Suchi Saria, Ph.D. 0:16
Hi, I’m Suchi Saria. I’m the Founder/CEO of Bayesian. I also hold an endowed chair professorship at Hopkins. I’m also a Day Zero advisory council member. And today I’m here to interview another advisory council member, Don Trigg. Don, welcome. So excited to have you here.

Donald Trigg 0:34
It’s great to be with you, Suchi, I’m super excited for this conversation as well.

Suchi Saria, Ph.D. 0:38
You don’t really need an introduction. Most people in healthcare already know you. I don’t know if they know all of the different exciting things you’ve been involved in. So give our listeners a little bit of a preview of your entrepreneurial journey.

Donald Trigg 0:51
I spent a decade in Washington in the public policy space and that really came at healthcare from a budget and tax perspective, really thinking about things like entitlement reform. That was sort of my introduction to key pieces of the regulatory and statutory environment for healthcare. And then people largely know me in the context of the role that I played as the president of Cerner Corporation, which is an organization that I was recruited to by Nancy-Ann DeParle, longtime Obama and Clinton administration official, along with Senator Jack Danforth, longtime senator from Missouri and a mentor of mine. So that was really my introduction into the intersection of healthcare and IT. A very incredible mentor and founder/CEO of Cerner Corporation, Neal Patterson, took me on my entrepreneurial journey inside healthcare IT, both at Cerner, but also in an early stage company that I was involved in called CodeRyte in the computer assisted coding space, where you and I had a number of mutual friends on the technical side. So, I have had the opportunity not only to play a variety of different roles inside a very large Fortune 500 company that really strived to think about entrepreneurial scale, but also an early stage startup company that we scaled and then subsequently sold to the HS division of 3M.

Suchi Saria, Ph.D. 2:18
So Don, you just described two really interesting big changes that’s happened in the last 10 years, I’d say at the intersection of healthcare and IT. One, which is the formation of the EMR as a foundational layer, where we’re going from paper records to electronic records, and what that means in terms of everything else that can be built on top. And two, an example use case where you all went to take the data itself and starting to implement AI ML technologies to be able to do coding in an automated way, so that we can do computer assisted coding. Tell me from your perspective, now that we have this EMR as a foundational layer, and more broadly, a digitized health record, what are some areas where you see, like, most exciting areas for impact in the next five to 10 years?

Donald Trigg 3:10
Look, we’re struggling through some of the early stage dynamics of first time digitization of an industry. And so I think, rightly, there has been frustration with the adverse impacts of technology deployment around productivity, things like usability of the data for purposes of advancing clinical, operational and financial change. And frankly, some of the associated people and process changes that need to happen to really get to role-based shifts, and task automation, and some of the things that will really allow us to tackle the healthcare cost curve. So we’re very early in this process. But I think, when we have an opportunity to pause and gap up, we can get very excited about not just second order use cases around the data, but the things that you’re working on, these very compelling, third order use cases that really begin to change healthcare as an industry. And so I think we’re just very early in that process, Suchi. But I think it’s very profound, very important, and it plays out in increments that we will measure on a multi-year or decade basis. But I really believe, and you and I have talked about multiple times, this is going to be a big and transformative decade. In fact, I have posited that the things that played out in the 2010s will make the 2020s as transformative and impactful as the 1960s where we saw passage of Medicare and Medicaid. So we’re right in the middle of a big transformative change that’s just beginning to play out.

Suchi Saria, Ph.D. 4:49
I think one of the very interesting things I saw last couple of conversations we’ve been having very recently is, you know, staffing shortages with COVID people are burned out. A huge part of the burnout is having to navigate, on a day to day basis, all the information explosion that’s happening in healthcare, and how do you make it so that you can use this information in a productive way to make it very easy to do the right thing. And almost like ideally, you know, in other sectors, we’ve seen massive productivity gains from better use of information in the right way. So I feel like the EMR has kind of created a layer to make all those toolings now available. And we’re sort of just at that stage where more and more exciting efforts are starting to come out that are leveraging the data to make it very easy to do the right thing. And perhaps even some simple things, like we should be able to improve ratios by providing AI/ML technologies that are sort of parsing the scene, I’m scanning the data providing a second verifies. So I’m very excited, just like you are. You’ve been part of both big and small companies. As you’re seeing sort of this next 10 years, lots of new exciting ideas coming to the forefront that’s going to get implemented. We’re going to go from phase one of this digitization to phase two, where it’s going from exploration to mature ideas at place. What’s your take on what big companies do really well, versus little companies, like compare and contrast your experiences at these different types of places you’ve been at.

Donald Trigg 6:24
Look, the SWOT analysis is, you know, has both opportunities and risks associated with it, both for the big company and the small company in the category. I think one of the things I would observe over the last two decades, I think more true today than when I came into healthcare IT in the early 2000s, is government’s role as regulator and payer is a really important dimension of how change plays out in healthcare. Nancy-Ann DeParle likes to say payment is policy. And I think that’s right, and so much of what we describe as the workflow impositions on the provider and that burnout is attributable to regulatory and payment related requirements that are a feature of what it looks like to operate in a health economy in which government is not only the largest regulator, but also the largest payer. And those are trend lines that will continue as we see boomers age into Medicare, and we see onward growth of Medicaid. So that’s a big thing that I think we need to appreciate and understand about the healthcare landscape and the health economy. The second thing I would say is that, because of that, a lot of what we see play out is iterative, and plays out incrementally in small steps over time. We should be frustrated about that. But we should also recognize it as part of what operational progress looks like for the enterprise. And that’s true of organizations big and small. So things like the data blocking provisions and the interoperability provisions, which you and I’ve talked about, I think there’s a nice regulatory progression playing out that wasn’t a part of the stimulus in 2009 and the subsequent meaningful use regs, but now has been addressed statutorily and regulatorily, and now will drive greater levels of data liquidity, and create new opportunities for data use as this decade plays forward. So, really understanding the kind of entrepreneurial notion of the artists in the timing and how regulatory and payment realities drive change, I think is a big, big part of what success looks like for organizations of any size. And then the final thing I would just say is, big companies do have structural advantages inside large, heavily regulated industry segments. So there’s particularly functional capabilities inside the large enterprise that don’t exist at a small c round, company trying to go from $50 plus million in top to $100 million in top line. And so cleverness is required in terms of what it looks like to think through some of these key areas inside healthcare. That is the complexity facing a smaller organization. At the same time, they can be more nimble, and agile, and entrepreneurial in ways that can be harder for the large behemoths who have those capability sets, but perhaps are more wedded to traditional product lines, traditional solution offers.

Suchi Saria, Ph.D. 9:50
Yeah, very interesting. I think the point about policy driving change and figuring out a way both to leverage policy or be more cognizant of it to influence strategy, both from systems that are used to thinking about it, but also sort of founders, right, or innovators, for them to be integrating policy as part of strategy more closely. And then also, this very interesting point you made, Don, that isn’t as true in other sectors, and definitely less so true in tech, I would say, is the very heavily regulated nature of healthcare, and therefore the need to have an arm and arsenal to be able to think harder about what this means from a day to day existence perspective. And maybe this means more partnerships like we saw for vaccines, right, like the Pfizer, BioNTech type partnership, where there was an innovator that was able to very quickly produce the solution. But by partnering with Pfizer, they were able to disseminate the solution broadly, very, very fast.

Donald Trigg 10:54
We tend to focus a lot on product innovation. You and I can get very excited about data as product strategies that play out and solve the key problem areas in the enterprise. But big pieces of what you and I are talking about that will play out in the coming decade are business model innovation. And so when we start thinking about business model innovation, you start thinking about, what does the partner ecosystem look like? How do we think about alignment strategies, both within our sector of operation, but increasingly across the health economy, non traditional partnerships that span providers, working with payers, perhaps also working with pharma as we think about some of the use cases around therapeutics, vax admin, etc. So I think we’re going to see a explosion of partnership activity, and really asking yourself as an organization and as a leader, what does it look like to partner well? Whether I’m a large Fortune 500 company, or I’m an early stage startup, who sees partnership and channel opportunities as a key a key strategy for increasing reach?

Suchi Saria, Ph.D. 12:09
Would you be open to sharing your thoughts on what does it mean to partner well?

Donald Trigg 12:13
Yeah, for sure. With a little bit of a bias towards our health system leaders, I think health systems need to be really thinking about executive level ownership. So who is that executive owner who can be the champion across and up the organization for a partnership is really pivotal. Whether I’m partnering with big tech, or I’m partnering with a point solution company with aspirations for a platform, I have to have an executive champion. Secondly, I think we’re always looking for scale benefit and scale impact. So there are a thousand different science experiments across 20% of GDP in the health economy. But how do we start proving out impact at scale? So someone has to really have a roadmap for enterprise wide deployment and impact. And then finally, to the discussion we were having earlier, someone really has to be thinking about, what’s it look like to harvest that qualitative and quantitative impact, and really be an evangelist for those impacts, not only with a go-to market and business lens, but also as it relates to convening an advocacy efforts in a way that creates consensus around how things like regulatory and payment should support strategies that can have impacts on quality, cost or experience. So I think those are three essential dimensions of what it looks like to partner well, and that is both with a lens towards the large company, and what it looks like for them to be a good partner, as well as an earlier stage company like yours, where you’re highly dependent on marquee client relationships and/or larger partnerships.

Suchi Saria, Ph.D. 14:10
I do know you’re writing a book around some of your experiences. I’d love to hear a little bit about that.

Donald Trigg 14:18
For sure. We are in the final stages of completing a book called “On the Health Economy”. And it’s subtitled around “Ground Rules for Leaders”. And so Georgetown University Press is going to be publishing it. It’s something that we began thinking about before the pandemic, but then was meaningfully impacted and informed by the events that played out in 2020 in particular. We’re excited to put it out in the public domain and let it play a small role in, I think, informing people’s thinking around some of the key changes that we think are going to play out over the course of the next decade. So we do believe you’re gonna see an elevated role for the person with emphasis on cost, quality and experience. So we think the trend around consumerism and the person is real. We do think there’s going to be a shift in the payment landscape in a way that drives payer/provider convergence, and really starts to reimagine how providers design, organize and deliver care on the provider supply side of the health economy. And then to our discussion today, we also believe that leaders are probably underweighted in terms of thinking enough about health policy and the associated topics of health politics, as healthcare has become more fully political, and how they play into their strategies for deploying operational efforts within the markets that they operate in and the communities that they serve. That’s a quick encapsulation of it. And we’re super excited about it. Georgetown has been a great partner for us around that publishing activity. And we’re looking forward to having market conversations around it over the course of the coming months.

Suchi Saria, Ph.D. 16:08
Very exciting. My own background tries to marry engineering with health policy, so I’m very excited to hear you emphasize how important that is and how it isn’t getting as appreciated as it ought to be.

Donald Trigg 16:21
As you know because you’ve spent a big part of your career working on it, breaking down the silos that exist inside healthcare and really getting to applied best practice is a big piece of what needs to happen for us to be successful in the decade ahead. And hopefully, this book will provide some framing around that in a way that will drive those conversations across the industry.

Suchi Saria, Ph.D. 16:48
I can’t wait for this book to come out. I’m very much looking forward to it. And Don, thanks so much for your time.

Donald Trigg 16:54
Thanks, Suchi. This was great.