HIStalk Interviews Michael O’Neil, CEO, Get Well

Michael O’Neil, JD, MBA is founder and CEO of Get Well of Bethesda, MD.

Tell me about yourself and the company.

I started GetWellNetwork 22 years ago following a personal cancer experience while I was in school getting a JD/MBA degree at Georgetown. I started the company with a simple mission to make it better for the next person. I had spent way too much time going through surgeries, chemotherapy, and coming in and out of hospital beds and clinics. I thought that these amazing people who were delivering my clinical care needed some help in delivering the kind of patient and family experience that could enhance not only my attitude, but also my outcome. I started the company to help hospitals leverage technology to engage patients and families more effectively in their care, and in turn, help clinicians and improve outcomes.

The original concept was somewhat limited, focusing on in-room patient entertainment and education. How did you broaden the company’s reach to include everything from pre-acute to post-care and even remote monitoring?

I look at this as two acts to a play with an intermission in the middle. Act I was long, 15 years of trying to improve a two-day, four-day or 12-day hospital stay. We met a patient at admission and we said goodbye to them at discharge. We we were in many ways proud of transforming the hospital experience at the point of care for the patient, family, and nurse.

A bit before COVID – and COVID certainly accelerated this — we began to invest, both in organic R&D and in some acquisitions. We knew that the impact that we could have on both our customers and people and their health journey, which had become nine or 10 million people in a year. Their journey was not just that two, four or 12 days – it was a lifelong journey, a 30-day journey, a surgery, or what have you.

We had this intermission period where we doubled down on investing in R&D. We bought a couple of companies and that helped us accelerate to build Act II for the last 18 to 24 months. That involves enterprise engagement, navigation, and retention. We have a chance to help organizations wrap their digital arms around either members or patients at scale, but do it with intimacy that is required in healthcare. We are excited about today and what lies ahead.

Patient engagement seemed to align well with value-based care, which has had perhaps less impact than everybody expected on health systems, and now the imperative involves patient recruitment and retention. What are the primary motivators of health systems to improve patient engagement?

It’s actually straightforward , and there is a triple purpose on this. The industry is littered with tiny niche consumer engagement solutions. It doesn’t have many true platforms at scale. When we talk to health systems, payers, and managed care organizations, we are talking about what we would call Get Well Anywhere. The value proposition is threefold. They need to drive their business because these organizations have been through the grinder the last three years. If you can’t claim, stand behind, and share risk in the ability of your consumer engagement solutions to drive business, we don’t think you can do a lot of business in today’s health system world.

Number One is these AI-driven outreach tools that we have now, the ability to navigate people back into their primary care, to help them navigate into a mammogram or a care gap or something like that. It is driving direct revenue when it comes to fee-for-service organizations. But a lot of times, those same organizations also have value-based pockets. They have taken on full inpatient risk in a certain market.

The powerful thing is that the same platform, the same workflows, the same what we call Get Well Navigators — who have been trained to help people in vulnerable moments leverage technology and then pick them up when they can — these same things work to make sure that we are guiding patients to the appropriate and oftentimes lower-cost point of care, or doing self-care. The number one value prop and number one driver of people investing in this now is business, whether you are in fee-for-service or you’re in risk.

The second reason, and I don’t say this lightly, is that loyalty and patient love are more important than ever. We have an internal Slack channel at Get Well called Call Patient Love, and all day long our navigators are streaming comments from our thousands of patients every day who have interacted with one of our navigators, who interacted with a nurse, or who interacted with a physician who has touched them in a certain way. It matters. This kind of patient loyalty and patient love is the second piece. It’s a little softer in its ROI approach but it’s not unimportant.

The third thing is that workforce challenges are everywhere. This isn’t a temporary thing. This has been going on for a long time. How can you leverage the power of the patient and their family caregivers to help drive efficiency of your incredibly precious workforce?

That is our three-part value prop. I will tell you pretty bluntly that we are driving at Number One. We are going at a lot of risk for this. If you have 800,000 dormant patients, we know we can convert them back to activated. They need care, and that care will also drive revenue. Let’s share in the risk of that. Let’s make sure they get the care they need. That allows us to then make other investments alongside of our partners in things that they want to do.

Insurers are making significant inroads into becoming providers, while providers are sometimes taking on the role of payvider. How does this affect your business?

On the payvider side, a lot of our large complex health systems have partnered fairly meaningfully and financially with local, regional or national payers. In those partnerships where they are taking on risk, they of course are terrific partners for us. We are doing a lot of innovative stuff. You are managing 12,000 mothers on Medicaid and you are responsible for their full cost, so we are running a Mothers on Medicaid navigation program that was a feature at the White House last December. We think there’s a way to really help these incredibly important people in our communities have the very best care and have a healthy pregnancy. In that case, you have an aligned payer and provider delivering great care and the solutions match that way.

In a world where you have payers who are starting to invest in direct care as you alluded to, they also need tools. You know from using your employer’s portals and digital tools that nobody uses them. The trust relationship and the navigation is light. We are partnering more and more these days with some folks on the managed care side, because we now have 20 years of data on when people are in this vulnerable spot, what are the interactions? How frequently should we be interacting with them? How can we recruit and hire local navigators who are in market who understand the communities, understand the local vernacular? How do you build trust on behalf of a health system or a payer? Those managed care companies have struggled for a long time with that, and we think we can help. We have shown some data to be able to help that as well.

How did your business change with the pandemic?

In all transparency — as you have built your entire organization around directness and transparency, which those of us who get to read it love — it was challenging. The most challenging thing for us was we lost touch with the clients that we work with day in, day out, month in, month out, quarter in, quarter out. We work closely with chief nurses, chief experience officers, CIOs, and nurse directors on an ortho unit that is doing a certain pathway for post-knee replacement patients and how they are going to navigate through their discharge. This is work that we do all the time. We have a lot of clinicians in the company. That changed. We had to figure out how to support them without being able to be with them, and that’s a difficult challenge.

On the other side, it tested the dynamism of our solutions and platforms. We gave a solution called GetWell Loop. It’s a library of 300 digital care plans. I was at a fellowship in Colorado when COVID broke out. When I got home, w4e met as a team. Within three weeks, we had built five COVID loops. We deployed them over the next six weeks in 200 command centers across the US at no cost to our provider partners. We ended up touching and helping over a million patients stay safe at home, and helped ER beds free up so they would stay available for the sickest people. It challenged folks to support our clinicians in a way that we are typically supporting them.

Thirdly, ironically enough, it gave us a little bit of room to double down on R&D and transformation. We contracted with this amazing firm in the UK to design a completely new consumer-grade UX that we just launched late last year. We built a BYOD version of our inpatient solution that we are deploying now across lots of hospitals without capital investment. We acquired a business that does AI outreach and navigation, which has been amazing.

We doubled down on our government investment. We spent quite a bit of time and resources on getting FedRAMP approval for our cloud-based solutions in the government. We do a lot of work across 70 or so VA medical centers and now we are able to bring our loops and our navigation stuff into those communities for our vets. That is a source of pride and drive for the company as well.

The interest in AI tools such as ChatGPT has been unprecedented. How will AI technology be applied to patient engagement?

We have a front row seat. We were admittedly a little bit slow on the organic R&D in AI. We just didn’t have the bandwidth to get ahead of it. We acquired a company whose foundation is in AI and chat. One of the elegant things that we liked about this was that it has an ability to interject AI and live chat simultaneously. You are building real-time profiles of patients and how they are interacting with the content and our people.

As an example, we are working on a large project in California, where we had close to a million dormant patients. We were given a file from their EHR company. They had not been in to see a primary care physician in over 18 months because of the pandemic. We used our AI to reach out to them. To give you a sense of this, you’re talking about 2.6 million AI-driven, text-based bidirectional interactions coupled with 40,000 supplemental live interactions from our navigators.

The good news is that we are seeing the AI work and people respond to it. But we also would tell you that the realization in healthcare is to think that this stuff will be done exclusively without people. We believe that human interactions in your biggest state of vulnerability will require people to make sure they are monitoring, looking, and attaching in highly personal, delicate, and intimate ways in times of need. We have combined AI with a high-touch approach as well. We are seeing some great results that we are excited about.

How do the areas of patient engagement and patient-reported outcome measures overlap?

This is where things get fairly complicated among the EHR and its capabilities; a large CRM platform and its capabilities; and tools, solutions and platforms like ours.

We are seeing that a large health system will often default to the large enterprise EHR or CRM. We don’t fight against those platforms at Get Well. We spend as much time on programs as we do on platforms, meaning that these platforms are only as good as highly discreet programs that help an individual or a micro population of people navigate through their incredibly individual journey.

It sounds cliché, but you had better be able to integrate into core EHRs in a deep, API-driven, and oftentimes more so these days, FHIR kind of fashion and have SMART apps and things like that. You had better be able to pick up on a broader campaign from a CRM outreach. But in our world, you had better be able to put on top of those two platforms some individualized and personalized programs. Because if not, we are going to see engagement rates just like we saw the portal for 20 years. That’s not good enough. People need help.

How does the company’s history of acquisitions and funding activities change with the current business environment?

It’s been crazy. At HLTH, the buzz wasn’t just patient engagement and health equity, but also the cash burn of companies that have spent a lot of money on marketing knowing that their solutions are fairly niche and are not scaled. I don’t envy being in that kind of startup, early stage, cash-burning mode.

Get Well was not an overnight success. This stuff takes a long time to get  right and to get to scale. But we are fortunate. We have a lot of customers. We have positive cash flow. We are able to invest our own money in things that we actually want to pursue. We will be working this year on an important youth mental health project in Mississippi. We can take our own money, which we actually make, and invest in things that we think are projects of purpose.

The funding environment has changed dramatically, literally over 90 days, because there was a lag. The private markets stayed relatively hot until August and September and then they started to cool. That has been a significant change.

As a company that has been around for a while that has some scale, these are opportunities for us. We are thinking about our strategy. We are thinking about how we might accelerate our own R&D efforts with other companies that might be willing and excited about partnering with us to do something bigger together versus smaller on our respective owns. We spend a bunch of time talking to the ecosystem and staying connected. Honestly, I’m rooting for all of them. Everyone that is doing good work in patient engagement means that somebody on the patient end is impacted.

I hope they all succeed, but they won’t. It’s tougher because there are fewer buyers out there, as health systems consolidate and become fewer and fewer prospects. It is difficult not only that there are so many vendors, but so few customers. It’s a double whammy for the small niche players. Fewer customers, and those fewer customers have a hard time adopting, integrating, and implementing tiny projects that don’t have the security measures and integration depth that these multi-billion dollar, multi-state organizations expect. You have pressure on that side to work with larger, more stable, more comprehensive solutions. Secondly, there’s a big movement at the CIO level to consolidate suppliers.They can’t manage 14 different consumer-facing tools or whatever.

This is not to say that I don’t believe in innovation. Our industry always needs people who have identified a pain point and are going after it in a creative, innovative, new way. However, these entrepreneurs need to spend as much time honing their business models as they are honing their elegant solutions, because too often these amazing solutions can’t get scale on the revenue side, and there’s not a lot of forgiveness out in the market right now for that.

What will be important to the company in the next three or four years?

One is what I will call Get Well Anywhere. That is, finding our way into relationships where we become that third core solution. You have an EHR, you’ve got a CRM, and you have an engagement, navigation, and retention platform with the depth, the credibility, and the security to make sure that they can deal with these two behemoth solutions while also having the rare ability to deliver digital intimacy that those big platforms lack. We want to find our way into more of these Get Well Anywhere partnerships that are large, where we are sharing risk, and where we can drive business, patient love, and workforce efficiency at scale. We are excited about the progress there.

The second thing for us is that we will continue our work and we are doubling down in the government space. We have had such success in impacting US veterans. We are doing more work these days as well in active duty military clinics and facilities. We are excited about the impact that consumer engagement and navigators can do with the folks that we cherish. We have 30 or 40 veterans on our  cohesive, amazing, and focused team. We are doubling down on their success to make sure that we can impact veterans in active duty military moving forward.

The third thing is that we have primarily been dealing with health systems for 20 years. There are school systems, payers, and other organizations that have a vested interest in engaging constituencies in their health. We need to get outside our comfort zone and help populations do food as medicine, navigating to treatments, and doing self-care. These are the kinds of things that give us great purpose and that we are excited about.