The Age of Personalized Health, Straight From the Heart ❤️📲

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Hey everyone, and welcome back to the TechLink Health Podcast. I am Justine Reese, and I will be co-hosting this episode with Dr. Rodney Samaan. This episode focuses on the evolution of personalized medicine and the devices that are on the forefront of shifting the way healthcare is practiced. So I'm really excited to hear about. All of the advances that are going on with devices in healthcare. Our guest today is Dr. Ben Green, who is an SVP of Services for AliveCor. Prior to AliveCor, Dr. Green spent 4+ years at Amazon, where he was the Principal of Healthcare Innovation for Global Benefits and the founding Chief Medical Officer for Amazon Care. Super excited to hear about that. Prior to Amazon, Dr. Green was the regional medical director at Landmark Health, a patient-centered comprehensive house call model designed for complex and vulnerable patients. Prior to Landmark, Dr. Green spent 8 years at Carina Inc. of Seattle, where he was the medical director for clinical innovation. While there, he helped to usher in Carina's transition from in-person house calls to telemedicine model and built a team of medical professionals focused on this novel field of medicine. And I think this said it was how long ago? Well, before we were all faced with the pandemic and forced into that, it sounds like. Is that right?

It, it was, yeah. We got started in telemedicine way back in 2009, which seems like a generation ago, but yeah, it was quite a while ago.

Well, I'll just finish this up because there are so many things that we want to get to here. He was directly involved in building the clinical software and operational infrastructure to deliver safe, high-quality, and evidence-based primary care telemedicine. Dr. Green holds a BA from Harvard University in biological anthropology, an MD degree from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, and completed his family medicine residency at the University of Pennsylvania. Is there anything you have not done? Dr. Green. It goes without saying that Dr. Green has a passion for advancing medical technologies, and we really look forward to hearing your perspective. So without further delay, we are super excited to officially welcome Dr. Green to the podcast. Hello, Dr. Green. Thank you so much for joining us today.

Hello, Justine, and thank you so much for having me. I'm super excited to join and to chat, and it's always great to kind of talk about healthcare and healthcare innovation and tech with people who are interested. So thanks for having me.

Absolutely. I mean, to look at where we've come And where we are today and all the things that have happened in between and all the time that you've been working through this. It's incredible. So why don't you give our listeners some background in your own words, introducing yourself in a little more detail about all these things and all these places that you have been in your training and your work life to get into this personalized medicine space?

Yeah.

Yeah.

Happy to. Well, as you mentioned, I've kind of done a lot of different things in my career and as a physician, it's certainly a non-traditional way of going through healthcare. And really kind of identifying and learning about different care models and different ways that patients, people can get care. And my journey, I think, was not preordained, and this is something that kind of organically evolved. And I have always really been interested in how care is delivered and how care can be delivered in different places, in places that are not traditional healthcare settings. And as you mentioned, house calls is really kind of where it all started for me. And I started doing house calls back when I was a resident in Philadelphia and starting to see people at their homes, really where, where life happens. And, you know, in my first job out of residency in Seattle, I joined a company, Carina, as you mentioned, that was doing house calls exclusively. So we did not have an office. We did not see patients in an office. We only saw them in their, in their homes.

Is that what we are calling concierge medicine now? Is that sort of like on the verge of what we're Yeah.

I mean, that's one way I think of terming it. Um, you know, house calls though are not a new thing and house calls have been around since the dawn of civilization, if you will. But I think the ability to do more and more things in the home has changed. And we, in 2007, when we were doing home visits, you know, we started learning about what things can be done safely in the home. Why does this person need to be in an ER or an urgent care? Or another setting when the care could be done in the home. But when you talk about personalized medicine, it really doesn't get more personalized than that. I'll tell you a funny story where I was at a home and I was seeing a patient and it was an early morning visit. And often patients and families would invite me to meals. They would ask me to join them for breakfast or dessert, or I was at a family's house during Ramadan at midnight. They were having a meal then. So one time a patient said, would you like to have some eggs? And I said, it was breakfast. And I said, sure, sure, why not? And instead of actually serving breakfast, they brought out eggs from their ducks that they were breeding in their backyard. And they gave me 2 dozen duck eggs that I went home with. And, but the relationships really was what triggered that. They, they obviously trusted me in their home and I, you know, developed a rapport with them and ultimately, you know, hopefully gave them the care that they needed at the time. But, you know, the rewarding aspect of it as a physician was, was tremendous, but it also really opened my mind to see that, you know, care can be delivered effectively and appropriately in other places. And why don't we lean, lean more into that? And obviously we're seeing a lot of that now.

This is so interesting cuz we're sort of like going back in time. You know, I picture sort of like, I'm gonna call the doctor and showing up with the bag and the stethoscope and, um, and 2 dozen ducats. Which, by the way, did they taste good? Were they just like regular eggs or did they taste a little different?

They're larger. I'll say they're a little bit more gamey than regular eggs, but if you want a large omelet, that's the way to go.

Okay. All right. Okay, great. But I mean, it is very interesting. And then we're now gonna layer this ability with more devices to follow healthcare and care for people. And like you said, not in an ER, which is probably a much better place to receive the care if you're not well. You know, that's why a lot of women started having home births. I think they didn't really want to be in a hospital situation, slightly different, but it's very interesting that you've been able to develop this high level of expertise in clinical and also corporate realms. So in the home and then this corporate realm as well, what advice do you have for others that want to explore a similar career path?

Well, I think for me, you know, the reason that I've, I think, Had these fortunate opportunities to be at these groundbreaking companies has been the eagerness to step out of my comfort zone. I guess I'll say, you know, when I was at Carina, I was there for eight years. As I mentioned, we did a lot of great things and took that house call model and developed a telemedicine house call model. Essentially, that was one of the first of its kind, and we were not afraid to do that. But for me, I wanted to really kind of see more of healthcare and see what else we can do, and. Yeah. So for me, when I left Carina and went to Landmark, that was stepping out of my comfort zone. Landmark was bringing house calls back again, but for very, very sick patients, people that were in and out of hospitals. And this was a population that I had seen in residency, but for 8 years I was not really managing directly. And so for me, it was clinically a little bit out of my comfort zone, but then operationally and from a business model perspective, Landmark Health was going at risk and managing populations not in a fee-for-service way, but in a value-based shared savings way. So again, it was, I think, an opportunity to learn about different care models and different business models in healthcare and how other models can be successful and how they can fail. So I guess for me, it was not afraid of taking risks or really kind of getting a little bit out of your comfort zone, and that will open up more opportunities for you. And then I kind of got the bug though of, obviously I enjoyed seeing patients and seeing them in their homes for many years, but I also realized that for healthcare to evolve and to change, we needed more clinicians and physicians in roles that were behind the scenes, either building products or helping operations or the administrative things that have unfortunately become maybe too predominant in healthcare. But that for me was an interest and has been an interest since. So that's kind of, I guess, how I've taken a clinical, you know, career and moved it into more nonclinical areas, but influencing clinical and clinicians over the years.

I don't want to gloss over the part where you were instrumental at Carena in transitioning from in-person house calls to telemedicine, because obviously that's something that we're now all familiar with. We all had to experience it. You know, I know some like therapists weren't even using it at all prior to the pandemic and now we're all used to it. And some therapists and other physicians, I think, don't go into the office as much or have certain days where they're still doing telehealth. So tell us about the birth of that and what was the acceptance rate of it and how did it help everything else that you did from there? Because that is such an important thing for us today. And it's amazing you were on the, on the forefront of it.

Yeah, no, I think it's important to kind of look at some of the origins of modern-day telemedicine. I'll say for us at Carina, It actually started with the last pandemic of our time, which was the H1N1 flu, the swine flu pandemic, where obviously a large proportion of our population was coming down with a really debilitating illness. And we as a company were doing house calls and we could not see all of these patients and see them in their homes. So I would come on shift and I'd have 30 patients waiting for me and I couldn't see 30 patients in a shift. So we were managing folks over the telephone and prescribing medications over the telephone, and video had just become more of a predominant communications mechanism. Skype was available. FaceTime had just come out. So we started looking into really a model where we would deliver our house call virtually, not just for H1N1, but for other clinical conditions. So importantly though, for us to do that, we felt we needed to clinically provide appropriate care. So before we did our first video visit, We, we developed guidelines and protocols and virtual practice guidelines, we called them at the time, which really helped clinicians make the right decisions. What diagnoses could you make over a video? What diagnoses could you not make? What prescriptions could you prescribe? What could you not prescribe? And since then, obviously there's been an explosion and the acceptance of telemedicine is no longer in debate, but we had a lot of headwinds at that point. I remember speaking with a prominent healthcare system in the Midwest, and I attended their physician town hall meeting, and we were the company that was delivering their telemedicine services, and the resistance from the physician community at that meeting was tremendous. And this was, like I said, come 2010, '11, '12, fast forward now 10 years, and there's not a physician on this earth now that doesn't acknowledge the value and the So, um, so it's been an evolution, but COVID has certainly accelerated all that, you know, quickly.

And the ability probably for people to accept it on the other end. And I'm wondering if when you were dealing with elderly patients and things like that, if you had a problem because they couldn't quite figure out how to use the video or sign the DocuSigns or whatever was needed, that was probably a challenge, right?

It was, was. And, and, you know, the telephone, the good old-fashioned telephone still works and is still appropriate for many things. You don't always need video. So, you know, For a lot of those folks who are not as tech interested, we would still manage folks over the telephone. But we had that house call in our back pocket where we could always send someone to the home to update it, which often came into play.

Okay. So let's now, I'm glad we like got into that a little bit, but now I want to hear about the vision at AliveCor and particularly as it relates to the Kardia devices and this transformation of heart care, which by the way, the personalization of healthcare at the device data and expertise levels are at the heart of the TechLink Health vision as well. So we really want to get into this space and talk about this.

Well, AliveCor, for me, it was really a perfect opportunity and a perfect company for me to join. And I've been here now a little over a year. And, you know, what AliveCor has done over the years is really developed clinically validated, physician-trusted devices that help folks with cardiovascular disease. Better manage condition, avoid unnecessary hospitalization. And our mission, LifeCore's mission, is to ultimately save lives and transform cardiology really as a trusted provider of remote and connected care services. So, you know, the devices that have been developed over the years, you know, the rigor that's gone into that, you know, getting FDA approval and clinical studies has really kind of set the table for where we are today. And I think that's really been, for me, a driving force why our devices are trusted by patients and providers alike. So we're still early. I think cardiovascular care is an area that I think we can do a lot of things in really helping people, like I said, manage their condition better, avoid unnecessary care, and ultimately help people live better lives.

Just for anyone out there who might not know, can you explain what a Kardia device is? Is there only one? Is that a brand name like Band-Aid? I mean, I know it's To deal with tracking cardiovascular stuff. But I always like to ask the layman question. The daughter of the doctor. I'm the daughter of the doctor, just so you know.

Yeah, no, no, great question. And sorry, I kind of glossed over that, but AliveCor has created Kardia devices, Kardia with a K. These are consumer EKG devices, electrocardiographs. This picks up electrical signals of the heart. So the devices that are commonly done in the clinic where 12 leads and electrodes are put on a patient's chest, arms, and legs now can be done with someone's fingers essentially. So in 2012, our first device came out, which was the KardiaMobile 1-lead. So this picked up 1 lead or 1 electrical signal from the heart, which allows someone to look at their rhythm, their heart rhythm. So do they have normal heart rhythm? Do they have an arrhythmia, atrial fibrillation, things like that? And since then, we've developed a device that picks up 6 leads.

I just saw that when I Googled, I saw that. And price ranges are affordable, very affordable, it seems.

They are. We've had a lot of buy-in from physicians who are recommending these devices to their patients. You know, Dr. Samaan himself, I think, has acknowledged that these devices are reliable, they're clinically validated, and they're trusted. So we're really proud of the fact that we can help these patients with arrhythmias and with other cardiac conditions really better track their health and importantly provide that data back to their physician or to their primary care doctor, their cardiologist, to really inform care. Those are the devices. We've actually recently released a credit card size version of the device. This just came out this past winter, which looks and feels like a credit card and, and it's actually an aging device. So yeah, so some pretty cool things that, that we're developing. We've got some things in the works.

You can't buy your dinner with it unless it's, um, unless it's low cholesterol, right?

Right, right, right. That, that's probably the next, the next frontier.

That's, that's super cool. You're right though, my son actually had to see a cardiologist for something and he ended up being fine, but he actually recommended or just Let us know about this device. And I can think back when my parents were getting pacemakers and my mom's a biker and she, at that point, I don't know that there was this kind of a device, but there was something that she was being monitored by the doctor when she was out on her bike. And, you know, that seemed like incredible technology to me. And so you've already kind of told us where this is evolving, but are there other devices that you haven't mentioned that you're kind of like super keen on as we do some self-monitoring and some monitoring, I assume, to report back to your doctor with, right?

Yeah. I mean, there's certainly a lot of things happening. There's a lot of devices that are generating data and putting that data in the hands of a consumer, end user, patient. And I think as you sort of think about the types of devices out there, there's devices that help pick up diagnoses or pick up conditions. So help to screen and, like I said, pick up conditions. There are devices that help with treatment and with therapeutics. And then there are other devices that help with decisions and helping a person decide or a clinician decide, should this patient go in for further evaluation? So as you kind of think about those different areas, I think what we're seeing in ultrasound, we've been able to miniaturize ultrasound and make that rapidly portable where people now can get, you know, really diagnostics or screening or that kind of urgent evaluation at the bedside or at the, at the home. Right.

Because I remember like even at the gynecologist level, sometimes like, oh, well there's that one machine and it's in the other room right now. You know, we only have one in the office. Right. And there's a lot of patients that need to use it. So that's fascinating. Yeah, absolutely.

Exactly. And I think as you look at, you know, globally, to your point, there are places where there's one ultrasound device or one MRI within thousands of miles in a region. So How do we get cheaper, effective versions of those devices in the hands of clinicians or in the hands of patients themselves? So companies like Butterfly that are developing these solutions are certainly interesting and very promising. And again, providing better data at the moment for diagnosis and screening. As far as less so devices, but I think in testing, we're seeing in the cancer space a lot of things, a lot of innovations in early detections. cancer, where before someone has symptoms, blood tests, liquid biopsies, where it's really trying to identify the cancers before it's detected on imaging. So that's really, really exciting.

That's really exciting. Is there any certain kinds of cancers that are a little more going in that direction, or you've seen or heard or had success yourself with certain kinds of cancer?

Yeah, well, I think if you look at pancreatic cancer as an example, often when it's diagnosed, It's too late, and it's to the point where it is metastasized or the treatment is no longer effective. So some of these companies, Grail and Exact Sciences, where they're able to detect elements of cancer in blood earlier than it would otherwise be detected via symptoms, I think they're very promising. It does, though, open up a big area of concern regarding false diagnosis, overscreening, and we could speak a lot on that, but I think It's balancing the promise and the opportunity with detection with the harms that it could also generate. So those are just some examples of companies that I've been kind of following. The other area, which is pretty interesting, is in kind of ambient or passive monitoring of folks' other vital signs. So Kardia and AliveCor is in the cardiology space, but there are other companies that are looking at respirations and other signals that would suggest someone is trending towards being sick. And there's companies that are using radar to determine respirations and other things that could signal illness. So those are some interesting things. And then I think on the treatment side, I think we're seeing a lot more in personalizing treatment. So in medication, it's not a one-size-fits-all approach any longer where I prescribe you, Justine, this medication and I prescribe Let's try Mary the same medication, but it's gonna affect you differently because your biology is different than Mary's biology. We're learning a lot about that. And I think there's now a lot of innovations in targeted therapies, whereas that prescription for you is gonna be different than the prescription for Mary. And how do we adjust the medication? And, you know, there's, there's interesting things happening in, in 3D printing and things like that.

I was just curious about the mental health, like monitoring of those. sorts of medications and how complicated. Do you see some progress made there for that space that is so desperately in need of help?

You know? There's, yeah, I mean, there's a lot in the pharmacogenomics. So I think we're seeing a lot where prescribing certain antidepressants, knowing that this antidepressant will work for you, Christine, but it won't work for Mary, that is happening today. So doctors though are still It's not widespread. So I think most mental health professionals are still prescribing kind of what they're comfortable and what they're used to prescribing, but it's not specifically tailored to that individual. There's still a lot more trial and error. And we know now that we don't need to go through that trial and error period. We can kind of get right to the right medication that would work for you.

That's cool.

So this is Dr. Samaan. Ben, I wanted to ask you, staying on topic of Personalized digital health solutions. In the future, what role will these solutions play in disease management programs? Also, as a former health executive at one of the big tech five companies, I'm interested to get your thoughts on how these companies can potentially influence such programs.

Sure. If you think about disease management programs and how they evolved and how they've developed, you know they they really were developed to fill a gap in that patients and people. Were not being optimally controlled, whether it was their diabetes or high blood pressure or heart failure, to name a few. And it wasn't necessarily because the quality of care was poor. It was more for the fact that accessibility and frequency, and those patients were not really connecting with their care providers in a regular way. So I think these programs fill that gap to really provide that between-visit care. If you look at diabetes as one specific example, There have been several companies that have been successful in really providing members, patients, with real-time support for when their sugars are out of control and what to do about that when their doctors may not be available. So I think that's where more data in the hands of that patient to inform, whether it's the disease management nurse or their provider care team, to make decisions between those office visits is really what disease management is all about. Now, I think when you look at the outcomes and the long-term benefits of these programs, the data has been mixed in that, is it improving clinical outcomes? I think in a lot of cases it is. Is it saving costs? It may be. Is it a better patient experience? I think generally, yes. I think a lot of the value is that it is improving the patient experience. And if you look at the Triple Aim of healthcare, those are sort of the 3 areas. When you think about an employer influencing the development of these types of programs, I think you're right in that they do influence the development of these programs. So now we have very large employers that have very large populations of members, and they are, if they're a self-funded insurer, self-funded payer, they're responsible for the costs of those patients or of those members. So they're looking at ways to better manage those patients, augmenting traditional healthcare, healthcare systems. And that's, I think, what we've seen in companies that have developed over the years supporting musculoskeletal care, cancer care, diabetes care. And a lot of them are providing care directly for these large employers. And I think we are seeing more of that.

And along those lines, it sounds like you're referring more to like multiple touchpoints, patients being seen or interacting with them much more frequently. But for a long time, there wasn't billable codes for that, and value-based care is a different model, which is great. But what are your thoughts about remote patient monitoring? Do you think it's really working or it's just another way for doctors to bill? I haven't personally utilized it as much, but I know there's a lot of doctors utilizing it, and there's obviously a lot of companies getting involved in that now.

Yeah. I mean, I think the good thing is that yes, there are now codes that exist. And we're acknowledging the fact that providers are doing work and providing care that's very appropriate and helping these patients better manage conditions, and that will produce better outcomes. The challenge, though, is that these new codes are, you know, in a lot of cases, additive to a provider's existing workflow. So while there are codes and a provider can be reimbursed for the care that they're delivering, they also need to do the care, the in-person care, the regular care. And so we're not seeing the broad uptake yet of remote patient monitoring.

And obviously the Kardia device is FDA approved, which is a clearance that many other wellness devices don't have at the time. And as more and more wellness devices continue to enter the market, how will the role of clinicians continue to evolve as they contribute to the creation of devices? And how will all that data from these devices be used and collated and analyzed?

Yeah, it's a great question. More data is more data. And doctors that I've spoken to and know well, more data isn't always better for them. It may be better ultimately for the patient and having more data and making more informed decisions, but healthcare is right now overwhelmed with data. So what do you do about it? It's a lot of information. I think what we're seeing is really more support, more technology to help separate the signal from the noise. And when it is a signal, what do we do about it?

Yeah. And along those lines, I think that you're touching on the complexity of medicine and all these tech companies getting involved and not realizing the nuances of healthcare and how the Collaborate and make healthcare better. It's so complicated.

I have one final question.

I have to ask you about the Amazon acquisition of One Medical and your thoughts on that. And in relation to that, whether you see AliveCor getting involved with Amazon in this realm of One Medical and how you see AliveCor in terms of international growth. Are you guys working internationally? Do you see Kardia being utilized in rural Africa and other centers?

Across the world, well certainly you know LiveCore today is available across the world. We are available in I guess four to four countries right now. So we have patients across the world benefiting from our devices, doctors who are able to gather that data. And you know like Amazon, AliveCore, you know we ultimately are focused on that experience for the member, for that end user, and and our devices are able to. Help people in times of need and help providers better manage their patients. That's why we exist. And to your question about Amazon, Amazon is a company that is obsessed with the consumer. And I think they've been obviously very successful in providing better experiences, whether it's buying a book or shopping for groceries. Healthcare is challenging. It is hard. And, you know, patients and consumers, you know, I think One Medical has done a great job at providing a very patient-centered and patient-friendly experience for patients.

Well, fantastic. So fascinating. All right. So Dr. Green, in closing, do you have any final advice for those that want to learn more about the future of personalized medicine? Where can we go? And also any topical book recommendations on this? topic or articles? Also, other problems that you feel personalized medicine is working to solve?

Thanks for asking that. First off, I think it's great for folks to look at the literature, look at what's out there to drive informed decisions. For me, I actually don't have new books that I would recommend, but there's some older books that I would actually refer people to in really guiding kind of areas and problems to address. This first book publication that Which actually came out back in 2002. I would encourage anyone who's interested in healthcare to read that book, and what it kind of talked about was was how healthcare can be done very well in certain areas, and what are the anecdotes, the stories. But I would absolutely encourage people to to read that.

And the book is called Complications. Is that right?

Correct, correct. And then also there's a there's a fantastic article about AI in health. Here by Siddhartha Mukherjee, who also wrote The Emperor of All Maladies about cancer. This article really explains, is AI going to take over healthcare? Is it going to take over physicians? So I'll just encourage people to read that article. It's a great one. And then other things that are just kind of more topical that I refer to, Medscape News, STAT News. And then when I want to look at data, Kaiser Family Foundation is great. Really great data on population health. Those are just a few.

Great. You'll be writing the next one, I'm sure. We're going to keep our eyes and ears open. And of course, listen to the TechLink Health podcast for always more information. And this is a great, great conversation. Dr. Green, thank you so much for joining us. I'm sure we can find you on LinkedIn and other places as well as the websites like AliveCore and such. And it's been just a pleasure talking to you.

Likewise, Christine. Thanks so much again for having me. And Dr. Samaan, thank you as well. And, uh, yeah, I enjoyed it and hopefully it was helpful.

Thanks for listening to this episode. TechLink Health is a healthcare advisory platform for consumers and organizations to stay informed with the latest insights while connecting with healthcare experts for telehealth, eConsults, and consulting services. For more details, visit www.techlink.health.