Datica Podcast

September 3, 2015

Molly Joel Coye, MD, MPH, Chief Innovation Officer, UCLA Health

Catalyze: Dr. Coye, thank you for joining us today. It really is exciting to talk to you about what you're doing at UCLA and then we'll touch on some work more globally around innovation.

First, I wanted to kind of get a sense, because innovation groups, digital innovation groups, are not necessarily a new thing, but they tend to sort of fall into different areas within bigger organizations like UCLA. So I was curious where you and your innovation groups fit within the broader organization.

[Earlier in the interview, Dr. Coye had issues with an errant computer notification sound. We apologize for the interruptions. It clears up shortly after the interview starts. —Ed.]

Dr. Coye: The first thing is, in most academic medical centers, for a long time, there have been tech transfer offices. Basically, these were offices that took inventions that the faculty came up with and helped them commercialize those inventions. Many times people think that that's what innovation is, in an academic medical center. And ours was really one of the first of a new breed, about five years ago, which focused on innovation as essentially scanning for product and services out there, most of the commercial ones that you could bring in house and really transform care very rapidly. So that's a different purpose. Maybe 10% or 20% of what we try to use and spread comes from our own UCLA inventions. The majority are things that are commercial products and services externally.

Catalyze: That is really interesting, because we talked to a lot of academic centers where innovation is just sort of a new branding for tech transfer. But, yes, essentially the same mission, and it's only about, like you said, 10% to 20% that's internal, and much bigger percentage being external that you guys are coming in and using to transform care at UCLA.

Dr. Coye: There's a very good reason for this. If you're in another sector, if you're a car manufacturer, or you're Google, you may be 20%, 30%, 40% of the market, but it's very fragmented. Even the $2 or $3 billion health enterprise delivery system can't invent all the things that are needed, so you really have to have a process where you can scan externally and bring in external innovations.

Catalyze: Very interesting. Where is it within IT—within operations or it's own bucket? I'm just trying to assess within the organizational structure, where the innovation group would fit.

Dr. Coye: Basically, we report directly to the Chief Executive. We're not inside IT, and we're not inside operations. A lot of places have said if you bury innovation, it will get killed by the usual processes internally.

We not only are in the executive suite and a direct report to the CEO of the health system, but we also have what's called a fast track for pilots, where we actually can get all the usual processes, Legal, Compliance, IT, Quality and Safety impact, etc., we can get a very rapid vetting in order to be able to move forward, rather than getting drowned in the usual process, because health systems, at least from our point of view, are relatively bureaucratic, and it will kill innovation's chance.

Catalyze: We had a conversation with somebody, maybe at University of Washington, where they had talked about innovation around research and some of the challenges they've had getting a new technology through the process of compliance and security and legal and all of these other things. They were talking about it in the context of within an IRB timeline. It's interesting that you have that ability within your group, just based on where it is within the organization, to fast track certain things, because I do think those bottlenecks exist.

That leads me to a research question. UCLA is a large academic medical center, and research is a big part of what UCLA does. Within the context of innovation, how do you see research and innovation fitting together? Adding on to that, how do you think about establishing an evidence base for these new innovative technologies or new delivery services that you guys are testing at UCLA?

Dr. Coye: Here it's not a brand new innovation. Something that still isn't dominant in the field is very important. That is, rather than having to do randomized control trials with huge numbers, doing what's called rapid-cycle evaluation. It's more like the lean approach to innovation. It says when you start out with your pilot for innovation, you always want to have an evaluation laid out. You want to know the targets, the metrics, definition of success, and what would cause you to pull the plug on it. And then you're beginning to track that within six weeks to ten weeks of kicking off your pilot.

Depending on the thing that you're testing, you may declare victory within three months of starting it. People who are listening to this should understand there's a big difference between a new pharmaceutical or biotechnology or imaging device versus IT and service innovations. The IT and service innovations you're less likely to do severe damage. It's more a question of, Are you able to bring about the positive changes that you want to? Are you seeing something un-looked for that's a problem? This rapid-cycle evaluation is what we use at UCLA, and it's increasingly what people are using to evaluate innovations.

Catalyze: Is there any way you could walk through a specific use case, or a specific example of a service that you've gone through that process? Maybe starting with a small pilot, and then within whatever time frame declaring victory and then deploying more widely.

Dr. Coye: We're an unusual academic medical center because we have a lot of primary care. In our primary care clinics, we wanted to test out having care coordinators that were not nurses but actually medical assistants or people from the community, social workers that had a short period of training and worked with the doctors directly to try and help the patients do whatever they needed to do. We set it up with collection of metrics of the numbers of patients that they were helping each week. Then we were looking at the number of times the patients visited the emergency room or were admitted for hospitalization.

Over the first three months, we could see a very positive impact. We got people involved in the project team who would be from the next, this was in five clinics, who would be in the next five clinics. They learned the process as we were finishing the pilot with the first five clinics, and had a chance to ask questions and see it operating. So when we got to the point that we were sure this was working, we would start rolling it out very fast.

As a matter of fact, the word had spread to other clinics, so we had to accept nine clinics for the 2nd wave. Then it went out through the rest of our 33 clinics in less than 2 years. They were able to build their oversight of the process and their commitment to it, instead of waiting and then coming to them and saying, look we've got this great thing, and we want to sell you on it, and starting from scratch over again.

Catalyze: Wow, 33 primary care clinics. That's impressive. In two years, even more impressive. Was that an internal initiative, one of those 10% to 20% that was something that you wanted to test internally?

Dr. Coye: Yes, it was.

Catalyze: How did these community care navigators interfacing with patients integrate within the heath system, from a data collection and communications standpoint?

Dr. Coye: Their titles are Care Coordinators. Basically, we would think of them as clinic-based as opposed to community health workers that are principally in the community. That is a fundamental difference. We had to create a new job category for them. We had to define their characteristics and capabilities, and the hiring basis. We developed a short curriculum. It's only a couple of weeks of training. But then ongoing supervision and the criteria for advancement, etc. We really did have to integrate it into the labor force of UCLA and the UC Health System.

Catalyze: How do you translate or spread the word? There are things like presentations at conferences, but how do you go about commercializing or spreading the word about that model?

Dr. Coye: You're raising a very good question because if it were a commercial product, then obviously we would have gotten investors and gone through the process of trying to take it to market. And one of the biggest problems in the U.S. is that you have millions of successful pilots within a delivery system, or even something that's been successfully deployed across a large delivery system that never really get disseminated beyond that. There are two things we're doing. In the short run, the University of California has five medical centers. They collaborate on a regular basis, sharing their best practices.

As soon as they heard about this, they all got excited. Now the rest of the UC medical centers are going through a methodical process of instituting their version of what we're doing. We also, as you said, are doing presentations. There are two articles about this coming out in the literature very shortly. But the second thing we did is to develop the Global Lab for help, and so if you'd like, I can give a few minutes about that, because that's essentially created as a platform for disseminating information about innovations that reduce the cost of care and improve access.

Catalyze: Yeah, I'd actually love to hear more about the Global Lab.

Dr. Coye: Okay. Well, so for the folks that may be listening to this, the website is www.globallabforhealth.org, and it's a nonprofit site. Anyone can go to that site and post an innovation. It gives information about innovations and displays it in a way that's searchable. You could go to the website and say, well, I want to see all of the care coordinators, or find a solution for readmissions, and come up with tiles, essentially. It's like playing cards in a sense of different innovations, and choose the ones that you want to go in more depth. It has very deep information.

One of the things that's very new and doesn't exist on other websites is that we then have information from the case studies of where it's been used. We contact the users of the innovation to see how it worked out for them. We're going to be doing a challenge on March 2nd. It will be open for about a month and a half. Catholic Health Association, which are all the Catholic hospitals and SNFs and home care agencies around the country, to see what their members have been using with the best results for population health management.

Catalyze: Wow, interesting. First question, is that a challenge that you guys are doing on your own, the Global Lab, or are you doing it as part of sort of some of the work that the government and HHS are doing around challenges?

Dr. Coye: No, this is just us with the Catholic Health Association.

Catalyze: Okay, and then my next question, the Global Lab, all the sort of pilots and different listings of projects and things where people can go and search on the website, are those both commercial as well as noncommercial like that example that you gave?

Dr. Coye: Yeah, they are both commercial and noncommercial, and right now there are probably about 120 innovations on there. Actually, I would say the larger number of them are ones that are service innovations that a health system or a hospital or a medical group has come up with. But as more commercial entrepreneurs find out about this, I think we'll start to see much more of the commercial innovations posted as well.

Catalyze: At Catalyze, we work with a lot of commercial innovators building new digital health services and different technologies for bundled payments, and some of the stuff you talked about. It would be particularly interesting to get the word out to more people, because I think that is some of the struggle. You can publish case studies on your own site or try to give presentations at events, but it's hard, right? And there are so many of these things going on.

Dr. Coye: We are aware of lots of young companies that have terrific products and services, and I know that the whole marketing process in this fragmented health system is really, really tough. This is a way for them to get the word out. We're excited about it. And a lot of the investors are excited about it because they see it as a way for their portfolio companies to get to market more easily, too.

Catalyze: Are there other partners that are part of the Global Lab or are you guys looking for partners, whether they be investors or health systems, or whatever they might be?

Dr. Coye: We're still in formation, but we have some core partners now. NEHI based in Boston, which is the Network for Excellence in Healthcare Innovation, and they tend to do more research in policy work. They're a big partner with us. We're also collaborating with Avia, which is a company that you may know about. We're currently talking with a number of other partners like that. Then there are a lot of other partners, like investors and researchers, who are coming up with new information about how effective innovations are. This is the kind of thing that can only benefit if we get lots of people involved. Those interested in partnering can go to the website and see how to do it.

Catalyze: How does an organization like UCLA, or your group within UCLA, go about scanning and discovering new services and products?

Dr. Coye: In past there wasn't a Global Lab, there wasn't a place to go to see everything that was going on. What you could do was just develop the best network you can. For the last three years, we also have been running the National Healthcare Innovation Summit. It was in D.C. in 2013, and in '14, it was in Boston, and this year it's going to be in Chicago. That is an opportunity where we get to see, we have a gallery and a showcase, and we get to see lots of innovations. But we work with California Healthcare Foundation that does a lot of investing in companies that are producing products for the safety net. We have an investor forum of about 20 to 25 VCs that come to UCLA and talk about trends. So we reach out as widely as we can.

Catalyze: Like the California Healthcare Foundation, you're definitely hitting on the brands that are making interesting investments in the space, and California Healthcare Foundation with companies like Propeller, DirectDerm, and some of the others that we know.

Catalyze: When I read the title of the Global Lab for Innovation, I was thinking globally—international health. There are a lot of interesting innovations and things happening internationally, which are forced by resource constraints. Is there an opportunity for international innovators and new international projects and services to also be listed there that we can learn from?

Dr. Coye: There definitely is, and we've already funded some groups in India to work on collecting innovations there to post. We held a big meeting about two weeks ago on reverse innovation, which is basically the concept of scanning in the developing world for solutions because they use less resources to accomplish good purposes, and then trying to see how they can be adapted here.

The truth is, as we've dug into this for the last couple of years, and I've been to India looking at a bunch of the solutions there, is that if you think about it, for the companies in South Africa or Kenya or India or Sri Lanka or in a lot of these countries, they don't really expect that they're going to sell a product or a service in the U.S. or in Western Europe, in most cases. Occasionally, especially if it's an IT enabled device, it's the kind that might actually make the jump.

In most cases, they don't have a lot of reason to want to post on our site because it's not like they're going to go and sell in the U.S. It's much more a question of us going out and scanning and finding the things that should get posted, so that people in the U.S. or Britain or Western Europe can understand what is possible with lower resources. I have some pretty good groups that are working on that now, it's just that the word of it isn't getting out in the U.S.

We're forming partnerships with them. There's a group at Duke called IPIHD. There's a group in D.C. called the Center for Health Market Innovations. There's another one called ACCESS Health International. And they're working in these other countries, mainly helping those companies develop their own businesses in that market. We are now piggybacking and bringing that information here to the U.S. There will be global information, but not by the same model, not because individual companies went on and posted.

Catalyze: A few years ago, before it got as big as it is now with the mobile health or the mHealth Summit, when the National Institute of Health owned it, there was much more of that international focus. That has changed now. National Institute of Health is still involved, but it doesn't seem to be quite as big, or at least as much of a proportion as it used to be of that conference.

Dr. Coye: I think that's true, and part of it is probably because some of the basic principles used in less-developed countries in developing products and services, we have actually started to incorporate. A lot of new products and services developed in the U.S. are much more disruptive. They're really based on, I mean, I don't know if they saw it another country, but they're similar kinds of principles for the development.

Catalyze: There definitely has been a significant shift in what companies here are developing and how much they look like what maybe were previous to them internationally.

Catalyze: Other than a small commercial entity, a small company wanting to expose itself maybe on the Global Lab website so that others can find it and maybe, if they're interested, to engage with that company, are there other suggestions you have for those smaller vendors?

Dr. Coye: There are now lots of incubators and accelerators that aren't listed. There's actually a great report on them out from the California Healthcare Foundation that just came out about two months ago. People can go to www.chcf.org and see the report on incubators and accelerators.

It helps to have essentially a body, a group, like an innovator or an accelerator, that is advising you and helping you make the contacts and go to sale. And one of the things that that report found is that a lot of the innovators and accelerators are now shifting their attention, so they're following the company for two or three years rather than the old three-month or six-month cycle. They realize how much of this is helping them actually get into the market. I think that's very positive.

Catalyze: You mentioned it before, we know Avia pretty well. We're in Madison, and they're in Chicago. It seems like they started with that premise, that model, where it's not going to be a three-month program, but we're going to try to build both sides, where we have these health centers that are looking for these services, and then we have these companies that are building these services, and we're going to try and build these long-term relationships, connect both sides.

Catalyze: Shifting focus and looking specifically at your organization and innovation within your organization, how do you operate practically within that and maintain a broader vision for how do you transform care at UCLA?

Dr. Coye: It's similar to leadership on any topic in a large organization. We have to have a very clear message about the vision and targets that you're shooting for, that over the course of at least the first year or so, a lot of people could repeat that, and they know what you're trying to aim for. Then any individual innovation that you adopt can be understood in terms of what you're trying to accomplish. So what we did, which was then a little bit unusual, is we actually took the strategy for UCLA Health, and we said, okay, what types of innovations could advance that best?

And we decided there were four buckets of innovations. One was telemedicine innovations. Another was, in a larger sense, anything to improve access, accessibility to maintenance services, convenience, things like that. A third one was to make primary care go upstream and be more preventive and more comprehensive. And then the fourth thing for an academic medical center is to help with the management of very complex cases so that the ones that actually did need to be in the hospital could come and get the care, but a lot of times the pre- and post-care can be done in their own communities, in their own homes.

By focusing on those and having a message that said, We're heading towards value-based care and population health, now I would say a fairly good share of the mid-level management and executive management totally understands that's what we're trying to do.

We've run contests internally. We have one-fifth of all the 10,000 employees here vote in the last election. They are involved in thinking about it and getting a chance to learn what this vision is.

Catalyze: How do you spread the word to such a large organization? How do you get them to speak up and participate and identify problems and potential ideas for solutions that are coming from the ground up?

Dr. Coye: We have done the contest. That is a really good way because all different departments and units get involved in that, and a lot of workers are voting, so that really helps. A second thing is that we have innovation officers in a lot of our units and programs throughout UCLA. So there is an innovation officer in the ED, and an innovation officer in the primary care group, and an innovation officer in Urology.

These are people who are responsible for helping spread the concepts and identify promising innovations, or do a pilot if we see something from the outside that ought to be piloted. That's been very effective, too. And then a third thing is we've had a lot of speakers at events. You know, in a sense, I think the innovation officers is the only thing that's sort of unusual, or innovative, in what we're doing, and I think it's been pretty successful.

Catalyze: That was the one that kind of caught my attention as we were going through the list of different things that you do. A lot of them are MDs. There are some who come from IT. Is there a typical profile for an innovation officer in the urology group, versus the orthopedics group, versus the whatever group?

Dr. Coye: We have quite a mix. Of the 12 or 13 we have now, I think 2 or 3 are nurses, and probably 4 or 5 of them are administrators in the sense that they are an MBA or a MHA rather than a physician. So there's quite a good mix. The one thing I would say is that we have chosen people who are pretty well integrated into management already. These are not like the most junior people. They are people who already have responsibility and are sort of mid-level.

They are looked to as leaders in their own organizations or units enough that people will listen to them and are interested in what they think. And I think that's valuable, because while it's nice to take somebody who's very young and doesn't have any standing yet, and then they have the best ideas in many cases, it's hard for them especially in an academic department, to necessarily get heard.

Catalyze: Do they meet regularly with you, or how does that communication work?

Dr. Coye: No, we tend to meet around once a month, and then they go as a group to several conferences during the year. Not always all of them can go, but so they will all go to the National Healthcare Innovation Summits, and some of them are going to HIMSS and the HX360. And a lot of them are going to other innovation conferences like Blueprint. We also circulate readings to them, and it's been, and they send us suggestions of things that we should do, because these are very active leaders already in the organization. They're not shy once they get dug in on it.

Catalyze: They're out going to these conferences. They're also in their specific clinical groups or specialty groups. They're identifying innovations that they might want to pilot within Urology or Orthopedics, etc. Then they bring that back, and you rapidly assess. Is that how the process works?

Dr. Coye: Yeah, it definitely is. One other thing I forgot to mention we've done that is also different is we worked very hard in the first two or three years to stand up and identify an approach to transformation. A graph that lays out the process that everybody in the organization, down to sort of low management level, has seen applied and used. It describes, here's the role of innovation, here's the role of transformation, here's the process for deploying something in operations from transformation.

That's now been used for 19 different change initiatives within the organization. I'm not talking small pilots. I'm talking about major changes in tertiary, quaternary care. One of the elements in the innovation part of that is what we call patient voice, which is medical ethnography, to understand the variance around an area, an opportunity, or something that you're going to change.

That has become very important, because that's sort of the way we can hook our star to that. You know, we can sort of say, well, innovation actually has a definition in every one of those 19 initiatives. There's what innovation is supposed to be doing, integrated into the understanding of change throughout the organization.

Catalyze: Interesting. Some big organizations have a new title or a position, like Chief Clinical Transformation Officer. Is that a specific area of transformation? Do you have a Clinical Transformation Officer, or does that all sort of fall under innovation?

Dr. Coye: We recently, about a year ago, recruited a new Chief Medical and Quality Officer, and I was very disappointed because I wanted him to be Chief Transformation Officer because. There are a lot of ways to cut the pie. I like the model that I'm familiar with from Geisinger and a bunch of other places, which is that you have a very small innovation group. Our ambition is not to have more than ten people in terms of on the staff of innovation, plus the officers. And then you need a larger capability to really roll something out across operations in a really big way.

In some places that's called a Transformation Department, and it has IT and Finance and change management like lean capabilities, and data, and a whole bunch of other pieces to it. We're not like Kaiser, I mean, we're not like Geisinger. We don't have a Chief Transformation Officer and an organized transformation unit that way. What we've done instead is say, well, then there's going to be a big change management effort, this is what you have to assemble. It's that process. So I think we will see more and more places saying, here's the Chief Transformation Officer, meaning this is the person who operationalizes change.

Catalyze: It seems it started at places like Geisinger, but we're starting to see it at more bigger, more academic centers, more organizations, much more commonly. It also makes sense to shift it a little bit. I feel like a couple of years ago, when they first started, they were just basically trying to convince physicians to use e-prescribing.

Dr. Coye: There's a certain thing to that, yeah. It's sort of ironic because our CEO just announced that he's been recruited to Geisinger as CEO to replace Glenn Steele at Geisinger. He'll now have a chance to go to an organization that actually has a Chief Transformation Officer. We'll see how he feels about that.

Catalyze: I wanted to jump back to a couple of things related to some of the things you mentioned at the start. Is the innovation group or UCLA also thinking, or does it also participate, in investments of internal or external pilots and projects?

Dr. Coye: We haven't until recently, because it was pretty hard in the University of California structure as a state institution to do that. But actually, the business school and the broader campus have set up some new incubators on campus. The university can actually make investments, take equity in new ways. And so they become more of a possibility down the road. Up until now, our office has not been doing that so much. I have a background as an adviser to venture and equity investors, so when we're looking at new companies coming in, we pay a lot of attention into how strong the company is, how good the management is, how likely they are to continue getting funded, etc. But we're not doing actual investments ourselves.

Catalyze: It's particularly interesting that you assess the fundability, which for some of these companies is how they're going to be here in a couple of years. I've actually never heard anybody say that's part of their assessment process.

Dr. Coye: It would be pretty crazy. I mean, you can look at something, and, boy it really helps patients manage their medications. But the company has no funding, or they have a CEO that no investor would ever fund that kind of thing. That's not going to help you to go do all that work and then wind up with your hands empty.

Catalyze: I agree 100% with you. Maybe it's partly because you have a background advising private and venture equity that you bring that perspective. I think it makes a ton of sense. Do you guys also work with companies which aren't funded yet, or are sort of pre-funded, like really early companies?

Dr. Coye: Not much. Our time horizon is shorter than BC. We're basically saying we want to have anything we work with, be able to have a broad deployment and big effect within our health system within three years. So that means that we're mostly looking for what you would say a series B or C, meaning looking for a company where they have their first two to ten customers as reference customers that can demonstrate that this actually works, and what's the business model, and all the rest of it. The best sweet spot is that they are not already, sort of hell bent for leather. I mean, for example, by the time we might have thought of doing something with Castlight, they were practically doing their IPO. You know, that was a little late.

Catalyze: Or Castlight's IPO was a little early, I guess.

Dr. Coye: The way you look at it, yeah.

Catalyze: That hump is a big hump from my perspective working with other companies, getting to that two to ten enterprise and having good reference customers is a significant challenge. There is a lot of de-risking that has happened by the time they get to you, if they're at that stage.

Dr. Coye: Right.

Catalyze: Yeah, and if you guys are looking for impact within three years, it's pretty hard for a very early, never-had-a-pilot-before funding.

Dr. Coye: And we have fabulous science and technology that's on that pathway of transfer here at UCLA. Our Wireless Health Institute has got computer-based technologies that are now becoming young companies, and they're doing really well, and that's tremendously exciting. But that's a different kind of enterprise, from being healthcare within a health system. That's why the difference in attitude or orientation.

Catalyze: It's really interesting to see how you guys approach innovation at UCLA and how it is so immediate results driven.

I don't really have any additional questions. Do you have anything that you'd like to add?

Dr. Coye: Well, first of all, thank you for the opportunity to describe the Global Lab. I'd just like to say the address one more time. The URL is www.globallabforhealth.org. Please, for anybody listening who is either an investor and has portfolio companies, or who has an innovation that could be a service innovation developed by a delivery system or a health plan, it's free to go and post your innovation, and we would be very excited to see it. And look for our challenge on March 2nd with health associations. So thank you. This has been a really fun conversation, too.

Catalyze: We really appreciate your time. Maybe we will end up crossing paths in person at some point at one of these events and conferences.