About the Guest:

Shantanu Nundy, MD

Chief Medical Officer of Accolade

Dr. Nundy is a primary care physician, technologist, and executive who serves as Chief Medical Officer for Accolade, which delivers personalized navigation and population health services to companies that cover over 2 million working Americans. In addition, he currently advises the World Bank Group on COVID-19 care and vaccine delivery and practices primary care in the greater Washington, DC, area. He is co-inventor of SMS-DMCare, an automated text messaging software for individuals with diabetes, one of the first mobile health interventions to be adopted by the World Health Organization.

Connect with Dr. Shantanu Nundy:

About the Episode:

Joining John this week is physician and entrepreneur Dr. Shantanu Nundy. Shantanu is the Chief medical officer at Accolade, where he oversees the company’s clinical strategy and solutions to improve health outcomes, and he’s the author of the new book, “Care After Covid.” Shantanu shares his circuitous journey into healthcare, the inspiration to write about the pandemic, and why he thinks his 3D model (distributed, digitally-enabled & decentralized healthcare) can transform medicine.

Shantanu’s book, Care After Covid, is available wherever books are sold, and you can follow him on Twitter and LinkedIn.


Entrepreneur Rx Episode 10:

RX10_Shantanu Nundy, MD, Author, Care After Covid: Audio automatically transcribed by Sonix

RX10_Shantanu Nundy, MD, Author, Care After Covid: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Narrator: ForbesBooks presents: Entrepreneur RX, with Dr. John Shufeldt. Helping health care professionals own their future.

John Shufeldt: Joining me this week is physician and entrepreneur Dr. Shantanu Nundy. Shantanu is the chief medical officer at Accolade, where he oversees a company's clinical strategy and solutions to improve health outcomes. And he's the author of a new book called Care After COVID. Shantanu, really great to reconnect with you, and welcome to the podcast!

Shantanu Nundy: Yeah, thank you so much. It's such a pleasure to have a chance to talk to you this morning.

John Shufeldt: Thanks. I appreciate it, and I know our guests will be really interested because you have a very cool background. So where I was a sociology major at Drake University, you seem to take the high road, and so give me a little bit of background from your educational perspective.

Shantanu Nundy: Yeah, I'm not so sure about that. So but I started off my career as an engineer, actually. So I studied engineering at MIT and kind of paid my way through college doing programming and such actually largely for the financial industry because there were frankly the ones who paid the most. And then, you know, came to medical school with that background and I think sort of have been trying to fix things in health care ever since. So it's kind of how I'm wired.

John Shufeldt: Did you do, so after medical school, you went to medical school at Hopkins. Did you go straight into residency then?

Shantanu Nundy: I did. Yeah, I mean, on paper, I went straight through college and straight through med school, straight through residency. But I was lucky enough to have a lot of opportunities along the way to do some interesting stuff like so for example, even when I was in med school, you know, I sort of finagled a way to count my, to get an elective rotation counted by working at the World Health Organization in Geneva. So I definitely use every opportunity I could to kind of exercise, I guess, other parts of my brain. But on paper, yeah, I went straight through.

John Shufeldt: Yeah. What was your residency in?

Shantanu Nundy: Internal medicine, and then I actually did a Health Disparities, Health Services Research Fellowship as well, which is largely a research fellowship after residency and again, but was always multitasking. Like during my fellowship did an MBA and also started my first company around that time.

John Shufeldt: And what was your first company? Because I know you're working for Accolade right now, which I still think is a very entrepreneurial company. But what was your first entrepreneurial venture?

Shantanu Nundy: Yeah. So when I was practicing primary care on the south side, you know, as a resident, you know, had all these patients with their diabetes not well-controlled, right? And as I'm sure we've all seen, and I had a really simplistic idea which was part of what happens is, you know, people leave the clinic visit and, you know, life takes over, right? And then so they come back three to six months later and they're still not taking their medications or still not making lifestyle changes. So I had a really simple idea which was, well, what if we could send people automated text messages that were personalized to them between visits to kind of help them manage the day-to-day changes, and so that was that's what the first company was around was really that the technology platform to be able to drive better outcomes for folks with chronic diseases like diabetes.

John Shufeldt: So you and I practice in the same area because I was on the south side of Christ, you're a little bit down the street, more towards the Lake Michigan. So that was a population where your health care disparities fellowship really came into play. That was a hard population to work with. They were truly disenfranchised.

Shantanu Nundy: Absolutely, absolutely. And I think, you know, one of the things that I found really interesting and I found over and over my career is, yeah, like if you zoom out and you think about the life of someone on the south side of Chicago and all the different barriers they face to managing their diabetes, right? So whether that's, you know, institutional and structural racism, whether that's, you know, affordability and safe places to walk, whether that's lack of primary care doctors, whether it's low health and digital literacy rate. So it's, we know all that information. But the thing that surprised me over and over again is that if you can build solutions that just create a much simpler, better holistic experience for them, you can make a difference. So like, so despite all those barriers, when we started sending these very simple automated text messages to folks reminding them about their meds, giving them sort of coaching, what we found was that people's diabetes went from wildly uncontrolled to controlled. And we actually showed that we could save eight percent of health plan costs. So I think the reason I bring that up is oftentimes when we think about health disparities, we sort of get overwhelmed, right, we're like, oh my gosh, there's this systemic factor and that factor and that factor, and those are all true. But it doesn't necessarily mean that our solutions have to be that complicated. And I think particularly if you take that sort of human-centered approach, I found that it oftentimes can circumvent those barriers to a pretty significant degree.

John Shufeldt: Yeah, I totally agree when you go to and look at the root cause analysis, some of those root causes are very simple and particularly for people who suffer under these disparities. If you can accomplish things, I just figured out a way to get them to the clinic and doing a rideshare or some other application for them. That solves about 80 percent of their problems with at least getting at least to the care. And now certainly virtual care has done the same thing.

Shantanu Nundy: Exactly, exactly. I mean, I'm sure we'll talk about this more, but one of the things that surprised me, so you know, I practice in the safety net in D.C. in a pretty complex, challenging patient population. And I typically have a no-show rate in my clinic of 15 to 20 percent, on any given day 15 percent of patients won't be able to make it for all these different barriers. And one of the side effects of the pandemic, as we went virtual, was that my no-show rate literally went from 15 to 20 percent to zero. Zero percent, and so again, it's the same point you're making, which is all those barriers are there, right, the, their jobs, their transportation, all those things, but that doing something as simple as making it available for people virtually can oftentimes overcome even the most entrenched barriers.

John Shufeldt: Totally agree. Now, can we go back to your roots for a second? As I recall, didn't you teach English in a school in rural India?

Shantanu Nundy: Wow, you were a really good memory. Yes, I did. So a lot of my family growing up do development work. So like my parents worked at the World Bank, I had an aunt that started a nonprofit in India. And so as a kid, we used to go to India and I would visit this, this school that my aunt created. And I kind of promise myself because, you know, when you see kids your age looking the way that those kids do, if you can imagine sort of the poorest of the poor children in India, I sort of made a promise to the first chance I have, I'm going to come back and help. And so fortunately, my college, we would get six weeks off for winter break. So my freshman year full out there, exactly like you said, with the intent to teach English because, you know, my aunt ran a boarding school for about 250 children, so I walked in the first day of class to teach these children English. And I just, you know, again, I was 17 at a time, I looked out at the students and I just couldn't imagine how anyone could learn just with the physical ailments that they had. You know, like they had open sores on their bodies, they, a lot of them had runny noses, they were barefoot. And so, yeah, I went to go teach English, but very quickly pivoted to saying, gosh, is there something we can do to improve their health status first?

John Shufeldt: So is that, was that your lead into medicine? I mean, when you were at MIT, you did engineering and I didn't ask you what kind of engineering you did, but you said it was more financial sector, when did you pivot to go to medical school?

Shantanu Nundy: Yeah. So it was really that experience. I mean, so yeah, so I was a computer science and electrical engineering major. But, you know, did programming largely, like I said, for the financial industry. And you're right. I mean, prior to college, I did have an interest in medicine, I was sick a lot as a kid and was always fascinated by, you know, the person in the white coat who poked and prodded you in a couple of days later, you felt better, but I wouldn't say I made that as a career choice until college. And you're right, it was that experience. It was this exhilarating experience of I went to this school in rural India, saw that the kids had a health challenge, and I enlisted the support of a local physician. And together we built a school-based clinic with some funding for my university to help these kids. And that was just, that was it for me, that was the moment I said, wow, this is why, this is what I want to do for the rest of my life, some version of giving people access to care who don't have it. And you're right, that's what cemented my journey into medical school.

John Shufeldt: That's a, that's a great light bulb moment when you realize that you can make a difference and then not only on an individual basis, but on a societal basis as well. OK, changing directions again. You and I both like quotes, and we like one of the same quotes, which I think was initially attributed to Einstein. But I understand Obama said the same thing. It's insanity is doing the same thing over and over and expecting different results. It seems to me that is often directly related to health care. What's your take on that?

Shantanu Nundy: Oh, I mean, I couldn't agree more. I mean, you're, actually, I pair two quotes together, John, so the first is every system is perfectly designed to achieve the results it gets, right, or otherwise known as it's the system stupid. And the second one is the quote you just said about insanity. And if you combine those two things, what that means is that we have to change the system and we have to try different things, even if we don't necessarily know what the answer is, because the answer definitely is in what we're doing right now.

John Shufeldt: Totally clear. And is that what spawned you to write the book? So let's talk about your book. It seems like that was your impetus to write your book on Care After COVID.

Shantanu Nundy: Yeah, you know, I never intended to write a book, right, I mean, I'm, you know, Chief Medical Officer of a public company. I got my clinic, I got my family. But you know, I think what happened, John was the first month of the pandemic if you remember, I know a lot of us have blocked it out, but if you remember that first month where the front page of every newspaper, every conversation in health care was testing, testing, testing, right? We didn't even have enough testing and the test we had weren't being equitably distributed. In that moment, you know, I think folks like us that just kind of are wired differently, I was chatting with another physician colleague of mine, and I said, couldn't people just test themselves for COVID? And I realized that, you know, you can mail the tests home, people could follow some basic instructions and swab their own nose, they can mail the test back in. And what that meant was that for a pandemic, that was going to hit say, like 100 million Americans, that means in 20 percent of them would be hit pretty mildly. That means you can manage the entire end-to-end illness, from symptom to triage to diagnosis to recovery all at home, like you literally wouldn't have to step foot into a clinic, you wouldn't have to overburden the health care system or risk exposure to other patients or to health workers. That was again, another light bulb moment for me, and that's what was, catalyzed the book because the short version was I wrote it up as a quick op-ed. I actually never written an op-ed in my life before we published that in JAMA as an op-ed. And instantly, I mean, instantly the piece went viral. I mean, literally, I was in Rolling Stone magazine a couple of weeks later. But despite all the interest from public and patients and employers saying, gosh, when can we get this? When can we get this? When I started talking to people in government, in policy, sort of the decision-makers, basically they said, no, we're not going to do this. To the point where I don't know if you remember this, but the FDA actually specifically came out and said at home testing is not authorized, and that was really the moment for me where the genesis of the book came because I kind of realized that, and a lot of people in health care have said this is not new, but it was really visceral for me that I saw the entire country get turned upside down, there was a really simple solution that we weren't even considering, let alone implementing, and that was sort of the moment I said, gosh, if I don't take sort of this unusual background I have and experience I have and communicate very clearly and loudly what it is that the health care system needs to do right that, you know, at least I don't know if that was going to change anything, but at least I had to try, to try to change the way we were making decisions that were impacting so many millions of people.

John Shufeldt: Right. So what are, so what are the take-home point? So obviously, you're an internist, I'm an EM physician, we probably have much different perspectives on COVID and how the health care system responded to it. But from your book, what are the take-home points for it?

Shantanu Nundy: Yeah. So I think the core message is the following, the number one is that COVID magnified longstanding failures of the health care system, that COVID is not an anomaly, right? The inaccessibility around testing reflects the inaccessibility of care, the inequity around death and mortality from COVID reflects the inequity of death and mortality from maternal birth, right? So it's, first it's a magnifying glass, the second is that by necessity, COVID actually catalyzed a series of changes. They're actually really positive at the front lines of care. Things like virtual care, things like remote monitoring, things like home-based care, community-based testing and vaccination. So that's sort of the second point is that this is actually a catalytic moment where the system's changed and there's broad understanding that we need to change even more. And then the third point is to create a very clear vision of where we need to go. And so I created a simple framework, which some people are calling the three D's, which is that health care needs to become distributed, digitally enabled, and decentralized.

John Shufeldt: Yeah, I read that and I, boy, that is genius. I love, I love the 3-D version of health care because I think you hit it on the head and, and you know, our thoughts align in the sense that I think at least for telehealth and home testing and home-based care, I've been singing this, singing this song since 2010, and it always wondered why it wasn't being picked up. COVID absolutely accelerated the need for something I thought was so obvious 11 years ago, so knock on wood, that's some positive things came out of COVID. What else do you think positive came out of COVID?

Shantanu Nundy: Yes, so let me just talk about my own clinic, if that's a good way to ground it. I mean, you know, I've been practicing the safety net for 15 years, I would say the way we deliver care has not changed in 15 years up until the pandemic, right? So the first is what you said, you know, we went from 0 percent to 80 percent virtual in two weeks. And today, now a year later, I'm about 40 percent of my visits are virtual, so that's obviously a massive shift. And then the second one is that community-based testing, right? So we spun up a drive-thru testing site, which basically means in our clinic, it's a parking, in our parking lot we have a white tent with a nurse and a megaphone, OK? But that concept of delivering not within the four walls of a clinic but actually moving care closer to the community, I think is a really, really important one. I think the third is, is the mass vaccination, right? It's the idea of we partner with the church and that church is where people can get vaccinated and then the last is data. So one of the things that's really interesting is, you know, we've had an EMR for, you know, the whole time I've been practicing in my clinic, but I don't think we've ever really used the data in a meaningful way, like we use it to report some quality stuff to some administrator, but what we started doing, during the vaccine rollout, as you remember, every week it was like, OK, people 75 and older, then people 65 and older with the condition, and what we did is every week we would extract data from the EMR and then we would actually proactively call or contact those patients and say, hey, you are now eligible. And so all of those changes are real changes at the front lines. And then if you think about, OK, those changes are not only useful for the pandemic, but post-pandemic, right, so take that last one as an example. I mean, imagine if we looked at our data and extracted which of our patients with diabetes or asthma haven't been seen in one year, and then we proactively call them right, just simple things, right? Or every year we know we don't vaccinate enough people for the flu, we don't vaccinate enough people for shingles, again, partnering with churches or community-based organizations who can do a much higher throughput, are places people trust, are places that people are already going to. So those are the kinds of changes that I'm talking about are, I think, real changes at the front lines that have relevance both today for the pandemic, but also tomorrow, for routine chronic and preventive care.

John Shufeldt: Where do you see? I mean, you're obviously a thought leader. And you know, I always like to say, you know, we're standing on the shoulders of giants. You know, if we can see farther over the horizon, and ... as I'm standing on the shoulders of giants, Isaac Newton was, this was a tribute to Isaac Newton.

Shantanu Nundy: Yeah.

John Shufeldt: From your perspective now and after you've given all the thought to putting this down on paper in your book, where do you see health care evolving to particularly as it relates to this 3-D model of health care, which again, I think is a genius way to sum it up.

Shantanu Nundy: It's a great, I mean, I think the way I think about it is what's really interesting, John, I didn't realize this until I started writing the book, honestly, is we as a country don't have a shared vision for how health care should work for people. And that's really fascinating, because if you, if you talk to most of my friends who are in policy, oh, what's our vision for health care? You know what their answer will be, they'll say it's Medicare for all or it's universal health care or it's something like that, or they'll say it's a competitive marketplace or it's dealing with antitrust or something, and those are all very important, and I don't want to, I don't want to dismiss those points, but those are all about health care financing, right? Or they'll say, a value-based care and they'll say ACOs or something like that. But that's just how we finance care. What we don't have in this country is a is a common frame or reference, a common vision for here's how health care should work. So, and what I mean by that is, you know, about a month ago or maybe two months ago now, my seven year old, I got two little girls, my seven year old, my older girl on a Saturday night at seven p.m. couldn't breathe. And that had never happened to her before. She's got a chronic condition, but she's never had a breathing issue before, and she was coughing literally every one to two seconds for over an hour. And my wife and I, you know, started, you know, as parents do, we put her in the, you know, in a bathroom and turn on the shower to get her some steam, we did the Vicks, we tried giving her a nasal spray we had and an hour in, we started getting really, really worried and scared. And that's the moment in which health and health care happens, right? When two parents on a Saturday night at seven p.m. or eight p.m. are staring at their kid and saying, we're really scared, what should we do? And I think what we haven't done as a country is say, what is our approach to serving that person, right? If we could lay out a vision for 2030, what should every American have access to in that moment, we have an answer to that question, but we have an answer to the question of if someone needs to be hospitalized for heart failure, like what's our vision for where people should be hospitalized and where they should go afterward, and maybe they can get hospitalized at home under certain conditions. You know, what I'm saying? So what I'm saying is that we've been so, our sort of vision has been so policy-led, finance-lead, cost-lead, we haven't sat down as a country and said clinically, experience-wise, human-wise, what should health care look like for people? And I think that's our first step. Because one of the other things we learned during this pandemic, in my opinion, is look at what we did with the vaccine rollout, like if you remember where we were in December and the vaccines were kind of ready and approved, but like we hadn't actually distributed any of it to what we actually got to, it was because we had a very clear vision, we said, or the president said or whoever said we have to get to X million vaccinations by Y date, right? And that very clear vision catalyzed an entire country, right, whether that was community organizations, pharmaceutical companies, for profit insurers, nonprofit hospitals, we all catalyzed around achieving a very clear vision. And I think that's what we need, we're sorely missing that, so what I mean by that is we need to say stuff like by 2030, 50 percent of people with hypertension should be well managed, by 2025, 30 percent of people who are, should be hospitalized at home, right? By 2028, you know, this many people who are on insulin should be reversed for their diabetes. We need to start to set true clinical goals. As a country, we need to have a very clear vision for what the care model should look like, and then we got to let a whole multi-sector approach to go get that done.

John Shufeldt: Yeah, it's a great thing, great perspective. We know we need a moonshot moment. We need the JFK speech, we're going to put a man on the moon by the end of the century. And it's, you know, I've never thought about it like you have. But if we had those defined goals that we shared as a community, it would make a lot more sense because what we've done thus far, like you said, is we've looked at it only in, coming not only but primarily in the financial sector, here's what the payer structure looks like, but not really the outcome structure from, it should bubble up from the bottom, not push down from the financial top. I think that's a great way to think about it.

Shantanu Nundy: Yeah. And then because look, there's no shortage. I mean, you know, there's no shortage of innovation, there's no shortage of entrepreneurial spirit, right, every day there's a new AI startup or digital. And look, it's all good. But until we have a common vision, right, because then all of us can make our own decisions as individual actors that align to the vision, right? Like when we put down that very clear marker about vaccinations, everybody knew their role, right, and we unleash an incredible amount of innovation. If you just talk about what my little safety net clinic did or if you talk about what Pfizer did, if you want to talk about what UnitedHealthcare did, right, you know what I'm saying? So it's not, it's we have all that potential, but I just feel like right now it's a thousand, it's ten thousand mutinies, if that makes sense, it's not goal-directed. And I think that's really what's sorely missing for us right now.

John Shufeldt: So changing gears here a little bit because they'll be people that are listening to this, who will hear what you've done and say, that's what I want to do. Give us an example of what your average day is like and then how do you manage all the different hats you're wearing?

Shantanu Nundy: Not well, it's a short answer, but I'm the first one, I mean, I think where I try really hard, I mean, in any organization, particularly if really fast growing ones, I think, you know, you have to have an amazing team, you have to trust, have the person next to you, you have to trust that they're going to do their job, and I think you have to be really crystal clear on what your job is. And so I spent a lot of time helping the team and, you know, talking to different people. But I know what I'm accountable for at the end of the day and where I try to maximize my time is what are we doing in three months? That's kind of where I live. I live three months ahead of the business and our clinical operations and that's where I spend most of my time. So what does that mean? You know, that means, for example, if we're going to create a new type of product solution offering to bring to the market, right, spending most of my time saying, what should that be? How do we differentiate it? What are the clinical outcomes that needs to have? How do we operationalize it? What is the technology need to do? And so it's really bringing all those different disciplines together around the next thing that we got to go, build and deliver to our customers.

Shantanu Nundy: So how much of your time is spent practicing medicine and one-to-one?

Shantanu Nundy: Yeah, so that's great. So the way I set up my time basically is, yeah, Monday through Thursday, I'm at Accolade, you know, serving my role as Chief Medical Oficer. Fridays, every Friday, I'm in clinic at my safety-net clinic, so it's just one day a week and then my weekend's with my girls. So that's pretty much how I structure my time.

John Shufeldt: OK, so that will, that will give people some context. How did you, how did you find the role at Accolade? Because as I mentioned earlier, I've got a, you know, I think a lot of your CEO, I followed what you guys are doing, you're definitely on the cutting edge of where health care should go, probably thanks to you and Raj Singh. How did you land that job?

Shantanu Nundy: There's two answers to that, I mean very tactically, they put out a search for a CMO, the call went to one of my long-term friends and colleagues, and he said, why are you talking to me? You have to talk to this guy, and that's how I got connected to the team. I think the longer answer is I don't know if I've done anything particularly well in my life, but the thing that I did over and over again was that I always looked for my own sandbox to build my own sandcastles, no matter how small they were, right? So what I mean by that is like early in my career, right, like, let's even go back to when I was in med school, or even I should go back to college, the example of the clinic in India, I was at a great university that I could have easily just joined someone else's lab, someone else's project and just kind of tagged along, right? But what I said was, and initially it was accidental, but later my career became deliberate to say no, no, no, no, no, I see that there's 250 children in India, and I want to build a public health and clinic program for them. And even though I'm not going to publish any papers, even though I'm not going to make any money, like that's my own thing and I'm going to go do that. And similarly, when I was in medical school, you know, I was working with the checklist team at Hopkins, so like the team that was building the checklist that helped reduce infections in the ICU, but even within that big team, I said, no, I want to create something of my own, so I started, we started this partnership with the World Health Organization, I went to Geneva and stayed there for three months and built out a specific component to reduce hospital acquired infections that I wanted to do. And that's sort of been my rinse and repeat. So I, I didn't look at the title, I didn't even look at the sector because a lot of the work I've done, frankly, has been in non-profit or academia as well as private sector. I've just always thought, where can I fail on my own? I guess, like, where can I try out my own ideas and really be close to the learning, right, so that I'm constantly refining my own understanding of what works for people, and I'm constantly going through rep cycles in order to sort of that concept of deliberate practice, like I'm constantly, right, like practicing the piano and constantly iterating and learning. And so that's what I've done, because going back to the clinical analogy, like when I was an attending, I used to say to my med students, hey med student, the only difference between me and you is volume, right? You med students have read about pneumonia, you intern have diagnosed a couple of cases, you resident have taken care of 20 or 30 people, I've taken care of hundreds, that's the only difference. And so I guess what I've trying to do in my career is just get as much deliberate practice as possible by doing my own projects and learning from them and failing often. And I think that's been part of what's enabled me so that when I got the call from Accolade, you know, I think they were, you know, excited to give me a chance.

John Shufeldt: So the ten thousand and ten thousand hours sort of model where you keep practicing things and doing them again and again and failing and iterating and moving, you know, basically going forward along the way.

Shantanu Nundy: Absolutely, because there are so many people, I mean, right, that come out of clinical training and look, there are 27, they're 30 to 33 or 35 and I think they want roles like maybe the one I have or something close to it, but it's a totally different thing. You've gotten your ten thousand hours diagnosing, treating, managing and caring for people, and that's amazing. And it's completely different than the ten thousand hours you need to go like build companies, solutions, technologies, programs, products, solutions. And so that's, that's really the thing that I think as physicians or clinical leaders, we have to have the humility to say, yeah, we have this amazing training and all that stuff, but we have like another steep hill to climb. And if this is the work you want to do, you've got to just go put in the work, in order to do that. You're not going to just automatically go from being, you know, an attending physician and popping over and being impactful and really be able to drive the kind of change that at least has been important to me.

John Shufeldt: Yeah. And I think that's a great, I think that's a great message because I've heard a lot of people say, well, you know, I've done this, so therefore I can do that. And as you pointed out, a lot of the skill sets don't align and you do need to put in the time and fail and dust yourself off to really get the information you need to be successful at a whole another dimension of health care. What are you, so you've had the, as I mentioned, the opportunity to stand on the shoulders of some giants of which you're becoming one, what are you most bullish on in health care today as far as merging or evolving technologies that you think we as a society should focus on to make the most impact in health care?

Shantanu Nundy: Wow. That's a really big question, I think the single technology or technology enables service is this idea of let's just call it, and I'll define a second virtual first care. What I mean by virtual first care is that regardless of wherever people are, regardless of time of day, people should be able to connect to a single entity that has access to their health data, who has a relationship with them and can help them decide the next steps in their care. And that entity, right, I mean, or that person, it could be a physician, it could be a nurse, it could be a health assistant or a navigator, as we call them at Accolade, but I think the most important thing, though, which is often missed, is the fact that they are accountable to you, that they're connecting the dots for you, not just online but offline, and have access to your data to be able to aggregate and understand where you are in your care journey. I think that is a piece of technology that, in my belief, doesn't exist anywhere, there's lots of people who claim that they do virtual first care, and certainly we are building heavily components of that. But I think that ultimate vision of there's this thing that's always on, that's truly accountable to your outcomes and that has the information to guide you wherever that might be. I think that's the most valuable piece of technology that we got to go build right now.

John Shufeldt: Do you see this ever being AI-driven, where it won't be a human physician or nurse or navigator? It'll be almost purely an AI-driven?

Shantanu Nundy: Yeah, I mean, I never say never. I think that look, relationships are complex, and I think the most important thing is that we have something that is a great experience for people, that people trust, and that is able to deliver value to them. I think that's to me, the North Star. And then within that, yeah, how to get there. I think there is definitely a role for a purely AI-driven model. I don't know how large of a, of the population that would work for, I don't know what set of conditions, but I definitely believe there's a slice. And part of what gives me confidence about that is some of the really interesting work that's happening at Northeastern University around AI chat bots, particularly for mental health, shows that people can build a true trusting relationship with an AI bot. And in fact, in some cases, better than they can with the human. And so I personally don't get into the semantics and the sort of politicization of that, of that question. I'm just much more focused on, look, we have to engage every single person, give them a great experience and build a trusting relationship with them that ultimately delivers outcomes. That's the thing and then we just have to not be religious about what is it going to take to do that for some people, that is going to be a doctors, for some people is going to be a health assistant, for some people that's going to be virtual, for some people that's going to be in person, gor some people that could be an AI bot. And ultimately, I just want to solve the damn problem. And I don't really, you know, I think let's just keep iterating and learning to see what objectively what actually works because a lot of our assumptions, I think, are wrong.

John Shufeldt: Interesting. Well, so this has been fascinating, and I know people listening to this are going to come away with the, wow I want to be that guy when I grow up.

Shantanu Nundy: I want to ask my wife about that before you, take that too seriously. Sorry, go ahead.

John Shufeldt: What advice do you have for folks who are starting out and saying, you know, I want a mirror, I want on my own path, but I want to have a path like that where I find satisfaction in making a difference, and I'm doing something exciting every day. What advice do you have for them?

Shantanu Nundy: Let me sort of say it this way. When I talk to people earlier in their career, right, you know, who are in college or their first job out of college or they're in med school or grad school, I think what always blows my mind and, John, you've probably had these experiences, I'm like, holy shit, how the hell did I get in medical school or college, right? Because the passion, the enthusiasm, the interest, the talent is just amazing. And then at the same time, when I look at people, when I go back to my 10-year med school reunion or 20-year med school reunion, and look at the people, they're not the same people. Let me just say it that way. I think the system, life, careers, their own choices, that spark that they had, is sadly, in many cases not there. And I think that the biggest, and this is odd, but we all want to grow, we all want to, you know, celebrate our careers and all that kind of stuff. But one of the biggest advice I tell starting med students is I say, my number one piece of advice is don't change. Like there's, there's something very special about you, you have your own background, your interests, your talent, and part of what you have to do, you're going to grow a lot, you're going to learn a lot, you're going to get lots of different opportunities, but part of your challenge is to renew that purpose that brought you into whatever space you're in and that has to be a deliberate, active process, right? And I don't want to be prescriptive on what that is. For some people, it's spending time with friends and family, and I was lucky to go to med school an hour drive away from my parents so I could see them off, and some people that's journaling, some people that whatever. That to me is the biggest thing because I think what we need in the world are creative leaders and we all have a creator in us, the question is, as we're sort of coming through training and life in our early careers, like, are we not just maintaining that but actually continuing to feed that? That creative sort of leader spirit that we have. I know that sounds really metaphysical, but I think that's really, really important.

John Shufeldt: No, I say it much less intelligently. I always say, remember why you're here in the first place.

Shantanu Nundy: There you go.

John Shufeldt: Because I don't talk to people who are, yeah, I just, you know, just getting mired in the muck. And I said, why did you do this in the first place? You did it to help people, and if you can put on those that set of lenses every time you step into the emergency department, it kind of makes life so much easier. Look, I'm just here to make your bad day better. If I can do that, whatever that means, I'm in.

John Shufeldt: That's inspiring.

John Shufeldt: You sound, you sounded much more intellectual, but I totally agree with you. Hell, if I was applying to medical school today, not a chance. The kids I see going to medical school like, holy crap, are they smart!

Shantanu Nundy: Yeah.

John Shufeldt: So.

Shantanu Nundy: Totally.

John Shufeldt: It gives me hope in the future. Well, Shantanu this has been, this has been really remarkable. Shantanu's book, Care After COVID, is available, wherever books are sold, I found that on Amazon. You can follow him on Twitter, at @DrNundy or on LinkedIn by searching Shantanu Nundy, thank you so much for being on the podcast, this has definitely inspired me, and I know you've inspired others, so thank you.

Shantanu Nundy: Oh no, my absolute pleasure. And it really, my dad would say you and I belong to the mutual admiration society, so thank you for everything you've done. And I think just, yeah, I've enjoyed your quotes and the ideas that you shared as well. I think just absolutely great way to spend an hour today. So thank you as well!

Narrator: Thanks for listening to Entrepreneur RX with Dr. John Shufeldt. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. This has been a presentation of ForbesBooks.

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Key Take-Aways:

  • Thinking about health disparities can be overwhelming, but solutions cannot be that complicated. 
  • Leveraging technology for healthcare can save more lives and reduce healthcare plan costs. 
  • The COVID pandemic magnified and shed light on long-going failures in the healthcare system worldwide. 
  • The new framework for post-pandemic healthcare is it has to be distributed, digitally enabled and decentralized.
  • Partnerships with community-based organizations are a great way to promote health-related activities. 
  • As a country, we still need to answer what healthcare should look like for the people, not the companies. 
  • Trust between teammates to get things done is particularly important to achieve goals. 
  • Don’t be afraid to build your sandbox for your sandcastles!