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 Welcome to this Week in Health, it influence where we discuss the influence of technology on health with the people who are making it happen. My name is Bill Russell, recovering healthcare, CIO, and creator of this Week in Health. It is set of podcasts and videos dedicated to developing the next generation of health IT leaders.

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We're excited to announce a new founding sponsor for this week in health. It VMware. It's exciting for me because I'm a huge fan of their offerings as well as their innovation. Special thanks to VMware for committing to develop the next generation of health leaders. You, you're gonna hear more from VMware next week when I sit down with them at the health conference in Las Vegas.

Speaking of the health conference, I wanted to make you aware of the fact that next week I'm gonna be dropping a bunch of shows onto the channel, as I do when I go to many of these conferences that I attend. Uh, we have some really cool interviews already scheduled and . Who knows who I'm gonna run into in the hall.

So, uh, video and audio next week. So follow on iTunes, Google Play, and YouTube. Today I'm excited to be joined by Nancy Ham, the CEO of WebPT. Good morning, Nancy, and welcome, uh, welcome to the show. Good morning, bill. Thanks so much for having me. Oh, well I'm, I'm really excited about this. You're, you, you have such a great background.

I mean, uh, uh, just ge WebMD, centillian me. Inventive. Medicity. I mean, we can go in so many different directions. And now WebPT, um, for those who aren't familiar with you or WebPT, can you give us a little bit of your background and how you got to WebPT? Well, as you said, I've uh, been fortunate to work in healthcare IT for 25 years and across a number of different companies.

One of the first unicorn IPOs help Beyond to a dot dead public turnaround that became part of Change Healthcare, couple of venture capital back companies that, uh, were sold to strategics. I did five years tour duty inside Aetna, so really different. And then I've been here at Web PT for three years. Wow.

Well, I'm, I, you know, this space, the rehab therapy space is exciting. My, my mom actually just got a new knee, uh, about three weeks ago, and she doesn't listen to the podcast, so just shout out to my mom, who's, who's doing the, doing a great job with her rehab and her physical therapist is my sister, who is, uh, and so I called my sister up.

In preparation for this. And I said, what, what do you want me to ask her? And, and so I have a couple questions from , from, from physical therapists as well, um, around this. But, um, give us an idea. So it, it is an exciting time in, in rehab therapy, but give, uh, for those who our listeners who aren't familiar, give us an idea of the state of the industry and, and what's going on right now.

Well, it, it's very interesting because there are a lot of, um, conflicting currents happening in the industry. On the one hand, as your sister knows, there's constant downward pressure on reimbursement. In fact, in the current Medicare proposed rule, it's an 8% cut, uh, coming into a couple years to a, to an industry that's already not highly paid.

On the other hand, there is so much mounting clinical evidence about the efficacy of physical therapy for patients like your mom, rehabbing from joint replacements. Mom, stay, stay consistent with all your therapy. It's gonna keep you outta the hospital, get you back to whatever you love doing most. But what's really been igniting the industry recently is the linkage to how physical therapy can prevent opioid addiction.

So about 75% of all opioids are prescribed for musculoskeletal pain, which makes sense. Yeah. Um, of that, uh, a huge amount is for low back pain. Again, undifferentiated pain makes sense. But here's what's exciting. Optum Labs is publishing research. It says if people with those problems are sent to physical therapy first and they go at least three visits, they're 90% likely to never be prescribed an opioid.

So physical therapy is coming out into its own as a way to stop addiction from happening. And of course, it is a incredible way to help deal with chronic pain and get you into a pain-free state and get you off. Whatever your problem is. So, um, it's really an interesting time, uh, for, for physical therapy to, to kind of claim its place as the musculoskeletal primary care provider.

Well, is it, so we have downward pressure on reimbursements. Is that message sort of getting out, is that getting out to CMS to. The providers that, uh, you know, this is a way to address the opioid epidemic and will we see that sort of reverse that, that trend or, or no idea? Well, we hope so, but it's very uneven, as I said.

So you see employers. Uh, embracing physical therapy more and more, understanding that it prevents upstream costs, downstream costs, returns, workers, injured workers, um, to work sooner. So you see employers really embracing it and doing more innovation. You see United Healthcare at the largest commercial insurer, but then you see Medicare going the other way.

So it, it is, uh, conflicting to us why more people aren't getting on a positive bandwagon. And we here at WebPT, it's kind of interesting, we're, we're almost two companies. We're obviously, uh, the leading EMR for outpatient rehab, but we're also the leading education advocacy company for the industry. Um, we get 7 million web visitors a year.

We're the third most access source of information on physical therapy after Medicare and after the American Physical Therapy Association. So we are passionate about helping therapists achieve greatness in practice, and we are very focused on getting out this word because if the opioid issue weren't enough, if the reimbursement issue weren't enough, here's another really depressing statistic.

Every year, 128 million adults have a musculoskeletal condition that lasts more than three months that would benefit from physical therapy, but only 10% of them ever start physical therapy. So we call that the 90% challenge. 90% of the people are not getting help. They're sitting at home on their couch in pain.

They're taking too much Advil. They're finding their way to, you know, a more meaningful drug like an opioid. They're getting injections and imagery and surgery, and we think this needs to change. And we just recognized, uh, one of our customers actually MedStar as the PT practice of the year. So MedStar is a big hospital system in the DC area.

They have 55 outpatient rehab clinics. And as a health system, they've changed the clinical workflow. So now if you have an MSK condition. You are written a script to go to PT first, whether you came in through the ED primary care, however you came in, and they are saying PT is best positioned to be the gatekeeper for M Ms.

K. And if they then need to refer 'em onward to an orthopedic surgeon, then they're gonna do that. That is game changing. And that's why I was thrilled to recognize them as the practice of the year, because that's what needs to be happening, is PT needs to be at the front of the chain, not downstream. Wow.

So, um, interesting, interesting space and I, I do wanna get into your, uh, technology solution. A little bit because I, I think I had some ramifications for all of healthcare and, and, uh, it's really interesting. But let, let me one last thing on the, on the state of the industry, are we, are we we're seeing a lot of consolidation in healthcare.

Are we seeing a lot of consolidation in this space? I know my sister has worked for four different companies, uh, at literally in about the last six years. So, and some of that is consolidation and some of that is just. You know, the, the just changing landscape. Is that, is that true across the board? Are we seeing a lot of consolidation?

We are. There are 38,000 rehab clinics, and there are 23 private equity firms active in physical therapy, buying up those clinics, enrolling them together to create larger companies. And so the industry is very active in mergers and acquisitions all, although it's still relatively lightly consolidated compared to other retail healthcare verticals.

So we're trying to do two things here at WebPT. We want to support the independent practitioner, give them tools to be financially successful, keep their doors open, treat their patients. . But we do believe that consolidation can be helpful to the industry because it's creating scale. It's creating scale to match up to payers to be able to enter into value-based contracts, because you have enough density, you can say, I can really cover your membership, because you can do the data exchange that's required to be in capitation, for example.

So I do think the scaling up by and large is good for the industry because it's helping the industry. Get more organized and consolidated and powerful and speak with a louder voice, which needs to happen. Yep. So why a purpose-built EHR for rehab, and how does it fit with the rest of healthcare? Well, specialty EHRs, by the way, are, they're back.

So they're, I could reel off 15, uh, without taking a breath that are active and backed by, uh, financial sponsors. And it's because if you read anything about general EHRs, you know, physicians hate them. They attribute burnout to them. They say, I have to work an hour more a day because it's not built for their workflow.

And in fact, when web PT started, virtually all of physical therapy was on paper. Pen and paper a mere 10 years ago. Because their needs of documenting the whole body, their needs to document thousands of functional exams, their need to go from treating a baby, you know, with a neck issue to a senior to an athlete, just couldn't be more different.

So they need software that's purpose built for what they're doing. That creates speed and efficiency. Physical therapists only get paid about $90 a visit. They cannot be get slowed down. There's also a lot of regulatory issues, a lot of gatekeeping, a lot of authorization, need to get physician plan of care, so it's actually very complicated.

Um, what physical therapists have to do and they need software that is uniquely built for them. And in addition to that, you know, we have sprouted out a whole ecosystem of tools all custom built for them that help attract patients, help educate patients, help prescribe home exercise, help. Uh. Keep patients compliant with their course of care.

So it's not just the documentation, it's everything else that they need to run their busy, complicated business. You know what, Nancy, you might be the easiest, uh, guest I've ever had on the podcast. 'cause I could go in. I can go in the consumer direction, I can go in the integration, uh, I can go inter interoperability, , I can go the data, I can go in the ER direction.

I can go in so many directions. This, this is gonna be a, a test for me to try to stay focused here. So, uh, short dive into the software. So, um, physical therapy operates within the larger healthcare ecosystem, so my sister's gonna go out and see a patient this afternoon. Does she have access to the, the complete medical records so that she can see the history and see what's going on, uh, as well as the, the ability to document her visit as she's out there?

Well, there's lots of different ways. Physical therapy is practiced, it's practiced inpatient, it is practiced in hospitals, it's practiced in the home, right? Web PT is hundred percent focused on the 30 outpatient rehab. So one, that's our space. We have 35% market share, about 15,000 clinics we serve on our software.

Uh, given my background in HIE, you might suspect that I've made a big investment in interoperability and we have about 7,000 interfaces running on a daily basis. And so that might be in the case of MedStar, the patient's registered in the hospital system and then they come over to pt. We document in WebPT, we send back the charges, send back the clinical information.

But physical therapy as an industry is less connected than almost any other part of healthcare. Um, which is true for a lot of subacute verticals, uh, post-acute verticals. And there was one thing that attracted me was not only the industry. And, uh, the power of what it does. I'm a healed PT patient, so I have that fervor about it, but also an ability to interconnect them because it's hard to be part of the care team if you're not sharing data.

So PT has a long way to go. Um, but I'd like to think Web PTs a leader in bringing the same level of interconnectivity that other parts of healthcare have. Yeah. And, and the show is this week in Health. It, so I might get a little geeky here, but I, I know, I know that you can handle it so away. So your interoperability, are you doing point to point connections?

Are you going through an HIE? Are you, um, are you using fire? Which, which direction are you heading that you think has the most promise for, for interoperability for this setting? The one we're doing, all those things. Um, I am a interop, pragmatist. Which means that good old point to point HL seven is gonna be with us long after I'm retired.

So if that's what's available, let's do that. A few cool people can do fire. Great. You know, I obviously love HIEs and so let's use those. Let's join Commonwealth, let's do direct trust. You know, let's send carrier pigeons. Um, I think you have to say yes, I will do all those things and not be snobby about it, frankly.

That's, um, . I love that answer, by the way. Uh, pragmatist. Exactly. I mean, if you're, if you're operating in healthcare, there's so many different things happening and so many different technologies. You have to just, Hey, what's gonna work in this situation? It would be nice to, you know, make everything perfect.

But, uh, that's not the world that we perfect is not the world we live in in healthcare right now. Well, it's not, and much as people, um, you know, look down on poor old HL seven. You know, at Medicity we were doing 5 billion with AB real-time, clinical transactions a year, and at the time I left it was 99.9%.

Good old, your grandfather's hl. So what you have to focus on for me is the. What's the workflow? How are you using this data to actually impact cost and quality of care? So use cases like real time emergency room notifications. I loved, you know, the ability to see the entire clinical record in the emergency room.

Um, you know, the prevention of duplication of testing, which is both expensive, but nobody likes to be tested twice. There is lots of great work that is happening, and I think if you just focus on the use case. And not be, um, so hung up on how you're gonna get it done. You can make a lot of progress instead of sitting around ringing your hands.

So let's talk about healthcare consumers. Um, the, the, the ot PT market, are they more in tune with the consumers because they're going into the home and, and those kind of things and. Um, are they, uh, so that's, that's sort of one question. And how does, how does your system, how does the technology help them to stay connected with their patients and help them in their care journey and, and help them in, in, I don't know, in, in, uh, growing their business and maintaining their business?

That's like five questions, but, uh, it's, it's a launching point for you. Well, one thing that I think is really good to understand about physical therapy is what a unique and intimate and trusting relationship it is between provider and patient. Because physical therapy by definition is hands-on care.

Yep. And so when you're having an episode of physical therapy, you're generally gonna go 10 or 15 times in relative close proximity. You're gonna be there for an hour and someone, your therapist is going to be physically with you, helping to heal you. So it's a really special relationship. So the, the challenges with consumerism is first that 90% of people who don't start physical therapy.

How do we educate them? How do we bring them to physical therapy? Um, and we have software that helps work on that. But then once you start, you know, physical therapy, 15 visits, it can be expensive. You're paying a lot of deductibles in out-of-pocket and close proximity. It can be hurt, it can be inconvenient.

And so we've invested a lot in patient relationship software to help engage you. As a consumer, make you a patient, bring you into care, support you, and help you sustain your care journey, give you home exercise. Uh, videos, a mobile app. Things you can do between visits. And now we're starting to work on solutions to help you with the payment challenge because that is the reason that people unfortunately have to discontinue care.

They just can't keep paying. So it is a burning issue and it's no different from many, uh, ambulatory providers that the patients, the top five payers now. And so you have to think about them as your patient, as a consumer, as a payer. . Yeah. My mom, my mom's first question. So my sister did physical therapy the first week, and then she actually saw the prescribed physical therapist and her first question was, how few times can I do?

I have to see you. It's interesting that that's how the conversation starts, and I would imagine it starts that way in a lot of cases. Well, it does because people don't like having to deal with their healthcare and they don't like having to go to the doctor's office or go to the PT office. But I think it changes.

What we see is people who go at. Then by and large will complete their entire course of care. So it is really crucial by the way that the physical therapists do a good job in that first visit. Setting the value proposition. Why are you here? How long is it going to take? What improvement can you expect along the way and to measure your progress?

We're huge proponents for using outcome software to measure the progress of the patient and then have a data-driven dialogue, which might go like this. Nancy, you entered your right shoulder. Uh, you've been here three times and you've recovered x percent of your range of motion. But if you come seven more times.

You know, we can get you to a hundred percent. And so it is really having that dialogue. And I do fear some therapists don't do that. They don't set that value proposition. They don't explain enough what's happening and how you're progressing. And that can lead to early dropout, which means by the way, people aren't healed.

They feel better, but they're not healed, and they're gonna rebound into the system one way or another. Or they're not gonna be able to garden or play tennis or walk their dog or whatever they love doing. So it is a real challenge and we're constantly thinking about it. Yeah. So what, what, um, mechanisms have worked or what platforms have worked?

I, I think actually I'm talking to you, um, Corina Edwards actually referred me over to you and Corina's doing some really interesting things now with Comcast on set top boxes, uh, we heard a lot about texting is still very powerful way to interact with patients. Um, and, you know, obviously mobile and, and voice technologies, whatnot, but you're, you're a pragmatist.

What, what works, what, what has the most, um, uh, what, what is the most effective way to get people to respond and get them engaged? I think you have to start with developing a patient personas. So a 16 year old soccer player. Who blew out her. ACL is completely different than an 82 year old skier who blew out his ACL, and yet the healthcare system tends to treat everybody the same.

Oh, you're a diabetic. I I'm jealous of the 82 year old skier, by the way. I, I hope. Well, there's lots of 'em where I live for sure. And they, they go past a lot faster than I go. Wow. Um, and so I'll give you a good example. When I was at Aetna, we did a project to look at diabetic. Uh, we brought in a lot of data, not just healthcare data, but socioeconomic data.

We put them into eight personas. We discovered two of those personas really didn't wanna engage in their own health. So we focused on the six remaining personas, and it took about two years on this. It was a long project to understand what technology works best with you, what day of week, what time of day, what tone of messaging, are you goal oriented?

Are you, although fear oriented and at the, do you, uh, can we bring you into anonymous group coaching? And at the end, we took engagement rates in half of those cohorts or personas from the low teens up towards 80%. So it starts with we are people, we are not a label, we're not a disease or a condition, and yet that's how the system meets us.

So for us, uh, we have within our patient relationship, uh, management tool, journey maps that are built, first of all by what happened, you know, what is the nature of your injury, what part of the body is it, how old are you, what gender are you? And then over the course of your treatment, um, we have. Learned over time, over 10 million messages, I think, how many messages to send you, how to best mix, um, you know, email, text, voice, and we're still perfecting that, but it really is helpful because we're talking to you in a way that's relevant.

We're not just sending you clinical spam, which frankly is what I think a lot of it is. That's interesting. Alright, so in, in, uh, we have about eight minutes left here. So, uh, and I wanna honor your time. The, the last two questions I wanna talk to you a little bit about investment. And, um, I read an article recently that painted a picture that the investment money in healthcare is becoming more, um, I, I think the word they used was discerning.

Uh, there's too many failed startups, um, because great solutions don't always gain a foothold. They don't, uh, they, they don't know how to plug into the healthcare ecosystem. And, um, and I'm sort of curious from your perspective, what are you seeing with regards to health tech investment right now? And potentially what advice do you have for current or future health tech startups, uh, to avoid some of the pitfalls that you've seen?

I have started saying lately that healthcare does not have an innovation problem. We have just a straight up adoption problem, and so there are plenty of great solutions that have demonstrated in a pilot they can work. The problem is startups focus on their technology and they don't focus on sales and distribution.

So it starts with what is your go-to market model? And I can't believe how many CEOs of digital health startups, I asked that question and it's not a very good answer. They're all over the place. They're trying to go multi-channel. It's a small company. You cannot go provider and payer out of the box and you can't just go payer well, which payer?

Medicare Advantage manage Medicaid commercial, like laser focus on your go-to market is what I see as completely lacking. There's also the sad fact we've trained the industry to be a bad buyer. Uh, somebody said that, you know, payers have more pilots than American Airlines, and I just love that. But it is so sadly true when we've been willing for a decade to do free pilots, to do cheap pilots.

You know, other software companies don't act like that. If I wanna buy Salesforce, Salesforce does not come over and offer me a free pilot. They offer me a very expensive contract. And so I don't know why we trained our buyers. To be dabblers. It's really bad for 'em, and people need to quit doing that.

It's really not helpful. Um, the, the other thing is you have to be brutal on your ROI, I don't care how pretty it is. I don't care how cool it is. Show me ROI and then you can make the product better. Uh, the last thing is people spend way too much money. You know, we've been through this. Arc of time where it was easy to get money.

I actually think that's bad for a company. Uh, WebPT only ever raised $4 million into this company, and one of our eight core values is MAs menos, do more with less. And if you are ruthless about. Making it on as little money as possible, that tyranny will force you to make better decisions. It will force you to get into market earlier.

It will force you to be more focused on what your customer's saying. It'll force you to be more focused on ROI. So, um, I think people have too much money and I don't think it's good.

Wow. Uh, you, um, again, you've given me a lot of things, but in, in, in the last couple minutes here, you know, you've thrived as a health tech leader for obvious reasons. I mean, your perspective, your background, and uh, your, um, uh, your leadership is obvious. Um, but the odds were not in your favor as a, as a female leader.

And, and give us, give us an idea of how were you able to break through. And, you know, is the environment changing for women leaders in health tech at this point? Well, one of the saddest stats about, uh, men versus women is that men will apply for a job that they're only 50% qualified for, and women will only apply if they think they're at least 90% qualified.

So I have, uh, fearlessly taken on jobs for which I was not qualified and learned as I went, which is what most people do. So, um, I got lucky. I got offered a chance to be ACFO of a.com startup in the original boom. And I thought, well, if they're dumb enough to offer me the job, I guess I'm dumb enough to take it , and you know, let's go.

And that's kind of been my mantra. Just say yes, say yes to more opportunities. Say yes to something new. Because I think, uh, I, I often ask women, what are you afraid of? Like, why are you afraid to apply so you don't get the job? You'll learn something. Why are you afraid to take on that assignment? So it is just being more fearless because, uh, women just hold themselves to too high of a standard, I think.

But it is also, I relentlessly network, um, and not from a. What can you do for me? I do it from a, I'm interested, I'm curious. I want to know people. I wanna learn from people. And so when I take those jobs and maybe I don't know what to do, I have a pretty broad network of people I can call up and say, Hey Carina, like how are you thinking about product marketing?

'cause you're a genius at that. So it's also just ask all the time people to help you when they will. I don't think it is changing fast enough though. Um, it, it's changing more on the customer side. You know, there's more female leadership now and providers and in payers. Uh, I just joined the Arizona Blue Cross Board and Pam Hawley is just a badass female, CEO there, but it's not happening in tech.

When I go to a tech meetup at JP Morgan or HIMSS or help, there are just not enough women in the room and. I don't think it's change, it's gonna change enough before I leave the industry. And that makes me sad. If, if you were starting your career today, so I have a daughter, my youngest is in college. My, uh, oldest, uh, daughter is finishing up school.

Took a couple years between, but she's finishing up. Uh, if you were starting your career today, how would you position yourself to attain the, a leadership role in health tech like you've been able to do? Do you think? Well, one is, careers are not about ladders anymore. They're jungle gyms. So it is so old school to say, I'm gonna start in this department and get promoted and promoted and promoted.

So just start and then go sideways. Go horizontal. Go backwards and say yes to, because all that matters is say yes to. You're gonna learn. , you're gonna get a mentor, you're gonna gain a new experience. When I look at my management team here, all of us have had at least three functional jobs. My head of sales started qa.

My CFO started in product management. I was an investment banker. So, um, linear careers are really not what's gonna make you successful. I tell everyone who is graduating, get a job in sales because leadership is about growth. Leadership is about revenue. Not saying you need to stay in sales, but until you understand how to sell.

'cause the CE o's always the top sales person until you love it, until you appreciate it. I think that's a gap. I tell a lot of fancy people graduate from Harvard Business School that they should take a sales job and they look at me kind of oddly. I'm like, yeah, you need a real job. Like before you go off and do strategy, um, and be curious.

Be a learner. We have an awesome young guy here. He's on his fourth promotion in two years, and each time it's a job he's never done before. And the first thing he does is he goes and reads five business books on that topic and he talks to 20 people and he learns. So be curious, be a networker, be a learner.

Be bold, because the very worst thing that's gonna happen is it's not gonna work out. That's okay. You'll find a better job, I promise. Don't be scared. Yeah, that's, that, that's fantastic. And, uh, and get your degree in economics clearly works, uh, for you. And it worked for me as well, so. Um, and it's working well.

There you go. Working for my son as well. So economics is a great degree. I I, I try to convince my two daughters to do the same thing, but everybody's different. So, you know, they're all studying different things and heading in different directions, which is exciting. Nancy, thank you for coming on the show.

I, I, this, this was fantastic. I really enjoyed our time together. Uh, open invitation. Anytime you wanna come on and talk about a topic because. We could probably talk for another, uh, two or three hours on, uh, on the industry and directions and things like that. So thank you very much for your time. Well, thank you.

I. Have your daughter reach out to me because I just preached that women ought to network. She's in PET, I'm in pt. Have her give me a call. Uh, absolutely. So, um, uh, is there any way people can follow you or do, do you write or post or anything? I, you're ACEO, so I'm not sure how much time you have to do all this.

Well, the best way is to follow me on LinkedIn because that's where I tend to post the most. Um, I'm, I'm not very good at Twitter. I. And then if they're interested in physical therapy, web pt, third most access source of information, we all write blogs. You can sign up for the blog. Yes, and your, your state of the industry, uh, posts are phenomenal.

Uh, way to get up to speed very quickly on, uh, the industry and what's going on. So thanks, thanks again for your time. I really appreciate it. I really appreciate Nancy Hamm joining me. Uh, she, she was such a great guest. She has so much experience and wisdom about our industry. Well, uh, you know, . Please come back every Friday for more great interviews with influencers.

And don't forget, every Tuesday we take a look at the news, which is impacting health. It. This show is a production of this week in Health It for more great content, you can check out our website this week, health.com, or the YouTube channel. Uh, if you get a chance, take a look at our designed guest page on the website.

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