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Flourish: Brainwave Tech Exposes Healthcare's Shocking Gap in Pain Data with Martha Lawrence

Sarah Richardson: Hey, it's Sarah Richardson.

Before we jump in, a quick note. This episode originally aired on Flourish, a show I hosted focused on leadership and culture in healthcare. It Flourish has officially joined the 2 2 9 Project podcast and over the next few weeks, I'm bringing some of my favorite conversations with me. If you're new to my work, I'm so glad you're here.

And if you followed me from Flourish, welcome home. The conversation you're about to hear is one I believe is worth your time. Let's get into it.

(Main Video) Welcome to Flourish, the podcast that explores bold journeys, brave pivots, and the art of building a career that feels both authentic and impactful.

I'm your host, Sarah Richardson, and I'm thrilled to sit down with Martha Lawrence Milken thought leader, CEO and co-founder of as AccendoWave and Board member of the UCLA Technology Development group, a true quiet giant in healthcare innovation. Martha, welcome to the show.

Martha Lawrence: Thank you, Sarah. Delighted to be here with you and to spend some time talking about healthcare and innovation.

Martha Lawrence: Great. First question. So I'll start with my background and then I'll talk about my motivation with AccendoWave. So in terms of background, I spent most of my career at HCA at Hospital Corporation of America, a company that we both have in common. And I was there for 18 years and HCA actually incubated my company's technology.

So forever grateful for their support. I spent 25 years on a payer org. So when I was at HCA, we owned a PPO, and so I joined that board to learn the payer space. I spent a lot of time with the Milken Institute. They reach out to me as a thought leader. So I'm on employer calls, panels. I attend their conferences.

And lastly, I am a entrepreneur in residence for one of our federal government agencies. So that's my background in terms of the motivation for AccendoWave I think it really stemmed from a deep understanding of the scale of the business problem of pain. And it's really one that I think insiders in our healthcare systems understand, but outsiders maybe not so much.

And so it's not something we really highlight to the marketplace, but insiders know that this is a significant strategic problem for us and we really need to advance. Both the technology and what we're doing in the pain space. So that's really what motivated me to move forward with as AccendoWave and so very grateful for HCAs backing and understanding of the scale of this problem.

Sarah Richardson: If you could describe for us, I feel like I should ask you what you do in your spare time, sort of cheekily because of all the things you've got going on, but when it comes to AccendoWave's, mission and innovations, especially around the data driven scaling your clinical and financial utility and de-risking tech adoption, I'm just curious how all those things come together for you.

Bias against ethnicity, bias against seniors. And I mean, no disrespect here to our male audience, but pretty much only white men under 65 aren't seeing this problem. The rest of us are on the receiving end of gaslighting. And why that's important a mission standpoint is that when you don't believe my pain, I lose trust.

So it's a primary driver of cost. Pain data shows up nowhere. It's not in claims data. You can't actually get it out of your electronic health record. Even if you could, it would be very low quality data. And so it's actually kind of shocking when you think about what other industry doesn't have data on a primary driver of cost, that'd be healthcare.

So that's really our focus is having. Objective data around that pain conversation and pain journey. And the audience may wonder exactly how are they measuring pain. And so I wanted to just mention that now so they don't have to sort of think through that as we're talking about some other questions.

Sarah Richardson: which I have to believe.

Each person experiences pain differently. And so you use really a scientific method to collect that information, to your point, to create those benchmarks. Because someone may have a massive tolerance, someone may not, but they still have the same need. And it's just how it goes about being treated ideally in ways that don't lead to addiction and other outcomes that we're also trying to avoid.

So you're getting in front of multiple problems with your solution.

Martha Lawrence: We are. And you know, on, in terms of your comment about the variance, I mean, pain is one of our most subjective measures in all of medicine, and so it's time that we had data around it. And in terms of just the subjectivity, I would mention to you, I actually sat through 300 intakes in the emergency department.

So what we're currently doing needs to be upscaled in terms of a data so that we really have a common bar around the measurement of pain so that we can actually, help our patients really achieve the outcomes, that they're looking for, and also reduce spend. In healthcare,

Sarah Richardson: I have to believe, Martha, that there's an element of.

The honesty of the measurement that comes from your solution, that to a degree also removes what I would call the shame factor for the patient. Because to your point, maybe it is an eight, but you don't wanna say it's a four because you're either embarrassed or I've just seen so many times in our industry.

Martha Lawrence: Right yeah. And I think what we learned is that people are interested in a data-driven conversation, both in terms of how they feel and how they're expressing. Also, in some cases, the bias that they're feeling from the individuals and clinicians that they're interacting with. And so having a way to sort of validate how they're feeling becomes really important to patients in terms of their care

[journey]

Martha Lawrence: Right so the market has changed. .80% of physicians work for Optum Private Equity or healthcare systems.

And so, I apologize to my physician friends, but when you have sold your practice, you are no longer a decision maker. You're an influencer. You're not a decision maker, and it's really the C-suite in those organizations that are now making decisions about the scaling of innovation, the acquisition of in innovation and priorities around innovation.

So that new landscape is important in terms of that interaction between vendors and those entities that are making the decisions because of how the market has changed

[Mic bleed]

Sarah Richardson: We're seeing now more than ever that clinical and that financial. Driver has to be hard. ROI. It has to be within a year.

And you were on a recent Becker's think tank. What are some of those challenges in selling independent solutions directly to hospitals? Because those point solutions and an innovator having the best. Solution that's not part of the EMR, but maybe it integrates all those different components. How do they actually get through some of those systemic hurdles to even have their product be seen and heard for evaluation?

Yeah.

But unfortunately, all of their internal processes. Aren't aligned with that strategic initiative, right? So it'll take you 10 months on the low side to 18 months on the high side to sell them. They don't stratify based on risk and spend. So a low risk decision that's low spend goes on the same conveyor belt that a very high risk, high spend decision goes on.

we consider our tier two customers. Tier one is the government. It's also work entities that work with work comp carriers and insurers of hospitals. And then the third is actually an org that works with biotech, pharma and device. So on the insured entities that insure hospitals.

One of the things that's happened in the last 18 months is three of our healthcare systems have been sued for pain. And these are massive lawsuits. 150 on the low side, 250 million on the high side. And our healthcare systems just don't have that data to defend themselves. So entities that insure hospitals.

If you want to defend yourself, you need to have better data, and this is a means of doing that. So it's a strategic lever. It's a way to reach hospitals without, you know, selling them one by one during a time where they're really distracted. There's a lot going on for our healthcare systems right now, whether it's government, whether it's their communities, whether it's, you know, staff and burnout.

They have a whole host of things. So from our perspective, it was just. A better way to approach the market by using strategic levers to reach them versus getting into that macro issue of, yes, they're interested in innovation, but processes just aren't aligned with that.

How do you help them decide how to go after their market?

Martha Lawrence: Yeah, so UCLA has done a really masterful job of having the whole spectrum around research and innovation. So obviously they've got IP and research that's coming out of the university and board members will, you know, will advise on whether or not, oh, this is a company, oh no, this is just an add-on to something else.

So, we'll give some perspective on that, but in tandem. With that IP and research, they incubate companies. So they've got a variety. They've got several innovation funds where they will fund, technology and research that's coming out of the university. They have one of the largest conferences UCLA does called LA Best.

Collaborative way. What I've loved to have seen is that everybody plays well in the sandbox and everybody in the sandbox is invited. And so Los Angeles is very much that kind of community, whereas some other communities are not quite that way. So it's really been a very collaborative process that they've had.

And then the last thing I would mention is, you know, on the research side. UCLA has understood that it's not only the very typical clinical utility research that's needed, but it's also an understanding of the real world data research that's needed. And so maybe an example here so UCLA recently did a real world deep dive on AI scribes.

[Mic bleed]

And this was in a public conference, so not sharing anything that isn't in the public domain.

So what they identified is that their, the clinical utility was pretty close on these particular solutions, the two that they looked at, economic utility. No, there was a difference. And so they made a choice that was a little bit more on the economic side because the clinical utility was so similar.

And so they understand that our healthcare systems are needing data around real world data because. And I would actually submit to you that's more important than just some, you know, 30 patients in a study. Because that's where we're looking at bringing this, right? So if it works in the real world, we know that if we have the right parameters, that we can scale this as opposed to something that's just done for 30 patients in a, you know, little tiny clinical setting.

[as well]

Sarah Richardson: Do you get a

sense that with our current international relationships that are evolving daily in some cases, that there will still be that drive and that desire to want to have that level of international collaboration on things that are universally applicable, such as healthcare and pain and scribing, et cetera. Like is there still gonna be that desire to solve things at a global level that are occurring everywhere?

Martha Lawrence: Yeah, thus far I've seen that to be the case where there's still that desire to collaborate. In fact uCLA had a recent announcement where it was a country from Asia where they were deepening their ties around innovation and research.

Sarah Richardson: And you and I are Californians, and we could also say California matters.

It's like, and you don't really wanna mess with California. And it does the most conversations that we just throw out there. I'm like, you're welcome. You know, it used to be, oh, California. I'm like, Hey, you know, we're still here. We're still a, we're still a big deal, as I like to say, also as a Milken and thought leader, what does that platform enable for you and how do you bridge government, university, and private sector innovation and conversations?

And that whole group is sort of focused on a particular area of interest with the desire for actionable an actionable approach. Beyond those conversations. So it's important that everybody understands and has a common theme of understanding of that particular strategic issue, but it's really focused on, okay, now that we understand it, what, where do we take this?

What action? So I've been involved in conversations around mental health. So that is of deep concern to our employers and to really everyone who has been touched or has. Identified for themselves some need of support in mental health. I was on a call a few weeks ago where we were focused on the rate of cancer in our young adults and how that's growing.

So those are three different use cases of bringing together those. Entities with the goal of action.

Sarah Richardson: I feel like you've touched on all the perfect sort of hot buttons in people's lives, because if pain's hard to quantify, try being over 50 and be a female and what that journey looks like. And I find myself drawn into those conversations more and more, not only because I'm that person now, but also because how hard it is even as an insider to get the care perspective and even the conversation that you need.

And here, you and I, again, we're on the inside and it can be really tough. I wanna flip though. Oh, sorry, go ahead.

Martha Lawrence: Just gonna add you know, one, one data point around this that I think it helps us as it pertains to pain, 80% of pain research was done on human men and male mice. So women are barely in the data.

their experience.

Sarah Richardson: And funny enough, you talk about shame associated with certain aspects of healthcare. I have no shame in explaining what it's like to just be aging, because I think my mom and my grandmother said, Hey, it's for the birds. And by the way, here's what happens to you every decade. Well, Sally, they both were gone before 80, so I'm like, oh.

What happens, you kind of need like a milestone marker. This is gonna happen next. Here's how you're gonna feel about this and working through all the parameters, but I wanna flip and put a little bit of education into some of the new CMS models, the team and the a SM one specifically. I'm gonna ask you some questions about that.

That's the first one. And then the second is the ambulatory specialty model, mandatory outpatient model, which starts January 1st of 27. Through December 31st, 2031 that focuses on chronic conditions, specifically low back pain and heart failure, and holding specialists responsible for outcomes and cost with performance data transparency and two-sided risk.

So with all that being said, as these CMS models shift hospitals and specialties toward episode and condition-based accountability, especially where data matters, even if it doesn't require the FDA approval, how is AccendoWave positioned to lead?

Martha Lawrence: So I think we're positioned well to lead in terms of the team model, which, you know, as you mentioned starts in January.

And so there'll be more data points to inform what might be the right care journey for this individual because we now have data around how they are feeling their pain versus benchmark data. And so, you know, under a value-based world, there will be more incentive to really understand which direction patients should go as opposed to the all, or many of them go the procedure direction, right?

There may be other options that may be more that would be preferable or a better match for their personalized care. So I think we're well positioned for that. I mean, under a value-based. Care arrangement when pain is your biggest driver of cost, might be a good idea to get some data on, on your, your primary driver of cost now that you're on the hook.

And so then we'll have specific low back pain that can be used as a data benchmark and metric so that patients. Understand what their level of pain is compared to benchmark and the clinical team who is incented to work together to really understand the best personalized medicine approach for this particular individual.

Sarah Richardson: So that. Aspect of helping hospitals manage risk, coordinate care, measuring outcomes, all goes back to that $250 million lawsuit. You get in front of that well before it becomes a mandate. To understand what's happening. But there's, even beyond CMS, there's initiatives like nihs, backpack for low back pain, there's the Washington's Low Back Pain and Implementation Collaborative.

I'm curious how Wave and even some of the institutions through like UCLA that you help advise. That promoting these integrative modalities and care pathways, how does it become part of a common conversation where there's the clinical space and the financial and there's all the, you could almost put this into a regulatory bucket, but it's more than a regulation.

Martha Lawrence: And we are big fans of integrated modalities and of the different choices that exist in the marketplace. For many of those, there's not been historically a great reimbursement pathway for them, and that has limited the uptake.

But I also think it's important to have data around each of those modalities so that we can understand. What's working well for that patient and maybe what's not. And so what might be a better choice as opposed to saying, no, you don't get it. It's like, okay, let's try this foot. You know, we did three of these, or three or four weeks of physical therapy that hasn't been effective for you.

Do we really need to do six? Maybe not. So maybe we can look at other options. In that care journey. And not all of those options have to be, you know, procedures and surgeries. There's a real place. And and our integrated pain programs are doing a really good job of trying to have those modalities available in a slightly challenging environment where.

A very personalized medicine approach to those individuals. And I think both our research, you asked about UCLA, our research institutions will help in terms of that real world data as well as research.

Sarah Richardson: You talk about data packaging as really one of those core value levers.

How can an innovator gather and present clinically and financially convincing evidence, especially for chiropractic, acupuncture, massage psychiatric, heck, I'll even throw in hypnotherapy that normally bypass FDA approval.

They may psychosocial, there are a variety of things that they're looking at as a real, as a part of the packaging of the information. Historically, it hasn't necessarily been around objective data objective. You know, it's a patient reported data, which is very important, but I think we need to have both.

And so there's an ability to go to a data platform like data ban and access that data and use that data in tandem with what you're currently doing to strengthen the case for reimbursement. For those modalities in a more significant way than what we have today in our marketplace. Because I think historically what we have done has not been sufficient, right?

[Mic bleed]

Sarah Richardson: So I'm gonna stay on the de-risking topic only because what strategies are effective do that for hospital adoption when navigating all the tiers, the government, the hospital, the payer, biotech, pharma, you named them all. How do you effectively de-risk that for a system?

Martha Lawrence: Yeah. So I think there are three things that help de-risk that for a system.

The first is really having data, whether it's both research and real world data. I think they do need real world data. I mean, just as UCLA did their own internal study because they needed to understand what the economic utility and clinical utility was for them, I think that kind of data will be important.

And so I would tell you that there is a secret sauce. To deploying in our healthcare systems. Unfortunately, we don't tell our vendors what it is. We just expect them to know. And then we're a little bit disappointed when they're high maintenance and it's not a low lift as we expect. And so having that deployment expertise, understanding that there's a pre-deployment phase, that there's a soft launch phase, that there's a full deployment phase, and then there's a post-deployment phase, and having the acumen so that, it's really a light lift. And I remember one comment from an H-C-A-C-E-O, who, and it was just a, I love this comment. [00:32:00] He said, you know, we hardly know you're here. It is such a light lift. Whereas that's not our typical experience. And so you have to think through every touch point for every individuals.

Minimize it because we just don't have a new team that arrives when we deploy. These people already had full-time jobs and now you've just added 10% to their workload. And so you have to understand each of those stakeholders and how you create that seamless deployment so that you get those kinds of comments.

And then the last thing that I would mention, Sarah, is that and people don't talk much about this, so I think this might be a sort of a unique perspective, but. And I'm not sure if you were at HCA at this point, but I was at HCA during the point where the Malcolm Baldridge Awards were created for, it was the first year for healthcare.

For externally, I would tell you that when I think about vendors, I can think about maybe five or less who asked me the right questions. So they were a successful deployment. So our vendors make a lot of assumptions about what they think we want and they don't point blank ask us. The key three questions, so I'll just give you one.

First one is, what do you need from

[me]

Well, I need data from you. Well, what kind of data do you

[Mic bleed]

We, we knew exactly where we were and what our because. We asked those questions and our vendors would distinguish themselves if they would ask these questions. So that they are very clear on what's needed to deploy successfully. And those are the strategies, you know, along with the expertise and having data, but really understanding what is needed for a successful deployment, post-deployment, and multi-year relationship [00:35:00] where you co-lead the innovation together.

Sarah Richardson: Those partners are fewer and far between in some cases. For sure. And to your point, having spent a decade at HCA, you got very specific about how we did things there, which is why we were able to do things, I believe pretty darn efficiently. We picked something, we knew how to systemize that no matter what.

What I have found post pandemic, and I'm really curious your thoughts on this as well, is that everyone got very focused. During the COVID initial epidemic, and we were able to do certain things very well, and now we're back to 300 projects in the pipeline and the portfolio. We've like lost everything.

We've learned about that. How do you start to reel people back in and say, look, you can't do 300 things at once, otherwise you just have this perpetuity of pilots and even failures in some cases, because you don't get to hone in on the things that are most important that we've been talking about today.

Martha Lawrence: So scale of the problem. We don't have the capital or the resources to solve all of our problems, but we can solve the ones that are the most important to us. So you have to be very clear.

on What are your top three to five? And then if you can do something beyond that, great, but top 300 is probably not a good idea. And then beyond that, in terms of you know, your roadmap and your process, I think you have to have data and metrics around it so that you can be successful with those projects and we have to have data and metrics around our internal processes. I mean, we can't continue to do a scenario where. You know, a vendors of interest. So it takes eight to 12 weeks to schedule a meeting because everybody has all these standing

[meetings]

In the room, never ask a question. And so we need to look at different, like, maybe it might make sense to have a vendor come into the admin conference room after two weeks and send the departments down to visit with them when they're available over that three hour period. So all the introverts get their questions answered.

It's a much better experience for everyone, and we can pull, you know, 10 weeks out of the sales cycle for our vendors. But we also have a metric very quickly around whether or not this is of interest to our staff. So I think we have to look at what I've heard employers describe as administrative bloat.

And I think we don't have the luxury of time anymore. I think the market is moving very quickly. And so I think we have to look for those opportunities to identify internally, what can we change? And maybe we could refine these standing meetings a little bit. because we did that during the pandemic, right?

And then we went back to old practices.

Sarah Richardson: Because we know it can be done. That was the thing about it. Illustration, there were silver linings and anything that happens, I'm like, we were really good at getting stuff done because we didn't have too many things to do at the same time. And yet now all we do is talk about what it was like then, et cetera.

Martha Lawrence: So by 2027 I think there will be entities that will be incorporating objective pain data. And it will be pushed down by sort of strategic initiatives. So I think you will see that because entities don't have any objective data and it's clear that the time has come. So we need [00:40:00] data just because of the spend that's occurring.

I think in terms of, UCLA I wouldn't be surprised if they were involved in some pain research projects. In terms of Milken, I think there's a real desire to focus on the Women's Health Initiative. And so I think you'll see some traction there and some movement and obviously given the fact that we have data on women in pain We think that there's a nice match there. And then you know, you, you mentioned earlier sort of being on a Becker collar too, and that is, I think we have to be very clear about what's working and what's not and sort of move forward with the things that are working and really sort of pushing aside those things that aren't working.

Sarah Richardson: Well, and I'm glad we get to keep talking about it [00:41:00] as well. Last question for you, and that is, if our audience walks away with one key insight about scaling innovation, where data, not necessarily FDA clearance is the currency, what would you want it to be?

Martha Lawrence: So I think we need objective pain data. I think that's the currency that we need. We need that to address pain bias. So our moms of color, our brown moms and our black moms are not getting less pain medicine than our white moms. And that we no longer have a scenario where the number one complaint of our black patients is that their pain isn't believed and they are getting later stage cancer diagnosis because of that pain bias.

We need objective

[Mic bleed]

Sarah Richardson: And I love that everything you're working towards has an element of health equity to it, because so often, so many people get left behind by the healthcare system and you're making sure that doesn't happen. So thank you for that.

Martha Lawrence: [Mic bleed]

Sarah Richardson: thanks. And most importantly, thank you for your incredible insights.

You are truly reshaping how data drives innovation in healthcare, all from the vantage of institution policy and entrepreneurship. Thank you for being on the show today.

Martha Lawrence: Oh, my pleasure, Sarah. Wonderful conversation. Thank

Sarah Richardson: you for the opportunity. Of course, and always thank you for sharing your powerful insights, practical wisdom, and this is from Scaling Innovation and Ascend, A Wave to shaping research and investment strategies at UCLA.

And as always, keep flourishing. That's all for now.