Andrew Brackin: [00:00:00] Hi, I’m Andrew, the co-founder of Vial, and this is First in Human. Vial is a tech-enabled CRO providing faster, more efficient trials for biotechs. Today, we’re here with Aneesh Chopra, the President of CareJourney, and former CTO of the United States. Anish, great to have you. Why don’t you tell us your story and introduce yourself.
Aneesh Chopra: Andrew, thanks for having me. Excited. I served as President Obama’s Chief Technology Officer and his first assignment on day one, which created the Office of the Chief Technology Officer was that we would open up the government and increase participatory democracy and collaboration with public, private, nonprofit stakeholders to solve big meaningful problems.
Among the most important parts of my role was to find ways to accelerate health care delivery reform. I felt that the most valuable asset held by the government was our linked longitudinal database for millions of Americans. That was illegal for the public to access. There were academic research opportunities, but the broader public and for profit parts of the economy would not be allowed. That policy changed in 2015. CareJourney, fast forwarding it to today, is one of the most active researchers in the VRDC, what’s referred to as a commercial researcher or innovator.
I share that history because the backdrop of the vision behind CareJourney is to unlock all of these data assets to help individuals through organizations they trust better navigate the system. That can be individuals who were eligible for trials that weren’t aware that they could access them. It could be accountable care organizations who are looking to find the highest performing specialists or service providers to help address the clinical needs of their given population. It could be, more broadly, methods for identifying and benchmarking waste and inefficiency.
Our main bread and butter is thinking through ways in which health systems, pharmaceutical companies, and networks see themselves in the performance matrix so that they can improve. We have a membership base of about 150 organizations. They look up areas where they can grow, and they look up their own performance. In the pharmaceutical space, there’s clearly a lot of data gaps that we’ve observed in the market.
For the Medicare population, in particular, it’s been difficult for pharmaceutical firms through the traditional commercial databases to have an understanding about where their populations get care. It’s not just the big academic centers that might be home to trials, but there could be a number of community sites as well as providers to engage to better understand the patient’s condition. Many of our pharma partners rely on us to help that map usually at a very specific clinical cohort level.
Andrew Brackin: Before we dig into the life sciences side, there’s a really exciting opportunity for CareJourney and you’re building an emerging business. I’d love to dig in on value based care. I think that’s where you started. Can you explain what is value based care? How does it reduce costs and improve outcomes for patients?
Aneesh Chopra: There are two ways we’re going to rein in health care inflation from the policy perspective. One is, you slash and burn everybody’s rates so that we can cap how much health care costs society. Not a lot of political interest in just slashing and burning, but absent an alternative, we’re going to have no choice but to do that.
The other opportunity is to package up the total cost of health care at an individual level. And, provide that budget to an organization that is accountable for both cost and quality. On the assumption that there’s all this 10, 15, 20, 30% estimated waste in the system that can be wrung out by organizations dedicated to making a difference.
We are on Team B, which is finding ways to identify how to wring out waste and improve. The bottom line, from my perspective, is this is the easiest project to commence. We have so many fragmented healthcare assets it’s often like picking up the low hanging fruit you’re stepping on with your shoe to say, “Hey, primary care doctor, your patient showed up in the hospital. You might want to communicate with them to explain the discharge instructions so that it can better manage their post acute care experience.”
We have value-based care organizations who are motivated to say, “Where do we perform well? Can we get more patients into preventive care services? Where are we struggling? People are using the emergency room more often than they should for reasons they could have been treated in the community. Or, admitted for reasons that could have been cared for in the community. From a quality standpoint, to the extent we can, are we honest, close to some type of clinical protocol, when it comes to what people should be doing, that can be derived in claims data?”
We basically run those benchmarks. Our members rely on that. Both to look for [00:05:00] physicians that they should recruit, who have exhibited that type of behavior broadly, as well as to improve the performance of the networks they already have.
Andrew Brackin: I know that the life sciences part of your business emerging and growing quickly. Tell us more about that. How have you built out your product offering for Life Sciences customers? How have life sciences companies use CareJourney in the development of new programs and new drugs?
Aneesh Chopra: We are stumbling into the life sciences. Let me describe this as, I wouldn’t call it purposeful, but maybe we’re learning to be purposeful because of it. As we began this journey, there was a broader market awareness that healthcare data held by the government might be useful to complement the wide-ranging and long-standing data pipelines that have been supporting the pharmaceutical industry through commercial means. In fact, one of the most famous examples of this is in the ACA, the US government said, we’re going to release Medicare data to qualified entities out in the private sector that are going to get copies of these claims data that I’m describing. But, it’s prohibited to be made available to pharma. Literally, as a sentence in the data use agreements.
If you’re broadly thinking about how to access the government’s data, the methods that have been historically available, didn’t seem like they were right for you. But, as I noted, the program we are part of allows for researchers to set their goals and objectives. Our view was that life sciences are very critical to value-based care where appropriate disease management involves medication adherence in use. Novel therapies are critical to determining whether or not for certain groups of patients, there’s no better path but a trial in order to get them the care they deserve.
It was a natural extension of our thesis there should be a role for all stakeholders to improve from the lens of: are we delivering high value care to this individual? It’s a new, entry point. Pharmaceutical firms typically rely on calling on health systems or physician groups, but they may not have picked up the phone to call those accountable care networks.
Early in our experience, we had pharmaceutical firms ask to what extent we know about these accountable care networks? We’re honored to serve roughly half the lives in the Medicare ACO reach model as an example. That’s the most advanced capitation program launched by the Medicare Innovation Center. We build those connection points and relationships between our members and stakeholders that can help them improve. We also found a few life sciences firms who had novel therapies on populations in the 65 + domain. Heart failure and other conditions where they were otherwise blind from the traditional commercial sources. We’re looking for anyone that had access.
At the time, and, frankly, through the last five or six years, we haven’t really had a dedicated product or sales function for the life sciences sector. We are growing. We’re now over 100 employees serving about 150 organizations. We are building up those capabilities. To some degree, this is a “coming out” conversation that we’re here and we’re eager to support.
Andrew Brackin: We’ve spent a lot of time in ophthalmology, and in retina where some of those indications probably are an ideal target for that, right? Macular degeneration and diabetic retinopathy-
Aneesh Chopra: -So, this may take us a little bit down path. I wrote a paper with Leavitt Partners maybe three years ago. We’ll maybe put a link in the chat. It turned out that this issue of treating macular degeneration is actually a make or break judgment for a number of Medicare ACOs. I’ll take a second to explain it, and I’ll share the results.
When the idea for PCORI (Patient Centered Outcomes Research Institute), one of the provisions of the Affordable Care Act, was that the government would be funding a lot of these sorts of value based, quality and outcome studies. The NIH wrote not one but two over the last decade that said, treatment for macular degeneration with this miracle of an injectable drug, a compounded version of Avastin, which would retail for 50 bucks, was clinically equivalent to the branded options on the market, Eylea, Lucentis and more have added since. This phenomenon, you would think, would result in ACOs encouraging more of the ophthalmologists to pursue the more conservative and cheaper therapy. But, no, that’s been a stubbornly high number.
What led me to want to write on this paper was we had a health network member of ours who had made shared savings for several years, and had just missed shared savings in this one year. As we did the post-mortem, looking at their data and benchmarking, what they found was there was over a million dollars of expenditure in macular degeneration, using the more expensive treatments without the less expensive compounded version of Avastin. That primary care group, for the first time, picked up the phone and [00:10:00] berated the specialists as to why they were not offering (this was an underserved community) a lower cost option.
It was the first time, (they invited me to listen in on that call) where that ophthalmologists group had ever heard from the primary care community about how they should be practicing medicine is a very interesting meeting. The paper we wrote said, 25%, of the ACOs that were on the bubble, meaning they were making some savings, but just not enough to earn a check, which is a big chunk of the market, could have moved into profitability if less than 15% of the patients switched to compounded Avastin. Now, this is becoming part and parcel of the strategy for value based care, for good or ill, in terms of identifying the right treatment, the right therapy at the most affordable price for the populations they serve.
Andrew Brackin: Absolutely. I think that’s an incredible real life example of value-based care in action. As the first CTO of the US, you’re responsible for advising the president on technology policy initiatives, and promoting innovation. Tell us about some of the initiatives you championed.
Aneesh Chopra: They were really the President’s initiative. I’ll share a little bit of a day in the life just to give you some context. Every morning at 8:30am, I would be walking into the Roosevelt Room, which is catty-corner to the Oval Office. It’s an awe-inspiring moment for anyone. It always was, every day, the highlight of my day. It was to coordinate with the President’s senior advisors. What are the big messages of the day? What are the news areas that would be of interest? It was a challenging time in the economy. He’d go to Peter Orszag about the budget, and Larry Summers about the economy, and Denis McDonough about foreign wars.
They’d listen, learn, and collaborate, so we’re all on the same page. Of course, they’d come to me and say, what’s the latest? “We launched a new open data set today.” Didn’t quite feel like it had the same heft of the bigger issues on the table. I joke. Open government was clearly a day one priority. However, there was a critical aspect of open government that I spent my time on. That was open innovation to advance the President’s national priorities, whether it be a clean energy economy, educating the future of the workforce, thinking about health care, inflation, and reforming the delivery system.
Imagine all the tools in the toolkit. What datasets can we release? What standards can we promulgate? What challenges might we proffer that don’t look like government procurement for the traditional beltway bandits, but could allow for entrepreneurs and innovators who visit challenge.gov (still alive to this day) where they can present their best ideas to solve problems? That framework of open innovation was absolutely my highest priority.
My biggest legislative approach was the President’s national wireless initiative. You remember we were the leaders, and we continue to be, in the transition from 3G to 4G, now on to 5G. We put forward a national strategy to unlock a government held spectrum to a regulated spectrum to be put to its highest and best economic use. To build out broadband coverage to 98% of the population from a wireless capacity perspective.
That allowed us the resources to build the last item of the 911 Commission’s report, that we were not able to complete. To give every first responder an interoperable communications network. That was funded by the president’s national wireless initiative, massively bipartisan. Last, but certainly not least, I have the honor of supporting Startup America, which was a national, all hands on deck campaign led by Steve Case, public private partnership, to spur innovation, because we knew from the data, all net new jobs in the economy going back a decade came from companies less than five years old, not a small business versus big business issue, but new business.
What we learned is that regulatory matters, skating to where the puck is heading in an industry, that the incumbents are slower to get to the future state than the entrepreneurs and innovators. My role in Startup America was to unlock opportunities for entrepreneurs and innovators, especially in health, energy, and education. I spent a lot of my time encouraging and nudging as many capital allocators to pursue, where the regulator’s were heading. A lot of fun, that first term.
Andrew Brackin: I remember, in the early Obama administration, how many government services were digitized in the shift from an analog world to more open services and more publicly accessible data. Then also, obviously, everything that happened around encouraging entrepreneurship and startups. Startups have gone from being this kind of inside baseball Silicon Valley game to being a national talked about phenomenon. Obviously, the ability to start a company is now easier than ever, and more popular in the media.
In your book, Innovation State, you discussed the importance of public/private collaboration. Can you talk about the differences in the approach you’ve seen in government [00:15:00] compared to private industry? How can private industry and government work together? How do they differ in their approaches?
Aneesh Chopra: This is really a description about public/private partnership in the digital era, which is one of abundance. If you look back in time, traditional public/private partnerships involve one partner to rule them all because it’s a physical connection, a capital investment, there’s some relationship where the government is ceding some function to a private enterprise. It had to pick one in order to make the transaction work.
One could look at that as really a cynic, that public private partnerships, in the traditional sense, are really big government contracts with insiders and lobbyists. It springs up a lot of concern and anxiety about, does it really reflect the best of us or the most connected among us? In the digital era, I identified a number of tools in the toolkit (we highlighted some of that) data sets held by the government that can be made available for the private sector, most notably, the weather economy. The Weather Channel competes, to some degree, with other media properties, but all their competitors share access to the same underlying public dataset, and it’s a multi-billion dollar economy.
The government didn’t pick one winner to rule them all. It opened up a platform on data standards. We’re, right now, in 2023, launching The Cures Act healthcare IT internet-based interoperability standards. Public/private partnership here meant that we wanted to get the stakeholders in the community to reach consensus as to how and in what manner, we should standardize these APIs. The development of the API was built by the private sector. It was scaled up by the government. That idea of early adopters, the role of Apple Health, before the regulations even happened, engaging and encouraging health systems to open up the data by a specific, tightly defined API. It needed the yin, to give us the yang of The Cures Act.
And then, last but not least, that idea of challenge.gov, where federal agencies can no longer rely only on the PhDs and procurement physics to show up and participate. But, we can open up opportunities. The VA was eager to get more veterans access to clinical trials. It didn’t pick one vendor to rule them all to facilitate that onboarding. It opened up a series of API’s and issued a challenge on challenge.gov.
The Girls Computing League, a nonprofit volunteer network, built the award-winning application where the veteran could authorize their Medicare claims records and their VA health records, put them together, run it against the eligibility criteria, thanks to clinicaltrials.gov APIs, and promote a personalized recommendations engine for my condition, what trials might be a good, option for me. That kind of democratization and liberalization of the data, is what a public private partnership in a digital era can mean in abundance. Girls Computing League would never bid on or win a government procurement, but they can actively participate in these sorts of open innovation steps, and that can result in commercialization success.
Andrew Brackin: How do you think government can improve on that front? Very few startups I know are currently engaging with government, in terms of their distribution, and market access. How do you think government can move towards a model more like the less single bidder contracts and more open innovations?
Aneesh Chopra: It becomes government with a lowercase “g.” My successor, Todd Park, taught me about the proverbial tree that falls in the woods that you can’t hear. Government can do all of this work, opening up datasets, launching data.gov, opening up access to patents data through public private partnership with Google, we can do all of these things. But if the average kids in a garage, don’t know about it, what’s it going to mean?
We created a roadshow. Todd used to say famously, if four developers would meet in a room in Kansas City, he’d jump on a plane to fly there and educate them on all that was possible. We launched an initiative under Todd’s leadership called, DC to VC. I participated to give some air cover from the White House. It was amazing when you bring lowercase “g” to people. You educate them on the datasets, then, folks that may not have been as familiar would say, “Wait a minute, I can build an app on this dataset. Let me see what I can do.”
Famously, the co-founder of Instagram, Mike Krieger, was a guest in First Lady Michelle Obama’s State of the Union box while I was in the administration. He shared with me that before Instagram, he built his iOS app chops building an app on a San Francisco City open government data challenge where he had access to where were there fire alarms and [00:20:00] police activities in the city to map and build an app to help people navigate a more safe experience. He credited that experience to giving him the experience he needed to then pitch his cofounder, Kevin, that he can be the app developer needed to launch this vision to life. Here we are celebrating one of the most incredible and iconic technology companies. It was born off of the experience of an open government initiative.
Andrew Brackin: I’d love to close out today learning more about CareJourney. What are some of the upcoming projects and initiatives you’re working on? Tell us more about the future, and the vision for the company. Where do you see it heading?
Aneesh Chopra: My north star is what we can do to help families with loved ones better navigate the healthcare system. We do that indirectly today because we serve organizations who reach out to those individuals. We don’t have a direct to consumer role. I aspire for partners who can help in my neck of the woods for patients suffering from pain with sickle cell, we have an opportunity to connect individuals to these emerging therapies. I am eager to “match.com” interventions that can help people live better lives, ideally with lower cost better outcomes, with organizations that are accountable to connect those interventions to those who can need the most. That’s the bread and butter.
Along the way, organizations need benchmarking support to learn where are the pockets of effectiveness here? Where are the rooms for improvement? We think we have a hypothesis about this intervention. But, we want to understand the size of the market and the current experience, how often folks are in the hospital for avoidable reasons, to really construct that kind of value analysis.
Where we are right now is actively seeking partners who wish to work with us in an open and collaborative spirit to contribute their questions and ideas across the membership. My broad goal is to eventually cross the chasm with open APIs, so we can deliver that kind of personalized experience to trusted, what I refer to as, health information fiduciaries. Whether that be a help desk type entity on behalf of a beyond the pill initiative in pharma, or an ACO like we currently serve or a legacy health plan or health system.
These entities that operate as fiduciaries can take all of that underlying data, link it up against these best practices and benchmarks and give you decision support that’s in your best interest. That’s the market I wish to serve, if and when the industry can consolidate and build towards that future. We’re not there yet, but we’re pushing to bring that vision to life. I want my mom and dad to benefit from a health information fiduciary.
Andrew Brackin: Amazing. Aneesh, thanks so much for the time today. This was an incredibly interesting conversation, just a great discussion and I learned a lot about value based care and about how we can improve the health care system. So, thank you so much for the time.
Aneesh Chopra: Thanks for having me.
