you talk about how that has shifted, particularly during the past year or so?

Martin:  Sure. I came to Providence from Amazon seven years ago; and we’ve been making these investments since that time. When COVID hit, we were fortunately in a good place because we had correct technology to address it, and we had built it to scale dramatically.

As a matter of fact, I used to complain to my engineering architecture teams. I said, ‘Do we really need to build this for this kind of scale? Shouldn’t we be focusing more of feature development? Because we’re never going to see these types of virtual visit volumes in our collective lifetimes.’ Boy, was I wrong — thank God they didn’t listen to me. They were used to building to that Amazon scale, and fortunately they had done that.

 

Leveraging technologies during Covid

A lot of these technologies were crucial in dealing with COVID. To give you an example, three years ago, we started moving to a single platform from a website standpoint. When I got here, we had something like 56 individual websites. Each hospital had its own website, which was totally unmanageable. Fortunately, we had migrated to one site — Providence.org — which made our COVID response a lot easier, because we could post messaging on a single platform and change it dynamically as new information came on board.

The second piece is that we had built Grace, our AI-driven chatbot. We used that to drive the conversation around helping patients assess whether they had Covid. We also worked with Microsoft to make it better using their healthbot technology.

The third area is DexCare, a digital health platform patients can use after they’ve self-assessed; this was early on when there was very limited testing out there, very limited understanding of the disease, and very little PPE available. This allowed patients to be seen safely, and at scale; we were able to assess and determine if they were under investigation and possible Covid-positive. If that was the case, we moved forward. If they weren’t sick, we could manage them from home.

We also used Xealth, which I had mentioned before, and another Providence portfolio company called Twistle to monitor patients at home on a scalable basis. These are patients who didn’t need to be admitted to the hospital; we could safely monitor them at scale with ICU nurses checking on them and reminding them to take their temperate and pulse ox three times a day. If someone started to decompensate, we can see them via a virtual visit and potentially admit them to the hospital. All of this technology we had built in was useful during Covid.

 

Creating a unified brand

There are two things we’ve done to make sure we have a consistent, scaled brand. We went from Providence St. Joseph Health to Providence, which helped from a simplicity standpoint. The second part was to unify the websites, which helps streamline our ability to attract new patients.

We’ve also been investing in our ability to capture and enable digital transactions. That’s been incredibly helpful. DexCare is the platform we’ve built around that. We also use a company called Kyruus that allows us to do the same thing for physician-specific needs. If someone tries to book an appointment with a specialist or a primary care physician, we use that platform. It’s another Providence Ventures portfolio company.

 

Engaging, not just transacting

The next step that we’re really working hard on right now, which will probably be our fourth spin out, is the engagement part of what we do. If you just kind of transact with people online, that’s great. You’re creating convenience. But you need to develop an ongoing relationship with them.

And it’s incredibly costly. You have the cost of churn.  Most health systems see their patients about two and a half times a year, which is very infrequently. We’ve estimated that we need to get that up to roughly 12 times. That means we’ve got to become more relevant between episodes of care. That’s the next big initiative we’re working on.

If you think about engagement platforms, there are typical ones outside of our industry that are based on points and loyalty programs. Amazon Prime is probably the most successful one. What these platforms do is keep you relevant and top of mind, and keep the conversation going between clinical interactions. It’s measured by monthly active users — i.e., how many patients are engaging with us on a monthly basis.

We’re about to hit 1 million per month, which is pretty good for a health system. But if we serve 10 to 12 million patients per year, we should be hitting a higher order of magnitude, like 20 or 30 million. I say this because there’s an opportunity for us to be relevant to people who aren’t our patients.

I know it’s true because there are examples of it in the market. If you look at Mayo Clinic, they punch way above their clinical weight from both a brand and an engaged user standpoint. They have invested a ton in clinical digital content.  They have met an order of magnitude where more users come to the site and engage with Mayo Clinic that the number of people actually treat. So there’s a possibility we can actually extend our reach even beyond our clinical footprint.

 

Gamble:  That hasn’t always been the thinking in healthcare. Do you see the industry shifting more in that direction?

Martin:  Honestly, I don’t think health systems have a choice. This is how an e-commerce company thinks. They think in terms of how good is my brand, and are digital transactions happening as conveniently as possible. And once I have that first transactions with the consumer, how am I creating an engaged experience to make sure that they choose us as the next place they transact with, whether it’s content or an actual clinical interaction? This is how Amazon thinks.

That engagement drives better branding, and it’s a cycle. Amazon really didn’t advertise before about 5 or 6 years ago. Jeff Bezos was very clear that instead of dumping money in TV ads, he wanted to focus on a great transactional experience. He also invested a lot of Prime, which has paid off. The Amazon brand has been incredibly successful with relatively little broad advertising, because every positive interaction you have with them online leads to more customers through word of mouth.

 

Amazon’s marketing strategy

There are two ways you can solve a lack of engagement. We only have one viable route, which is to do what Amazon did and create more and more opportunities to transact and engage digitally, which is relatively cheap versus what property and casualty companies do.  They will typically create huge very, very costly marketing campaigns.  If you think of Progressive and Geico where there’s entire like plot lines and characters because they advertise so much, that’s incredibly expensive and health systems don’t have that margin structure.  We can’t afford hundreds of millions of dollars to support the brand and stay top of mind; property and casualty companies have effectively the same, if not a worse, problem in that people rarely are out shopping for car insurance. When you’re in the market, they want to make sure you remember them, and so they hit you with endless TV ads.

The better way for health systems is to get those transactions online and capture that engagement. Another big benefit of Xealth is that it captures all the engagement that was typically done offline between the physician and the patient. Things like, ‘you should watch this video’ or ‘you need to read this.’ It’s also kind of pulling in engagement that we should have been getting anyway, but digitally.

The process is make sure you have a good brand to reinforce — and there’s a whole discussion around that, but also make sure you get as many digital transactions as possible. And where there is already engagement, try to get as much of it on digital as possible, and then increase the opportunities and the irrelevance through talking about health between episodes of care.

 

Gamble:  Is that why you chose to come to healthcare — because of the tremendous opportunity for growth in the digital arena?

Martin:  Yes. I’ll never forget telling my boss at Amazon that I was going to go work for a health system. They were totally confused. This was seven years ago, before Amazon really had any ambition in healthcare. It took a 30-minute discussion with my boss just to like get across what the opportunity was, and then at the end of it, it was, ‘You should totally go do this.’

The thing was, I had worked in healthcare about 15 years prior to that. I left healthcare and I went into technology and founded two companies in banking and financial services and manufacturing software, and then I went to Amazon for e-commerce.

During that time, the things that had changed in healthcare were pretty significant. AI was really starting to look promising again after the cold winter it had. Mobile was now thing, as well as the Internet and wearables. There was a lot of enabling technology that seemed to support that. And, by the way, Meaningful Use happened, which meant health systems at least got the basic digital infrastructure in place like EMRs. There was enough investment in the infrastructure and enable technologies existed for this to work. That’s what drew me in.

 

Three stages of technologists entering healthcare

Gamble:  And you have no regrets?

Martin:  No. It’s interesting; I always tell people there are three stages when technologists go into healthcare. Stage one is hubris. You can’t avoid it. You don’t understand the system; it seems really messed up, and you’re here to help. Stage two is the pit of despair where you realize, ‘Wow, it’s really messed up for some fundamentally hard reasons.’ There are some very smart people are in healthcare — it’s not that they don’t understand what’s going on, it’s because there are structural issues.

Then phase three is you either get the bug or you don’t, right. You either say, ‘I really enjoy the mission of healthcare and I’m willing to do something that’s a lot harder than it is in other industries,’ or you’re not. I’ve gotten the bug.

 

Gamble:  Very well said. I have to let you go, but I want to thank you so much for your time.

Martin:  It’s been a pleasure talking to you.  Thank you so much.