“Our purpose has become activating better health outcomes”

An interview with Outcome Health co-founder, Rishi Shah

Q: What drove the change of the company name from ContextMedia to Outcome Health?

Ten years ago, when Shradha and I were first starting the company, we were interested in healthcare. Both of us had family members who had diabetes, and my father was a physician.

We were specifically focused on the potential, in the digital age, to serve up information that could be personalized for the time and place where it would have the most impact. As time went on, the DNA of the company evolved. The original essence of the company – serving information when and where it was actionable – became a “how” rather than the “what.” Our purpose became activating better health outcomes for people. We can do this through media, but there are other ways, such as providing technology to support decisions within the system, and automating workflow at physician offices.

Q: Is it daunting to take on the challenge of improving healthcare in the US?

The healthcare system can look like a multi-headed monster, and it might seem like the only way to change it is in Washington. We have a different perspective: that change happens locally.

The health outcomes of the population are the aggregation of billions of decisions that take place in examination rooms. Our view is that, rather than starting at the top of the pyramid with macro topics like health insurance regulation, we start at the bottom, to help in these micro moments when a doctor and patient are deciding what to do. If we find ways to give them all the information they need to make the best decisions possible, we will change healthcare for the better.

Q: What kind of support can Outcome Health provide at those decision moments?

To start with, we can digitize information that is currently on paper. Consider other areas of your life, like choosing where to eat or what house to buy. Today, we are well-equipped to make these choices because there is data available in an easily-navigable form. If we can do the same with health information, and add the capacity for things like search, ratings and context-awareness, we will have a positive impact on decisions in the exam room.

Looking forward, we can assist with things like practice workflow. For example, we can introduce solutions that enable patients and providers to more easily, and transparently, see costs and other payment-related information. There’s also clinical workflow – for example, helping providers decide whether or not to renew a prescription request.

Ultimately, we hope to deliver clinical intelligence: providing decision support that goes beyond mere information. Let’s say my fiancé’s mother is deciding whether to get knee surgery. How do we gather all of her information and preferences, and then contextualize that against the relevant data and longitudinal studies that are out in the world? We want to use technology to help provide her with this wisdom to inform her decision and ultimately achieve a better health outcome.

Q: What are the challenges you’re encountering so far on this path?

The hardest thing about healthcare is how scattered everything is: with so many doctors’ offices, there’s a fragmentation of providers. There’s also what we call fragmentation of value, which is more complicated. If you’re my doctor and I’m a diabetic patient, we don’t necessarily have an economic stake in the decision being made.

We see this fragmentation of value as a barrier to innovation and investment in the moment of care. A hotel will improve its property because it can see the upside; a restaurant will improve its service so it can get better Yelp reviews. In healthcare, better patient experiences and outcomes aren’t always directly tied to the economic stakeholders.

That’s why it’s so important to network everyone together. This is a complicated challenge. Two sided networks, like eBay or Stubhub, are hard enough. But what’s so interesting and challenging about healthcare is that there is a five-sided network: the providers, the patients, the life sciences companies, the payers and the service companies.

Q: Let’s say you manage to make that five-sided network run smoothly. What’s your vision for the patient experience in the exam room in ten years?

Whether the exam room is a physical or digital experience, I imagine it being a system that knows you. It has all your clinical data, and also knowledge of how you live your life. Let’s take the knee surgery example again: through intake of information about you, your pain, imagery of the injury and all the available insights out in the world, it can provide wisdom for you and your doctor. It might say, we have the data on similar people with this condition… here is what they chose to do, and these are the outcomes they experienced.

Q: But the doctor will not be replaced by the computer?

Not any time soon. We’re not planning to build robot doctors inside kiosks in a mall! We believe that the relationship and trust between the patient and the doctor is paramount, and that technology can support this relationship by relating and contextualizing data.

Think of an airplane cockpit. Systems like autopilot and fly by wire have dramatically changed the role of the pilot in the last 30 years. We think the same can be done for doctors, through improved workflow and decision support.

There is also the challenge of integrating new flows of data from areas such as genomics. But I don’t believe that we will ever lose the human connection that lives at the core of the patient-doctor relationship.