Med Tech x Health Equity Panel

Olyvia Phillips, MATTER (00:13):

Hi everyone. Thank you for joining us and welcome to our MedTech and Health equity panel discussion with Accenture. The topic of today's discussion is how MedTech can help address health inequities. I am Olyvia Phillips, manager of Equity Initiatives here at MATTER. And just for those who are not familiar with MATTER, here's a little background MATTER is a healthcare technology incubator and innovation hub. Built on the belief that collaboration between entrepreneurs and industry leaders is the best way to develop healthcare solutions. Our mission is to accelerate the pace of change of healthcare, and we do three things in service of this mission. First, we incubate startups. Since we launched about eight years ago, we worked with over 800 companies that range from very early to growth stage startups, and we have a suite of services to help. At every stage of development, our member companies have raised more than $5 billion to fuel their growth.

(01:10):

Second, we work with large organizations. This includes healthcare systems, life science companies, payers, and others. To strengthen their innovation capacity, we help 'em find value in emerging technology solutions, unlock the full potential of their internal innovators, and create a more human-centered healthcare experience through system level collaborations and third MATTER serves as a nexus for those who are passionate about healthcare innovation. We like to bring people together to be inspired, to learn and to connect with each other. We produce a lot of events, some open to the public, and some exclusive to our members and partners. Today's event is about helping us understand how to address health inequities. While we know that social determinants of health account for over 80% of an individual's health, actually addressing these factors can be challenging in practice. We're thrilled to co-host today's program with our partner Accenture, who does extensive research into health inequities and how the healthcare industry and MedTech can help address them. Accenture's US health equity beyond the statistics report found three key areas to focus on when developing MedTech solutions to improve health and healthcare delivery. The first is mitigating bias and data and algorithms, the second designing inclusive products and services, and the third, creating sustainable and structural change. With that, I would like to introduce our moderator for this panel, Laura Westerkamp, director of Accenture's Life Sciences and MedTech practice. Laura, I'll let you take it away.

Lauren Westercamp, Accenture (02:48):

Hi, Olyvia. Thank you so much and I really, really appreciate the introduction. We are so glad to be here today and we're so glad that you've taken time out on your Friday to join us to dig into this really important topic, which is how can MedTech play a more significant role in addressing health inequities? So Olyvia, thank you for the introduction. My name is Laura Westerkamp. I'm a managing director at Accenture. I focus a lot on new commercial models and experience, and I'm really honored to moderate today's panel with some very, very esteemed panelists who will introduce themselves in just one moment, we're going to cover three big areas today, which Olyvia gave you a short preview of that really come out of this recent report that we issued around US Health inequity and how we can start to get beyond the statistics. The first big bucket of questions that we've got for our panelists is around creating sustainable structural change.

(03:51):

The second is around supporting access and awareness. And thirdly, we'll talk a little bit about how we can start addressing some of the bias that exists in data and algorithms, which is so important in MedTech, especially with all of the discussion around generative AI and other tools. So with that, I would like to get the discussion going. We'll spend about 30 minutes on these questions and we will make sure we've got about 15 minutes at the end to address questions from the audience. I know last round the folks that were able to join us had quite a few, so we want to make sure we get to those. Although I'll note it might be tough to get to all of 'em, but we'll do our very, very best. So please keep those coming as we go. Okay. All right. So I'll ask the panelists to pop on video and to introduce themselves. So if we could, Nick, I'd love if you could get us started and tell us a little bit about yourself and your role at Philips.

Nick Wilson, Philips (04:54):

Yeah, absolutely Laura. So I'm the general manager of what Philips calls our virtual care business, and what that means is we support and deliver solutions to patients or healthcare members who are not in a clinical setting. So think about a diabetic who's out in the world, how can we better help that person live a healthier, longer life without necessarily having to go into a healthcare setting to receive the care that they need as they go about their daily business?

Lauren Westercamp, Accenture (05:25):

Awesome. Well, thank you Nick. What an important and interesting area. Fido, maybe you could tell us a little bit about yourself too before we get rolling.

Fido Willybiro, Becton Dickinson (05:33):

Hi Laura and hi to everyone. Thanks for the opportunity. Looking forward to the next hour. So I'm Fido Willie Biro. I've been with BD 15 years plus. I lead the commercial marketing team for medication delivery solution business, which really focuses on providing access to anything ranging from your syringes to the IV catheters to actually even more complex devices. So honored to be here and excited for this discussion today.

Lauren Westercamp, Accenture (06:04):

Thank you, Fido. Providing access for tools that really help enable treatments is so critical. So we're really looking forward to your perspective. Okay, Jackie?

Jackie Roche, Johnson & Johnson (06:15):

Sure. Thank you Laura, and thank you Olyvia for that terrific setup. Also happy to be here and sort of thrilled to be talking about a subject near and dear to my heart. So at Johnson and Johnson, I lead our global policy institute within our government affairs and policy team and lead a team of experts in payment and delivery system reform. So that means our day-to-day is Medicare, medicaid, payment and health system delivery redesign, et cetera. And we do that for both med tech and farm life sciences, which is very interesting to get to work across both sectors. Although when it comes to health equity, we find a tremendous amount of synergy and opportunity. So prior to joining J&J, I was a tenure veteran of CMS and there I was charged with implementing a number of the key provisions of the Affordable Care Act and was a community-based occupational therapist practicing in the neighborhoods of Baltimore City where I got started in healthcare. So happy to be here and look forward to the discussion.

Lauren Westercamp, Accenture (07:19):

Thank you so much Jackie. Having that lens of payer and really access I think is so critical. So we're really, really looking forward to hearing your voice on these topics, especially with IRA and so much happening across the industry right now in this area. It's just so, so critical. Okay, Oliver, if you could round us out, would love to learn a little bit more about your background too before we get going.

Oliver Richards, Accenture (07:44):

Great, thanks Laura and thanks everybody for the audience here today, I've been working in healthcare and life sciences for the last couple decades. I am focused on MedTech strategy within Accenture, managing director within the practice, and I think similar to Jackie, I take a pretty wide lens where I focus across pharma and med device and diagnostics and really looking through that from a patient and a provider lens. So really looking forward to talking about some of the challenges that we see and some of the opportunities that we see to improve health equity during the discussion today.

Lauren Westercamp, Accenture (08:23):

Yeah, perfect. Oliver, we appreciate that. Taking the broad lens, this is such a broad and deep systemic issue. I think all of the different perspectives you bring will be so important to the discussion and really furthering it as a med tech in pharma community. Alright, so let's start with the first big topic area and that's around creating sustainable and structural change. Fido, I think we're going to pass this first question to you. So this one is really around investments and we hear a lot around investments and things that MedTech is doing in the industry right now. I'd love to get your perspective around what are some of the investments that you believe need to be made by MedTech now and potentially a little bit in the future to really see some lasting improvements in health equity. Fido, what's your perspective?

Fido Willybiro, Becton Dickinson (09:18):

Yeah, Laura, thanks for the question. I think, well, a couple of things, creating a healthier and more equitable world is really core. So I think what we all represent on this call, and so we're focusing here at BD, we're focusing on some of the most challenging global health issues. I mean, if you think about from supplying instruments in the world's first portfolio trials in the fifties to delivering more than 2 billion syringes to combat Covid pandemic, we at BD have been involved and have been looking at partnering and leading in those spaces. But ultimately to improve health equity collectively, we must first the knowledge that the health system is not equal and until it is they cannot be health equity. So what we do here at BD is we actually make innovative technologies, but there's no point making innovative technologies if those technologies cannot be used or leveraged or accessed by those that I know most needs.

(10:26):

So going back to your question around what we can do and how we're thinking about making it more equitable, there's really three areas that we typically would focus on. One is really around public private partnership. It's very clear when you think about a health equity that industry alone cannot do it. You really need a public-private partnership to drive toward a more equitable world. So we build partnerships with government agencies, nonprofit organizations, advocacy groups that support innovative ways to care for those that are vulnerable and meet them where they are, where they are while also helping improve their setting. We also partner across the industry with ED on the medical technology fraud. We understand that industry partners play a big role in driving toward health equity, but I think we all kind of technology and innovator providers. So we also obviously look at the solutions we develop and we continuously look to develop solutions that from the core beginning include the concept of equity, ensuring that the accessible, affordable and so forth. So these are some areas that we're focusing on and really trying to drive and march toward a more equitable healthcare system.

Lauren Westercamp, Accenture (11:59):

Fido, that is so encouraging to hear. And if I were to summarize what I'm hearing you say is it's really about starting from the beginning, very intentionally investing in the right relationships that have the end user in mind or have, gosh, I hate to say it, but some of those challenges or barriers that might exist even from a public standpoint so that you can start to address the needs. I think you said something really compelling there and Jack many things, but Jackie, I would love to get your perspective on this one. To build on Fido's point, you said there's no point in making innovative technologies without access, which I completely agree because we've seen especially at places like MATTER, fantastic startups, but we just don't have the pathway. So Jackie, if you don't mind, I'd love to just get your perspective around some of those pathways for innovation and from an access standpoint, maybe what you're starting to see in the marketplace.

Jackie Roche, Johnson & Johnson (13:04):

Sure, thank you. I think what has felt fresh and new in this space or in this new era in zeki and focus on health equity has been this intentional, meaningful, focused, insert favorite, your favorite group there, attention on the importance of the private and public sector partnership. And I think that is a term that can be overused, but it is going to be the lever we really need to create the structural and permanent change here. Perhaps this is my long-winded way of saying I think we've been talking about health equity for a long time, but what we really need to do is move and pivot from what feel like episodic pilots or programs to building those longer term foundational structures we need in order to make sure that all Americans experience an equitable system of not only healthcare but social care. And so at J&J that means a couple of things, and I'll echo certainly echo a number of the sentiments that Fido shared, but one, we really have put a lot of time in thinking about the response to whether it was Freddie Gray or whether it was covid or a number of the prevailing social issues of our time where we think we should invest meaningfully.

(14:28):

And so we did make a decision in 2020 to launch what we refer to as our race to health equity campaign. And within that campaign we thought to pledge over a hundred million dollars over five years to directly combat racial and social injustice. And to me, what was really meaningful about J&J's commitment there is that we took a step back and we started from the perspective of directly having to address, make the statement, treat it head on, that racial and social injustice is a public health threat. And making a statement of that should not be as historical, historically controversial as it has been. And so then we had to do the hard work to say, okay, then really what is our role in this space as a large healthcare company, as a multi-sector company in both the life sciences and in med tech.

(15:20):

And after some real thoughtful analysis, we really anchored on three areas. One is that we need to live into creating healthier communities and really having an understanding of that intersection of the social care network and healthcare that we couldn't do this alone and certainly needed to foster new and unique diverse alliances. And sort of the last part of our three-part theme here was that this needed to start at home. We needed to cultivate an inclusive workforce and add real intentional and critical milestones to that commitment. And I think this pulled through pretty well in our MedTech space where we have spent a lot of time and resources thinking about an inclusive healthcare workforce across MedTech, not only inside of J&J, but being very intentional and mindful about diversity within our contracting resources, diversity in our health systems, enhancing patient and provider education and diverse spaces.

(16:24):

And then to your primary question here, how do we enhance patient education and access to innovative medical technology and services? And so that is really where my hook and expertise has come in and I think it's really challenging, but it's how do we advance policies to create those sustainable changes and what type of policies do we and social I justice interventions do we need to pursue across sectors to really create this sustainable change. So I'll throw in a couple ideas, but happy to discuss any of this throughout the discussion today. First and foremost, we believe we need to protect and strengthen the health safety net. So we do pay a lot of attention to Medicare and Medicaid policy and making sure that the traditional access to healthcare services are improved upon for all people. But then I think more aggressively it's really thinking about how do you promote care delivery models that incentivize payment reforms that really address equity and directly recognize the role of addressing to Olyvia's earlier point social care and healthcare, whether or not you refer to that as social determinants of health or what have you really understanding that you need to directly address and finance the intersection of those two components.

(17:46):

And although it's painful to talk about healthcare financing, you do have to follow the money. So if the systems were further incentivized and resourced to provide these services over time, it also helps us partner in multi-sector commitments to promote longer term structural change. I know you're going to have a rich discussion about data and digital and AI technologies, but we have a strong understanding and commitment in terms of the significant role that data and digital technologies will play in advancing health equity, both in the sort of more obvious, making sure everybody has access, but also in the more thorny and tricky, which is to make sure that these data sources aren't used to risk adjust in ways that may be harmful to traditionally marginalized populations. So really, really tackling those issues straight on and really getting at how do we collect and develop and foster data beyond traditional epidemiologic data that includes cultural data in terms of developing policies that are inclusive and responsive to those in need.

Lauren Westercamp, Accenture (18:56):

Yeah, Jackie, wow, it sounds like you and the J&J team have really crafted a comprehensive approach to thinking about health equity and having that commitment really built from the start and how you work and how you think about not just your business but the people that you're serving and impacting. You said something in there that I run into a lot with my clients. I think for the startups on the phone for MATTER, they probably run into a lot too, which is a little, you didn't quite say this exactly, but I'm going to synthesize it into Laura terms, which is sometimes there's a little bit of death by pilot with these equity initiatives and we kind of lose the thread on the scalability and what's really realistic in the market. So I think that's an incredible point and something for us to all bear in mind.

(19:45):

And actually I want to flip it over to Nick because I think there's a thread here around inclusive design strategies. And Nick, I know you've spent a lot of time in this space, so I'd love to get your perspective on, and I think Jackie started to touch on this, what are some of the practical methods that you use and you've used throughout your career to really involve those underrepresented communities in the design of healthcare products and services so you can make sure that there's that voice in the development process from pilot to scale and really what ultimately gets into the market. Nick, what's your perspective on this?

Nick Wilson, Philips (20:25):

I think first of all, just to maybe build on something both our panelists have already said. So one was meeting that patient or that user where they are considering the context of the end user, which is often going to be a patient and not a clinician depending on the use case. And I think that the policy context is super important as well, because what the policy context influences is affordability. And in the US we've intentionally designed our programs and our health structures, and in many cases we call it the consumerization of healthcare. What it really means is making people pay for things. If we strip back all of the nice language, so that means copays, high deductible plans, and we as med tech and health tech need to really think about that. So what does that mean for us concretely? It means if you design your program around a thousand dollars phone, that's not inclusive design.

(21:37):

If you design it around an $800 smartwatch, that's not inclusive design because you're immediately eliminating a huge portion of the population. Often the population who may need that remote or connected capability the most, and especially if they're going to be in a program where there's going to be copays or high deductibles or what have you, where it's all funded out of pocket, that becomes a real challenge. So a couple of things that we think about when we think about servicing populations is first of all, how can we make sure that Medicaid rural patients start with them? If you can solve for that particular cohort of patients, they are the lowest income and they're the hardest to reach. They're usually at least an hour away from any healthcare provider. If you can provide access and include them in your program, you can kind of work upmarket, if you will from there.

(22:38):

The second one is we spend much as Jackie talked about for J&J, we spend a ton of time working with state and federal level policy makers around things like access, but really, for example, we've worked in Georgia, how can we work with Georgia to make all 26 counties provide free remote prenatal care to pregnant mothers? Why is that a concrete example? Because the US has one of the highest costs of birth and one of the lowest and outcomes in terms of complications, miscarriages, post-birth NICU entries. So if we can help move the needle, we can lower the cost of care, but we need to cost shift a little bit, right? We need to invest upfront so we can reap the benefits at the backend. And really the only one who can do that is the government. The government is the only one that has that long-term perspective of its citizens, right?

(23:45):

Individual payers, we all rotate through payers as you rotate through jobs. So I think you have to combine three dimensions that we've talked about here. So first of all, designed for that end user where they are. And if you start with the hardest end user group, which again for us our kind of benchmark is rural Medicaid patients designed for what they will use, what access they have to connectivity to technology, et cetera. The second element is if you can meet them where they are, how can then you design those programs to engage them in a way that empowers them to take control of their healthcare without it frankly costing them? Remove that friction point. And then the third one is work like hell at policy, both at the federal and the state level to try to remove practical barriers to care copays, right? There's a host resolution going through right now around eliminating copays for telehealth, which were eliminated as part of the pandemic and now have come back. For instance, how can you make and expand access to telehealth for conditions beyond the 65 year old Medicare patient? These are very practical policy decisions that once implemented can move the needle incredibly fast, as we saw with Covid, right? So we have a predicate situation that now we can look back on and say, how can we use that situation where for a very specific circumstance, we implemented essentially a national healthcare policy overnight and pull that through to move the needle for additional cohorts of patients like pregnant mothers?

Lauren Westercamp, Accenture (25:34):

Yeah. Nick, I, gosh, I think it's such a great point around ensuring that our policy isn't so shortsighted and that we're really, we have the benefit of some time to see the outcomes and the impact of some of these good decisions that we made, especially around telehealth during the pandemic that have now slowly or quickly been eroded and made things a little bit more difficult. And Nick, the point around rural patients is very close to my heart as someone from Iowa and from a rural area, I've seen firsthand there's some challenges there, and it's encouraging to think about Medicaid rural patients as a, if we can get them sorted, then we've got a lot of hope in rethinking inclusive design. Oliver, I'm curious if you've got any thoughts or reactions. I know you've spent some time in this space as well, working with a number of different clients. Any reactions with all the richness from Fido, Jackie and Nick and what they both on here?

Oliver Richards, Accenture (26:38):

Yeah, I think a lot of great points, and I mean I think as a starting point, Nick, I think the point about Covid kind of being a test bed and a driver of, Hey, we can make these changes quickly, I think was really interesting. I think one of the problems that we've seen over time is that there is interest in improving health access and health equity, but it takes a lot of momentum to get that rolling. And so again, I think it's a good proof point that yes, we can adjust quickly and we can move quickly. The other point I would say, I mean I'd be curious to get some of the other panelists thoughts. How much of this is a technology problem to be solved versus a process problem to be solved? I think a lot of times what we see is that there are opportunities, to your point, to provide care at different settings, to innovate from it the way that these patients are interacting with the healthcare system, where they're interacting at what step in the process. And so in some ways it's almost a combination of that. And then I think to Jackie's point, there has to be a policy angle to it and an incentivization angle to it to make sure that all of the relevant players are falling into line with the direction that things are moving. But I guess I would open that up to the panel of what is this a technology problem? Is this a process problem?

Lauren Westercamp, Accenture (28:06):

And maybe Fido would love to, especially with the area that you work in around access. And Jackie, I'm sure you've got a perspective on this one too, to Oliver's point, but Fido, maybe you could kick us off. And then Jackie, if you have anything to add?

Fido Willybiro, Becton Dickinson (28:21):

Yeah, thanks Laura. I just got a couple simple thoughts, and I completely agree with what Nick was describing in my mind is it is simple. There's probably three areas to focus on, and I think, Laura, you mentioned some of the folks attending the calls are more on the startup side and whatnot. So when you're thinking about inclusive design, I think to Nick's point, meet your patient, meet your customers where they are. So that really means understanding what the core requirements are going to be for these technology, these solutions to be used and leveraged by those end users. So I think investing upfront in better understanding and defining the requirements or the needs of that customer population is going to be key. The second piece to me as well is where there's still opportunities is I think as we look at our teams, as we are looking at the team of developers, make sure that within your teams you can have that voice, that can be the voice to support the need of driving more of an inclusive and an equitable design.

(29:35):

So I think there's opportunities for sure for the developing teams to continue to ensure that we reflect that. And now on the development side as well, when you think about requirements, product requirements, I think there's still a lot of opportunities there to ensure that even in developing and defining the core product requirements, requirements as well in themselves look for equitable type of a design. So I think when you think of that front, there's quite a lot of opportunities. And then finally, just like I think Jackie, Nick, and then the panel was saying here, you can't do this on your own. So there's still a very big angle of the public private partnership of really finding how these technologies and these solutions are going to be funded. But so it's really an ecosystem of processes, tools, and people coming together that are going to be needed in order to drive a better equitable type designs.

Lauren Westercamp, Accenture (30:35):

Yeah. Excellent, excellent points. Jackie, do you want to add anything?

Jackie Roche, Johnson & Johnson (30:39):

Yeah, I'll just pick right up where Fido left off. I mean, the short answer to your question is this process and structural or something that technology can solve for, I mean, it's both. I mean, there's not a simple solution to advancing health equity. And we went at this for 10 years in the Obama administration, and there we aim to handle access first in terms of the ACA and Medicaid expansion. But we didn't pivot fast enough to health equity. And if it was simple, I think we would. And so what I think is fresh and new to echo, something I said at the outset of this call is the collective interest and passion of multiple different stakeholders coming together and throwing all of our collective tools at that, whether or not it's the incubators and the startups. And I'd echo the comments of our panelists about the importance of inclusive design and being financially incentivized to meet customers where they are is a terrific tool in that toolbox within J&J and our med tech efforts.

(31:38):

I would be very remiss if I didn't mention the importance of diversity in clinical trials among a number of partners in our organization who are passionately working at this. We have an effort called the Research includes Me program, which it's sort of a simple concept, but we recognize was very much needed. That helps folks understand what is the profile of clinical trials that are available. Does it promote and promote inclusivity and representation? That looks like all of us, and we know the answer, there is no. So we have a lot of work underway. We also have a campaign called Our Health Can't Wait, which was a result of covid, which we understood and experienced very much in the med tech side of the house, which was that folks wore foregoing really important critical procedures and treatments during that time. And of course, who were those that most suffered were those who were traditionally marginalized. So I think we are collectively in this together. And whether or not you're a behemoth in healthcare like J&J maybe, or somebody out there on the line who's working on the front lines of an incubator, you have an important role to play and appreciate the form to bring us together.

Lauren Westercamp, Accenture (32:55):

Yeah, excellent, Jackie, that it cannot be understated. The criticality of diversity in clinical trials. And when we think about health equity, I often don't think as much about women's health, which is very misplaced, but the lack of clinical evidence specific for women for some of our most established medications on market is just really remarkable. So rethinking the difference between the biologies and how we

Jackie Roche, Johnson & Johnson (33:27):

Or pregnant women, right? Pregnant it, it's the first, to Nick's point, first I was a pregnant woman during Covid at the vaccine. Do I not get the vaccine? Do I get the treatment for, I mean, so yeah, it's a really good point.

Lauren Westercamp, Accenture (33:40):

Yeah, absolutely. Gosh, and having that risk of safety is so terrifying. So how the industry can help address that is so critical. I think we've talked a lot about supporting access and awareness through this discussion around patient, including them, making sure that we think about working with the government, working with different organizations to really reach patients. So I'm going to move us over to mitigating bias and data and algorithms, and we certainly can go back to access and awareness if we have some time. But again, I do want to make sure that we've got the opportunity for the audience to ask a few questions. Jackie, I know we just tapped you, but if you don't mind, we'd love it if you could get us started off with this question as well. So this is really all around unbiased AI impact. So with the emergence of digital health tools in MedTech, we think there's an opportunity to deliver more transformative value to patients and to improve outcomes. So with that said, how do you think we can really make sure that we're using all this digital data, these clinical data solutions, which you just talked a little bit about so that patients actually see this benefit? Because AI is one thing and generative AI is all the buzz. We're big believers in it at Accenture, but that said, AI is one thing, but really applying it in an unbiased way is another we think. But Jackie would love to hear what you think.

Jackie Roche, Johnson & Johnson (35:17):

Sure. On this issue, I'll be brief. I mean, first and foremost, I do think it's very much about education and not throwing a bunch of new buzz terms out at the general population and assuming folks are going to understand what this means for me and my interaction with the healthcare system or the social system of care. And I do think our number one priority here at J&J, and we are really thinking as meaningfully as we possibly can about what our activation strategy would be. In response though, is the bias question. We have real concerns about that. And at the same time as we're trying to achieve our really ambitious goals about representation, and not only clinical trials, but to our rich conversation before, access to our procedures and our products, services, solutions, what have you, making sure that these tools are additive not only in terms of tracking to the health outcomes and the experience of our beneficiaries or consumers or patients, but truly making sure that they're not used in an advance, in an unbiased way.

(36:26):

So like others on the line, and I'm curious to hear from Nick and Fido about this, but do we need to really stretch our muscle and regulatory tools and pathways there? I mean, the technology has definitely got out ahead of regulation and you guys are the experts there. That happens a lot. But what do we need to reign in and do in a way that does not curb the innovation side of this piece? What are the policy responses? But I think a big part of that is the education campaign. So we're focused, we're very focused on that. We're very focused on the policy. England, we're very focused on the bias, essential for bias, to be

Lauren Westercamp, Accenture (37:02):

Honest. Great points. Jackie, great points. And Nick, maybe I'll throw it to you first because I know you've spent a fair bit of time in technology, in data and analytics and in general in product development. Thinking about the space, so any reactions, policy, so important, getting to human factors design that's important, the synthetic data sets you might be using to train your models so important. But Nick, additional thoughts and reactions?

Nick Wilson, Philips (37:33):

I think what Jackie mentioned is something that definitely concerns us as well. To give a concrete example, we have colleagues who are really good data scientists and trying to figure out how we can up resolution consumer based data like the Apple watches, ECGG. The challenge is we all know PPG has a built-in bias for black skin versus white skin. So you have to account in your algorithms for the data you're getting based on the skin tones that the PPG is looking at and how you interpret that for your algorithms for SPO two, ECG, et cetera. That's based on PPG as a technology.

(38:21):

We're really looking at how do you make sure, for instance, when you're building and training the data sets that the data sets are trained off a very diverse population of all skin tones because otherwise you have built in a bias to your core algorithm, which in and of itself then translates downstream because someone is going to make a decision off of what that algorithm means, right? A clinician's going to look at that and say, oh, I see a declining SPO O two, therefore maybe I need to bring you in the hospital. Maybe ultimately you end up on a vent, which we know is a great therapy, but if you're on a vent unnecessarily, it actually is counterproductive. So I think practically this is something we all have to keep in mind that we are not the patients. Sometimes we can sympathize with the patients, but often we cannot empathize with the patients because they're in a completely, I've never had cancer. I can't empathize with what it's like to be discharged from chemo and need to take my temperature every two days or every couple days, couple times a day, right? Post chemo when you're feeling awful and you just don't want to be in that situation. So I think that's a really important element is there's the standard things we think about inclusion, skin tone, gender, age, but there's also the non-standard things that we often don't think about. Like Laura, you just said, you often don't think about women because you're a woman. So

Lauren Westercamp, Accenture (39:52):

Yeah, it's who

Nick Wilson, Philips (39:54):

I think there's the inclusion of the context is really important to, because we talk about social determinants of health quite often. I think we also need to take that same thinking into how we deliver technology to these patients and what is the social determinant that is going to drive the context and be inclusive of those social determinants as well. There was a recent report, for instance, about Chicago, your hometown in Chicago, 25% of black and Latino children don't have access to high-speed internet. That's a hugely important context we need to take into account, and that is a hugely important element that I think we also don't bring into healthcare policy, right? As more and more of the way we deliver education and healthcare is predicated on basic what we now should call a utility, high-speed intranet. For instance, if 25% of children don't have access to that, that's 25% of the population we're leaving behind.

Lauren Westercamp, Accenture (41:01):

Yeah, excellent point Nick. And gosh, I think encapsulated in what you said there too, there's a core point around adherence, especially your example of a cancer patient coming back from chemo, where I think often in industry, sometimes it can get a little harsh of like, oh, bad patient or bad HCP, and they're just not following the regimen when the reality is there's such a human element of I don't feel well, I feel horrendous, or I can't get to my doctor because I live in a rural part of a state and I need to wait for my son to take me, and he can't do it until next Wednesday after he gets off a shift. So there's just a lot of considerations from a very human at Accenture, we talk a lot about ethnographic research and insights, that very human element that comes into play. Fido, any perspective on this too? I'm sure you've got a ton, but any ads? I know there's been so much rich discussion around this one.

Fido Willybiro, Becton Dickinson (42:02):

Yeah, no, I think, again, I just agree with what the panelists said. I think it's, I'm just hopeful. I think because we are having these conversations now and we're going to continue to have the conversation toward minimizing bias. So I think you can count on industry to play a big role, and we have to play a big role in minimizing bias. So I'm just hopeful that things are just going to continue to pan off better.

Lauren Westercamp, Accenture (42:32):

Totally. Fido, it's so encouraging to hear about Nick, the way you're thinking about things at Philips, your commitments at BD, Fido, and of course J&J, the commitments that you and your team Jackie are helping to realize. Oliver, I'd love to get your perspective on this a little bit more from a technology and business strategy standpoint as you've worked with a number of clients in this space. Back to that core question of how do we think about data in clinical data decisions, commercialization? How do we really make sure that we're not biasing the data points? Oliver, let's bring it back to core of really technology, ways of working op model. Anything that you want to share with us?

Oliver Richards, Accenture (43:20):

Yeah, I think a couple points that I would make, Laura, I think the panelists made great points around thinking more broadly about how patients are receiving care and where they're receiving care. And some of that, I mean, you made the point around the drive or the transportation to receive chemo or to get blood drawn or for a follow-up appointment and how that fits into their process. The other big reaction that I had, I think there's kind of this framing of this is an extra burden or something that we need to think about. I think we've encouraged our clients to flip that around and say, this is an innovation opportunity. And so you're creating ways to disrupt the system. You're creating new solutions that are meeting patients where they are. You're creating different cuts with more diverse patient populations that are feeding into training your algorithms or feeding into the clinical trial populations that you're studying.

(44:19):

And that increased diversity and that increased innovation. It leads to new business opportunities and new solutions. I always go back to some of the examples of work that we've seen where looking at how to do imaging in rural India and that leads to product innovation that can then come back to markets like the US or the EU to drive more inclusive types of solutions. And so I would just encourage the mindset that this isn't, and having a more diverse, more inclusive strategy in how you're designing these solutions, that isn't necessarily a bad thing, obviously from a growth and innovation perspective as well.

Lauren Westercamp, Accenture (45:02):

Yeah, and encouragingly, we had an audience member who popped in the chat some good news that they just saw an FDA cleared pulse oxometer that has clinical data to support accuracy regardless of skin tone showing there's progress. So Nick, to build on your point there, so I do want to make sure that we move to audience questions. We've gotten a couple. So the first question that I think I will pitch over to Jackie, given your deep experience in policy, the question is, do you think there's a perception issue with the public not understanding health equity and making an affiliation with public health care? How can we help separate the ideas? Jackie?

Jackie Roche, Johnson & Johnson (45:49):

No, that's a great question. I thought maybe you were going to lead with the question too about prioritizing issues in healthcare policy right now too. It's great one too. It's a lot of really great questions coming in from the audience. So thanks for your participation. I agree with the commenter in question or that there is a perception issue, but I think it's something that we struggle with across public health and public health initiatives. We experienced this certainly had a front row seat to it at J&J and our experience with the vaccine during Covid and trying to bring helpful solutions whether or not that was testing or vaccine during that time. And there is a component of not only the bully pulpit but the public in terms of perceived notions. But I personally think that we need to tackle it head on. I mean, that was a big part of our analysis at J&J and making public statements in a collective recognition that any injustices, whether they're racial, whether they're social, are direct public health threat.

(46:57):

I mean, what is not new about this space is there are generations of data demonstrating the impact of health outcomes and longevity on those lived experiences folks have. And so I think one, it's the direct recognition that despite the controversy, we need to call a spade a spade and call out injustices and that we need to educate. You need to educate people on the importance. I'm very biased here in that I'm dual degreed in public health, but we do need to educate folks on the importance on public health and not only the importance in terms of what that means for a healthy society, but the financial benefits of that, the improvements in your workforce. If you own a small business that's more people coming to work that day, that's more beneficial for your bottom line. And so just bringing more people into the pie versus developing or promoting any of the divisiveness. It's a little bit of an apple pie answer, but I truly believe that's where we need to start and where there is only, there's only we, right? Bring more people

Lauren Westercamp, Accenture (48:05):

That start somewhere. And apple pie is also delicious, Jackie. So I'll take an apple pie any day, and I think that's a very fair answer. I do think this question that we also got from the audience that I'll read, what kind of policies are coming down the pike that could address reimbursement issues for providers that are adopting these technologies but are reimbursed at a lower rate. So Jackie, I'd love to get some rapid fire thoughts from you on this since we've got you and then Nick and Fido and Oliver, because the reimbursement piece is such a really, really important one. So Jackie, any kind rapid fire,

Jackie Roche, Johnson & Johnson (48:43):

Right? It's also a really good response to the first question you just asked from the audience, which is how do you want to compel more folks to understand and have the empathetic passion that you need to advance public health initiatives while you pay folks well or appropriately? So there are a number of incentives happening in this space. I think we all need to take a look at what's happening out of CMS and the CMI shop. They put out a new model this week. This is going to sound very technical fast, but we've been supporting something called a Z code, which is just another code used by providers in their associated billing offices to identify those patients who may have higher healthcare needs and thus should be an associated higher payment. With that, of course, we could have a whole political discussion about who does pay for these things, but the importance of recognizing and tracking to then tie reimbursement more closely is critical.

(49:37):

And I think it also is very much tied into, so there's the technical, but then there is the more ambitious, which is we need a healthcare system that rewards good health outcomes. If you're directly addressing social and health services together and you're doing that well in a network as a provider, you should be rewarded for that and the better outcomes that come with it. There is a lot of energy behind that. My concern is how do we make that sustainable and how do we make that investment appear attractive to policymakers so that once again, we don't end up in this space where a lot of these social care interventions feel episodic versus that structural change and pull through.

Lauren Westercamp, Accenture (50:16):

Yeah. Alright, so Z code new models from CMS, CMI, Nick, any hopeful reimbursement strands of glimmer that you see for adopting that are reimbursed at lower rates? I know you work a lot in the remote patient monitoring space,

Nick Wilson, Philips (50:33):

So not necessarily on technology as we would traditionally think about it, right? The widget, but we are seeing some really interesting things coming down in terms of the technology combined with the clinical service. So for instance, in the physician fee schedule that was published that hopefully we'll get a final reading on here in the next month or so, there was a proposal to increase reimbursement for coaching and helping diabetics better manage their weight, which we know there's a direct correlation in that cardiometabolic dynamic. So there are things coming that will couple technology with clinical service to help clinicians better provide support to patients who need that support in that interaction. I think one of the things that we need to think about though is a lot of the new models that we're talking about are predicated on primary care, and that's a great thesis, but there's a huge number of people who don't have a primary care physician, and we know primary care physicians are becoming more and more overworked and more and more short supply.

(51:50):

So I think one of the things that I see coming over the next several years is how can industry help primary care, but also the connection between primary care and specialty care, most of which are specialty care is largely fee for service or in very certain circumstances, an episodic payment, joint replacements, but it's still, it's a fee for a rather short window. It's not a population kind of inclusive to care fee. So I think there's something that we all need to evolve in as well is how can we help specialists start to join in and connect in to this primary care driven population management, but then also how can we help patients get connected to primary care? And that's where I think the evolution of the retail and the virtual primary care setting that we see evolving, right? C V Ss and Walgreens on one hand, but also Oak Street and one Medical and some of these new delivery practices, I think are going to be a really interesting evolution in the healthcare and the care setting landscape that we're all going to be playing in over the next several years.

Lauren Westercamp, Accenture (53:04):

Yeah, great. Great points. Nick, all around. We got another question in the chat that Fido, I'd love to get your perspective. Oh, actually, you know what, before we move to Fido on this next question, Oliver, I'm just reminded of some of the work that you've done in this space too. Maybe you could just, if you'd like to add anything to the conversation before we move to a question for Fido.

Oliver Richards, Accenture (53:30):

Yeah, I'll give the real quick 22nd follow on. But I agree Nick, and I think some of the innovation in reimbursement and policy is around setting of care. And so you mentioned the retail kind of model or telehealth model, but I think some of the incentivization of care delivered outside of the hospital at different settings at places that are going to be more accessible by patients. That's been one of the big movements that we've seen over the recent years. So just wanted to make that point quickly.

Lauren Westercamp, Accenture (53:58):

Yeah, that's a great point. And I think just speaking of kind over the years and how things have changed, Fido, we got another question in the chat around, and the question is, as the training ground for healthcare providers, data scientists, technologists, and so many others that play a role in these systems, we'd love to hear where you'd encourage universities to step up to address these issues raised throughout the conversation, how can we be a better partner with industry to make change? Fido, what do you think?

Fido Willybiro, Becton Dickinson (54:29):

Actually, first of all, that's a very good question.

(54:34):

I think mean we all know universities play a key role in helping develop and advance healthcare. So I think what universities can do and what universities should do is actually include in their development of solutions and their development of solution, they should be including health equity early into the process, validating some of the concepts I think that industry might be looking at leveraging, and once they're validating it, I would say leverage any kind of public forum to share some of the insights I think that they would've kind of generated. So I'd say universities play a key role, obviously in advance healthcare, and I would say just continuing to push for funding for funding toward the areas that may better help address health equity in general. I hope I've answered the question.

Lauren Westercamp, Accenture (55:33):

Yeah, very well. Fido. Anyone else want to add to Fido's points?

Nick Wilson, Philips (55:38):

I think training doctors in these new technologies is really critical, especially because example of stethoscopes. Physicians have been trained using traditional stethoscopes for hundreds of years, and about 20 years ago we started to introduce digital stethoscopes and now you start to see medical schools actually making that the standard of the training. It's not the standard of care, it's the standard of training that new med students coming through and are being trained using these new tools which offer potential higher fidelity, additional diagnostic value. You can start to introduce algorithms. So I think that's a long game, right? We're talking about training new physicians coming through that entire pipeline, but it's a game that's going to change the ground level interaction. I think the other thing is unconscious bias in corporations. We all get those kinds of trainings. I think introducing those kinds of trainings into clinical practice is also really important. You hear all the time about physicians', unconscious bias, discounting patients saying something doesn't feel right. I get what you're telling me, but it doesn't feel right. I think those are really important elements that are maybe not sexy to introduce, but will be really important in terms of moving the needle in terms of the way we interact with each other as humans, which is kind of what the whole point of healthcare is.

Lauren Westercamp, Accenture (57:09):

So get those brilliant basics, get in there with the universities early and make the impact, build the partnerships. Alright, so I'm going to give Oliver one more rapid fire question. I think we got to quite a few of the questions in the chat. We really appreciate the act of participation from everyone. This has been such a rich discussion, Oliver, very quickly, we've talked a lot about this one, Nick, I know we've talked a lot about this one too. Can we leverage pharmacy more? We saw a lot of use in the pandemic, different disparate points of care and locations for care. What can we do now?

Oliver Richards, Accenture (57:45):

Yeah, I mean I think it's probably a good wrap up question because it summarizes a lot of the things that we've talked about, the payment model or reimbursement model for pharmacies going to where the patients are in the communities, having solutions that are going to work into workflows within those settings. And I mean you saw with diagnostic testing for Covid with vaccine administration, with health check consults within pharmacies. I think it's a good example of moving it from a historical hospital setting to a community setting and having all of that sort of ecosystem around it and designing in a way that's going to be a useful and efficient product to be able to be delivered within that setting. So short answer, yes.

Lauren Westercamp, Accenture (58:28):

Yeah, and all of our, I love it, but I think so often, especially in pharma, sometimes in tech, we don't think about beyond the HCP as care providers and nurses, pharmacists, everyone in that whole chain is doing so much to help patients and improve patient care. So with that, oh my goodness, what a fantastic discussion. We are so grateful that y'all joined us today. What an amazing panel. I think I've got to rewatch this thing just so I can download all this great information again, it was so incredible. We really, really appreciate your time. We really, really appreciate you joining us. Any final words from the MATTER crew? Oh, thank you, Olyvia. Yeah, feel free to pop on.

Olyvia Phillips, MATTER (59:12):

No, I was just going to say thank you all again. This was such a great panel. I couldn't get off Zoom or mute fast enough

Lauren Westercamp, Accenture (59:19):

On Zoom. Fair enough. We've all been there, Olyvia, we've all been there.

Olyvia Phillips, MATTER (59:22):

Just thanking everybody again and thanking the audience for joining. And I'll turn it back over to you, Laura, to wrap us

Lauren Westercamp, Accenture (59:28):

Up. Alrighty, well thank you so much Olyvia. I think all of this will be available on MATTER's website as well as podcast. So if you'd like to re-listen to hear all of the fantastic deep perspective and experience from our panelists, we really encourage you to do so. And we're wishing everyone a fantastic weekend. And thank you for always bearing equity in mind so we can better serve people, not just patients. Thank you all.