PaceSetters: with Venky Ananth and Dave Grimm

00:13

Dave Grimm

Thank you. Thank you for having me.

00:15

Venky Ananth

Absolutely. Let's start off first. My first question to you is, how are you doing?

00:21

Dave Grimm

I'm doing well. We're at the Adobe Summit for your audience, and we both had a really good presentation on stage for a mixed audience of healthcare members and digital experts. And it was an enjoyable conversation. I really liked it.

00:36

Venky Ananth

Awesome. I couldn't agree more. You have a fascinating background. I want to hear from you. Let's talk about your own background, Dave, and where you started, and then, of course, we can talk about what you're doing today, but sure. I thought it'd be better to hear from you given your very rich experience.

00:56

Dave Grimm

Well, let me see. The way I usually describe it to people is I'm what you call a digital native and what that means last century, in the late 1990s, I was reading a Time magazine, the paper Time magazine, and I was reading about startups in Silicon Valley. And I was sitting on the couch drinking coffee. My wife was in the kitchen, and I was joking with her. I was like, we should go out there and apply to one of these companies. And she's like, well, we have a vacation. Let's do it.

01:29

Dave Grimm

So, we took a vacation. Within a week, I was starting at Esurance, which is one of the first insurance providers of online insurance. And she got a job at TiVo, which was the first DVR and probably the best software platform for a DVR. And from then, I didn't look back. I've always been working for companies either on the B2C or the B2B side. Very small startups to international companies, both in financial services, healthcare, currently, life sciences, data information, and data exchange. So, I've had a really cool career, and I was fortunate to be there early when we were making things up. And every company I worked for or worked in, I'd always get the question, have you done X before? And I'd say no. But I think I can figure it out and I'd go do it. And now you can get a master's in user experience design that didn't exist when I started.

02:32

Venky Ananth

So, let's talk about your current gig. Blue Shield of California and Enterprise digital growth. What are you focused on and what are you excited about? Tell us about it.

02:46

Dave Grimm

Well, let's see. I'm focused on four constituents. So, in healthcare, you obviously have the patient or the customer. That's the number one focus for us, because without them and their care and wellbeing, nothing else really matters. I work for Blue Shield of California. It's a not for profit, and the whole purpose, the mission of the company is about helping patients, which is a really nice place to be. And I've always worked for mission driven companies. Now, outside the member, you have providers. So, physicians, nurses, nurse practitioners, chiropractors, dentists, name your specialists and they interact with Blue Shield. Right? They file claims, they transfer medical records, whatever. It is good on the line. Their employers, large employers who buy insurance for their employees, and brokers salespeople who sell on our behalf. Each of those groups has unique business needs, and they all have modern consumer expectations of interacting with a company. From a healthcare perspective, the patient the member expects to be able to find a physician, look up their claims, look at a medical history of themselves, refill a prescription, all those things that are interacting with the product that they purchased. All the other audiences have similar needs.

They won't exhaust them all, and you can do them all electronically. So, the Digital Enterprise Growth, that's my title is about modernizing for each of those constituents. So, they call less. It's a classic call avoidance strategy. Like don't call a self-serve that they utilize more. So we get more contacts with them, with each other's audiences, and ultimately become sticky, for example, with the providers. As a non for profit, we have a very good reputation with providers, but we're difficult to do business with transparently because we compete with nationals who have invested at a much higher level than we have. So the basics of healthcare are harder for us to do in an automated way, but that's where we are putting our investments in. And it's my job, as we build that infrastructure, to build an interface that creates value for each of those four audiences, right? Yeah.

00:15

Venky Ananth

And I want to go a little bit deeper. Look, everybody agrees that healthcare, especially in the space of digital transformation, is still an evolving space. It's definitely something that not as progressed or advanced as in a retail industry, as an example. And you heard me speak about the fact that areas like pricing transparency or interoperability, driving & using technology to actually materially and meaningfully impact health outcomes, et cetera, there's still a lot of work to do. So, if we take it back and kind of overlay that in terms of your own digital transformation journey at Blue Shield, where do you think you are in the journey and how do you see the future unfolding from a Blue Shield perspective?

06:16

Dave Grimm

Okay, that's a heck of a question. Let's see.

I'll start by saying at Blue Shield, we are nascent, like the rest of the healthcare industry, and also my tenure. I've been there a little over two years, and I'm very much focused on core plumbing -metaphorically. Like, there are standards that we need to get in place in order to modernize. An example is we created the concept of identity management. And what that is healthcare, historically is a contract company. You bought a health contract, right? You bought a health contract. It's an HMO or a PPO in a different line of business. Well, that's fine for that contract. But what happens when you change jobs? You're under a new contract. Well, prior to us actually creating identity management, you were two people, right? Because you were two contracts and we couldn't cross the data. Now that's antiquated. There's nothing like security was good, right? No data is escaping. We are proper, we're protected, we're compliant, but we're not getting the value out, right? So imagine if over the course of your life, like we have a concept of Ever Blue. So you're born and your parents insurance cover you and then you go to college, you stay with them because of Obamacare wonderful law, you finish college and you go get your own job.

Now you're on a commercial plan, right? And then you get laid off and now you're on Medical, but then you decide to go start your own business. Now you're on IFP I don't know if your audience is going to understand this jargon basically product types. So in terms of a consistent experience, being able to recognize the person in that continuity is really, really important and it actually goes all the way to Medicare and end of life. That's part of our business. Now from that basis, think about how much you can do. We intend to create a very rich health record for our members, right? And I don't want to be inappropriately promissory. We have to make investments, we have to develop technology. The rules of engagement are changing around us when it comes to HIPAA compliance, interoperability rules. With all of that there though, if we are going to disrupt ourselves and disrupt healthcare, what we have to do is extract the value out of the data that we have with proper permission from our customers and to be able to create value for them. And if you think about that, a really good metaphor is air travel.

So the first time you used your travel app for whatever airline you use, you could see your flight- amazing. It wasn't much more. A little while later you would get a message saying, "oh, your gate changed. Wow, thank you. You just saved me a 30 minutes walk across the Dallas airport," which is enormous. You get to the flight now and you want to upgrade your seat or change it. I don't want to sit in the aisle. You can do that real time. But all that is is the data of the flight and the itinerary and the seat location put into an interface for you to interact with to get value. Now, of course, a business, being a business, every time you do that, there's an upsell, there's a cross sell. As a consumer, that's a little exhausting, sure, but there's also an exchange of value. I get exactly what I wanted and I made the choice. And that's the nature of being in a commercial country, I guess you can say. So that whole mashup is how you can get value out of data. That's persistent and existent. I think the biggest issue that healthcare and B2B's have is they're not unlocking their data, they're not federating their data, and more importantly, they're not sharing across industry.

10:08

Dave Grimm

So will your audience know what Interoperability is?

10:11

Venky Ananth

Sure.

10:12

Dave Grimm

Okay, so we talked about this today in our presentation. The fact that the government came in and said, no, you must share your information this far back, and here are the rule sets between plans. And by doing so, you're going to unlock the data of your customers. Now, they can only see so far in the future. They can only be so prescriptive. But that's the kind of unlocking that makes what I would like to do for my brand and my customers possible. Because prior to that, it's scratching your head like, well, how are we going to convince our competitors to share data with us? That's a really hard proposition. Right. So sometimes the government is quite helpful in a situation like that where they come in and say, no, thou shalt share data. Now, the trick is for all of us who are in this space to understand, what does that mean for us? How do we get value out of it for our customers? And let's not forget, there's value there for a provider.

11:12

Venky Ananth

Right.

11:12

Dave Grimm

So if you think about the concept of first party data I'm going a little long here, is that okay?

11:17

Venky Ananth

Sure.

11:18

Dave Grimm

You think about the concept of first party data, that means a claim. We paid you're a physician, one of our customers came in, presented to you, you took care of them, gave them prescription, whatever, and you file a claim and we pay you. Right. That transaction you're aware of because it happened in your doctor's office. What happens when your patient shows up a week later in a cast? They broke their leg skiing. You weren't there. You weren't in the emergency room. You don't know what happened. Well, with interoperability, ultimately what it means is the X-ray from that emergency room is available to your primary care physician when you come back and you can see everything that happened to you in that hospital. Right. That's the exchange of information that makes healthcare so much more valuable to providers, to the payers, to the patient, to everyone included. And it's all art of the possible. It happens in other industries. It just doesn't happen in healthcare yet.

12:20

Venky Ananth

So you spoke about customer experience. Customer experience journeys and unlocking data to create that contextual value for clients when they need it, where they need it. You spoke about portability of data through the interoperability mandate. So what are you most excited about in terms of whatever program and project that you're trying to drive right now?

12:48

Dave Grimm

Right now, specific to Blue Shield, I'm excited about creating mobile first utility for you and your family. Right. So that in our very busy lives, you and your significant other and your kids all have a digital presence inside of an application that you choose to download. And with that we can make sure that- I'm making this up. Your son's ADH method prescription is refilled to make sure that your daughter's allergy appointment, when it's coming up, you take her there, that your wife gets that reminder for her mammogram, right? All made up scenarios, but again, it goes back to the data. And imagine if you don't have to think about that stuff. It's like when you go to the airport and they tell you your gate changed. Well, when you're in looking at Instagram or looking at your kids on Facebook, you get an instant message. It's like, oh, we've got a reminder for you, come back. Hey, we need you to set this appointment. You asked us to tell you to do it, to remind you to do it. Please go ahead and schedule. And in that way we can keep our members, we think, healthier because they're interacting with the healthcare, not sick care as my boss would call it.

14:08

Dave Grimm

It's healthcare. They're being proactive, right? They're doing detection, they're taking tests and they're getting the treatment that they need. That's the type of thing that we intend to release in waves. And we will be agile, have a minimum viable product that meets certain data criteria, certain utility, certain audiences, and then just like an onion, get more and more value out of it, more and more layers.

14:33

Venky Ananth

Awesome. It's like personalization at scale.

14:36

Dave Grimm

It is. And it's just utility. But you and I talked about genomics, right, and the promise of pharmacogenomics and personalized medicine.

14:47

Venky Ananth

The most exciting part for me from an AI perspective in the context of healthcare, really is about personalization is at two levels. Level one is really about what you just spoke about, which is simple, extremely useful stuff like reminders, medication adherence, scheduled visits with my PCP, extremely useful contextual information when I need it, where I need it, how I need it, through the channel I need it. That's level one.

15:29

Venky Ananth

Level two, in my view, from a personalization perspective is really about how do you. Again, within that there are two levels of sophistication. The more basic level of sophistication is, is there a way to match my chemistry with the chemistry of a drug to figure out which drug is, from an efficacy perspective more impactful. Right? So there is a basic level of personalization that's happening. The higher level of sophisticated matching is really about is there individualized medicines that can be built up again based on your own genetic information? You worked at Alumina and they were the players who dramatically brought down the cost of genomic sequencing from $100,000 to about $600, which is insane. Keeps going down and it keeps going down, right? So as genomic sequencing becomes more and more affordable as we make using genetic information into mainstream treatment processes, right? Then we can drive that level of personalization. Again, I believe it's at a nascent stage. But I'm now overlaying technologies like AI and generative AI's into the healthcare context of how you can drive meaningful material impact on health outcomes.

16:57

Dave Grimm

Right.

16:58

Venky Ananth

We're really talking about quality of care here and of course, corresponding reduction in healthcare costs. So that's, in my opinion, the very exciting part that I look forward to from overlaying AI in healthcare.

17:16

Dave Grimm

Right. I've got a unique vantage point in that. As you mentioned, I work for Allumina, which is a genomic sequencing company. And it's interesting, inside the company there is a research arm and there is a clinical arm, meaning clinical diagnostics, IVDs clinical equipment. And for those in your audience, if you work on one side of that fence or the other, they're very different. And it was unique to being a company that's doing both simultaneously. So on the research side, with genomic sequencing, they could find the biomarker for some illness and in many cases simply by accident. Sometimes they would find an existing prescription, existing pharmaceutical that would positively impact that negative phenotypic response. Typically in children, they're very focused on healthcare for children where they had rare undiagnosed genetic diseases. Rugged, it was called. Well, that extended into well. What about pharmacy for the individual, that's the end state. And just personalized medicine, which is kind of the middle state. If you think about prescriptions for mental conditions, the ramp up time to take a drug of that type can be lengthy and the doctor is using best judgment medical practice. But it is guesswork because you don't know how that person chemically is going to respond to it.

18:52

Dave Grimm

Now, to your audience, I am not a clinician, I'm not a physician. I learned this through my seven years at Allumina. So I'm speaking from a layman's position, but I understand it because I was there long enough. And what's amazing about it is if they can say because of your genome, I know you're going to negatively react to this drug and this drug, but this one will be favorable to you based on the thousands and thousands of people we've seen go through that. That's where I think the power of AI comes in because it's not AI prescribing a drug, it's AI crunching very large number sets of reactions to drugs by gene location and by drug type and saying this is the signal.

19:34

Venky Ananth

Exactly.

19:35

Dave Grimm

Because no hospital clinic in one city, in one state is going to figure that out.

19:40

Venky Ananth

That's what I call as the matching the chemistry of the individual to the chemistry of the drug.

19:45

Dave Grimm

And the same thing applies for cancer treatment. Absolutely. There's so many interesting mashups to it. What's cool for me is having gone from the manufacturer side, working with so many brilliant people, creating that technology and by the way, COVID was sequenced on Allumina technology. The drugs that were developed to fight COVID, the vaccines, they weren't developed by us, but they used our RNA inject methodology to create those vaccines that saved millions and millions and millions of lives. It's really cool stuff, but now to be on the healthcare side, where you're actually I don't interact with patients, but many people in the company do the clinicians, the actual physicians, nurses, and they deal with the pain of people going through this drug - is making me nauseous. I can't sleep. Whatever it is, that'll really be game changing, I think, in healthcare, way outside of what I do, that'll be really.

20:42

Venky Ananth

Fascinating and very exciting times ahead. Thank you for sharing your knowledge. Yeah, absolutely. Thank you so much, Dave. Absolutely.

20:52

Dave Grimm

Thanks for having me. I appreciate it. All right. Thank you, everyone.