Chief Medical Officers, The Keystone of Health Tech Innovation!

Brian Urban:

Yes, this is the Healthcare Rethink Podcast. I'm your host, Brian Urban, and today, we are talking all things healthcare tech innovation, and what better guest to do that with us than the Chief Medical Officer of North America for Aon, Dr. Charlie Smith. Charlie, welcome to our show.

Charlie Smith:

Thank you, Brian. Thank you for having me.

Brian Urban:

Well, this is going to be a lot of fun. We've gotten to know each other a little bit before the recording here, and we're going to get to know each other a little bit more and your work more as well. With every show, we like to get our audience familiar with our guests. So let's go back before the MD for Dr. Charlie Smith, before the big fancy titles and all the work you've done across the US. Take us back to how you got into starting in medicine, how you got into innovation, and take us up to current speed.

Charlie Smith:

Well, I think I was a nerd from the beginning. My parents say that about age five, I announced I was going to be a physician-

Brian Urban:

Wow.

Charlie Smith:

... and never veered from that path. I went through high school, college, and knew it was going to be pre-med, was fortunate enough to get right into medical school and never veered away from healthcare.

Brian Urban:

Wow.

Charlie Smith:

Interesting enough, I didn't know until many years later, my parents said that they were talking to a family friend that I went into medicine because I had a little brother who died at age two of meningitis who, of course, now vaccines years later would've prevented that. I had grandparents that died about the same time in their early 60s, and it was the environment at that time, I just announced, "Okay. I'm going to be a doctor." So interesting, I didn't know that for many years, but that's what my parents told me.

Brian Urban:

Wow. So dare I say prodigy or you self-proclaimed maybe at the age of five.

Charlie Smith:

I just self-proclaimed that I guess seeing things around me that with healthcare challenges, "Okay, I'm going to fix this. I'm going to be a physician."

Brian Urban:

Thank you for sharing that, Charlie, and it's lovely to hear that because a lot of the great folks we talked to on the show have some family tie or life experience that's deep-rooted into why they got into what they're doing now or why they got into, in particular, medical sciences, research, et cetera. Yours is right on track with that and it shines through too with a lot of things that you've done. So thank you for sharing that.

I think I'd lead off with wanting to touch on your physician side of your brain for a moment. So physician by training, and you've been on the business side of healthcare for many, many years, and looking at today's current state, what are the biggest challenges we have with physician and patient engagement or really across the whole healthcare ecosystem from a physician's point of view?

Charlie Smith:

I think of two major issues. One is the fragmented care in this country, and then two are the environmental and lifestyle issues. So it's nice when we think of healthcare systems and ecosystem, which is a huge terminology we use now, and there are some very good integrated delivery systems in the US, but it makes up for only a small margin of the total care that's out there. Most healthcare is very fragmented. Core communications between primary care and specialist, between virtual care options, you think of all the different access points to healthcare and they're very fragmented. So unfortunately, there are some real healthcare improvement opportunities for individuals that are being missed and people are falling through the cracks. I think that is still a major challenge. We make progress in certain areas, but then the overall complexity of healthcare, it's really hard to get everything so connected in the way most offices are set up today.

Oh, and I was going to say the other, obviously, are the environmental and lifestyle issues. Obesity, it continues to increase an alarming rate and the whole concept of childhood obesity really came to the forefront a few years ago. We know with obesity comes over 200 different conditions from chronic diseases to cancer and we're projected to be at 60% obesity going from 42% to 60% in the not too distant future, which means even more chronic conditions, more cancers, et cetera, be it the inactivity, processed foods, et cetera, all of that contributing to that.

Then you think about the environmental, the climate impact, the warming and the impact on people with respiratory diseases. You think of the environmental factors, I think, of social media and the stress that puts on young people. So I think both of those have huge, the fragmented care and then the environment and social, both have a huge impact on individuals' lives and the quality of care they get.

Brian Urban:

You covered a lot in a very succinct way too, and I think it actually makes me think about the very intriguing conference you all hosted this past September. I believe it was in Chicago. It's based on mental health, behavioral health focus. We'll get into that in a moment, but it's just so connected into that what popped in my brain there, Charlie, but you bring up a couple of interesting things in terms of our society changing so drastically now, things becoming a little bit more visible now as well across all different rungs of the socioeconomic ladder. Looking at coordination and communication, it seems like that's always been the foundation of a lot of challenges for healthcare going onto the payer side, even going into perhaps retail pharmacies, social health services. It's very hyper-local, but very disconnected in a lot of ways.

So in thinking about the innovation side of your brain now, let's go from the physician side to the innovation side for a second. You've been with a payer for a long time. You're with Cigna for a long time as a CMO as well. Now, coming on to I'd say more of the huge landscape of innovation because Aon touches employer groups, cybersecurity, reinsurance, everything in between, what have you seen from your perspective and your background over the last five years going through the pandemic that maybe were gapped on or maybe some innovation trends are starting to fill those gaps?

Charlie Smith:

Well, I think that it has been very interesting to say the least five years. It was amazing how quickly we saw healthcare rally around COVID. You think about the speed to which the vaccines got developed, the development of the antiviral treatments, the antibody treatments. So no other condition in our history has brought about so much advancement of technology so quickly. So that was exciting to see because, unfortunately, we know there probably will be another pandemic. It's nice to see that we could develop therapy so quickly.

If you think about it following the heels of that was the RSV vaccine, which has been a problem in this country for many years and again, speed to market, got the vaccine there. I think that we're seeing so much development in the cancer space. The pipeline for new cancer treatments are phenomenal diseases that were previously considered terminal five to 10 years ago. Now, there's good potential for quality of life as well as increased longevity for many of these diseases.

So it's exciting to see what's happening in that area. They related the speed to rollout of gene therapies. You think how quickly science is evolving in these areas from the CAR T therapy delivering a cancer treatment into your cells and then the gene therapies treating conditions that were people with genetic abnormalities and putting missed genes into their system. It's phenomenal to see what's happening and then excited to see what will be coming the next five to 10 years.

Brian Urban:

It's amazing, especially on the gene therapy you're discussing. We're going into the coding of what makes us unique and trying to be able to repair or prevent certain rare conditions that can get exacerbated in a lot of different environments that are either overcrowded, overpolluted, et cetera. Just amazing how things in science are getting narrow and narrow, precise and precise. So there's so many different things across the innovation space that are starting to impact healthcare.

So I got to go into Aon now. Your role is really unique. Very big title. You see a lot of different things. You have a really cool health equity and affordability tool out there as well, but I want to go a little broader for a moment. Where does Aon play a role in healthcare landscape these days and taking innovation through development and out to the market?

Charlie Smith:

I actually start at the beginning. What are our clients trying to solve? What are the issues they're affected? They're typically around affordability or value. They're around the quality of care and access, and then around the member experience. So when you look at any innovation, any strategy, you have to look at, is it impacting what is important to the clients and will it drive meaningful change? Is it really going to move the needle, so to speak? There are so many distractors out there. We know point solutions, new technology, and some of them have great promise, it can be very exciting, but then you have to go back to the basics of, what will that solve? Is it going to address a client need and is it impactful enough to really change the outcomes, again, around affordability, the experience or quality of care?

So I think that's a big part of our job is trying to continuously update what are we seeing as far as employee trends, what their cost drivers are, what are health improvement opportunities, how do you improve the member experience, and then look for what's happening with new innovations, new technologies, new vendors, new treatments, and do they have the potential to really change things. You evaluate those vendors. How well are they performing? What are their outcomes? Is the science real? Do we really believe their methodologies and what they're doing with the individuals and/or physicians? Is it meaningful impact to drive the outcomes they're trying to ascertain?

So that's a big part of our evaluation, and then making sure we're keeping up-to-date on the vendors that are there, as well as what vendors and technologies may be early on trying to get funding, what they're trying to solve for and is that going to be a differentiated approach to driving these changes that are needed.

Brian Urban:

You saw a couple really interesting things there. The latter note that you shared, being able to pay attention to what startups are getting traction or proving out their use case or their service or tech, et cetera, and paying attention to that. I think a lot of, in traditional sense, health plans, private payers not really done that, but the last five years, maybe eight years or so, they've really queued in on that to fill in their own gaps or to fill in a better member experience, patient experience or engagement.

The other side of it I thought was really interesting and you've said this a couple of times, really, where is the healthcare spend associated? You've talked about social influences a lot, and we talk about that on our little show here a lot as well. So in terms of the food, your household, access that you have to education, healthcare, vehicles, financial means, et cetera, how have you all been maybe starting to go deeper into that space in addressing the social health influences that are directly connected to the spec or the challenges that employer group in particulars is experiencing with their staff?

Charlie Smith:

It's so important. I think more and more awareness is coming out. I was just speaking with a group last week and it's amazing that we're still getting publications come out nearly every week about the inequities in healthcare and their impact, quality of life, longevity, healthcare cost. So we're aware and more and more of inequities. I think it is interesting. Every vendor we look at, every business, a core part of the evaluation is what are they doing to address the social determinants of health. Whether it be a diabetes solution, a cancer solution, musculoskeletal, whatever the solution is in their program core strategies, what are they doing to ascertain the individual's needs, and then what are they doing to address it and then modify their program accordingly. So I think that's a critical part of any type of evaluation.

Now, for clients, it's interesting too because you get into things that are beyond the traditional benefits. The whole concept of food is medicine, which as a physician I believe in, but we know the way we're set up with ACA and with spending rules for healthcare and ERISA, paying for food except for those individuals who have metabolic abnormalities, food was not considered medicine from a public pay standpoint, but if an employer has populations in these areas that are high risk for food inequities, how do you help them bring solutions to those markets if they're willing?

I think it's a great opportunity. Some are willing to take that challenge to say, "How do we bring solutions there?" You think of health literacy. You think of financial disparities and, again, how do employers address those needs in their at-risk communities? Again, things beyond the traditional healthcare benefits, but how are we creative, what are those creative solutions you can bring to address those needs, and bringing the awareness of how they're impacting the quality of care, compliance with medications, with treatments, everything else.

Brian Urban:

So this investigative analysis that you do with partners and then across into your client group as well, critically important because you've connected four or five really big dots there. That was the basis of my question. It's interesting, Charlie, too, you've seen HEDIS measures get a little bit more focused on addressing and screening social needs. NCQA had a social needs screening that is now taken as a requirement from CMS, but then it goes beyond capturing those needs in a screening.

It goes to identification and actually matching needs to a service, et cetera, and tracking that all the way through within a care journey I think is the next big step we're going to see. It makes me think of Medicare Advantage plans that United came out with this, I believe Evolent. There is a social health benefit package that comes along with [inaudible 00:16:40] plans now. It's transportation-based, it's food-based. It's a spray method across a whole population that's a menu, but the next step is really identifying, well, who is most likely to need X, Y, Z, and starting to bake in the right data and intuitive technologies to help people get engaged with the members they're serving. So you made me think of all of that stuff.

So I guess as you're moving forward in this landscape, I'm curious of the Chief Medical Officer role. I want to get into this for a moment here because you've had this title in various ways in a couple of different organizations for a while. I want to understand how that role and that title has been evolving maybe the last 10 years or so or maybe even closer the last several years. How is that role seen in the market because you wear that title? So how is it seen? How are you seen at the table whenever you go into these innovative discussions?

Charlie Smith:

I think you still have the traditional role of looking at an employer, and most of the employers I worked with over my years have been self-insured. So they're at risk and they're paying the bills, so to speak. So they want to partner to help understand their population health needs, what's, again, driving costs, where are there gaps or opportunities, what are the right strategies to address those needs, and are you moving the needle, are they doing better. So that's traditionally what the medical officers have done and it's still very important.

Now, it is a lot more of the evolving, the bigger picture. We just talked about the social determinants of health. Again, beyond that, what are other factors that are influencing health that they may need to address like social determinants? There's a lot more focus on the future analytics, and COVID brought out that so much across nearly every employer. Early in COVID, obviously that first year, healthcare costs were going way down, utilization was going down. Employers were really looking for answers to say, "What does this mean and what's coming? Are people avoiding cancer screening? What's going to happen with cancer after this? Are we going to see more cases, more advanced cancer cases?" which impacts not just, obviously, their healthcare and the individual's health and quality of life, but, obviously, healthcare costs, disability costs, et cetera.

So there was a real push to help and partner with them or to say, "Look at the data," and as we started to see healthcare slowly reopening, "What are we seeing? What are we going to predict? What do we think is going to happen with healthcare costs the next six months, a year, two or three years out?" So that was a really change in what medical officers were doing, consultants were doing because it really was predicting more of what we see.

We're doing that now a lot also with the pipeline of new cancer treatments. We talked about gene therapies. What's the rollout over the next three to five years? Looking at an employer's population, what do we think they need to budget for? What are those opportunities that need to be addressed? What strategies need to be put in place to make sure they're making sure these therapies are given to the right populations and in the right setting? So I think there's a lot more drive to be predictive partners and help them get ready for what's coming three and five years, not just addressing what's driving their costs today, which I think, again, very excited that, one, these technologies are out there, but then two, how do we partner together to put some predictability around what to look at, what's coming around, again, cost impact, what it may do to improve member experience, and then how do we make sure the right strategies are in place to support these individuals?

Brian Urban:

The long range view, so critical here. So it's not just reporting retro or looking at current state. It's what is ahead. You gave a great example of employers at that time, large employer groups and maybe in particular saw a dip in healthcare utilization around the height and just after the height of the COVID-19 pandemic. Were people delaying care delaying these that they had? Were things going to get worse for their healthcare condition, their healthcare needs? How do you predict that? For the last time we had a global pandemic, I was alive. A lot of these employers that are here weren't around. How do you partner with that?

It's so interesting because it goes beyond a lot of the traditional consultative approach that a lot of organizations like yourself had. You're now a deep-rooted partner and you're integrating different data sets and data resources to look into the future. That's so insightful, Charlie. Let me dig a little bit deeper onto the CMO side of your brain a little bit.

Now, when you were getting through medical school, at that time, there was not a trend of business or public health courses being inserted into the programs. It seems now that is popping up everywhere. There's a lot of MPH, MBA, dual programs, a lot of MDSs that come with MPH and MBAs. Do you think this is a distraction or is it a critical need for the next generation of medical practitioners to see the business side of healthcare, at least in the US?

Charlie Smith:

I think it's critical. I think at two levels. One is how do they run their businesses? It's interesting that the lightest statistic was that, I think, 74% of physician practices are now owned by hospitals or corporations, and that's moved significantly in the last five years. So I think if you're in that 24%, 25%, they're still independent. It's critical that you know how to operate your business because it is a business. Obviously, if you're an employee of a corporation, you have that business savvy too of how does a company run, how do you fit into the company. That's been a huge change.

You look at the corporate side of medicine, corporate acquisitions, large hospitals buying up practices over the last 20 years has been phenomenal. So I think it's important that individuals who are in medical school start thinking about what type of practice they want to be a part of and what are the business implications of being a solo, small group or a part of a corporation. If you're a corporation, you're working for a hospital, an integrated delivery system. So I think that's so important. So that's just for how you practice medicine and what you're doing.

Then you look at the bigger picture too. I think you look at ... Now, we've talked about some of the social determinants of health and how it's healthcare related and lifestyle, but the impact that has on the healthcare dollars and the way businesses need to operate. You mentioned Medicare Advantage, which is, again, those medical groups are at risk. So they're taking risk for how well a diabetic is controlled, which means, are they eating well to control their diabetes? So they're expanding what they do on a day-to-day basis because they're seeing the big picture need to control health and offer services that traditionally medicine hasn't. So I think all these reasons, understanding the business is so important from socioeconomics to just planning how do you run a business on a day-to-day basis.

Brian Urban:

It's amazing that you mentioned that statistics about 75%, 74% of hospitals, health centers are owned by a group, by a corporation. The M and A activity that's been occurring over the last several years is unbelievable and at the speed too. So I think about Walgreens with Village MD, Oak Street Health, CVS, and all other primary care or boutique surgical centers that are popping up in between. Did you ever think, going back 10 years or so, that you'd see these large retail-based pharmacies buying primary care entities to couple the patient experience or fit the patient need? Did you ever think you'd see that rapid movement of M and A in that space in particular?

Charlie Smith:

I didn't, although I was part, in the '80s, I was part of a large multispecialty clinic that was acquired by a healthcare system. So I saw the trend early on, but then it was mostly hospitals buying practices. I would've never thought a Walgreens or a CVS or a traditionally PBM type of business buying out practices or newly developed corporations buying out entities. It's phenomenal though to see the pace that has happened, again, beyond health systems and hospitals buying practices, the more corporate practice. I think of CVS and Walgreens, even though they're in healthcare, but more of a corporate type of practice of medicine, that pace has been phenomenal. I would've never predicted it.

Brian Urban:

It's quite unbelievable. I think you and Aon now, you see all these different chess moves across the marketplace. I feel like at the level that you're at and all of the clients that you face, the partners that you're with, you see all these big chess moves happening. So it's probably an interesting perspective for you to look back on that and see it now.

Charlie Smith:

Yeah, and be cautiously optimistic that maybe if there are on one big system, that there could be better data sharing, less fragmentation, so cautiously optimistic that with the right applications if you have someone who owns every stage of the delivery system that perhaps that will reduce the fragmentation and there will be more investment in making sure every touch point from the consumer is addressed and connected to everything else that's going on. So cautiously optimistic.

Brian Urban:

I am right there with you, Charlie, because I think this is going to spur more innovation. I hope it spurs more open walls and partnerships that can stem from this. So I think societal fissures can close and people can get what they need across the healthcare experience. So I want to take a look into the future, Charlie, in a couple ways. I want to take a look at the Chief Medical Officer role and Aon, the impact you all are going to be making over the next few years. So let's start with the Chief Medical Officer role. We've been talking about this a lot, the evolution of and what you've experienced through having this title yourself. What's the next arc you think the Chief Medical Officers will play relative to developing new healthcare innovations?

Charlie Smith:

I think we've probably addressed most of them. It really is identifying what's coming and how do we prepare for it. Again, I think of gene therapies. We have employers asking to say, "As we move some of the gene therapies from the really extremely rare diseases to some that are a little bit more common like sickle cell, is going to be more people impacted?" Then you have to look at ... Historically, we thought of gene therapies as being a one-time cure. You implant the gene, they're fixed. Now, there's some of the newer things in the pipeline we're realizing we don't know. Maybe after three to five years it may stop working and do you give another treatment?

So there's a lot of focus on that predictability, what's coming, help them partner with it, is it something we should be covering, number one, is it a one-time treatment or is it potential for more? How do you budget for those things, and how do you identify people that may be candidates today to help put some predictability to budgets for that employer? I look at the same thing with cancer treatments. You look at the pipeline, there's 60 to 90 treatments in the pipeline. Costs are supposed to go up 9% to 12% every year through '26 because of the new cancer treatments. Again, looking at an employer's population, are they older and have a heavier cancer burden to where that's going to be even a bigger impact or are they a young, service-related company that has a lot of turnover, they may not feel that?

So I think that whole thing of predictability, what's coming and how to apply it to a population or give an employer and prepare them for that, I think, I want to say it's a new direction, but increasingly more of a focus of a medical officer and a consultant to really help people prepare for what's coming.

Brian Urban:

I love it. That's very helpful to look down the road and see what's going to be needed from this role ongoing. Let's look at Aon. Aon's done so many interesting things the last decade, last five years. We mentioned the health equity and affordability tool that's been running for a little while now, but what's the next few years look like for Aon? What's going to be some of the biggest contributions you all think you'll have across the healthcare ecosystem?

Charlie Smith:

I think they're, again, twofold. One, continually updating our understanding of what's there and what's coming, so every solution around every condition, every population need, and we do keep an active inventory, usually updated every six months to a year. Diabetes as an example, what are all the point solution vendor opportunities? What are the health plans doing? What are their impacts? So to help employers understand, "You have a given need, we want to do something, here are all the opportunities." So I think that is going to be a growing important part because we do see more point solutions coming out, and not all of them are going to be here for the long haul. Some of them, it sound good, they look like the shiny new object, but they're really not going to drive change. So you have to be constantly updated what's happening and are they continue their investment to improve health? That's number one.

Number two is, what do we see needs that really are not being met? For any given condition, maybe there are some good point solutions out there, but it's not a good comprehensive package. So one of the things AI is increasingly invested in is bringing solutions to market, which could be organically building something we feel is necessary or it could be that you need to put two or three solutions together and build an integration to have an end-to-end solution because when think about clinical conditions, you should be addressing prevention, risk reduction, and then the treatment.

Well, many of the solutions out there address just one. So you may need to put two or three together and then build integration, data flow, patient experience across them. So we're increasingly focusing our attention on what are those solutions that address the continuum of the patient needs. Is it out there or do we need to work with solutions organically, inorganically and bring that to the market?

Brian Urban:

That is extremely insightful, Dr. Smith. I think a lot of the viewpoint on large consultant firms, large brokerage firms are, "Hey, they're going to help me with that front end piece that you mentioned." Just being able to prepare for risk, prepare for healthcare spend shifts, but having the full end-to-end and maybe integrating new datasets, new views into an employer or employee's life that's going to help better address the needs they have, it goes beyond that. So it is great to be able to understand that end-to-end is really where Aon is and is going to continue to go. So extremely, extremely insightful. I got to tell you, this has been a great conversation, Dr. Smith. So I thank you so much for being able to take some time out of your day and join us on our little show here.

Charlie Smith:

Thank you, Brian. Appreciate the dialogue. Very good.

Brian Urban:

It's been a lot of fun, and for more exciting insights and experts, please visit us at finthrive.com.