Anita Pramoda, CEO of Owned Outcomes, a health analytics company that has worked with more than 100 hospitals implement value based care initiatives and bundled payments. Breaking Health Host Steve Krupa, CEO of Psilos Group, delves into Owned Outcomes unique approach to helping health care systems – and patients – migrate to new forms of health care payment.
Anita Pramoda is the CEO of Owned Outcomes, a health analytics company that has helped >100 hospitals succeed in various value based care initiatives and bundled payments. Anita was recently the CFO at Epic Systems, a $2 billion healthcare IT company, that provides electronic medical records for >40% of the US population.
Tom Salemi: Hi, this is Tom Salemi, Content Director at Healthegy. Welcome back to the Breaking Health Podcast. Happy to be here with our host, Steve Krupa.
Steve Krupa: Hi, Tom, how are you?
TS: Doing great. About a week removed from the Digital Healthcare Summit, still a little bit hung over. How about yourself?
SK: Yeah, I thought it was a great summit, and been taking in what I learned there over the last couple of days, and looking forward to the release of all the content so I can check something out again.
TS: Excellent. Well, one of the people I enjoyed speaking with there was Anita Pramoda of Owned Outcomes, and you’ve had her as a guest on this show.
SK: Yeah. She’s next up. She’s a wonderful person. We’re sort of going back to bundled payments, similar to our interview with Steve Wiggins. And she’s got a different business model in that area. Where Steve, I think, is a combination of software provider and a services provider, I think Anita’s goal is to provide software to the providers so they can manage this process themselves. So it’s a very interesting interview.
TS: And she does seem to have a real human quality about her. She’s very positive. Her Linked In description is very hopeful and just very people-centric.
SK: Well, yeah. A lot of the interview will talk about how she believes that payment reform equals better healthcare. She has really a total focus in that area in terms of the idea that technology should be making healthcare better, the healthcare experience better, and help families take care of their loved ones who are sick better And she does a good job of articulating the way she feels about that in this interview.
TS: Excellent. Well, let’s let her speak for herself and get into this great interview.
SK: Welcome to the Podcast, Anita.
Anita Pramoda: Thank you, Steve. Glad to be here.
SK: So there’s a lot of activity in the bundled payments space. This is a space that’s very interesting to you. You’ve got a fantastic background, professional background on the electronic health records side, having spent a fair amount of time at Epic, and some very impressive relationships with large organizations where you are a board member. But as a beginning for me, give me a sense for how you arrived into this space, what of your background informed your interest here, and led you to start your company.
AP: It’s a fair question, Steve. So in terms of what’s happening in healthcare, I think it’s so terribly obvious from an economic perspective how unsustainable the spiraling costs are. But also from a human perspective for me, you know, my dad is a very sick person. So if he was at any of my customers’ sites, if he was a patient at any one of my customers, the CEO would probably know the people that any of my customers take care of. So for me, there’s the human side of healthcare is very bothersome in terms of how fragmented that patient experience is. So when we saw the opportunity for different forms of payment reform, we felt very encouraged. We looked at this and we said, Wow, you know, we know the doctor genuinely wants to give our patients very good care. As a daughter, I take my dad to the doctors and I’m very grateful to them for the outstanding care that he receives. But then the incentives are not set up very well, right? And so when we saw bundled payments come through, we were like, Wow, how cool that our government is so progressive it kept us thinking about what – using its legislative power to perpetuate paths of change in society. Things I like about bundled? So when we saw this we said, you know, it is simple. It is monumentally simpler than something more complex like ACOs. It is retrospective. It exercises the same muscles that you need for ultimately being risk taking, but it doesn’t do it completely – you’re not completely exposed. You know, that it’s with corridors. It’s within a very tight sort of guard rail. You get a chance to practice all the muscles for risk and become more and more accountable. And third, it addresses the fragmentation of care issue because when you have very sick patients, that’s what essentially makes the difference between a win and a lose from a patient and a family perspective. So when we saw this we thought this is very easy for providers to voluntarily sign up for and chances are if there is sufficient voluntary signup, sooner than later it’s going to – some of them are going to start becoming mandatory. Again, we’ve been constantly surprised by the enthusiasm of our government in making the joint care replacement bundles mandatory.
AP: It’s quicker than we expected. And we had huge support of it and eager to help our customers embrace it.
SK: Well, let me take a step back for a second. The idea that there’s a benefit for the patient in bundled payments is interesting to me, and I’ll tell you why. When I talk to physicians, they love fee for service medicine, right? They love the idea that they can provide a unit’s worth of work and get reimbursed for it. So when we begin to think about bundled payments, I always think about it as a cost containment strategy first. How do I go from that to thinking about it as a better care strategy?
AP: So let’s take the example of knee replacement. I’m not a physician, right, but it’s pretty obvious that you can have the world’s greatest orthopod getting you a prosthesis that’s highly precision engineered, and then you’re there at the hospital for 2, 3 days. But from a patient’s perspective, the success is not that surgery. The success is being able to walk again. Walk again and be pain free. Right?
AP: That’s what the patient is calling for. So the way a bundled payment is set up is now every single person in that continuum has incentive to help the patient get to where they need to get, which is walk again. That’s what an outcome measure is from a patient perspective or a family member’s perspective. And yes, if you do that in a cost-conscious fashion, then everybody as an entire society we win. And I’m certainly sympathetic to the physician’s perspective, which is I have a unit of responsibility and I’m supposed to turn it into a unit of excellence, and then I get paid a unit of payment, right? So that’s the way traditionally our physicians have thought about things. And so therefore, it’s a little bit of a leap to say from – we have to get a little bit past the unit of excellence from an individual’s perspective, and think about that unit of excellence from a patient’s perspective and say a joint replacement is about a patient being able to walk pain free. And to me, bundled payments is the path to get there.
SK: Yeah, you know, it occurs to me that patients do not see their doctors or really get a lot of support, generally speaking, post care delivery. Post-acute would be the way they think about. And for our listeners, bundled payments refer to an episode of care, so a knee replacement, I guess from the moment you decide to get the knee replacement to the point in time in which you’ve been discharged and some point after discharge, say 90 days or something like that, which suggests that there is an amount of care that takes place for a fixed amount of money, and that the providers are responsible for delivering all the care necessary to have that become a successful episode of care, and coordinate that. And it seems to me that there’s a lot of coordination, particularly in your example of a knee replacement, that would have to take place post-discharge. And that’s not something that, from what I can tell, is done very well today in fee for service medicine. Would you agree with that?
AP: It’s a fair comment. And some of it is structural. Some of it is tradition, some of it is structural, and some of it is incentive, right? So traditionally, if we’ve invested in hospitals as a country, we have set them up as institutions that have to do occupancy management, right? And from a business perspective, it’s an occupancy management business to have high utilization, a little bit like a hotel, right? And then from a clinical perspective, it is getting patients through and repeating world class care within the four walls of that hospitals. Today, we have to fold down those walls of the hospital and reach into the patient’s life, whether it’s from the post-acute setting or in their homes and community settings, and take them through that 60 or 90 days before they can sustainably walk and be comfortable again. That was the goal in the first place, and today we have the opportunity to start thinking about that. It’s a new competence, and I think new competence is uncomfortable. But it’s the right competence to acquire for society.
SK: Yeah. And so tell me how it all works. I’m sure that there’s a lot of people delivering care to a patient, including the hospital, the primary care doctor, the orthopedic surgeon, etc., and a post-acute. You’re going to – somebody is going to receive, let’s call it the hospital in this case, a fixed amount of money for that case. How does the bundled payment apparatus work?
AP: So there’s a couple of ways we can make this work, right? So the CMS approach is a retrospective bundle, which is essentially everybody keeps providing what they’re providing, but then on a retrospective basis we’ll add up all those numbers and then we’ll say where did you come in relative to a target price. And then the risk taker on record either gets a check back because they beat the target price, as in came in under it, or they have to write the check because they spent more than they should have spent and they didn’t manage to that number. So that’s sort of the retrospective approach, and that’s the CMS approach. That is one CMS model, and we’re also starting to see some examples in the commercial world of something more prospective, where then they’re getting a bolus of money, and now the cost of it has to break the dollar and pay out claims as well. And that’s a whole lot harder, right? So the model for, at least in the example of the BPCI has substantially fewer signups than the model two, which is much more – which is the retrospective model. So the infrastructure is – leverage is pre-existing infrastructure, so everyone’s doing what they’re doing, except ahead of time they’re trying to coordinate, during the episode they’re trying to coordinate with each other. When I say ahead of time, we’ve seen hospitals that are starting to be very thoughtful about certain works, networks of post-acute facilities that they will partner more closely with than we’ve seen hospitalists come in, and some hospital companies are also work around these post-acute facilities, and so they are some part of that glue. Then we’ve seen some conveners, very progressive conveners that have stepped in, and they are offering that core coordination paradigm and ultimately all these players come together to quarterback the patient to walking again.
SK: So if I think about it from the orthopedic surgeon’s point of view, he is going to be paid some fixed reimbursement rate for the effort of the surgery. And how is – then is the rest of the network of providers going to get paid off of a fee schedule? And it’s the responsibility of the risk taker in the bundled payment to manage the utilization of those services? Is that they way to think about it?
AP: Yes, that’s structurally how the retrospective bundled payment works. So now if you take that orthopedic for example, the orthopedic is now motivated to worry about the cost of the prosthesis, you know, is this really the right device I need for a given patient. They are worried about, you know, does this patient need to go to an inpatient rehab, or will they be better off having outpatient rehab. And then does this patient need a nursing home, and if yes, for how long do they need it for. And if there are 27 nursing homes in this catchment area, which three are the most likely candidates as a good match for this patient based on their prior track record? And those are all analytical decisions as opposed to kind of afterthoughts, if you will. Now you’re leading with information based decisions and you’re paying attention to each one of these steps. And when very smart people like orthopedics pay attention to each one of these steps, good things are bound to happen. The patients win, and it’ll be done in an economically efficient way.
SK: So where does your company come into the process of the bundled payment system?
AP: So we’ve helped our customers very early in the process. You know, we were helping our customers pick the bundles that they wanted to sign up for. So from an analytical perspective, that requires review the data that they have both from internal systems, whether it’s their costing labor systems, some clinical data and some claims data, so we have the batch. Once our customers go live on these risk based arrangements, then there is a process of retrospective analytical support. You know, what would we hope for, where are we relative to what would be hoped for, and then identifying specifically what are some very practical stuff that we can do. And we do most of this programmatically. And then we also help with from a point of care perspective. What we’ve found is there’s certainly 3 levers of economics in the bundled payments world. I’m over-simplifying this, but you know that it’s a very hard job which is lower readmissions. There is a much easier job – it’s hard operationally, but intellectually much easier, which is manage the utilization around post-acute services. And the third lever is sort of the internal costs within the hospital. And so we help – one of the ways we help is we built a transition care model that can predict on an n=1. So individual patient level, for this particular patient, this is the right site of care they should be discharged to. This is how long they need to be there or what services they need to receive and how long they need to receive it for. And then the last decision is here is a plethora of choices of various providers that could do it, but then we’ve looked at a named provider. So in this particular case, the Jones Nursing Home has been very good at patients of Hispanic descent, with comorbid diabetes and mild depressions, and having a knee replacement. It’s fantastic at that cohort; they’re monumentally better than their counterparts in that particular area. And so slashing is set up well ahead of time, right when they’re planning the surgery as well as throughout that completed care. And the last piece that we help with is gain sharing models for physicians so that they’ve got economic incentive and alignment.
SK: So and this is largely software, right? Is it software –
SK: – and software enabled services. So where – you’re connecting to, I assume, the EMR data, the financial databases. Where are you getting your information from, and how is your software working?
AP: So our software has multiple sources of data. Yes, the usual suspects, so we get information from clinical information systems. We get feed from labor and cost information systems and hospitals. We certainly are beneficiaries of the claims that are available. That’s the administrative side of the data. But in addition to that, we also mash up a whole bunch of other sources external to this. So for example, we mash census data along with environmental data like air quality, pollution, what have you. Based on the census detail we know the likelihood that this patient probably doesn’t have transportation and needs a ride to a post-acute appointment. So we include all of that into consideration as we come up with recommendations of gaps in care or risk carriers for a given patient. So that’s – so for us, we think about data as any and all data that completes the picture of a patient, not just in terms of the specific procedure that they’re undergoing, but in terms of their overall life. What do we know about the life of this patient?
SK: And is that data readily available from multiple sources? Does the hospital provide you with that data? Do you get it from external data sources? Where does it all come from?
AP: So multiple sources. Certainly multiple sources. Yes, the hospitals offer – share their clinical data and cost and labor data with us. Then there’s a whole bunch of public databases and certain proprietary ones that we pay and subscribe to that then we mash up and try to glean that complete picture of the patient. You know that data is not either or one; it’s a whole bunch of decimals in between. So there’s always going to be sparseness issues, there is always going to be quality issues. That’s just the nature of the work we do.
SK: Excellent. I’m talking with Anita Pramoda from Owned Outcomes on bundled payments. I want to go back to one of the points that you made, just to make sure that I understand: gain sharing for physicians. So what do you mean by that? Is there an opportunity in this model for a physician that has a lower utilization or fewer readmission rates or some metric to actually be paid a bonus based on their performance?
AP: Correct. So there’s this anti-kickback rules, and so there’s a very specific carve-out relative to those anti-kickback rules that within the bundles world, statutorily yes, you are allowed to be economically aligned with a physician for payout and bonus based on achievement of certain health goals or quality goals. And you’re asking doctors, you’re asking physicians to perform, reorganize their activity and you’re asking them to pay attention to some other things in addition to the clinical responsibility that they already have always taken for the patient. So it makes a lot of sense to push for that economic alignment as well. Gives everybody a reason to focus.
SK: From a standpoint of your revenue model, are you focused on basically a SAS model where you’re charging for your services and software? Are you getting involved in managing the costs with your customers? How do you get reimbursed for the value that you bring to this process?
AP: So we do have a somewhat traditional pricing model software and service. We have some examples where we’ve partnered a little bit more closely with our customers and we have opportunities to earn certain bonuses based on contributing to certain forms of success.
SK: Where do you think –
AP: Our goal in the long run is to be as closely aligned with our customers as possible because I feel almost a little disingenuous saying that I will continue to be fee for service and somehow support you in getting away from fee for service. Seems sort of morally gray, right?
SK: Sure. Well, absolutely, but I mean it depends on how well your customers are doing with your software. I mean if they are knocking the cover off the ball, so to speak, in reducing costs and having a nice margin on their risk business, then they would want to theoretically just pay you for the value of the software.
AP: That’s interesting you brought that up. There is one other increment there. Our customers often also want certain fee from a budgeting perspective. And that was a surprise. I didn’t expect it. So for them it was more valuable to know exactly what it was going to cost. They put it in their budget and then they have an approved budget and then they can go from there. And that uncertainty was very uncomfortable, even though I suggested that economic alignment or willingness to put ourselves on the line. So that was the learning lesson.
SK: So when we think about bundled payments, we think it’s better for the patients because the care outcomes will be better, and the reason that is is because the entire community of providers or team of providers that’s brought to bear on a case will be incented to provide excellent care along the way, and that will reduce primarily, I would guess, readmissions or post-acute care intensity because the better the care that’s delivered, the less you would need to go in and do additional rehabilitation or have a readmission due to infection and so forth. And we think it’s going to cost less because there’s a bogie that’s been set up by CMS that says this is how much these cases have cost us; we want to save 2%, and if you can deliver this under that amount, you can keep the savings for yourselves. How well do you think those ideas are working and will continue to work on a going forward basis?
AP: So from a human perspective, if I was a patient that was 79 years old, I’ve been on Dilaudid for four days because I had a GI obstruction, and then if I have to somehow listen to a bunch of folks – the discharge instructions, and then they give me a lot list because I’m supposed to have choice in my post-acute providers, they give me a really long list and I’m supposed to go through that and somehow pick my own nursing home, and then figure out transportation; I’m well enough to walk so it’s not like a need an ambulance, so then I’m probably cognitively temporarily compromised, and then when I get home then I’m a little confused and then I can’t tell which pills I’m supposed to take; I’ve forgotten half the instructions, there is a human cost to this. And it’s probably several days or sometimes even weeks, depending on what else I have going on before I’m up to my usual self and I’m able to take care of myself. So from a human perspective, from a human dignity perspective, boy, this is a good thing. Economically, you ask a very fair question, Steve. There is a lot of – I think it’s early days. I think it’s early days; it’s too early to tell whether this is for a fact going to be successful or not. The intentions are very good. The program has been devised to be well thought through. As with everything else, there is limitations and there is something, features that you put into a program that have unintended consequences. In the example of the CMS bundle, CMS has been extraordinarily receptive to commentary from the various constituents, and have constantly been refining the program. The answer, my answer will be too early to tell. You can’t measure these things month to month or quarter to quarter because by the time you break it down to an individual episode at an individual hospital, there is basic statistics will tell you it’s not enough volume, and low volumes cost volatility in numbers. So we need more time to see moving averages and trend lines that we can believe. And then so too soon to tell is my answer. Intentions are that too soon to tell, too much change underway.
SK: Yeah. Yeah. But look, CMS is attacking this problem from multiple angles. The three that come to mind for me are first, bundled payments, right? The other would be Accountable Care Organizations where physicians groups end up taking a capitation premium for all the care for all the members, like a health insurance company. And the third is sort of the star ratings and the measurements of readmission rates and the penalties for hospitals that have high admission rates. It seems to me they’ve got a general commitment to this idea that if hospitals are providing great care, then patients should be able to generally go home and not have to come back to the hospital. Is bundled payments just one method, that the effect of which is really trying to avoid readmission to the hospital and move care outside to less expensive places in the post-acute setting?
AP: I think you’re absolutely right. It is one of several initiatives. You know, I once read that food was very expensive in the 40s and 50s in the United States. It costed as much as well north of 30% of GDP. We didn’t know how to produce enough food to feed our growing population. And then it took a series of efforts in private and public partnerships before now I think we’ve brought it down to what, 2% of GDP, and we know how to feed our people, and we can be a net exporter of food if we need. And so that the great example to learn from, and I think it’s very similar to what’s happening, what we see in healthcare right now, whereas with everything else, it needs to be – it is a multi-faceted problem and it needs a multi-faceted approach. And so that’s exactly what I think the government seems to be doing. And bundled payment, to your point, is one of several trends that we have to pursue so that we touch different parts of the care continuum and touch different constituents in the care continuum. I for one would like to see the opportunity to collaborate a little bit more closely with pharmaceuticals and medical device companies because I feel like somehow, you know, intentionally or otherwise, we’ve sort of left them out. They are important, they’re good to participate. And I would like to see us listen more closely and collaborate with them.
SK: Yeah. It would be interesting to see for example, orthopedic companies participate on the risk side of the bundled payment. I don’t know if that’s going to happen, but somebody will probably try that. Of the three methods that I just sort of laid out for you, I know you’ve got a commitment to bundled payments, but my method is sort of the ACOs, bundled payments, penalties for readmissions and other things. Which do you think is going to be the most effective if you had to make a bet today? I know we think bundled payments will work, but which of those 3 has the most likes to it today?
AP: Wow, it’s a good question. I hadn’t thought about it as having to pick one because I see them as addressing very, very different things. My biggest criticism on ACO or my biggest concern, should I say, is how complex it is. Just standing one up and maintaining it is so expensive that it makes it hard for smaller organizations. But in theory, it can actually help a lot of the larger organizations. So from that perspective, it’s limited for some people, but good for others. So that’s how I think about ACOs. I like the readmissions penalty a lot. It’s a little bit of a, you know, the shame list, and you’ll get on it, and you’ll get fined and it will publish it in public. It has its benefits. From a social science perspective, it’s questionable how long you can keep that shame list going and still keep for people to worry about it sufficiently.
SK: Right. Well, they’re actually charging them some money if they’re bad, too, right?
AP: Exactly. So there is definitely economic piece that can give it a little bit of a [ramp?] But as a patient, as a community member, the way I think about it is if we have avoidable readmissions, we are at war against it. As a society, as a country, we at war against avoidable readmissions. And so if this is one of the tools we’re going to use to see if we can go after it, of course we should, right?
AP: And what I would like to see, though, is a little bit more information sharing in terms of how some of the ones that have dropped off the shame list have dropped of it, because at the end of the day, this is healthcare, and there is very big collective goal we are chasing. And we’re not competing with each other; we’re actually competing against readmissions at the end, right?
SK: Yeah, sure. Absolutely. So let’s talk about your business and how you think about it. As a VC, I can tell you companies that are doing population health, trying to do bundled payments, trying to do readmissions prevention, creating technologies and software to help in all these areas are in the market today, looking for funding. And so it’s a competitive place in a very new area. Give me a sense for what you think the parameters of competition are for your company as primarily a software company, and how you’re creating a strategy to differentiate yourself relative to others that are either competing for this business or will be competing for this business in the future.
AP: So before I answer that, I’d say I had a formal academic education at Penn, and I had life education at the Faulkner School of Business in Verona, Wisconsin. And I was taught to focus on doing a good job and not worry about other people, and stay laser focused on what I’m chasing.
AP: So and I take that lesson very seriously.
SK: They didn’t teach you that at Wharton, did they? They taught you worry about what other people are doing? Is that what you mean?
AP: Well, Wharton taught me to focus on my job. But also Wharton had a class on competitive benchmarking. Right. So there’s merits to everything, but I’ve sort of taken the life lessons very seriously in terms of put your head down and remember what the enemy is. So for example, when we think about transitions of care, we don’t think about here are 5 people and here’s how they’re approaching the problem. Instead, we think about what is fundamentally the – who is the enemy? Enemy is avoidable readmission. Enemy is a suboptimal site of care. Enemy is alert fatigue as one of the enemies, and you write software, you worry about alert fatigue. Enemy is lack of engagement because your users are crowded out. Those are the enemies we fight. And we think of each one of them very, very rigorously, and we engineer not just our product and feature set, but everything we do in our business, everything we talk about every day in our company is very specific to each one of those problems, and we do have an exhaustive amount of rigor. I don’t know that we care to talk about this particular vendor is doing this at this place. In fact, they are also partners in the world because they are least – we have a lot on common because we care about the same problems.
SK: OK. Well, you opened up the door for me, so I’m going to go in for a second. Your background with Epic, you told me that you started out as a coder and programmer, and ultimately became the CFO of what is a very substantial company in the electronic health records base and healthcare information technology in general. And it sounds like that experience has informed a lot of your view about how to run a business and how to approach building a business. Now, of course, it’s a private company, and it’s a big private company. So a lot of what goes on inside of Epic is a little bit secretive or unknown. So tell me, of the culture that you were exposed to there, it sounds like one of the things you’ve taken away is do your job and do it well, and you will have the competitive advantage in that way. What were some of the other special things about Epic, being there for the time period that you were, and being, obviously, Chief Financial Officer there that you’re now applying to your startup?
AP: We played for the long haul. This is a marathon. It’s going to take years and years, and I’m young enough to have staying power and have the commitment. We care about what you’re doing, know why you’re doing what you’re doing. And not all of this is observable on a spreadsheet, but you know, spreadsheets don’t inspire you to think about the problems that you think about when you’re brushing your teeth in the morning, right? What inspires you is you’re a daughter of a very sick person, that you have members in the community that are receiving suboptimal care, and what you put up with is what is paid for. So you can’t watch that and be OK, do nothing. That means you’re OK with it, right? So we think about our feature set, we think about the instability and we think about the problems our customers are trying to solve for the long haul. Because our customers are going through a very difficult stage in healthcare with this transition. And so it’s a little bit of they have to refuel this jet in mid-air. So when you think about it from a supplies perspective, so they are delivering the same outstanding care that they can for each patient, but then from a payment perspective, they have a multitude of contracting arrangements and they have to reconcile these 2 things all the time. And this period, this is not something that we’re going to cross over in one year, right? This is going to last for years and years and years, where we’re going to be in this mixed world. And depending on who you ask, God knows how long it will last. Some people tell me that there’s going to be 5 or 6 systems in the country with some Catholic heritage, and the rest of them are all going to be privately owned enterprises. I don’t know that we particularly care about how that will shake out because I don’t know that anyone’s guess is that much better than the others. But we know that our customers need help because they are doing something very important, which is – the other valuable lesson is simplify, right?
AP: So recently I had to take a relative to a dermatologist. And he had biopsy from his leg and on his head. And this is for his – for certain things on his skin. And the doctor looked at this and he told me, you know, Anita, here’s how I want you to think about this. One end of the spectrum, you know, basal cell carcinoma. Very slow, not going to really hurt you. But one should still be proactive with it. You don’t need to blink an eyelid. Right. The other end of the spectrum, when we do these kind of biopsies is melanoma, right? And that one, you worry about it. It can be very fast. It can get pervasive very quickly. And in some way in the middle, but closer to BCC would be squamous cell carcinoma. So we had one BCC and one squamous cell. And don’t worry, both of them we’ll cut and burn. This is what the doctor told me. And then I thought about that interaction, and I realized, Gosh, he took all the complexity of medicine and explained it in 15 seconds in an intuitive manner to me. He explained it in a way with compassion and he gave me hope, and he told me that he had it under control. Which means he owned the complexity and gave me the benefit of his competence. That’s what I feel like we have to do in technology. That’s what Judy taught us how to do. Difficult for us, easy for them. Right.
SK: I like that.
AP: And so those are the things that I think we need to own. And in technology we need to own that as well. Right. I had a chance once to learn about the Ferrari factory. And you know what they told me after, you know, they dye their own leather, world class machinery that they make. And they said, All of this is fantastic, but really for a driver, it’s a stick shift and a bunch of pedals. Right? And we have to deliver that driving experience through that stick and a bunch of pedals. And it’s the same thing with our software, right? And we have to own that take it seriously. We can’t hide behind complexity and say that’s the user’s problem. We can’t speak in technical jargon. Because that’s not what our doctors do to us when we are sick and vulnerable. So those are some of things we try to think about every day and try really hard in terms of how we work at it every day.
SK: Very good, very good. I’m speaking with Anita Pramoda from Owned Outcomes, the CEO there. It’s a startup offering software and services to providers that have decided to take on the challenge of bundled payments, primarily on Medicare. Last question, really, for you, and thank you very much for your time. It’s been wonderful talking to you. Give me a sense for the culture at Owned Outcomes. How does it feel to show up for work every day? What do you get from your people? What do you try to give to your people? A startup is a risky endeavor for everybody, investors, the CEO, the employees. How do you approach the human dynamic at your company?
AP: So we are here because we care. We are here because we are embarrassed by status quo. And we are here because we have the opportunity to apply our talents to something that’s much bigger than any one of us, actually something that’s bigger than all of us collectively. So that’s who my colleagues are, and I feel privileged to work with them every day. We must set up for the long haul. And a part of that position we made is to self-fund ourselves to profitability. And that allows us the opportunity to focus on that long haul and own the problems. And sometimes that means it takes a little bit longer – it takes a lot longer sometimes. And sometimes that means you have to backpedal from the original approach and not marry a mistake. And we allow ourselves the privilege of doing that. A lot of constructive confrontation within our walls. And that’s something we’re very comfortable because ultimately, we have to find the right answer. None of us care individually to be right, but all of us care about finding that right answer. It doesn’t matter who it comes from. So that probably is how I would describe what we do every day for a living.
SK: Terrific. Well, thank you very much for your time.
AP: Awesome. Thank you again, Steve. Take care.
TS: Anita Pramoda, thank you for coming on the Breaking Health Podcast and joining us and sharing Owned Outcomes’ unique story. It was a pleasure to meet you at the Digital Healthcare Summit in Boston last week. It was a great event. And for those who were not able to attend, good new, we’ll be posting content from the event soon. Go to digitalhealthcaresummit.com to sign up for the Breaking Health Newsletter, and we’ll keep you updated on what videos and interviews will be posted on the website, and of course pushed out directly to you. So don’t forget to sign up. Go to digitalhealthcaresummit.com and supply us with your email, and you will be in touch. Steve Krupa, another fine interview. Thanks for leading the Breaking Health Podcast charge. It’s a shame that the Patriots are going to beat your Giants this weekend, but I’m sure our relationship will survive. Thanks again for everyone who is listening, and tune in next week for another tale of innovation from the Breaking Health Podcas