HIStalk Interviews Carina Edwards, CEO, Quil Health

Carina Edwards, MBA is CEO of Quil Health of Philadelphia, PA.

Tell me about yourself and the company.

I have spent my career leveraging technology to improve the clinical and patient experience across healthcare. I’ve done that at companies including Imprivata, Nuance, Zynx Health, and Philips Health.

Quil is a digital health joint venture between Comcast NBCUniversal and Independence Blue Cross. We are on a mission to help people organize and navigate their health lives. We have proven that an educated and engaged consumer leads to better outcomes at a lower cost. That has been the holy grail and we want to see that through. It’s an exciting venture and I am thrilled to be at the helm.

To what extend has widespread availability of consumer technology, as well as comfort with using it, provided richer healthcare at home options?

The home as the center of care is squarely in our remit. We purposely think about the connected home, which with devices, wearables, and the television hanging on your wall, can be truly differentiated and activated in health. But the core comes down to, why aren’t consumers activating in their health?

One of the big things for me is that we need to stop, as an industry, thinking about the patient, the member, the employee, and the caregiver. We need to start thinking about the person. We need to be thinking through how we bring health and the navigation of health together for the individual. That means meeting them where they are — whether they are in a high-tech or low-tech household, whether they are connected, how they are connected — and trying to figure out the best way to activate that persona in a healthcare journey or in health literacy.

Nobody wakes up hoping to be admitted to a hospital or nursing home. Is it hard to tell the story of care options that don’t involve particular venues?

That’s the part that is rapidly changing. My customers span providers, payers, and employers. When I speak to all of them, they see their as-is state moving very quickly. The more progressive ones get it. The hospital at home concept has been touted for a very long time, but COVID brought to life the need to do infusions at home and do cancer treatment at home. Nobody wants to come in to the city center to the amazing, beautiful, big cancer tower, because that’s inconvenient for their life and they are already in pain and struggling. 

How do we bring as many services, knowing that there is a huge cost implication of that, too? Where we can leverage people, process and technology, we can rethink many things at a lower cost and meet people where they are. I love that sentiment.

How will health systems change their business model as the pandemic winds down leaving deeper experience with delivering care outside the hospital?

Everybody realized that, and they quickly spun up the technologies. It’s an interesting perspective where both providers and payers realized where the gaps were in the other side of the pane of glass. It wasn’t so much, can I get and engage my patient, member, or employee on a digital medium? It’ more like, how does it fit into the workflow of healthcare as we’ve established it? How does that integrate to make sure that the waiting room is virtual? The thoughts are virtual? You’re keeping people engaged, you’re meeting them, and they’re not meeting some random doctor or someone that doesn’t have their health history.

As they look forward, we hear a lot about, how do you bring information sharing? Now that we are all working towards interoperability with the passage of the legislation and the activation of the legislation, how do you bring that to the pane of glass in the provider workflow? In the patient workflow? So they they can not only interact, but they know what to do pre and post, because so much is forgotten during the encounter.

That’s another stat that I love to bring to people’s attention. People forget that when you hear a critical diagnosis or even a joyful diagnosis – congratulations, you’re pregnant, or I’m sorry to inform you that you have cancer — your brain goes to a whole different place. Studies have observed time and time again that patients can’t easily recall information that was relayed during an appointment. So now in this new medium, how do you make sure they understand, acknowledge, and can continue learning and engaging post the video visit?

What expectations come with the big investments that are being made in healthcare companies that offer everything from primary care chains to employee wellness technologies?

It’s an interesting world and I’m really encouraged by it. You’re going to see a lot of starts and stops, and we’re going to get to new models because consumerism is creeping in. 

The excitement is around consumers and where we’re trying to meet people where they are. We are trying to segment the market. There isn’t one size fits all for an individual, what they need, and their health at a certain part of their life. If I am a younger employee trying to figure out basic care and navigation, things like needing to get a flu shot, that’s a very different patient persona than someone who has been given a new diagnosis, is dealing with a chronic condition, is aging, or needs to go in for a procedure. Care at that point in time becomes very local.

I love that these new models of care are springing up. Just like there’s not one department store we buy clothes in, and there’s not one TV channel that we consume information on, we are giving people opportunities to engage in mediums that might work for them, make it easier in their life, and get all of us to better outcomes. I’m encouraged by it. But I don’t think there’s one big magic bullet that will change healthcare as we know it. At the end of the day, complex care requires care coordination, testing, and all those diagnostic tools that hopefully will move over time into the home. But those towers will still be relevant in someone’s health journey over time.

How do you broaden the use of apps, wearables, or other technologies beyond the “worried well” to more effectively move the health cost needle?

We spend a lot of time thinking about care in the home — ambient sensing,  wearables, technology, and voice. Together with our parent Comcast, we’ve run a bunch of experiments, especially with the silver tsunami that is coming, the aging at home of a generation that I adore that wants to go out fighting. They do not want to go to assisted living facilities. They want to live exactly where they are and how they want to. We have done a lot of consumer research where those who are aging at home will sometimes buy some of these technologies to allow them to continue to live independently. The other thing that we see is that there are 54 million unpaid caregivers in the US, those unpaid caregivers are also managing their own lives, and 23% of them have worse health because of their caregiving responsibilities.

Finding technologies to support the care recipient and being mindful of the individual that wants that independence, but also wants that safety net, is a great segment where you will see consumerism come to life for aging and home solutions that are way better than the “I’ve fallen and I can’t get up” button. That’s where you are going to see some really fun innovation.

Some people dumb down hospital at home and remote monitoring to “can get a pulse ox into the chart?” That’s not the challenging part. It’s the figuring out what data to get, what ranges to allow, and how to make sure that when it comes into the clinical record that it’s clinically relevant. How do you start thinking through the lens of the clinicians at that point in time to say, what is useful in an encounter? What is useful for me to remote monitor? When do I actually look at thresholds, alerts, and alarms?

That remote patient monitoring world will continue to scale from simple wearables to ambient sensors. We have been playing with this concept of, can you make the bathmat a scale? Can you start using new technologies for those that are very chronically ill, that might have episodes that they might not be self-aware enough to tackle?

A new article just concluded that nurses spend twice as much time managing a patient who is seen virtually instead of in the office, mostly because they need to monitor a steady stream of data from wearables and patient-reported information instead of just looking everything over during a three-month office visit. Has the capability of sensors exceeded the ability of people or systems to monitor the data those sensors create?

It’s a workflow and insight challenge. When you start looking at data, data is data. Data is overwhelming. You can start gleaning insight from data through models, algorithms, and deep understanding, but you have to do so through the lens not just of the data and the individual generating it, but the individual who has to consume the data. We spend a lot of time on user experience and user design, and sitting with clinicians – which has been challenging during the pandemic – to observe their workflow, watch these things, and design the system around when it should alert, when it  should tell you, what’s overwhelming, what can be computer screened out, and what can be noise in the system. Then, what is actionable, and where does that action lie?

When we redesigned these versions, the process side of it, we try to throw tech at a lot of things. The process and understanding side is important. Then, there’s the financial component. Is the nurse doing some of those things because that is the right data digestion, or is it also because there is a documentation requirement to get reimbursed for remote patient monitoring? Thinking about that whole spectrum and making it a win-win for all three parties involved is key. The payer truly comes into this as well. It’s a new frontier that can only be better. When we start any new technology, it changes. When it moves the cheese, it changes the workflow, and so many times we don’t assess the workflow change and acknowledge it.

With all of the provider roles, who coordinates monitoring the patient’s data that is created by devices in the home?

The key for us is today, where we are. This is all a life cycle, and as we are progressing down our life cycle. We see convergence coming together for the individual. That’s our three- to five-year vision of how I, as an individual, get the different streams of health, care, benefits, and employee benefits all navigated for me in one pane of glass that I choose. We’re starting in the provider, payer, and employer world, with unique use cases. Learning and aggregating, and where we can collapse them, we do. If I am on a pregnancy journey that is navigating me — not just on benefits, short-term disability, talking to my manager about being pregnant, and thinking about childcare post delivery — and I am also on a pregnancy journey with my provider, those two worlds come together for me today on a pane of glass.

But each of those pieces is uniquely owned by the organization. The employee benefit side of it is going back to the employer. The clinical insight generator is going over to the provider. But the individual has one pane of glass to see the experience together. That is the nirvana as we think through data sharing, permissioning, and where all of that needs to go. And to your point, who is bearing risk on that? How do I make sure that the risk-bearing entity — because there’s many models of risk now — that you need to align around that model of who’s there in it with you, that everybody wants the best outcome? Then, who is incented for better outcomes?

Is it hard to sell an employer an app or service using metrics around employee adoption or satisfaction rather than cost savings that will deliver return on investment?

Is it difficult? No. Do you have to understand their world? Yes. All employers want the best outcomes for their employees. There are more forward-thinking ones in benefits and benefits aggregation that are thinking through better outcomes, getting people to higher-quality venues, because that’s a win-win for everybody. It’s not wasting time, and it’s keeping presenteeism. There are so many ways to measure success.

But to your point, the more progressive employers are looking for real, tangible outcomes. It’s not just about X percent engaged, X percent liked it. Clearly, there’s a point that you want a great employee experience. It has to be usable. Those are almost table stakes today. How, though, do you generate that longer-term ROI that justifies that? Who do you put in the middle of that? We have taken the approach where we are going to be focused on a digitally-forward health engagement platform, not coach-enabled. But others have taken the approach where we are coach enabled, and then through digital interaction, we can get you to a next action. We will see that evolve over time. Can we get more digitally forward so we can scale and improve outcomes across the continuum?

How can technology support unpaid caregivers of people aging at home?

I look at it pretty simply. It’s there for them and it’s there for you. For them, it’s technology that is easing the care recipient’s mind. For you, it’s also there for the caregiver. They are able to do task trade-offs with their family, coordinate things, be in one space, not have to time slice, and have one point of view on what’s going on with mom, dad, loved one, neighbor, etc. There’s also levels of caregiving. The fun thing is there for them, there for you. As the care recipient, there for me, I want to know who has access to my data, who I want to have permission to my data. 

We think a lot about the tier of caregiver you are. If you are the neighbor who might have a key to get somebody in if something happens to you, that’s a tier one relationship. If you’re navigating and supporting me for a geriatric hip fracture to home, or through hospice to home, you want that person to have access to everything. Making sure that the tool understands that it’s not one way. It’s not a caregiver tool, it’s the caregiver and the care recipient tool. I’ll leave it with there with there for them and there for you, because it’s multi-sided.