Marketing Challenges in Advance Care Planning, with Scott Brown

October 20, 2021
PRODUCED BY POLLY YAKOVICH

Scott Brown is the Co-founder, President, and CEO of ADVault. He is also the co-editor of the HL7 CDA® R2 Implementation Guide: Personal Advance Care Plan Document, Release 1 Standard for Trial Use and a reviewer of the HL7 CDA® R2 Implementation Guide: C-CDA R2.1 Revised Templates for Advance Directives, Release 1 Standard for Trial Use. Prior to co-founding ADVault, Scott was an international corporate and securities attorney practicing in Paris, France and Dallas, Texas. He earned his undergraduate degree with distinction, graduating Phi Beta Kappa from the University of Oklahoma, and he earned his Juris Doctor degree from Tulane Law School.

What you’ll learn about in this episode:

  • How Scott and his team navigate the complexities of the healthcare industry, and how they identified a need within healthcare that wasn't being served
  • Why healthcare providers haven't been talking about advance care planning, and why Scott is motivated to improve systems and connect people with advance care services
  • What intense marketing challenges Scott and ADVault have faced, and the steps they have taken to overcome these unique obstacles
  • Why one of the major challenges has been getting the attention of the people at the top of large medical provider companies who have the power to affect change
  • How the global pandemic has accelerated progress in informing healthcare providers and consumers of the importance of advance care planning
  • What advice Scott has for organizations new to the healthcare technology space
  • Why the outbreak of the pandemic has highlighted the many ways in which our healthcare systems are struggling and were unprepared for crisis

Resources:

Additional resources:  

Show Transcription:

Intro: Welcome to A Brave New Podcast, the podcast all about how brave entrepreneurial companies are unlocking their business potential using inbound marketing. Here is your marketing expert and host, Polly Yakovich.

Polly Yakovich: Welcome back to A Brave New Podcast. I am so excited to have a good friend, and to be very honest with you, a client of ours, Scott Brown with me today. He is the president and CEO at ADVault. He's going to tell you all about what that means, co-founder, he'll tell you all about the journey. He has probably one of the more impressive LinkedIn profile pics I've ever seen. And so we'll have to link his LinkedIn for you in the show notes, but Scott, thank you so much for joining me. Welcome to the podcast.

Scott Brown: No, it's my pleasure. Thank you for inviting me to join you.

Polly Yakovich: So 80 volt is a very, very cool company and I'm not just saying that because you're our client, but your product is a really incredible thing. And one of the reasons I really wanted to talk to you is we're in this time of incredible healthcare innovation, particularly coming out of the pandemic. And everyone is rushing towards these digital, virtual solutions for patients, but you have a 15 year company that's been doing that for quite some time. So I want to hear ... tell us a little bit about ADVault, how that happened, how you started it, why, all of that. Give us the high level there.

Scott Brown: Yeah, sure. So ADVault, the AD stands for advanced directives vault, the company started in 2007. And to answer your question, my career path really didn't lead me to build ADVault at all. Prior to doing this, I was an international mergers and acquisitions and securities lawyer.

Polly Yakovich: Yeah, crazy.

Scott Brown: I was licensed in New York. I lived in France for a number of years. I was here with a big law firm in Texas in the early 2000s. I had no background in health law in particular, no background in wills, trusts and estates, which are the kinds of people that do these advanced directives, which are documents that help people direct medical personnel to treat them a certain way or who makes decisions for them if they can't communicate themselves. So I was running along happily in my law practice.

Scott Brown: And I have a grandmother that grew up during the Oklahoma Dust Bowl and strong woman. And just really lived through some hard times and unfortunately, she spent about the last 30 years of her life in a nursing home. And she went through all the terrible things that old people go through in a nursing home, multiple strokes, dementia, what we call the dwindling.

Polly Yakovich: Yeah.

Scott Brown: It caused her a lot of stress in our family because my mother used to say, well, she has a do not resuscitate order. And I would say, well, no one will let her get there.

Polly Yakovich: Yeah.

Scott Brown: And so we didn't know who made decisions for he. We didn't know that we could make decisions for her. So when she passed away, we looked around and my mother unfortunately has multiple sclerosis. And we realized that she was going to go through the same thing and this was 15 years ago. And we figured there had to be a better way than these documents that had been existing for, I don't know, 40 years and were just terrible and legalistic and nobody understood them and nobody had them. When we started looking around, we said, there has to be a better way. And there was a [crosstalk 00:03:32]

Polly Yakovich: You're going to carry around a piece of paper with you and hopes you need it?

Scott Brown: Yeah. Yeah. Or even at the time, people were talking about using a memory stick or something. And nobody knows what's on it, nobody wants to go looking for it.

Polly Yakovich: Yeah.

Scott Brown: Hospitals aren't going to let you plug that into their computer, so there had to be a better way. And we looked around and the more we looked around, the more we realized there wasn't a better place. So we decided to build it. And that's what we've been doing since 2007.

Polly Yakovich: That's crazy. In your experience, you've probably seen a lot of other healthcare innovations come and go. How do you see healthcare innovation happen? Does it typically start with seeing a hole in services? Does it come out of a personal story like yours? Is it about addressing the marketplace and what it needs? I mean, healthcare in the U.S. is so complicated.

Scott Brown: It is, it is. And to be honest, sometimes I'm not sure how healthcare innovation happens, because healthcare is hard and it is complicated. I think there are very many passionate, very intelligent people that are trying to improve our healthcare system and the care that we give to patients. In our own case, obviously we saw a hole and we saw a need that wasn't being filled. And quite frankly, the technology wasn't even really there to solve it.

Polly Yakovich: Yeah.

Scott Brown: But all the statistics and research pointed to the need for a scalable technology solution around advanced care planning.

Polly Yakovich: Yeah.

Scott Brown: We figured out the addressable market as we went along. We're still figuring it out with the help of folks like you.

Polly Yakovich: Aww.

Scott Brown: So for us, it was finding the need. We knew we saw the need first because it just didn't exist. And it wasn't anybody that was trying. They weren't being successful and so we did just a mountain of research about why. What was the need? But you're right, healthcare is very complicated. And what's interesting about healthcare is what motivates and brings a return on investment to one stakeholder in healthcare is completely different from what brings an ROI to a different stakeholder.

Polly Yakovich: Yeah.

Scott Brown: And you have to discover how all of those things work together to improve the system as a whole. And so that's what we work to do. We tried to find a way that serves [inaudible 00:05:45] three major stakeholders in healthcare. You have the P, obviously the patient is at the center. They should be at the center all the time. And their caregivers and their loved ones and there's that. Then you have the just army of extraordinary people that are providing services to these people and trying to provide them care and medical interventions and things that they want. And they want the best for their patients. And then of course that has to get paid for somehow.

Polly Yakovich: Yeah.

Scott Brown: So whether you're looking at ... it's not a debate, whether you're looking at a government payer, or you're looking at a private health insurance plan, you have to serve that stakeholder as well. And so that's what we've tried to do is to, is to really look at all of those stakeholders, look at all of those target, I guess, markets or customers or users and give them each a solution that works for them.

Polly Yakovich: Yeah. What are some of the challenges that you faced in building a new health care technology, particularly when you think about the last 15 years, how much the technology landscape has changed. Did you go about and build something first and then try and sell it? Or did you pitch your idea to people to get ...

Scott Brown: Right. No. So some of the challenges we faced were challenges that face, I think, every technology developer. Others are specific to the healthcare industry and still others were very specific to ADVault and our niche in the healthcare industry. So for example, when we started our work, cloud computing was only just beginning, storing things in the cloud.

Polly Yakovich: Yeah.

Scott Brown: And healthcare data exchange was bad then. It's still notoriously bad today. We don't exchange data in healthcare seamlessly and freely, even the way we do in financial transactions. You can go to an ATM anywhere in the world, put your card in, and they know what your balance is and you can withdraw cash. You can't do that in healthcare. Sometimes systems inside the same hospital system don't even talk to each other. So those are the kinds of technology challenges, the data exchange, the cloud, computing, security, those kinds of things that every technology developer faces.

Scott Brown: But I think being in the healthcare industry adds another layer.

Polly Yakovich: Yeah.

Scott Brown: Both healthcare providers and healthcare payers who are our primary customers that pay for our service, because our consumer facing platform, my directives is free. So we make our money off of healthcare payers and healthcare providers. And so by nature, each of those groups are resistant to change and risk averse.

Polly Yakovich: Yeah.

Scott Brown: For healthcare providers, think about going into your doctor's office. They have their established clinical workloads and they are not fans of disruption. They like the way they do things, don't want them to change.

Polly Yakovich: Yeah.

Scott Brown: And insurance companies don't like taking risks, whether it's on technology or anything else. So we're constantly having to fight those battles for change, but then you really get into the very specific challenge of what we do, which is advanced care planning. So prior to COVID-19 [crosstalk 00:08:40]

Polly Yakovich: Someone no one want to think about even [crosstalk 00:08:44] Yeah.

Scott Brown: Yeah, the world ignored advanced care planning. It was something that was reserved for our oldest and our frailest and our sickest members of our society. And healthcare providers didn't want to talk about advanced care planning because death is the ultimate adversary. That's what they're trained to do, to defeat death. And healthcare payers didn't want to talk about advanced care planning or offer it to their members because they're afraid of being seen as encouraging early demise in order to save healthcare costs. Remember the death panels comment?

Polly Yakovich: Yeah.

Scott Brown: Sarah Palin?

Polly Yakovich: Yep.

Scott Brown: That one comment set the advanced care planning movement back decades, decades. And it's only just now with aging baby boomers that people are having the courage again to talk about it, realize this is a huge need. And so, because of what we do specifically, advanced care planning, it's a huge challenge. It's a challenge.

Polly Yakovich: A daunting business model that you tackled.

Scott Brown: It is. There are easier things that we could have decided to do, but what keeps us going, we're passionate. I mean, this matters.

Polly Yakovich: It's needed.

Scott Brown: It is, and when you think about the healthcare spend in our country, Medicare spends 25% of its annual budget on treatments in the last year of life of Medicare beneficiaries. And if you did the research and you asked people, you would find out that the overwhelming majority of those treatments and interventions may be unnecessarily and certainly unwanted.

Polly Yakovich: Yeah.

Scott Brown: And yet we're spending the money and we're having to do things ... And just the human stories that we've heard over 15 years, it's important what we do.

Polly Yakovich: Yeah.

Scott Brown: And I guess that's what keeps us going.

Polly Yakovich: Yeah. And that combination of unnecessary cost and effort, but also patients who just don't want that, but have no real way to communicate. I mean, I think people think they have a DNR and it covers more than it does.

Scott Brown: It does. Yeah, and the statistics show that somewhere between 18 to 36% of Americans have advanced care planning documents like advanced directives. It's a little higher when you get into the older demographic, which is normal as people approach it. Out of those documents that exists, 2% can be located and retrieved wherever and whenever they're needed for [crosstalk 00:11:06] So only 2%, and then the overwhelming majority of those documents you can find are terrible documents.

Polly Yakovich: Yeah.

Scott Brown: They were written by lawyers. People don't understand them.

Polly Yakovich: Yeah.

Scott Brown: They write conflicting answers or ambiguous answers, and they provide no actionable information for clinicians. So it's a failed system. And again, I go back to it, it's important and it has to be solved. So I think that's what keeps us going.

Polly Yakovich: How do you approached this marriage between I have this service, this product or service that people really need and they actually want? If you talk to my grandparents, for example, they really want people to know what they want [crosstalk 00:11:44] because they don't want interventions. And they've been through everything that healthcare has to offer them.

Scott Brown: Right.

Polly Yakovich: How do you bridge this gap between getting this to the people who need it, or who could benefit from it the most?

Scott Brown: So again, we have three ... it's a difficult model because we have three primary audiences, right?

Polly Yakovich: Yeah.

Scott Brown: We have the consumer, we have the patient, and then we have the healthcare provider who is providing services to them. Then we have the healthcare payer who's paying for those services. And we need to message to all three, so we evaluate our addressable markets. We look where the opportunities are really by listening to those customers, constantly reading in industry research. And we participate in industry associations that meet the needs, not just one stakeholder group for just the payers, for example, but everyone. So we look at things like National Hospice and Palliative Care Organization who's a great supporter of our work. And so they're working in the long-term care, but we also look at industry organizations like AHIP, which is America's health insurance plans that represent many of the payers.

Scott Brown: We look at consumer groups. We listen to the people that are out in the community, whether it's AARP who we've worked with in the past, or whether it's community and county level organizations that are just trying to educate people and make them more health literate.

Polly Yakovich: Yeah.

Scott Brown: And we see what resonates with them. And then we try to address that in our solutions and in our messaging, making our tools easier, making them more seamless, making them more secure, being able to be that middleman that talks between all of them, who talks between the consumers that are at the center, the payers on one side and the providers on the other. We want to be, that exchange of information about what the goals and preferences and priorities of that patients and their caregivers are.

Polly Yakovich: Yeah.

Scott Brown: And that's what we focus on every day.

Polly Yakovich: It's tough because it seems like you have to be direct to consumer on the patient side to help educate and to raise awareness and to hear from them what they want and need. But really from a business perspective, you have to get your product into the systems that can deliver it.

Scott Brown: That's right. Yeah, it is.

Polly Yakovich: And the healthcare system in the U.S. has so many disparate systems for delivery, even if you get into a payer, you have all the providers that are having the real-time conversations in the room. It's such a multi layered marketing challenge.

Scott Brown: It is. It's a fascinating problem to try to solve. For a long time we looked at that going to the consumer, but direct to consumer marketing and healthcare is not the easiest path.

Polly Yakovich: No.

Scott Brown: And I think that's because in the United States, traditionally people are passive.

Polly Yakovich: Yeah.

Scott Brown: There are people that are more active in their healthcare and will be proactive about staying healthy and exercising and eating right. But when you look around, it's really a small percentage of the population. And so in the United States, we wait for doctors to tell us what to do. They wait for there to be a problem. I'm generalizing, which is a terrible thing to do. But in many cases, we wait for something to go wrong. We go to the doctor, they tell us what to do to fix it, and we fixed it.

Polly Yakovich: Yeah.

Scott Brown: We don't focus on solutions as consumers.

Polly Yakovich: Yeah.

Scott Brown: So we used to say there's not enough money for Superbowl ads in the world to get all the consumers to do advanced care planning. And they're busy with so many other things. Although we support groups like National Health Care decisions and others who are doing that direct to consumer education and advocacy, we focus on the payers and the providers, because it turns out that if your doctor tells you to do something, you usually do it.

Polly Yakovich: Yeah.

Scott Brown: And so if we can get the providers to tell you to go create an advanced care plan if you don't have one, then you probably will. And so they can control your behavior.

Polly Yakovich: Yeah.

Scott Brown: And then the payers, they can control you as their member and control you [inaudible 00:15:53]. They can influence you and encourage you and get you to do something because you're a member and they incentivize you.

Polly Yakovich: Yeah.

Scott Brown: And it turns out that those payers are in their provider networks, so they can also affect their behavior. So we really try to focus on bringing our solutions to the healthcare payers and the health care providers and let them bring them to the consumer.

Polly Yakovich: I think that's smart. The hard thing too about being a consumer of healthcare in the U.S. is that it's expensive. And so you avoid it at all costs. We don't really have a preventive, proactive relationship with our doctor, because it costs us time away from our jobs. Even if we're lucky, we might have to pay for a day off, for our childcare. And then the visit itself has expenses and all the follow-up, whether it's a prescription or anything else. It would be tough.

Scott Brown: Yeah, it is. It's tough in the first place. And then again, you go into the advanced care planning, which has traditionally at least been reserved for advanced illness and critical care and terminal illness and end of life and all these things. And those are just things that people don't think about on their own and probably don't want to.

Polly Yakovich: Yeah.

Scott Brown: So it has to be ... Number one, we have to take the stigma away from it. And the way to do that is to get providers to operate up. And then even just the healthcare payers that's just part of, for example ... again, I've mentioned that there are 75 million baby boomers that are aging into Medicare. Well, part of your annual wellness visit, or your welcome to Medicare visit can be, Hey, do you have an advanced care plan? You don't, okay. Go over to this place, or you do. Well, okay, we don't know where it is. So go to this place, create one. It doesn't have to be us. There are a number of solutions out there, but you just have to normalize it. And that's what ... you do that through the payers and the providers.

Polly Yakovich: How do you prioritize and tackle the marketing challenges? Because you can't cover everyone. From a marketing and even from a branding perspective, how do you prioritize?

Scott Brown: So we look for willing participants. That's the easiest way to say it.

Polly Yakovich: Yeah.

Scott Brown: So we look for healthcare systems that are traditionally more open to technology solutions and innovation, that are progressive in the way they're using digital tools that exist already, and that really want to apply those tools. Not only to make their patients healthier, but to provide them better care.

Polly Yakovich: Yeah.

Scott Brown: And when we talk about better care, we have our own definition of it, which is to provide them goal [inaudible 00:18:23] care.

Polly Yakovich: Yeah.

Scott Brown: If you're providing me great care, but it's not according to my values and my wishes, then you're not providing me good care.

Polly Yakovich: Yeah.

Scott Brown: And so we look for those partners on the healthcare side. On the payer side, it's the same thing. The reality is that we focus on the Medicare beneficiary age because that is where the healthcare spend is. And end of life, the costs of healthcare, as far as services go, it's like an [inaudible 00:18:54] you. It's very high when you're born.

Polly Yakovich: Yeah.

Scott Brown: And as you reach your twenties and thirties, it's very low, goes down, it's very low. And then it comes back up as you start to go towards the end of life. And at the end of life, it's very high. And it turns out that 2.1 million out of 2.5 million people that die in the United States every year are Medicare beneficiaries. So that's a natural demographic for us to try to help. And so we aim for healthcare providers and healthcare payers that are serving that demographic. And then again, we look for innovators. We look for people that don't just talk the talk, they walk the walk.

Polly Yakovich: Yeah.

Scott Brown: And really want to use technology to improve care and not just care for healthy people, not just care for people as they start to get sick, but again, for the sickest and frailest members of our society. The ones that really want to help them, they're helping them by listening to what they want and trying as best they can to provide care and interventions that can coordinate with what they want and don't want. And we're just trying to help.

Polly Yakovich: That's great. We were chatting before we officially started recording about some of the sales challenges for new healthcare technology. And one of the things that you brought up, I thought it was really unique, but probably experienced by lots of people, is that big systems, big payers always want to do a pilot, and how challenging that is literally just to get paid.

Scott Brown: Yeah.

Polly Yakovich: And big enough systems want to do a pilot for their pilot. Talk a little bit about why pilots are challenging and what some of the sales challenges are of getting even an incredible healthcare technology into systems.

Scott Brown: Yeah. We have a saying in healthcare, death by pilot, and that's what happens because speaking generally, again, we're marketing to healthcare organizations in the United States that are so big.

Polly Yakovich: Yeah.

Scott Brown: How do you get the attention of the decision-makers in one organization or another? So how do you reach the decision makers of a hospital system with 50 facilities, and engage them to the point where they're actually able to move on something? And our health insurance companies have revenues in the billions of dollars, tens of billions every year.

Polly Yakovich: Yeah.

Scott Brown: How do you get the attention of a one person or the one group who believes that advanced care planning technology will make a significant, or I would say even a measurable improvement in either the services they're providing to their members or to their bottom line? [crosstalk 00:21:36]

Polly Yakovich: Well, and even if they believe in it, you really have to get them to champion it internally, which is an additional challenge.

Scott Brown: That's right. You always need a business champion. And again, as I was saying, in the United States, most people don't look for solutions in healthcare. They wait for a doctor to tell them what to do. So how do you get those people to start moving? How do you get those people to do something so that even if you get that healthcare organization who is forward-thinking and innovative, and want to use technology and wants to reach out to their patients or that Medicare advantage plan who realizes the value of advanced care planning as a service to their members and as a cost avoidance measure and quality improvement measure, and they decide, okay, we're going to do this, how do you get the people that they're trying to reach to actually engage and do something?

Scott Brown: So those are the challenges. And then there this natural tendency in healthcare, and we've seen it on both sides, both healthcare payers and providers, to want to pilot. If you have 5 million people in your Medicare advantage plans, you're not going to roll out something to all 5 million people at once. You're going to start with the region and that's just the way they do things.

Polly Yakovich: Yeah.

Scott Brown: So how do you survive, and how do you get paid, and how do you convince them that there's value in what you're doing, and survive and thrive at the same time?

Polly Yakovich: Yeah. What's the answer for whether it's a pilot or whether ... because I think even with a product like yours, and I'm sure a lot of people have similar challenges with their health care, technology, product, service, app, et cetera, have you found that it takes a lot of assistance to your customer to sell it internally to their providers and to patients and educate? Have you found that an important part of the package you provide them is teaching them how to roll it out, get people on board, talk about it?

Scott Brown: It is, it is. There are so many competing priorities in healthcare today that, again, you have to get on their radar. One of the things that we've done to improve our marketing and our sales is we have experts that have gone out and looked at the published peer reviewed research and just statistical, not only on the benefit side, but on the cost side. For example, I don't know, we'll say a home health agency. So there's more and more care that is shifting out of the hospitals and into that these days. So there are agencies that are trying to create that care. So what is the benefit to them of adding advanced care planning to their business model, to what they're doing, the services that they're offering?

Scott Brown: And they're so busy, they don't have time to go out and build this model for themselves. So we have literally gone and built the model. And we've gone to agencies and said, okay, tell us how big your patient panel is, give us a few data points. And we can tell you by doing advanced care planning, how you're going to ... of course, you're going to improve the care that you're providing to those patients you're serving. But just as importantly, for you as a business, you're going to get a preferred provider status with both the payers and the acute care, the hospitals. When they discharge people, they're going to discharge them to you and not to somebody else, because you're doing advanced care planning and you're doing it right.

Scott Brown: So we've built a financial model so that we can actually go out and show these home health agencies, if you do this, and if you do it right, again, here's how it's going to affect your bottom line and make you stronger in the market. And we've done that for every segment. So we have, whether it's home health agencies, whether it's long-term post-acute care or whether it's the hospital setting. And you have to build those tools. And you're right, you have to go out and tell them, okay, this is how it's supposed to work.

Polly Yakovich: Yeah.

Scott Brown: And on the payer side, here are the things you should say, and here are the things you shouldn't say.

Polly Yakovich: Yeah.

Scott Brown: And unfortunately, pilot is one of those words, because when you say it's a pilot, people say, well, this is good. It's going to end at some point, so why should I participate in the first place?

Polly Yakovich: Yeah.

Scott Brown: So you have to [inaudible 00:25:41] over some of those things.

Polly Yakovich: Yeah.

Scott Brown: But we're finding more and more courage in both the providers and especially the healthcare payers. And more willingness to take a look at how just getting your members to express their wishes in who makes decisions for them, if they can't communicate with their care team.

Polly Yakovich: Yeah.

Scott Brown: That alone brings so much value and so much Goodwill, and they're becoming courageous and they're starting to do it.

Polly Yakovich: That's great. I have two trains of thought that are in opposite directions. My first is, do you think that COVID has given people more courage? Or do you think COVID has really changed the game for either a new healthcare technologies as patients really had to make big digital transformation leaps over the last couple of years? Or just an acknowledgement of what kind of end of life decisions are being made? Or do you think that that hasn't been a factor for you?

Scott Brown: No, I think it's been a huge factor. So for 15 years we've been focused on getting a patient's voice into the medical record.

Polly Yakovich: Yeah.

Scott Brown: We think it improves clinical decision making, it improves outcomes, it improves satisfaction, it reduces costs. There's a thousand reasons to do this. But before the pandemic, emergency care planning and advanced care planning were either overcomplicated or they were neglected entirely inside certain health systems. So the pandemic showed everyone in healthcare that a person, a young, relatively healthy person could go from being generally healthy to being on a ventilator in 24 to 48 hours.

Polly Yakovich: Yeah.

Scott Brown: So you have these patients on ventilators, they can't communicate with their medical personnel.

Polly Yakovich: Yeah.

Scott Brown: They don't have family with them because you can't have visitors, because they're afraid of contagion.

Polly Yakovich: Yep.

Scott Brown: The hospitals aren't taking paper documents because they're afraid of contagion. So all of a sudden, digital emergency, care planning and digital advanced care planning takes on a whole new sense of urgency.

Polly Yakovich: Yeah.

Scott Brown: And the ability to create these documents, these types of documents digitally, and then to be able to share them across all points of care seamlessly and securely in the last 18 months, it's become critical to what I think is the provision of high-quality, high-value care. And you've seen studies that have come out that because of that specific thing, we're seeing a transformation, I guess, an accelerated transformation to digital documents over paper forms. I think there was an Accenture study that came out very recently that the hospital respondents said ... I think it something like 58% said that they had a preference for digital documents. That goes for advanced care planning documents, just like it does admissions forms.

Polly Yakovich: Yeah.

Scott Brown: And so we're seeing our customers at every segment, so acute care, long-term care, home health, hospice, everywhere. They're moving to digital documents and particularly digital advanced care plans. So it's accelerated interest and made advanced care planning ... it's put it at the forefront in people's minds.

Polly Yakovich: Yeah.

Scott Brown: And we've seen it, we see it every day.

Polly Yakovich: The other question I had that's a little bit different, but was just along the same track of talking about how you're getting into systems. What would you say either on the marketing or sales side? And I know they're different, but overlap has been one thing you can point to that's just really moved the needle in the last year.

Scott Brown: So I would say there are two things, and it's not just ... Over the last year, it is COVID. COVID-19, it has really opened people's eyes, both on the consumer side. We have people reaching out and doing advanced care planning that I honestly believe never would have thought of doing it before.

Polly Yakovich: Yeah.

Scott Brown: But on the institutional side, on the enterprise side, so on the healthcare providers and payers, they also are seeing that there is not only a need for high quality advanced care planning, being able to share these documents and seamlessly and so on, but a desire. And I think that that desire is a longer-term trend. I'd mentioned it earlier. We have 75 million baby boomers.

Polly Yakovich: Yeah.

Scott Brown: And there are, I think, 10,000 turning 65 every day. And they're aging into Medicare and they're living longer. And just because they're living longer, doesn't mean they're living healthier. They're more prone to accidents and illness. And so I believe that longer term trend as the baby boomer's aging is driving this. It's driving a lot of the courage, what I would call courage and willingness to do this. They changed every phase of consumerism throughout their lives, whether [crosstalk 00:30:38] it was they just started having babies, they changed Gerber baby food and disposable diapers. They changed the mortgage industry. They changed all these things. Well, guess what? There are 75 million of them and they're growing older and they're getting sick and they're having accidents. That doesn't mean they're going to be quiet. They want to say in their care just like they've had a say in everything else.

Polly Yakovich: Yeah.

Scott Brown: And I think that that is finally empowering. It's empowering healthcare leaders, both on the payer and provider, but also in the regulatory space, in the political space to really think about what this means for the healthcare system. We have a Medicare system that's in crisis, that's going to be overloaded. We have more money going out than is coming in, our utilization model isn't sustainable. Something has to change.

Polly Yakovich: Yeah.

Scott Brown: And the reality is that we're spending a great deal of money at the end of life on things that doctors don't want to do. They wouldn't want done to them. They don't want to do to a family member. The patient doesn't want it. The caregivers don't want it, but they have to do it to practice defensive medicine. And because they don't have any instructions to the contrary that they can do something else.

Polly Yakovich: Yeah.

Scott Brown: And it's not sustainable. And I think that the baby boomers are giving leaders across the care continuum, across this healthcare world ecosystem that we have the courage to actually do something different. And realize that advanced care planning is something that's responsible. It's something that can help everyone, every stakeholder in the system.

Polly Yakovich: Yeah. Yeah. It seems like everyone is, I would say, thrilled and curious about what kind of healthcare innovations, technology, opportunities there are going to be over the next few years, right? It feels like so many more players are entering the marketplace every day. And in part encouraged by the digital transformation of just the last couple of years and all of the other things and technology becoming easier to enter into. What advice would you give to some of these new healthcare innovations entering the market?

Scott Brown: I think there are several pieces of advice.

Polly Yakovich: Is it the more the merrier or ...

Scott Brown: I don't think so. I don't think that it is. It's not a case of if you build it, they will come.

Polly Yakovich: Yeah.

Scott Brown: We have seen people come from other high technology industries. And again, I know high-tech pretty well. That's part of what I did in my prior life as a lawyer. And they think that they can translate something that they've done in a consumer retail industry into healthcare, and they're just going to build something. And then everybody will naturally come and that's not the way healthcare works. I think you need to find your need. I think you need to find that need first and you need to figure out how you're going to solve a problem and not be a solution looking for a problem. That's probably the biggest thing.

Polly Yakovich: That's a great piece of advice.

Scott Brown: I think you need to find patient investors because again, healthcare is not really a direct to consumer market. There are some things that are tracking wearable fitness [crosstalk 00:33:59]

Polly Yakovich: Yeah, wellness kinds of things. Yeah.

Scott Brown: Yeah. There's some things like that, that you could sell, and you sell those to consumers. But healthcare as an industry is not always a direct to consumer industry. And many investors don't understand that, and they're looking for the quick return. Healthcare as long, healthcare is hard. Sales cycles are tremendously long, ridiculously long. And some things that work that we've even seen in our own product development. Some things that work in retail and consumer segments of the market don't work in healthcare.

Polly Yakovich: Yeah.

Scott Brown: And so it's tough. You have to find your need and you have to find your passion. You just have to stick with it and you have to stay and wait. One of the challenges we have faced in marketing is trying to compete against what we call the next bright, shiny object.

Polly Yakovich: Yeah.

Scott Brown: So a few years ago it was fitness tracker, Fitbits and Garmin watches and Apple watch and all these things in tracking. And the year after that, it was Blockchain and everything and secure data through Blockchain. And now it's artificial intelligence. Those are all really, really sexy technologies, they're awesome. Advanced care planning, death and dying is not sexy.

Polly Yakovich: Yeah.

Scott Brown: And so how do you get the attention away from the bright, shiny object and get it over to what is an actual solution? I think it's very difficult to stay on your path. And that's what I would tell people to do is just find your path, find your solution, be willing to flex, be willing to pivot, all those little terms that people use [crosstalk 00:35:41] to adapt to the market, because you're going to learn along the way.

Polly Yakovich: Yeah, and it's going to change a lot.

Scott Brown: It will. It continues to change very rapidly. And we see even in our products, as you find that new [inaudible 00:35:53] or you find that something that you thought was great, as far as a product, as far as a marketing message, as far as something ... you have to be willing to pivot when you find out you're wrong, [crosstalk 00:36:02] because you're going to find out you're wrong.

Polly Yakovich: I have a big question that you're going to hate, but I'm just curious how you would respond to it. And this is a nightmare question that no one can answer. How's that for a set up?

Scott Brown: Uh-oh. Uh-oh.

Polly Yakovich: But where do you see the market going? What's something on the horizon that you're watching? Or that you think is going to happen in healthcare in the next year or so? I think we all knew it if we've worked in and around healthcare, but it's taking the scales off our eyes a little bit about how broken our system is, just almost as a foundational component.

Scott Brown: Yeah. Very early in our company history, and I've been trying to find it. I've been trying to dig it out of my archives. We've worked with government regulators at a state level, at a federal level, agencies. And I remember there's an email out there somewhere after the SARS pandemic or whatever that we had, SARS. And I wrote to someone and I said, it's not a question of if we will have another one of these, it's when.

Polly Yakovich: Yeah.

Scott Brown: And when that happens ... and I've got to find it because it's the best email I ever wrote, because it's exactly what happened with COVID. It's exactly what happened. And we have all these people that you're talking about. There are hospitals now up in the north Pacific, Northwest by you all that there are reports that they're having to ration care.

Polly Yakovich: Yeah.

Scott Brown: What? Why? Why? We're not prepared and some of those people, if they had an advanced care plan, they might have said, if I ever suffer massive respiratory failure ... I'm 92 years old, I've lived a good life.

Polly Yakovich: Yeah.

Scott Brown: You don't need to keep me on a ventilator, use it for somebody. And that's a terrible thing to think about, but it's true.

Polly Yakovich: Yeah.

Scott Brown: And so we don't do that. And we said at the time everybody should be doing this to be prepared for the next one, and we didn't do it. And now COVID-19 has changed all of that. But yeah, it's a terrible ... So for us, for ADVault, I think our path is straight, our path is pretty clear. Again, in the United States alone, we have 75 million baby boomers that are aging into Medicare and the system is unsustainable. And research shows that you can achieve quality improvements and you can achieve spending reductions if advanced care planning is carried out at scale and carried out well. And that can only happen using technology.

Polly Yakovich: Yeah.

Scott Brown: As we're probably not very objective, but we think that ADVault is probably the best position, digital health company focused on advanced care planning. So our specific market outlook is pretty positive.

Polly Yakovich: Yeah.

Scott Brown: I think we're seeing a lot of movement in the market. From a broader healthcare and maybe really a healthcare IT perspective, I think we're focused on two market trends that we're seeing leading into the horizon. First, if you're in healthcare IT, you know that consumers are demanding not only to have access to their healthcare data, but they also want to be able to add documents and data to their medical record.

Polly Yakovich: Yeah.

Scott Brown: So in particular advanced care planning documents, but not just that, mental health directives, birth plans, nutrition plans. These are all patient generated data that patients want to get into their metal record and share with their medical team. And I think that you're going to see that more and more, not just patient access to data, but the ability for patients to add something to their medical record.

Polly Yakovich: Yeah.

Scott Brown: And I think that those kinds of patients [inaudible 00:39:32] documents like advanced directives are a great example of that. They're not the only example. Social determinants of health information is an even better example. So I see that accelerating. The second trend that I think we're seeing is really with the payers. So, like I said, you have healthcare plans, especially Medicare advantage plans that participate. CMS has a center for Medicare and Medicaid innovation, and they have a program they call their value based insurance design models, or VDIB models. And you're seeing health, Medicare advantage plans that are participating in VDIB. They're experiencing an increased focused on providing advanced care planning for the Medicare beneficiaries. And even more importantly on reporting the metrics that demonstrate their progress in their efforts.

Scott Brown: So again, the only way to do that and effectively comply with the program requirements is to leverage health IT. And so we're seeing health plans increasingly willing to do that, and even to encourage and incentivize the providers and their network to use tools. We have a tool, we have a clinician facing tool called MyDirectives for clinicians. And so we're seeing health plans that are not only working with their members to get them advanced care planning documents, but that are actually licensing our tools so that the providers in their network, specifically their care delivery organizations and vendors that are working with their chronically ill members, to facilitate the creation of a seamless and secure sharing of advanced care planning documents [crosstalk 00:40:59] for the beneficiary. So I think that that's going to accelerate again. It's due to a baby boomer population that drives change in every phase of life that they go through.

Polly Yakovich: Yeah, that's great. Wow. This has been so rich. My mind is so full. I've made many notes of things I need to explore further. I always ask people this last question that's more personal and I love to hear the answers. What would you say is your super power?

Scott Brown: My wife.

Polly Yakovich: Aww. Oh, my God.

Scott Brown: My wife, seriously, seriously. My wife, she's so smart. She's so intuitive. She is hard when she needs to be, and she just has an amazingly high level of integrity and instinct for what's right and wrong. And again, innovation and change in healthcare is hard.

Polly Yakovich: Yeah.

Scott Brown: And it is especially hard when you're trying to digitize a 40 year old process that involves advanced illness and death. So if I hadn't had my wife by my side for 15 years to encourage and keep us going, I probably would've given up a long time ago.

Polly Yakovich: Wow.

Scott Brown: But other than that, I'm not sure I have any super powers. Maybe it's a lack of ego. Anyone who's worked with me has hear me say this literally 100,000 times. I don't need to be right.

Polly Yakovich: Yeah.

Scott Brown: I just want to find the right answer.

Polly Yakovich: Yeah.

Scott Brown: So I tried to do what I think any good company leader does. I've recruited and hired a great team by sharing information with them and try to be transparent, so that they can develop and be empowered. And then I just get out of their way and let them do their jobs. And we celebrate the successes more than we criticize the failures, and we're all in it together. And we all realize everyone at this company, at ADVault realizes what we're doing is massively important. So the best thing I can do is put the right people in the position to succeed and then just get out of the way.

Polly Yakovich: Yeah. Yeah. Well, that is incredible. Thank you so much for sharing your wisdom. I really appreciate you sharing your time. I hope everyone listening had a few nuggets that they took away and encouragement about Scott's journey. And tell us where we can figure out what you're talking about, follow you, keep up with you.

Scott Brown: So if you're looking for our consumer facing platform, it's mydirectives.com. It's free, always has been free, always will be free [crosstalk 00:43:27]

Polly Yakovich: Go fill out your advanced care plan.

Scott Brown: That's right.

Polly Yakovich: Yeah.

Scott Brown: Create a digital advanced care plan, or if you already have something uploaded, just upload it and store it and share it with your family and friends and loved ones. If you're on the enterprise side, you can go to my directives.com. If you're a health care payer provider, you're probably more interested in going to advaultinc.com, which is where we talk about all of our tools that are available to healthcare providers and our reporting that's available to help the payers. You can follow me on LinkedIn, ADVault. I would love for people to go follow ADVault on LinkedIn. And of course, Facebook and Twitter. My Twitter handle is L_Scott_Brown. And I always have to tell people that I don't represent the views of the company because I'll get in trouble. Sometimes I'm a little more provocative than the trouble may be, but if you like soccer or football, yeah, as they call it everywhere outside of the United States, I'm a huge soccer/football fan. And I talk about things like football, but also a lot of health care and hospice and palliative care advocacy and things like that.

Polly Yakovich: Quite the blend.

Scott Brown: It is. It is. It's a rough sport.

Polly Yakovich: I will link all those in the show notes as well. Scott, thank you so much. I can't thank you enough for coming and sharing with us.

Scott Brown: My pleasure. Have a wonderful afternoon and talk to you soon.

Polly Yakovich: Thank you.

Outro: Thanks for listening to this episode of A Brave New Podcast. Go to a bravenew.com for more resources and advice. If you enjoyed this episode, show us some love by subscribing rating and reviewing A Brave New Podcast wherever you listen to your podcasts.

 

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