Designing for Health: Interview with Brian Urban [Podcast]

Show Notes:

[00:00] Intros

[01:43] Brian’s background

[07:20] The mission of Best Buy Health

[12:38] The difference between providing care and enabling care

[14:47] Hospital at home

[22:05] Best Buy Health’s place in the healthcare ecosystem

[25:02} What’s new in remote patient monitoring

[30:28] Incorporating design into clinical workflows

[33:14] Design that brings Brian joy

[36:15] Outros

 

Transcript:

Dr. Craig Joseph: Brian Urban. Welcome to the pod. How are you today, sir?

Brian Urban: Oh, I am beyond the moon to be on Dr. Craig Joseph’s podcast, Nordic Global Consulting. I couldn't be more excited, I'm good.

Dr. Craig Joseph: Now you know we're not paying you. We discontinued the program that will repay you every time you say the name of the company. I just want to make sure that you know not to expect any money for that.

Brian Urban: All right, that's fine.

Dr. Craig Joseph: All right. Now, my understanding is your official title at Best Buy is BMOC for Population Health. Big man on campus. How does one get that title? How does one get a job working in healthcare at Best Buy? Let's start from birth. You were born into a family of retail giants interested in healthcare. Is that true? Or am I just making this up?

Brian Urban: In short, yes, but you're missing a lot of the good parts.

Dr. Craig Joseph: Keep me up to date, how does one get a job at Best Buy in healthcare?

Brian Urban: Well, I first got to show off this because you knew I was going to be donning the beautiful colors here of Best Buy on the chest and then also in the hand here as well.

Dr. Craig Joseph: I've got my Nordic logo here.

Brian Urban: I see the swag.

Dr. Craig Joseph: But you're required to wear that. I'm assuming if someone comes to your house, like you have to give tech support.

Brian Urban: Me not knowing tech support, I at least have to put on a show and then I coordinate to the next person.

Dr. Craig Joseph: Yeah, well, you're not required to do a good job of the tech support, but you are required to do the tech support. Your shirt looks good. What background do you have that has given you the ability to get this kind of a job? Where did one start?

Brian Urban: Yeah, you know, I'm a bit of an oddball. I am obscure, I think in most approaches that I take in my day-to-day life, let alone my little career. So, I'll give you the quick of it and to current time. My first job out of school was working for Cal Ripken Jr. and Bill Ripken in Aberdeen, Maryland. I worked for them for about a year. That was amazing. That was something I wanted to pursue, baseball as a part of a learning activity for youth and how I could grow my career. It didn't pay very well. Great people, great access to some legendary ballplayers. But I had to kind of move on into something where I thought I could really make a dent in society. And that's through entering the healthcare ecosystem. And I think, you know that obviously with your passion, for medicine and in your background and where you are now. So, I went into the health insurance side of our ecosystem. I worked for Highmark before it became Highmark Health. Spent a few years there on the Medicare Advantage side, back when there was private fee for service plants. So, it was a different time back then in a lot of ways, transitioned my career to Signal, I was there for about eight years. Got a couple master's degrees there, private Christian school locally, an MBA. And then I moved into Walgreen's in the specialty drug, rare and orphan disease side, where I really started to find my stride. I was studying the different data source vendors out there for how we could put together an analytic engine that would tell our payer partners and our pharmaceutical manufacturer, life science research partners, what are the social needs that are connected to health outcomes, and how can we bridge that gap? And, during this time, the global pandemic happened and it's amazing. It took a global pandemic to shift the way that humans look at each other. That's how ridiculous I think our global society is so short term, especially in healthcare. So aside from that comment, my work really led me to pursuing a master's in public health. So that led me to Dartmouth College. I was there for a few years. Hybrid program. I was there about 5 or 6 times on campus, and I was fortunate to bring my family and my son with me so he can experience that. School's not scary. It's hard work, but it’s a good thing that you can be a part of and maybe contribute to a bigger cause. And with my work there, I stood up the Data Humanity Lab, in which we were donating raw, and at the aggregate level, socioeconomic data, from Change healthcare at the time when I was within thrive. And that was really, I think the biggest light is, hey, I need to be as close as I can to individuals and make it an altruistic model that has a financial benefit for all the stakeholders. And it was tough for me to do that in the last few roles I was in. So, I saw this opportunity through some of the great strategic leaders at Best Buy Health. Diana Gelston, and our CEO, Deborah Di Sanzo. Just the way that they were taking technology and saying, hey, we're not going to provide care, but we're going to enable care to be able to make a real impact and the developing and developed communities across the US, and, globally as well, but starting in the US. And that just made so much sense for me and I was really attracted to that. I could just see the potential. So, my obscure background has led me to where we are today.

Dr. Craig Joseph: That's awesome. So, you really are leveraging your whole history and your scholarship, if you would, to focus you at this point. So, kind of give us an overview of Best Buy Health, right. Is that like a subdivision? Yeah. Okay. So just a division of Best Buy focused on health. So, what is it, that you do with respect to pop health? Where's that overlap?

Brian Urban: This is cool. This is where technology stops being nice, Craig, and it starts getting real, I think I took that from something.

Dr. Craig Joseph: That sounds like MTV, but I'll go with that.

Brian Urban: So, Best Buy is a huge enterprise, global presence. It’s had a really interesting history through its birth and its acquisition of the Geek Squad, over 20 years ago. And then skipping a lot of history there of Best Buy Health, in 2020. So, it's coming to about really four years of life and through a few series of acquisitions, we are now one Best Buy Health. And our technology is really the sweet spot of where we are. So, it's the remote patient monitoring and personal emergency response devices that's powered by our caring center that we have over 100 folks across five sites in the US that respond to medical emergencies, and non-clinical emergencies. A lot of non-COVID emergencies really social health, daily living challenges. And then our clinical command center, which is just the expertise of synthesizing data from remote patient monitoring devices, that goes on our dashboard that we then share out to our healthcare system partners. So, it's really enabling, the care systems in place regionally, in the community sense, nationally to be able to have the best impact they can for people aging in place that might be elderly, frail, managing a lot of conditions that are a forest that don't have close to kin or family nearby, and they need frequent touch. And I think this kind of idea that's really making an impact, and we're still quite young, but it's the idea that technology is going to not only provide capacity for a lot of models that need help today, like the PACE model, like clinicians going in homes, gerontology or just PCP. I mean, we're in a gap right now. I don't know how we're going to fill that gap human wise, but technology has to be adopted to be able to bridge a little bit of that and also make us all more healthcare utility players in the same sense. So that's my take from coming into Best Buy Health and that's how we exist today. There's just a ton of beautiful stories that we have right now with our existing customers and where we're going to be going in the future as well.

Dr. Craig Joseph: Well, what are some of those stories? I guess I'm a patient who is getting discharged from the hospital and someone mentions Best Buy to me. That's going to be a little bit shocking. Are they going to mention you by name or how does that work?

Brian Urban: This is a good example. So, when we think about chronic care management, we're not providing that care. But we are an accelerant to it through the technologies. I just mentioned transitional care. When we think about populations that are either having a joint procedure, whether it's acute injury or if it's a replacement and they're going home, they're absolutely a fall risk for a certain period of time. And if they're managing other conditions that require multiple medications or other complex treatments, you can think about respiratory, cardiovascular, metabolic. In particular, the diabetic population needing a consistent remote monitoring of their conditions, especially if they're on new medications when they're transitioning home. And a hospital or system like a PACE model might not have the ability to have a daily or weekly touchpoint with them. You have this technology that is very user friendly. The Geek Squad enables it, installs it, and services it for individuals. We had over 40,000 of these touchpoints just last year, and we're going to have continually more and more of those as we continue to scale our efforts logistically. So that's kind of an example of the transitional care when someone's going home, how do we marry a technology to their needs? And then we provide digital literacy, as well. So, we actually educate them on a continual basis of how to use it. And then we also bridge things like connectivity. So when you think about folks not being able to, my mother-in-law in particular, maybe she'll hear this podcast, maybe she won't, she has a lot of challenges using her general hardware, let alone understanding Wi-Fi, which is very new to her in rural Pennsylvania, even though it's been around for a long time for other parts of the developed, acute counties in Pennsylvania. So that and all the way up to social needs is something Geek Squad is starting to address. Some may go the threshold from doorstep to in-home, that's invaluable. And that's something I'm attracted to, of how we can really start to help people and not try to bid for trust as currency and healthcare, but actually already be a part of it.

Dr. Craig Joseph: So, you had mentioned that your CEO was very clear that we are not providing care or enabling care. Where does that line how sometimes it's a little unclear, right. So, if the monitoring device, let's just say it's a scale. I've got congestive heart failure and my weight's been going progressively up, which can be a sign that I'm in some sort of exacerbation. How does one decide, how do you get that information to the people that need to hear it? How do you know when it's something actionable or when it's not?

Brian Urban: Yeah, it varies by population and by partnership that we have in the healthcare setting. But in large part when we have data that's continually flowing from our RPM remote, our patient monitoring devices back to our dashboard that our clinical command center sees, they're trained not only from their clinical licensure and their experiences, but they're also trained into how to either alert as an urgent or send trend information to the appropriate healthcare providers or care managers on the healthcare system side, so they can take the appropriate action. So really in this scenario, we're the care orchestrator and we do it at the frequency and the immediacy based on the population and also based on the partnership that we have in place with the healthcare system. So, like Atrium Health, we've been with them at the very beginning. They're most skilled at in-home care programs, so it's very routine for them to be able to take us in and kind of guide us. So that was like a big deal for us and now that we've grown into healthcare, we've had so many different use cases that are in hospital. Also, the acute hospital at-home program, which I believe is going to be a staple, regardless of any administration coming in the presidency, it's just something that's proven the value to all stakeholders, especially with an aging population. So, like those types of models, we've been pulled into because of great partnerships like that.

Dr. Craig Joseph: Yeah, hospital at home. It sounds pretty simple until you actually start trying to do it. I've heard about, you know, electrical requirements for electricity and other things that seem like a big wire that needs to be connected. So, the more you think about hospital home the more complicated it gets. But to your point, a lot of us, I think everyone would rather be at home when they're healing. If you can do it and can get away with just having a nurse come once or twice a day. It's definitely something that we're going to need to continue to do and so that's a lot of what you would do as well. From a Best Buy perspective, it sounds like.

Brian Urban: Yeah, so looking at the landscape today of, acute hospital home program, it's across about 37 states, well over 300 healthcare systems and standalone hospitals. So, it's been well adopted. Not only is it new ways to engage patients and control utilization, or appropriate utilization, but it's made more sense economically to shift the alternative point of care to be at home. So, it's no longer a rural play. It's no longer a population. That is what you call a designated Snap. They're on Medicaid either for cognitive or physical challenges. It's for so many different use cases across so many different populations, really 40 and above and there's a lot of pediatric use cases as well that are growing out of children's hospitals. So, it's something that I see so much value in and I think in terms of the other side of the house, health plans see a lot of value as well because, I worked at Cigna for a long time. Not many people want to willingly engage with health insurance or straight up, that's it. It's not like they're bad guys or bad folks, but it's not of value or an entertainment factor that really pulls someone in to talk about their health or their needs with an insurance plan, because there's a trust barrier and it's always been there. But when you have an organization like Best Buy come in and they're doing work with the acute hospital at home program, and they're working with healthcare, it helps bridge the gap with engagement to health plans as well. And it's just, I think more health plan. The really effective leaders and the next generation folks are thinking about strategic partnerships in that way, and not just the vendors and thinking about who's a long-term partner that comes in and knows the community like we do. Let's see if they're a Blue Cross Blue Shield licensee, that can come into a home and do a great job and they're not, at risk, of any, really scary things happening to them. That's not a gig, a contracted economy that we work in, these are ten-year Geek squad. These are ten-year technical folks and tenured social health workers, too. So, it's quite a fascinating evolution that this acute hospital program at home has really changed the landscape in a lot of ways.

Dr. Craig Joseph: You mentioned trust that, you know, one of the benefits of having someone from the Geek Squad, pop in and help you set up whatever you need from a patient perspective. Hey, I've heard of Geek Squad and there's some trust there. There's been some struggle in other retailers of getting into healthcare. Are there, and I'd like you to name specific names, who has Best Buy or who do you think Best Buy has learned from some of the stumbles of, other large retailers across the United States and their attempts to become more, involved in healthcare?

Brian Urban: Yeah, I think it's valiant efforts. I speak to my Walgreens brethren and their investments, CVS as well, Walmart. They've all had really great, engagement rates and trust factor as I was mentioning before, like a currency and the way that you can continually build new relations and delight and surprise your customers. But going into healthcare is, you know, it's a different ballgame. And working with payers it’s like welcome to the jungle. Like this is very different. There's a different Department of Insurance every state. The way that you file a contract with providers, there's federal guidelines. And then this also changes every four years, sometimes in a big way, sometimes not. The big way is depending on the administration. So, there's a ton of complexity to think about in a short- and long-range plan from a retail perspective when you want to deliver care. So, the low hanging fruit, it seems like, hey, let's be preventative. And then the big cost savers, you want to work with populations that are taking very expensive medications or are dealing with rare disease or that have, multiple conditions or, been to a variety of other boxes that would make someone think that they're of a vulnerable, high need population. So, there's a lot of different perspectives there. But I think what we've taken a look at is saying, you know, we shouldn't be providing care. Ours is pretty straightforward, at least with Best Buy Health among other retailers that are thinking about getting into healthcare, and that's quite simple. It's to be able to have our technology be at the center of all things. And the mission itself is that we want to be able to enrich and save lives through technology and meaningful connections like that. Those words are very simple, and they're not so aspirational that we can't reach it. It's something that we're already doing on a daily basis, but we're not providing care. When you start to cross that threshold, you as a business become very vulnerable to the forces that are outside of your control, not only from a policy perspective, but if you're dealing with large private health plans, the way that they contract, reimbursements at a state level all the way up at a population level, very, very different. So, we learned that our technology and our logistic and fulfillment is our secret sauce and let's stick with that. I think we can make the back-end impact to what healthcare can follow through with and that makes sense to me. I know that we're not going to ever provide healthcare and that's a very strong statement from our CEO and from our chief medical officer. And it makes sense with where we are, so that's kind of how we’ve seen it personally. How I've seen it is partnerships have to be key, and populations are very important. When you can show that you're having an impact economically from a balance sheet with healthcare utilization and engagement and experience at an individual level, like that's where things start to really change. And you can find your rightful place in healthcare as a retailer. But until then, proceed with caution. That's what this told me.

Dr. Craig Joseph: That makes sense. When we were preparing for this conversation, you had mentioned that the word disruption is not high on your list of words you like to use, because it kind of sounds like that's a bad word for what Best Buy's trying to do. And others in terms of, hey, it is a big disruption and we're doing it from within it in terms of sending patients home to continue their hospital stay, but not in a hospital or avoiding the hospitalization altogether. And can we send them home from the emergency room as opposed to sending them upstairs? To a bed that may or may not exist? Certainly, sounds like disruption to me. What's a better word? Or how do we use that word to not cause the bad things to happen?

Brian Urban: Yeah, and this kind of goes maybe to my philosophy of being such an oddball is, I just I'm not a big fan of trends. Most trends, I think, we’re past the maturation point of being disrupted, like breaking stuff and working quick, like that's fine, but how many damn things are we going to break until we have to start from scratch and build something new? So, I think unifying the things that need to be functioning better makes more sense. If we just take a look at it practically, I don't think that we have a crisis in healthcare in the US. It's a current malfunctioning in operation system that is very advantageous to certain parties, mainly those that have heavy lobbying power in DC, that write mandates that can vertically integrate and keep people in a network and have them be able to be confined to how they access healthcare and spend their dollars and engage in healthcare. That's just the way it's gone in the US. It's the capital system. It's not horrible, but it's created these huge gaps in our society of who can access care, who can afford it and right now, we need to start to unify things instead of constantly breaking things until they're out the little, teeny bits. Then we have to build things back together. So, I think we can be a little bit more practical and work through the existing model in the US of healthcare and how things are paid for and how services are rendered, and just start to fix things together by stitching stuff, I think technology is a big stitch that can go in and unify things, especially from a hardware, software, underwear perspective, that being the people force. So, it's like more of a time that we need to unify stuff than constantly battling Big Brother and trying to break things.

Dr. Craig Joseph: Well, you mentioned technology and you mentioned hardware, software and underwear and that brings me to my next question of, well, what is new in remote patient monitoring. So, I gave one example of a scale, and there's a blood pressure cuff that automatically uploads some numbers. You mentioned underwear, is that just a poem, a poetic moment there or…

Brian Urban: That was just a fun phrase that I took that has nothing to do with it.

Dr. Craig Joseph: Is there going to be Best Buy underwear that is connected to the internet?

Brian Urban: I don't see it happening, but yeah, happy to be a guinea pig. But no.

Dr. Craig Joseph: I might buy that. Well, what are these new things? What are you guys installing in people's houses besides blood pressure cuffs and scales? Because I think I can handle that.

Brian Urban: Yeah, I think you could, too. It's simple stuff that exists today. Glucometer is blood pressure cuffs. If you're familiar with the aura ring, heart rate, sleep, all these devices almost do the same things as each other. Except some are quite nicer than others, and one device might be able to track sleep better. And then one might be able to also track sleep but try to track heart rate better. So, there's different things that almost overlap in this technology. The Venn diagram that we're seeing in this continual evolution of advancement, device-wise and I think the power of scale speed and I are only going to add to that. But the newer things that I see happening is the way that our model is being put together, like puzzle pieces that can suit. We're not going to be for everybody. And I think, quite frankly, it kind of makes sense to be for everybody. But that's bias. But I think there's a lot of health plans in particular that whether they've been at four and a half stars or they're at three due to recent changes that they might be struggling through or wanting to take action on. But there's a clear sign that the landscape is going to change over the continued administration, and then the following one in the following one and to be able to be prepared, let's not just simply take legal action. Let's not just simply continue to acquire the companies. Let's find long range partnerships from a technology side that you can feed insights into that you can co-develop things. So, I couldn't tell you about our roadmap in terms of devices, but things are going to be more sophisticated and stitched together to help address, for me the underlying human condition and the social health needs that are directly connected to urgent or chronic healthcare needs for an individual, let alone a population in developed and developing communities in the US. So, I think that's a large part of how our model is going to be more next generation is how we're using our logistics fulfillment device and people force as this really cool combination to fill a lot of cracks that I see out there that inherently a lot of health leaders have on their plates. They're trying to figure out how to work with.

Dr. Craig Joseph: Yeah, it's kind of magical. Some of the things that are happening and I'm not sure if it's remote monitoring, but, you know, thinking of, hey, did grandma open the refrigerator in the last 24 hours? Because if not, there's a problem. Or did someone, who's struggling with depression leave the house? We can know that maybe by whether the door is opened or whether the phone, which is usually with us, has left the house. So those kinds of things I see, and the good news is that's a lot of data that we can use to determine if people are in trouble and if so, how bad. The bad news is, it's a lot of data, and to your point, like you need an artificial intelligence or something, akin to that to be able to kind of look for things that are out of the norm and then kind of tell the appropriate person to who can reach out and figure out if it's a real problem and how to address it.

Brian Urban: Yeah. I think to maybe where you're going, no matter what, we're always going to have to have, very skilled, licensed healthcare professionals in between a device, the data that's coming from it, and then to the next party or platform that it might be going to, because you still need a real person to be able to synthesize. Is this an emergency? Is this a trend in this person's biometrics that's saying, you know what, they're at risk for a stroke. We need to get ahead of this, need to adjust medications. They need to see one of their specialists immediately. So, I think that's also part of the secret sauce that I've always seen and Best Buy Health, aside from being able to go in home and help people from what's always a confusing, like technical perspective with, you know, Wi-Fi or, devices or how they, in home can start to use different things to communicate with their family abroad. That's always made sense. But I think the human part of its always going to exist, no matter how many holograms we might have out there, that might pop through devices in the future and how smart a smart home might be. People are still going to be needed to be in between some of that info flow.

Dr. Craig Joseph: So, Brian, we like to talk about design at a high level here. How do you incorporate some of the basic principles of design and in the work that you've done in the past or that you're doing now with Best Buy?

Brian Urban: Yeah, this is a great question. I think at the center of how our philosophy is evolving toward new partnerships. So, in the past, a lot of my work has been direct to working business to business. But strategic partnerships and alliance is, especially when you're working with a population that overlaps the type of care or technology that you provide makes a ton of sense. And I think when we look at Best Buy Health and the trajectory we have, not only with our people for X, Y, but also our device and the engagement rate that we have. I think the next obvious place for me, when you think about population health, is kind of the new iteration of a third peak of population health that's grown out of academic medical centers and clinical practice and research data, SDH policy. And then now really, technology is kind of the next obvious peak for pop health and thinking about that from a design perspective, it's how are we engaging populations with high need that are aging in place, that have a lot of clinical challenges or need continual monitoring from clinicians or from social workers? That can be done in part through technology. In that, there's the center, I think, of the next iteration of pop health, so it doesn't stay stagnant. Where it's been in academia and in clinical research and really in the medical setting, which is fine, but it needs to grow and evolve, just like all things have in medicine and technology and now having this as a third iteration, at least for my design focus of how we're approaching some of the different things that we can puzzle fit to help a population, whether it's managed care through a health plan, through a healthcare system, an IDM right there as well, or even out into life sciences, how clinical trials are being monitored and how drugs are being developed. There's a world that's just beginning to open up for what I think from a design perspective, pop health needs to be at the center at with technology.

Dr. Craig Joseph: That's great. Well, this has been a super interesting conversation. I love the Best Buy shirt.

Brian Urban: I didn't have the collar popped. I should have had this popped the whole time. It's too late now.

Dr. Craig Joseph: We will go back in, and we'll use an AI to make it look like your collar was popped.

Brian Urban: Fix my crooked nose too if you got the chance.

Dr. Craig Joseph: Also, we will make you taller. We like to end all of our interviews with a question about design and anything in your life that's so well-designed that it brings you joy whenever you interact with it. So, are there 1 or 2 things along those lines?

Brian Urban: 1 or 2 things. You don't know this. I don't think you know, I'm not sure of anyone you've interviewed, it has gone in this direction, but I have a lot of chickens, a lot of ducks as well and we have a little what we call community farm and it’s where -

Dr. Craig Joseph: You live in Manhattan.

Brian Urban: I could not live in Manhattan. There's no way.

Dr. Craig Joseph: Okay. You know. Okay.

Brian Urban: Yeah. No, I don't think I could survive in a city, I need dirt. I need a lot of dirt and snow. I don't think Manhattan gets that.

Dr. Craig Joseph: Well, all right, so I took you off. So, chickens and -

Brian Urban: Yeah, so my son and I, my daughter's quite young, but my son and I, he's a professional chicken wrangler, I'll call him that. He and I take care of the birds almost on a daily basis because you upkeep it, and this is a nonprofit. It just started out as a fun thing. I don't think any of your guests have maybe gone this far, but I'm thankful to say I'm seven years deep in sobriety and engaging with domesticated farm animals has been a large part of helping my little brain. A lot of my continued academic work, my family life, through my work life, and through just living a clean life. I think the fun part about having this little project going and now we get about 30 or 40 eggs a day, so we donate those eggs, 100%, to a campus that serves women, children, veterans and homeless, next to the county jail that's in our county. So, we go down there, drive about a half hour every Friday and donate eggs, and it's feeding over 100 families a month, and they don't get fresh food. And now my son can see that. So, you know, whatever he chooses to do in life, you know, lawyer, doctor, business executive, whatever. That's getting in the dirt and being with animals and seeing the downstream impact of how little farming can help other people and you don't put a cost to it, that's for me. That's where I get joy. I love it. So, you know, if anyone has a little bit of land and they can get chickens, do it. I highly advise it. It's a good thing when an animal looks you in the eye and they just, you know, they care about you, and they need you. So that brings me a ton of joy.

Dr. Craig Joseph: That's awesome. That's a that's intentional design right there.

Brian Urban: Yeah. Yeah.

Dr. Craig Joseph: For real. So awesome. Well, thank you Brian. That was great. I really enjoyed our conversation, and I want to thank you again for your time.

Brian Urban: Thank you. This has been an honor to be on the list that you've interviewed.

Dr. Craig Joseph: You're on it. You're on it now. You're on it.

Brian Urban: I’ve got to get you an official shirt. It's coming in the mail.

Dr. Craig Joseph: All right, and we will make sure not to post this episode until the shirt comes in. So, dear listener, if you're hearing Brian's voice, you know that I have received my Best Buy shirt, and I might be doing some freelancing as well. I'm not very handy, but I try.

Brian Urban: There's always room for another Chief Medical Officer.

Dr. Craig Joseph: On that note, thank you again, Brian.

Brian Urban: Thank you, Dr. Joseph. This was awesome.