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Dr. Neel Shah, Chief Medical Officer of Maven Clinic, deconstructs what it means to be a CMO and gives an inside look into his roles and responsibilities regarding reproducibility with clinical outcomes.
Listen in as Dr. Shah discusses:
The indoor vs outdoor cat methodologies of CMO (90% are outdoor cats)
Why resolving Medicaid constraints means putting your fees at risk for clinical outcomes
His system for qualifying providers (And how he gets product and protocol feedback from them)
Some examples of what he believes to be disinformation within the fertility space
The overlap between business and clinical operations (and where the CMO role converges and diverges with the CEO and Medical Director)
Maven Clinic:
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Dr. Neel Shah
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Transcript
Dr. Neel Shah 00:00
The way that I look at the Chief Medical Officer job is that there's basically two kinds of chief medical officers. There's outdoor cats and indoor cats. The outdoor cats like sales for thought leadership, and the indoor cats are like product and operations.
Sponsor 00:14
This episode was brought to you by Embie. To see where your time is going, visit embieclinic.com/report. That's embieclinic.com/report. Today's advertiser helped make the production and delivery of this episode possible for free to you. But the themes expressed by the guests do not necessarily reflect the views of inside reproductive health, nor of the advertiser, the advertiser does not have editorial control over the content of this episode. And the guests appearance is not an endorsement of the advertiser.
Griffin Jones 00:54
Are you an indoor cat or an outdoor cat? That's not a phrase I was expecting to talk about in this interview. But it was a fun metaphor that I took from my guest, Dr. Neel Shah, Dr. Shah is the Chief Medical Officer of Maven clinic. According to this CrunchBase profile that I'm looking at right now that may or may not be accurate, they've raised over $290 million in funding. They're a digital health platform that works with health plans and employers to offer virtual services for women's and family health. So they're also in that employer coverage game, but I spend my time talking today with Dr. Shah about how the role is constructed. Dr. Shah says there are two kinds of Chief Medical Officer outdoor cats who are more figureheads of sales and thought leadership in indoor cats who form products and operations, etc. He thinks 90% of CMOs are outdoor cats, where he was charged with reproducibility of medical outcomes. Dr. Shah talks about the economic constraints of Medicaid and how resolving those constraints means putting your fees at risk for clinical outcomes. So I asked him, what was his original mandate? What were some of the first things that he worked on to create reproducibility for those clinical outcomes. He talks about what he did to reduce the need for C sections. Dr. Shah shares which positions are his direct reports, he talks about where the chief medical officer and the Medical Director roles converge and diverge, where the CEO and ce o roles converge and diverge with that. And the chief medical officer, if you listen to this show, you know that I'm not convinced that there's a complete separation between clinical and business operations. I simply don't believe that there is I don't want to speak for him. But Dr. Shah seems to agree with me that there's a great overlapping area of the Venn diagram. And he talks about what that is specifically, he talks about his system for qualifying providers in getting product and protocol feedback back from them. And he gives a couple of examples of what he views as disinformation in the fertility space that I hadn't heard about yet, so I'm gonna go look them up. While I do that you enjoy this conversation with Dr. Neel Shah, Dr. Shah. Neel, welcome to the Inside reproductive health podcast.
Dr. Neel Shah 02:50
Thank you, Griffin. Thanks for having me.
Griffin Jones 02:51
I want to have you on because you're the chief medical officer of a very large organization. We have chief medical officers of varying size organizations listening, but I imagine we also have some folks that see that in their career path. And I've never spent an episode breaking down structurally what that looks like. I want to go through that with you today, what the duties look like what the corresponding roles look like. But perhaps we'll just start with Maven clinic as a large organization. I've read headlines where you've all raised a lot of money and you're growing fast. And how did you become the Chief Medical Officer for Maven clinic.
Dr. Neel Shah 03:35
It was a combination of the midlife crisis and Pandemic onwy. I think I spent the last decade most of it as a professor of obstetrics gynecology and reproductive biology at Harvard Medical School. And so actually, fertility was relatively far flung from my primary interest other than the fact that I did women's health, but I was one of the people who helped uncover the maternal mortality crisis in the United States and some of the underlying racial inequities and had been following Maven for pretty much the whole time since Kate Ryder founded the company back in 2014. And we Kate Knight, who's the founder and CEO had corresponded, you know, as a professor, you get to have hot, hot takes and just sort of pontificate. So she emailed me, I'd email her back. And then, honestly, I remember being pretty skeptical, not of Kate, or Maven, but just as digital health as a whole. I mean, there's a lot of hype in digital health, you also can't deliver a baby through a screen or do an egg retrieval through screen. So it's just kind of confused, you know, obstetricians are pretty tactile. But then in 2018, Mavin, started to increasingly convert from being a direct to consumer business to being a b2b employer benefit. In fact, there's a really good Harvard Business School case study. We're almost a canonical example now of how to do that conversion. And I remember when Maven signed up Bank of America as an enterprise client, and I was like Bank of America knows what they're doing. They've actuaries so it's probably valuable to them. Sorry to pay much more attention. Ultimately, I joined the Scientific Advisory Board of Maven. It was actually the first for profit board I joined. Because as an academic, you try to be pure, you know, and neutral and objective not have any, you know, profit driven interests. But this was a company that was doing really innovative things. So that's where I started. And then when Kate was looking for Chief Medical Officer, my plan was to help her go find one. And I was like, Hey, what is the Chief Medical Officer kind of like you're asking me now. And it turns out, there's many kinds Griffin, if you've met one chief medical officer, you've only met one chief medical officer, they're all different. So we converged on what the roll would mean for Maven. And then the more we talked about it, the more I felt like that's something that I wanted to do. So I was like, Hey, how about me? And here we are,
Griffin Jones 05:44
I want to talk about how that role converge. I do want to dig in a little bit more to your skepticism of digital health, because this is one means of you vetting, not just the company that you ended up going to work for. But the whole space that you ended up going into what were you skeptical about? Specifically? What are you no longer skeptical about? Either because you your skepticisms? were unfounded in that regard or something changed? And what skepticisms Do you still hold on to?
Dr. Neel Shah 06:14
That's a great set of questions. I'm skeptical that there's such thing as a pop up fertility clinic, that's any good, I'm still skeptical of that. I don't think that you can create a fertility clinic overnight. I think that there's a lot that needs to go into ensuring quality for people who are building their families. But I guess that relates to how I thought about the transition. My mentor is Atul Gawande, who is a New Yorker staff writer and a surgeon and innovator. And he had famously left his academic role just like I did to join Haven, which was the JP Morgan Chase, Berkshire Hathaway, Amazon, health care startup that lived for a couple of years, and then didn't, but he gave me a lot of really, really good advice about that. His own skepticism and what led him to do it. And what he told me to do was to be intentional about, you know, the hardest thing for me and joining a startup, honestly, was not the leap of faith on the company, at the end of the day, it was myself of identity, because it's an academic, your job is to be an honest broker of information. And you know, now when the CDC wants comment on, you know, new numbers that come out, I'm not the person they go to, because, you know, I'm at a startup, I'm no longer an academic. But what he told me was to be intentional about what I leave behind in the academic world, what I bring with me, and what I newly adopt and kind of make room for, and what I left behind was my objectivity when it comes to, you know, profit. But what I brought with me was my commitment to scientific evidence, I think that digital health has as much potential to improve people's well being as drugs and devices, but it's not regulated by the FDA. So there isn't the same standard of rigor to proving that things actually work. But when I came to me, but actually brought my whole Harvard research team with me, and that was a big part of how we formulated the role to
Griffin Jones 08:06
Let's talk about formulating the role. Did it start off as Kate asking you to help find the person in the same way that when people are like, do you know anybody that would babysit my kids this weekend? Like, well, you, they're just politely asking if they'll do the babysitting was? How much of that was at play?
Dr. Neel Shah 08:26
Yeah, that's a good question. I don't I think it was genuine, can you help me find someone because I mean, I've been pretty fixed in place, like, you know, like a decade into being a professor. It's pretty cushy, you know. And I think that was actually part of my own personal motivation, as I was a little bit too comfortable at a time where Honestly, I'd been kind of radicalized against the status quo. I mean, the pandemic for me, in 2020, there was a moment it's rare in life, that you have a cinematic moment that totally changes your worldview, but I was afford deployed physician, and there are pregnant people that were calling me. And there were no beds in the hospital. And if you weren't sick enough, I couldn't make room for you. And I've profoundly remember there was a woman who called me who had shortness of breath, she was pregnant, she was frightened. And I told her, she wasn't sick enough to come into the hospital yet, and she should stay at home and self isolate. And she was like, I can't because I live with my young children and with my parents. And it was very clear to me in that moment, that health is not produced in the four walls of my hospital. It's produced in people's homes and their communities and the workplaces. So, you know, I was already kind of thinking in that direction. But I think when Kate asked me, you know, she honestly just wanted to know who is out there that would be credible. And we really did have a conversation about what the role was that evolved. But, you know, the way that I look at the Chief Medical Officer job is that there's basically two kinds of chief medical officers. There's outdoor cats and indoor cats. The outdoor cats like sales for a thought leadership, and the indoor cats are like, product and operations and I came to the company with a public profile. And so I expected to be involved in our growth. But I didn't want to be the spirit animal Maven clinic, I wanted to make sure that I had a role in building the things that we were going to do, so that I could represent them and really believe in them.
Griffin Jones 10:14
So the indoor cats our product, and operations in the outdoor cats are What did you say sales and business development?
Dr. Neel Shah 10:20
Yeah, the some BD, but usually just like thought leadership, you know, that kind of thing. Which, like, that's, that's important, too. But I would say like 90% of CMOs are more outdoor cats, and about 10% of them are focused internally on building the things that they're trying to sell. And, you know, it's not necessarily a criticism, I think that, you know, it's very clear with a CEO as some of the CFOs, I think, chief medical officers have space to design roles that makes sense for their company and their phase of business. But we were in a phase of our growth, where it made sense for me to have the remit that I have today, which is, you know, I'm responsible for designing our care model for delivering it and for proving that it works, which, for me, was sort of the ideal job. And I think that combined with the opportunity, you know, the the momentum of the company, but also just a window of opportunity in what I see as a movement, to try and improve the well being of people who are trying to build their families in America at this time. Like, I couldn't say no to that.
Griffin Jones 11:23
How much did Kate have in mind really specifically detailed before you started contributing to what the role would become? What did she come to you with it with what she viewed she needed at that time? Specifically,
Dr. Neel Shah 11:39
I think this is almost emblematic of our working relationship to the present, I think, you know, she can't always has a point of view, and a high level vision. And then, you know, and brings the perspective of both the business leader and a woman who's had multiple pregnancies while building Maven out. And I bring, you know, I'm the nerdy Doctor alongside that. So like, I was like, Okay, well, you know, we're a technology company, and a healthcare company. And those two things are sometimes intention, you know, and I had a point of view on that. And we sort of worked through like, for example, you know, the canonical product leader, their source of truth is always the end user. And if healthcare had more of that, it would be a lot better. Also, very few folks in the technology business have ever heard of the evidence base that we're discussing at the future IVF clinic, you know, like they're at BDM, epidemiology and product management are like worlds apart. And so oftentimes the job of the chief medical officers together the two together,
Griffin Jones 12:42
So talk to me about how you started to actually delineate the role and what it would become what did that process look like? Was it you starting to think of certain areas that you might be responsible for? Was it specific duties? How did you start to map it out?
Dr. Neel Shah 13:00
Well, honestly, the commercial impetus was that Mavin was increasingly successful as an employer benefit. At that time, we had just started to contract and develop formal relationships with a lot of the national health plans. And we were seeing a growth opportunity into Medicaid and fully insured. So I wrote a whole textbook on value based care, actually, and didn't understand until I came to Maven, how a health plan has multiple product lines, they have a product line that is kind of like their cash cow, where they're just doing administrative services for self insured employers. And this may be obvious to a lot of your listeners, but I didn't realize that, you know, they think about that business really differently than their fully insured business and their Medicaid business where they're taking a lot of risk. And so, you know, the willingness to pay of a Medicaid plan is lower than a fortune 50 company. And the only way to make the unit economics work is to put your fees at risk for clinical outcomes. And, you know, you're not really putting your fees at risk if your outcomes are reproducible, but the only way to do that is to have scientific rigor, the purpose of science is reproducibility. So I didn't come in as a business operator, but I understood science really well. And that was the focus of my role. It's like how do we do that? You know, how do we build the almost like Toyota precision reliability into our care model so that we can actually go and put our fees at risk substantially for both fertility and maternity
Griffin Jones 14:36
You brought your team with you to do that. Did you start working on this process and bring your team over little by little was this was you bringing your team contingent upon you taking the role? How did that work?
Dr. Neel Shah 14:49
No, I mean, yeah, it was more little by little, I mean, I made the jump first and with a lot of humility about how to build inside of a hypergrowth FISI Baxter Now, you know, the way I think about it in the public sector, there's sort of this classic project management triangle where you have time, scope and budget. And if somebody gives you two of those things that sort of fixes the third, you know, and in the public sector, I just squeezed resources out of stones, but you have a minute to solve a generational problem. You know, in this world, you have access to liquidity, you have, you know, revenue streams, but you've got to turn it into shareholder value in like two seconds, you know, and so there are different constraints. And so I came in with a lot of humility about how one does that well, and the team in place was masterful at moving fast. In fact, it's a company value. But yeah, there were opportunities to bring in more clinical expertise around me. And so yeah, it was bit by bit. And also, you know, when you're moving from, I think we three or 4x in size, so you just got to hire quickly. So you hire people that you know, are great, you know,
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Griffin Jones 17:08
In order to be able to have a model that works you have to be put your fees at risk for clinical outcomes. In order to do that you have to have reproducibility. What was your mandate? In the beginning? What was the first thing or set of things that you were to work on that needed to become reproducible?
Dr. Neel Shah 17:28
That's a great question. So my initial attention was on people who are already pregnant. And it's it's since shifted, not shifted, but it's been balanced out with people who are not yet pregnant, where you know, honestly, Griffin, fertility is like the total Wild West. So we should get into, you know how we're starting to think about being honest brokers, they're in a sea of disinformation. But on the maternity side, that was where I had my real depth of expertise. And it was trying to consistently help populations, decrease the section rates, decrease the number of babies going to the NICU, improve mental health outcomes, and avoid emergency department use. And we built a whole ROI model around that. And then we built a number of programs to address specific conditions that people have. So you know, Maven isn't a condition based company were really a phase of life based company. And the chassis of the product that was already in place was we're very good at engaging people digitally, who, you know, they're not in a waiting room that can put their phone down at any moment. So you've got to be you earn the opportunity to make people healthy, if you can engage them all that already existed. And we were really good at sort of learning about the context of people's lives. So my job was just like, Okay, once you can engage them digitally, and you can connect them to a provider within 30 minutes anytime a day. How do you wrap that around a person to demonstrably make them healthier? That was the job?
Griffin Jones 18:54
What did you do to either reduce NICU time or to reduce C sections? What were some of the measures that came from that?
Dr. Neel Shah 19:02
Yeah, I mean, this was like, What made this a greatest job ever, right? It was like, Okay, I've got this awesome capability. And what do you do? So for example, how does an app decreased NICU utilization? answer is, it can't like an app isn't what's going to fix health care, what we did is we turned the device in people's hands into a portal that connected them with a human service on demand. So for example, if you're a Medicaid recipient in the Delta region of Arkansas, and you have gestational diabetes, you probably don't have a nutritionist anywhere close by. And you certainly don't have one on demand. But the difference between good glycemic control and bad glycemic control is having someone who can look through your phone at your refrigerator and help you plan a meal in real time. Because changing your diet is very hard. But, you know, if you're not able to do it, you might be induced in labor at 34 weeks, and that's months in the NICU, if you do it, well, you can get all the way to term. So it's like one example. It also turns out, you know, only 5% of Americans who are priding come to see a mental health provider, you know, it's very supply constrained. And there's all kinds, there's all kinds of reasons to slip stigma. Whereas depending on the population, 30 to 40%, of our total membership, say that we help them manage depression or anxiety. And that's just about like, showing up for people at the right time in the right way, and then connecting them in a timely way to the right service.
Griffin Jones 20:31
And then how do you make these into protocols? So is that the role of a chief medical officer as well? So your job is to discover the reproducibility to see what interventions are working, then how do you build that into protocols that the rest of the organization executes?
Dr. Neel Shah 20:49
Yeah, that's a really good question, too. I mean, so the way that my org works, I have an innovation team, that's sort of like a clinical product team, we work alongside product to design these care models, we have a provider group, and that team's job is to scale the care and deliver it and then to qualify the providers to write the protocols to QA it to make sure that people are providing the care that we expect them to. And then there's a team that measures the outcomes. But I mean, yeah, I mean, honestly, when I first joined, Mavin was growing so quickly, there were 1000s of providers across 30 different specialties. So a big part of my job was to make sure we're qualifying people credentialing them in the right way. And then because our care model was also rapidly evolving, making sure that we were training and engaging them in the right way to
Griffin Jones 21:39
What roles are your direct reports.
Dr. Neel Shah 21:43
So we're startup, which is sort of like being in a garage band, sometimes you learn how to play all the different instruments. So right now, it's I've got a Vice President of Clinical innovation who oversees a clinical product team, I have a senior medical director who has the whole provider group. And we have a large as I mentioned, provider group, including people who are fully employed for mental health, obstetrics, pediatrics, and other highly, highly utilize specialties. So it's a big team. And then we have our clinical outcomes team, which is both the academic research team that I brought over from Harvard, and an economics team, it does all the actuarial calculations for a health plan.
Griffin Jones 22:18
So that's probably going to be a lot larger than many, or at least in different areas. I don't expect a lot of chief medical officers having an economics team, but maybe some will. And maybe that's the future of of that more will, that you said earlier, you may have talked about something that many of my audience already know, I don't know if they'll know that or not, they might know the next question that I'm going to ask you. But I want to ask it anyway. Because I don't know, where does the role of Medical Director and Chief Medical Officer converge and diverge as a suspect, it'll be something like you said before, if you've met one chief medical officer, you've met one chief medical officer, and I suspect that that relationship is unique to every to every role as well. But in your view, where where do those two roles converge and diverge?
Dr. Neel Shah 23:05
That's a really good question. Because, you know, I've hired a couple of medical directors along the way. And I think that there's actually more of a clear delineation, and even consistency in these roles, what I've observed, I'll tell you what I've observed, and then I'll tell you what we're doing at Maven, because you know, I did a lot of benchmarking. And it's, it's hard to hire medical directors, you want to find somebody who is grounded in scientific evidence, but also not totally dogmatic, such that they can think progressively about the difference between the alternative which is a brick and mortar healthcare system, such that it is and what the future might look like. But I would say what I observed in out there is a lot of medical directors are not full time. And there's advantages and disadvantages to that. I think, actually, there's advantages to practicing in the brick and mortar world. And, you know, I still see patients not very often for two half days a month in my clinic in Boston, and it keeps me grounded and honest. You know, like, if what we're building at Maven can't work for the people in front of me that I'm eyeball to eyeball with. That's sort of my litmus test for developing a good product. So I actually encourage medical directors to spend some amount of time I think a lot of them are pure outdoor cats. And we have a mix of both at Maven, we have people to help on our commercial team. And we have people who are just embedded with our product team, particularly on the fertility side where there's a lot of building to do. I think one of the differences though, in my opinion, is that the CMO should really be, you know, an executive, somebody who can help run the company and drive it forward. And typically, I think for a startup, it would make sense to have a CMO at the point where you're, like in that hyper growth phase of the business.
Griffin Jones 24:57
Want to Talk about what driving it forward looks like. But in this case of a medical directors, is there a distinction between medical directors that maybe work for a company, whether it's a new tech platform versus working for like a group of clinics? Because if it's a group of clinics, I don't think the medical directors are typically part time. And I think they usually are also seeing patients. So is there a distinction in what type of company it is?
Dr. Neel Shah 25:24
I think that there might be Yeah, I mean, typically, management of physicians or clinicians is a little bit different from managing, like other kinds of business operators. You know, I mean, clinicians should have KPIs, but they generally have not heard of them. You know, and, really, in any setting, clinicians, generally speaking, are a little bit more self sufficient. They need performance management, they need accountability. But it's, it's just different, because part of the value of having a physician in particular is that they are able to use their discretion within certain boundaries. So I think there are differences, I mean, in let's say, a big IVF clinic network, probably the medical director would be responsible for like a region, right, and then their primary role is to ensure quality. Because there's not necessarily a product to be developed, right or there, there, there may not be there's a very clear revenue model, so not doing a lot of BD, or they're not doing a lot of commercial work.
Griffin Jones 26:29
Should the KPIs be coming from the medical director? Or should they be coming from the chief medical officer? If it's both, then where does the distinction lie between which KPIs should be coming from where?
Dr. Neel Shah 26:43
I mean, I think it depends on the company, the organization, the face of business, but I would imagine that it's the executive team that setting the objectives for the business. Right, and usually KPIs for a forward deployed clinician should be a combination of clinical quality related KPIs and, you know, efficiency KPIs, for example, or even just service level KPIs. Right, like we expect our clinicians to be responsive, show up on time finish, you know, things like that, like, you've got to monitor all that you can't assume it. But typically speaking, it'd be the job of the medical director to execute on those to enforce them to make sure they're actually happening.
Griffin Jones 27:24
Whereas it's the job of the chief medical officer to be an executive and drive the organization forward. So where does the CMOS role converge in diverge with that of the CEO or the CEO? Oh, if if the CMO was supposed to drive the organization forward, but that's really the that as a globally, that's the CEOs job, and then CEO is executing in a lot of different levels. So how does this the Chief Marketing Officers role in driving the organization forward look, and then how does that converge and diverge with other executive roles?
Dr. Neel Shah 28:02
Well, you said chief marketing officer,
Griffin Jones 28:05
Which is I'm sorry, I know, I misspoke.
Dr. Neel Shah 28:06
It's funny, because I can't even tell you how many times I've met chief marketing officers were like, I'm the CMO. I'm like, Cool. I'm the CMO, too. And then you have a conversation for 45 minutes. And like, nobody knows who the person is talking about. And they're like, Ah, okay, got it. That's a good question. You know, I mean, I think CEOs also have very different REMAX right, and really different roles, depending on the organization and how they partner with the CEO. But I would say, what's unique to the CMO is often they're like the scientific or even the moral voice of the company, particularly in spaces like reproductive health, where there's a lot of underlying injustice and challenge and things like that. So they have, you know, they're aspects of the role where they're your job is to sometimes be the keel sometimes be the kind of grounded scientific voice. But I would say it depends at our company, the way that I see the identity of my org, which is not just about the person, right. And so the org that they run, is that we're the glue between product growth and operations, all of which you hope are tightly tethered together, but may not otherwise always be the case, right? You want to make sure that product is building, what growth is selling, and that the ops team is operationalizing within the company. So the clinical team and even the way that I've organized my team is that there's a arm of my team that's directly partnering with product, a team that's directly partnering with ops and a team that's directly partnering with growth.
Griffin Jones 29:35
Talk more about how your team's interface so in some cases, you're you're developing protocols, you're developing reproducibility and other people are executing on what's currently in place. How do how do your teams interface with each other while you're working on something new. We're improving something that exists and is already being deployed at a big scale.
Dr. Neel Shah 29:59
That's it Question? Well, I think, and these are, these are all really good questions, and they're so deep in the weeds that you're not getting a canned response on anything, right? They're just like, you know, I don't have like a schematic diagram, because it's so dependent on the use case. But I'd say generally speaking, there's a team that's like delivering the services, right, like day to day, like, literally like 1000s and 1000s of visits per week appointment. And then underneath that, there's a team that's QA it, which means like, they look at every single interaction with a member or patient that's less than a four out of five out of 10. They go through all of the comments that we get back as free responses, and then they audit the medical records themselves. They do random sample audits. So that's happening in the background all the time. Right. And there's a there's a dimension of improvement, that's just QA, which is like, isn't the right service quality? Is it clinically appropriate? You know, are there product related things that are getting in the way, then there's okay, we're going to stand up a new program around conception, because we've decided that among a fertility population, we think that we can help a lot of people conceive naturally. And we think anybody who should should be able to conceive naturally, we should support them to do that. So we actually have to build a more robust program. So that, you know, for example, if what they actually need is a $5, thyroid medication, we can identify that need and get it to them. So that team will spin up that program. They'll pilot it with a limited set of clinicians, they'll demonstrate that it works, they'll learn a ton about it, we'll model out, like how to scale it up. And then we'll deploy it at scale. And then the sort of QA team will sort of take over from there.
Griffin Jones 31:52
You have mentioned a couple of times how important it was for you to be an indoor cat meaning to have influence over the product itself, the operations, as opposed to an outdoor cat, one that might just be there for the figurehead of sales and thought leaders. Yeah,
Dr. Neel Shah 32:08
I mean, I like being outside. I just didn't want to only be an outdoor cat, you know, you're outside today.
Griffin Jones 32:12
There's this there's a little bit of,
Dr. Neel Shah 32:14
Yeah, exactly. Yeah, towards the tribe. Meeting, that was great. That was a lot of fun. But, you know,
Griffin Jones 32:20
So but you want to have a role in development for you what were specific, can you think of what the deal breakers were specifically, in other words, if I don't have control over x, then I'm not an indoor cat, if I don't have ability to work on these areas, or hire these people, or whatever it might be as specifically as you can, what were deal breakers for you, that would have meant I'm not an indoor cat.
Dr. Neel Shah 32:45
Maybe rather than deal breakers, I would like kind of frame it as what are the pillars of my role? And I think it's really important to think about that with a lot of intention. Because at a startup, everything about the company is continuously evolving, including like org structures, right? So, for example, actually, and until relatively recently, I oversaw a big part of our operational teams like the shift scheduling, workforce planning, you know, and then we brought out a great operational leader, and I gladly handed that off, I didn't feel like that was a pillar of being the CMO. Right? I think when I'm in the market, I want my counterpoints our clients, the chief medical officers of health plans, the benefits teams, you know, among the employers that we work with, I want them to be able to know that they can hold me accountable for the quality of services that we're delivering. So I need to control that. That's really important. How we qualify our providers, like is, I think the job of any cmo in any organization. The other thing is, you know, Kate and I are very aligned in one wanting to differentiate Maven. And hopefully this will be honestly less of a differentiator as digital health enters the Pruvit era, and more people are developing an evidence base, but, you know, I wanted to make sure that it was when I, when I, again, like look at a client, and tell them the evidence for how something works. I wanted to make sure that it met my standard, you know, because it's, it's very rare that things are totally black and white and either work or don't. Right. And so like, as a scientist, you're always hedging. But in the market, it was important to me to say, Okay, this is why we think this is a good product and why we think it will be capable of making your population healthier. Here's how we did the study. Here's how I think it translates to your population. So that was really important to me.
Griffin Jones 34:44
I want to ask you about the qualifying of providers and how you interact with them and feedback loop. But while we're on this topic of developing things with the CEO and the CEO, I've argued for some time that I don't see I don't see A clear cut separation from what people might call business operations versus clinical operations. And that I think that there are things when people say, Oh, we we don't make clinical decisions, we leave that to the doctors. It's what you do. Because you might, you might choose what software they're using, or you might choose what vendors they're able to access or a couple other things. And there's some overlap. And I think even when people say that in good faith, in my view, they don't fully understand that these things are not perfectly surgically removable from one another. And so in your view, what what is where is the separation between clinical apps and business apps? Where it's like, okay, okay, you get to say this. But when it comes to this, this is, this is my area.
Dr. Neel Shah 35:51
Okay. Kate is the CEO. So she's, she's, you know, there's very, very few things where I wouldn't defer to her. But I think the way that I would answer that, first of all, it's a really good question. And it's one that we've thought about a lot internally, too, because there's not there's definitely gray between the two. What made sense for us, for example, is we've got this big, wonky, complicated provider network, one of the one of the wackiest math problems in the world is how do you connect a person anywhere in the world anytime a day, to the right provider within 30 minutes, wonky math problem. Network ops can have that we and we have we have input into it, especially when it comes to the booking flow and the logic for how the matching works. And that's where that gray is where the collaboration is so important. But yeah, I mean, ensuring that our providers are paid on time, doing the projections around what we think our capacity needs are going to be in a seasonal business, it's really tied to benefits, like all that stuff, very happy for that to live with the expertise that it should with a great operational leader. And then the the clinical piece of it, a lot of companies actually have a kind of dyadic relationship between the two parts, right, such that, and you need to separate KPIs so that there's clear lines of accountability, I really believe in single points of accountability. But yeah, when it comes to the standard for clinical quality, how we determine clinical appropriateness, how we credential a provider, how we write the protocols for which medications we can prescribe, and how, like that very clearly lives on the clinical side. So I think it's a Venn diagram, I actually think it's fairly easy to figure out what's on the two sides of the Venn diagram. The hard part is like that middle part, right? I think so too. And it's not even defining what goes in the middle. Because that can be pretty clear to it's like, to your point, like how you actually operationalize that. So for us, you know, it's how we actually define a clinical need and put into the booking flow is right at the center, and our product, if that Venn diagram, it's a very, very close working relationship and with product as well.
Griffin Jones 38:04
So how do you met that's in that in that specific example? How do you manage it? You know, it's close? It's right in the middle of the Venn diagram, how do you manage it?
Dr. Neel Shah 38:12
Yeah. So like, basically, to do it really well, you need a couple of different inputs, you need user research, which comes from product products, job to make sure their KPIs or like make sure we're engaging people in the right way at the right time. You also need to retrospectively like, look at, you know, your notes. So we looked at like 1000s, and 1000s, of clinical notes, and we continue to do that ongoing basis. And we're like, what are people coming to us for? How do we put it into categories? That makes sense clinically, right? And then, you know, the ops team is like, Okay, well, based on our network constraints, you know, and the requirements were being given like, this is how we think we can set that up. This is how many clinicians in this service line we have to recruit, it's their job to model that out. So when you get down into the details, it kind of actually pulls up pretty cleanly,
Griffin Jones 39:01
To talk to me about qualifying providers, or perhaps even more the feedback loop that exists between you and provider. So you you're working on protocols, you're working on scalable processes for the company, how do you get feedback from them? And how does it? How does it get down to them? How does it get back to you?
Dr. Neel Shah 39:24
Good question. So we are in the fortunate position of getting to be selective about the providers we bring on, first of all, so we've got a pretty rigorous recruiting process that I think is the first step of qualifying. Then before they can practice on our platform. They have to be credentialed. So we have to verify their identity, we have to make sure they've got the licenses that they say that they have. We look at all their dealt malpractice history and review it with the committee in detail. And then once they're qualified to be on the platform, they get scorecards every month that are quantitative that show whether they've met the service level or not. are minutes like setting their availability 30 days in advance showing up on time, things like that, that they're meeting the right member experience metrics. So we look at a star rating after every appointment. And then we do a review of their records. And we check for clinical appropriateness. So they get that every month as feedback. And if they're below benchmark, they get a conversation, depending on where they land or more. In addition to that, we make sure that we have a service line structure with clinical leads over each one. So the communication is bilateral, we're getting product feedback from them all the time, we're taking care of an increasingly diverse population. So it's not just product feedback, sometimes it's about the populations we're serving, we're learning about what their needs are, for example, we relatively recently stood up a menopause service, and came out of the gates with a strategy to make sure we're getting people HRT that needed it. And we very quickly learned that there's six other ways we can help people resolve their menopausal symptoms that don't involve HRT. And so we had to adapt our clinical protocols to be able to prescribe gabapentin, or to bring on board physical therapists for people who have incontinence related issues that, you know, we didn't realize we're going to come in that way. So anyway, I think on a principles standpoint, it is very important to make sure that it's truly bilateral. And that, you know, there's sort of two ways of designing a complex care model. One is to draw a schematic diagram and hand it to people to deliver it. The other way is to put your best people in front of it and actually learn what they're doing, and then scale it up. And Maven is honestly doing much more of a ladder than the former.
Griffin Jones 41:40
Do you have people that try to go outside of that communication framework, like someone that's got your phone number, or they're hitting you up on LinkedIn, or, you know, you have the clear systems for them to give you product feedback, but they're like, I'm gonna text, Neel. Anyway, I want to text. Yeah,
Dr. Neel Shah 41:56
Totally. I do want it to do that, honestly, yes. But my point of view is, if they're motivated enough to just reach out directly, I probably want to hear from them. So, you know, I'm used to having, you know, kind of most of my career, I was a public figure with a email address that everyone could see my Harvard page just came down a few months ago, you know, and so the entire world could email me whenever they wanted. And that was something I just sort of got used to. And there were things that were pretty wild, that would come into my inbox, and there were things that were really compelling. The same is true now. but to a lesser degree, I'd say the ratio is even more skewed towards things that are compelling. Like if a provider really wants to reach out to me, it's because they've really got something to say, I should probably hear it. So you know, my policy last two years is to try to be as successful as possible.
Griffin Jones 42:40
That's an interesting thought, how much of a pre work requisite Do you think it is for someone to have been a public figure before they decide to be a chief medical officer? And even if they haven't been one before? Are they basically agreeing to be one,
Dr. Neel Shah 43:00
I don't think it needs to be a prerequisite to be a quote, public figure. I mean, what, what that meant in my case, was that I was an academic, and I saw my job as being a teacher broadly, so to my students, but also to like industry and to, you know, other people out there and ended up really enriching my academic career. Because it turns out, there's a very diverse group of stakeholders that care about the well being of people building their families, you know, elected officials, people creating documentaries, and it was really compelling to me to be a part of that whole ecosystem. I think that aside, I do think it's the job of a CMO to be accessible. I think that's a hard requirement, in fact, so you know, my team knows that they can reach me 24/7 All the time. Part of that mentality, honestly, came from being an obstetrician. And, you know, that being kind of my disposition towards my patients anyway, but always on. Yeah, and I think part of a safety culture is that people have to not feel like their barriers to telling you something uncomfortable, you know, so I really encourage it, and it's, it's benefited us, right. You know, I think things happen when you're taking care of people at scale, recover 15 million lives. And so, you know, there are all kinds of things, cases of domestic violence things, cases of mental health acuity where there are people that are really in trouble, and we have to go the extra mile to figure out how to make it work for them. You know, we've taken care of Ukrainian refugees, where again, we had to we had to go like an extra couple of miles to make sure that person was getting what they needed. So I don't I don't mind being accessible.
Griffin Jones 44:37
That brings me back to your honest brokers comment that you made earlier in the conversation and you talked about a sea of disinformation around fertility. Tell me more about that.
Dr. Neel Shah 44:49
Well, people are anxious out there, Griffin. And I think, you know, in high school, a lot of people are told how easy it is to get pregnant. And then as soon as they get to be a certain age, maybe just post college, they're told their fertility is rapidly declining, and they're anxious. You know, and I think that we need to be thoughtful to make sure that we're not stoking that anxiety in order to sell things. And I see a lot of examples of that. This there's a difference between misinformation and disinformation. So misinformation is well intended, but it's not necessarily factually accurate. You know, and that's a lot of like, for example, what's on tick tock, where, actually the plurality of people today are getting their fertility information as a primary source, then there's disinformation, which is intentional, and it's for power, politics or profit. And in our space, that is, there's a Washington Post article yesterday about a prominent Rei in New York City who's Hocking, a supplement, a hormone supplement that's considered dangerous by the medical establishment but has a stake in the company. There was an article in New York Magazine this month about a company that is selling sperm freezing services, which could have a lot of value for some people, but it's doing it in a way that may make many men think that they have to do it in order to preserve their fertility. And so I just think that we've got to be careful about things like that.
Griffin Jones 46:31
How would you like to conclude with an audience of many people who might like to become chief medical officers someday, whether it's something that maybe I didn't ask you or something you'd like that, that you want to expand on further about the role of being a chief medical officer, the floor is yours.
Dr. Neel Shah 46:49
That's quite an opportunity, Griffin, I would say, you know, a title is this a title. But healthcare is messy. And there is no shortage of opportunity to jump in and try and make it better. I think that a lot of I assume a lot of chief medical officers or people who maybe today are working in roles as forward deployed clinicians. I'll tell you, Griffin, I have never seen the clinical workforce more demoralized than today. It's it's really profound. And I think it's sort of partially related to the pandemic, but partially related to a whole bunch of convert converging forces, and it's very clear that healthcare is in need of more leadership, and that we're better off when clinicians stepping on roles where they can work alongside business operators, technologists, and others to make things better.
Griffin Jones 47:41
Dr. Neel Shah of moving clinic Thank you very much for coming on the inside reproductive health podcast.
Dr. Neel Shah 47:48
You bet Griffin My pleasure.
Sponsor 47:50
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