E4: the OVERcast - Interview with Dr. Jhaimy Ferndandez
Host David S. Williams III and guest Dr. Jhaimy Fernandez
Dr. Jhaimy Fernandez, Associate Medical Director of Digital Health at AltaMed, the largest FQHC, federally qualified Health Center in the United States, drops absolute gems of wisdom for startup founders in this episode of the OVERcast. Learn how to find the right spaces in healthcare to offer your solution for the highest impact. Find champions for digital solutions for both clinicians and patients. Avoid the obstacles that the industry presents by focusing on the green areas of growth and lack of support. Those are just a few things you will learn in this episode of the OVERcast.
Transcript (AI-generated)
David S. Williams III (00:00):
Hello everyone, and welcome to the first video recorded episode of The Overcast, the official podcast of overlap, where we help entrepreneurs overcome the obstacles in starting and growing a business in healthcare. It is my pleasure to introduce our special guest. It is Dr. Jamie Fernandez, who is the Associate Medical Director of Digital Health at AltaMed, the largest FQHC, federally qualified Health Center in the United States, serving more than 700,000 patients. Dr. Jamie, welcome to the Overcast.
Dr. Jhaimy Fernandez (00:48):
Thank you, David, and thank you. Why don't you tell us a little bit more about Overlap? Does.
David S. Williams III (00:53):
Absolutely. Overlap is a virtual accelerator that helps startup founders who are interested in building digital health, healthcare services, and life sciences companies from the ground up, get them started and get them to the point where they're viable. And that means getting you through in startup language, a minimally viable product, but really helping you understand how to bring your idea, your dream, your concept to life. Learn more@overlap.co. And if you're a startup founder, you can sign up and participate in our webinar series where we go through a proven process that can help you bring your startup to success. Thank you for bringing that up, and thank you for joining us here on the Overcast, Dr. Jamie.
Dr. Jhaimy Fernandez (01:47):
You're welcome. It's been quite a pleasure,
David S. Williams III (01:49):
But one of the things that we're really excited about and having Dr. Jamie here, is to talk about how entrepreneurs and industry can work together to forward health.
Dr. Jhaimy Fernandez (02:02):
Well, thank you, David. Very happy to be here. I have to say, once I learned that you were starting overlap, I was not surprised, especially coming to UCLA. So I am A-U-C-L-A alumni, went to undergrad here, and I'll tell you a little bit about the story, how I got into digital health as a physician,
David S. Williams III (02:23):
Please,
Dr. Jhaimy Fernandez (02:23):
And then a little bit of some advice for your builders in this first cohort.
David S. Williams III (02:30):
That's great. Tell us more about you. Tell me
Dr. Jhaimy Fernandez (02:33):
More. So I actually am an LA native, grew up here in la, went to UCLA for undergrad, then went to Vermont for medical school. I as an LA girl, completely froze, could not wait to come back, graduated in 2021, so a year after the pandemic, and did my family medicine residency at Harbor UCLA.
(02:54)
So Harbor, UCLA is a partnership between, this is LA County Hospital serving LA County residents. Anyone, never refuses anyone, and a partnership with UCLA. So UCLA clinicians come and are the ones that teach us during COVID. Like I said, my whole family lives in LA Hispanic community. My dad is one of seven. We're very, very close. We actually had many other Latino families in LA where my uncle, who was a 53-year-old construction worker at the time, was considered an essential worker, had to continue to work while everyone was coming in back at home. And I remember when I was in medical school, I get a call from him, which was really rare because he's always busy working. And I answer because it's 10:00 PM in our time, right? 7:00 PM here in la and he's kind of like coughing. He thinks I might be sick, I don't know. But my mom told me to call you and medical student at that point, and I hear him talking. He sounds okay, but everything, we don't really know what COVID is like at that point. And then I get something in my, so I get a thought saying, I really want to see him on video. So I was like, can we switch to FaceTime? So we switched to FaceTime, and at that point is when I see him and I see his face is tired,
(04:14)
I see he's actually struggling to take a breath. And that's when I know even as a fourth year medical student that it's time for him to go to the hospital. And I tell him, we need to call 9 1 1. Now.
David S. Williams III (04:29):
Really, you saw from that video that a nine one one call would be necessary just from video on the phone,
Dr. Jhaimy Fernandez (04:40):
Just from video. And I bring this story up because COVID was such a transformational crisis for medicine in more ways than one. Yes, through medical innovation, through the stealth development or vaccine, but also in aiding doctors to make diagnoses faster with the aid of technology.
(05:07)
So across the country, doctors had to switch from in-person consults to video consults. And in the beginning in family medicine, we thought, oh no, we're going to lose a lot of patients. It's not going to be the same. It's not the same sort of validity. Am I going to be able to make those clinical decisions? But what we also saw is those communities that were able to transfer to not only audio, but video, were actually able to meet their patients where they were and get those diagnosis and those transfers earlier. Unfortunately, in LA County, that wasn't the case.
David S. Williams III (05:40):
So
Dr. Jhaimy Fernandez (05:40):
LA County did not have the capability to go to video visits as soon as they could. So a lot of, we actually saw some really, really big mortality with our black and brown population here in la, not getting to the hospital fast enough and not getting the care that they needed and higher mortality rates. And I want to start off this podcast with the story because not only did that was a personal story for me and my family, and unfortunately my uncle was one of those many underserved populations that did get to the hospital still too late and still didn't make it. But when I started residency, I started with that color, with that point of view of medicine. So when I started my first day of family medicine at Harbor, UCLA, the county hospital that served or didn't serve so many of our population in a time of need, the first question I asked is, how can I do a video visit?
David S. Williams III (06:36):
And what was the response?
Dr. Jhaimy Fernandez (06:38):
Our response was, this is in 2021. So year after the pandemic saying, oh, well, we have the technology now to do the video visits, but in family medicine, they were like, but you know what? Our patients don't really like it. I was really okay. And then they're like, yeah, we don't really use it, so let's just do in-person visits. So I was like, okay, my intern year, I go with that. I was like, okay. And in back of my head, I was like, I dunno if that's true. So I kept asking my patients, do you know we can do telemedicine? My patients that hadn't been in clinic for a whole year? And they were like, oh, you can do that? Yeah, I can see you on video. Oh, I didn't know you could do that. And I started for a second year. I was like, okay, maybe this telemedicine thing could work. Of course, COVID in the back of my mind, seeing the literature knowing it did, but then going to that cultural change of almost that shock. I think as a healthcare institution around the country, everyone experienced, it wasn't just ideal to harbor where we transferred everybody to video. There wasn't a lot of training. What there was kind of an ad hoc, people just did their best practices, but when everybody came back in person, everybody's like, oh, it's sigh of relief.
(07:44)
Right? Clinicians are happy to get back. Patients are like, okay, I can see my doctor again. But what we don't realize when we serve the safety net, a lot of our patients actually live in that pandemic constraint
David S. Williams III (08:00):
Every day.
Dr. Jhaimy Fernandez (08:01):
Every day.
David S. Williams III (08:02):
That's right. In survival mode is what I talk about it and think, why is it that we're only changing when there's this massive pandemic, this massive health crisis? Why can't we continue on and use these new tools, if you will, to service people who didn't have access to healthcare before? I'll stop my soapbox, so please continue.
Dr. Jhaimy Fernandez (08:26):
So yeah, so the story continues, right? Because at Harbor UCLA is very fortunate that Dr. Anus Shabbat and Dr. Alejandro Casillas from UCLA started a digital navigator program where they recognized this in digital inequity and digital health equity after the pandemic was seen as a super social determinant of health,
David S. Williams III (08:49):
Super social determinant of health.
Dr. Jhaimy Fernandez (08:51):
Yes. Because digital access really is the key to other services, transportation, food services, internet, just basic health information that our patients need. So with this digital navigator program, they hired a group of community health workers, train them to help our patients sign up for the healthcare portal, something so simple, a technology that has been around way before
Dr. Jhaimy Fernandez (09:15):
The decades.
Dr. Jhaimy Fernandez (09:15):
Decades, exactly right. Our Latino population, they're the number one users of social media. So WhatsApp, Facebook, on Facebook, use WhatsApp to communicate with family members of abroad, but somehow how haven't been able to get them on the healthcare portal.
David S. Williams III (09:37):
So without continuing on the soapbox, one of the things that I wanted to ask you though was as you got more people on board the health portal, did you also see them wanting to engage with more digital tools and have access to more of their health information as well as their doctors and other healthcare team members?
Dr. Jhaimy Fernandez (09:58):
That is a great point. So being the curious person I am and being the family medicine doctor who we wear multiple hats. So let me just take a pause here and say, family medicine physicians is your primary care doctor. So we see kids, we can deliver babies, we can see adults, we see older adults, we see the entire family. We also work in the hospital, so we can work in the ed, we can see patients in clinic. We see the whole healthcare system. So a lot of times people say, oh, you only see kids, you only see adults. No, no, no, no, no. I see everyone. So we have a really keen understanding of the healthcare system from the beginning, even from our training. So from that, I think that gave me some really unique expertise as a clinician, really being able to see those hurdles that my patients felt by seeing a patient who in the ed, who was like, oh, I just run out of my medication. So I'm in the ed. I'm like, oh my goodness, this should not be happening. No, no. A simple solution. So as in my third year of residency, I was like, you know what? Forget it. I'm just going to start advocating really prescribing digital health products, the way I prescribe medication,
David S. Williams III (11:06):
Prescribing digital health products, the way that I prescribe medications.
Dr. Jhaimy Fernandez (11:12):
So my clinic interaction and started after I learned the medicine. My first two years got really comfortable with the medicine doctor side, was practicing my motivational interviews. I started transitioning and using those really critical 10 minutes of patient clinic time that we have to introduce digital health.
David S. Williams III (11:34):
Awesome.
Dr. Jhaimy Fernandez (11:34):
It started with, and I get really excited about this because it was fun for me. So a patient comes in, I do my cripple thing, and then I say, you know what? Your blood pressure, I really want to know what your blood pressure is like at home. Why don't you send me a message on WhatsApp? And my patients were like, doctor, wow, you're on WhatsApp. That's incredible. And I'm on my computer. Be like, yeah, yeah, yeah, of course. Aren't you? She's like, I use it every day.
David S. Williams III (12:00):
Right? Meeting patients where they are.
Dr. Jhaimy Fernandez (12:02):
Yes. And then I say, my WhatsApp is called the healthcare portal. Let me show you how to sign up. And at that point, my Latina patients don't even care what it's called. They just want to know. I get to communicate with my doctor.
David S. Williams III (12:15):
That is the key because so often in my experience, you're having to call into your doctor, you get put into the queue, you get swirled through the system, and you never get your doctor, and you may or may not get a return call, and so therefore you're kind of lost in the system. Whereas now you're talking about direct access.
Dr. Jhaimy Fernandez (12:40):
Exactly.
David S. Williams III (12:40):
Direct communication with my doctor.
Dr. Jhaimy Fernandez (12:42):
Exactly. The value add is directly coming from the doctor's mouth. The same way I prescribe medication, and I say, if I'm going to, for instance, new diabetics, Metformin, typical first line has really good cardiovascular benefits. I say, I want you to take one pill. If you get side effects, cut it in half, go three days. If you still don't get it, do this. But I do all these things to make sure you're successful. Why don't we do so with digital health?
Dr. Jhaimy Fernandez (13:06):
So
Dr. Jhaimy Fernandez (13:06):
What I did is I brought some premedical students who were super enthusiastic, and because I still have my doctor work to do, as I was writing my note, I had my student help this person sign up for the healthcare portal. So by the end, they had a message for me. We were sending messages back and forth that went on for a month, two months. Then I said, what else can I do? I said, I was doing video visits, can I prescribe video visits? So I said, you know what? I want to see how you take your blood pressure at home. I don't really trust your numbers. Are you doing it correctly? So then I would say, let me show you how to do, it's really easy. I'm going to send you a link from IHR to your phone right now. Now you take your phone out, press the link and just sideways. Technology is not made for all languages. So the link for my Spanish speaking patients, it would come up on their phone in English, even if they were Spanish speakers. So I often had to say, click the triangle.
David S. Williams III (13:59):
So as an app developer, I have been accused of doing the same thing. I can fall on the sword here,
Dr. Jhaimy Fernandez (14:07):
But something so basic. But again, I had my pre-medical student help them through digital navigator. They got in, they saw their success, they left. Oh, okay, I can do it here. I'm going to do it at home next week. Worked out three months later. Can I do this with continuous glucose monitors?
David S. Williams III (14:23):
Nice. Next step
Dr. Jhaimy Fernandez (14:24):
I did, and it worked out really well. Then I saw my patient's A1C go down. So what I started was a relationship with my patients that was like, huh, this doctor really cares about my health. She is teaching me how to use these new tools in ways I've never thought about before. My patients were telling me, I'm getting my husband on these apps. I'm inviting my husband to do continuous glucose monitors. Now. It wasn't, I'm only seeing my doctor here in one place. I'm seeing my doctor longitudinally,
David S. Williams III (14:54):
Right?
Dr. Jhaimy Fernandez (14:54):
Because my health happens
David S. Williams III (14:55):
And you're seeing them longitudinally.
Dr. Jhaimy Fernandez (14:57):
Exactly
David S. Williams III (14:57):
In between visits. And
Dr. Jhaimy Fernandez (14:59):
I'm getting the data in between visits. So the reason why I spent so much time explaining the story is because as a healthcare system, I think we've been very bifurcated. We had did this transition to digital health. We had a slingshot backwards, and we're like, oh, it didn't work. People don't like it. No, people did like it. We just never did the training. So I've been spending the last four years really massaging, figuring out what that training looks like and what it takes for doctors to actually receive technology in a way that's applicable in a way that we can get our patients to engage and utilize it.
David S. Williams III (15:37):
You have a formalized thesis then on the role that doctors should play in the adoption for themselves of digital health and for patients.
Dr. Jhaimy Fernandez (15:48):
Yes.
David S. Williams III (15:49):
Tell us a little bit about that thesis then. It sounds like that's where this story is leading.
Dr. Jhaimy Fernandez (15:53):
Yes. Yes. And within this story, I have those key aspects that I want these startup founders to know.
David S. Williams III (16:00):
Yes,
Dr. Jhaimy Fernandez (16:01):
Because you are selling right to a healthcare system, your buyer, but your user is the clinician before the patient. Oftentimes, startup founders come to me and be like, no, I'm designing for the patient. I'm designing for the patient. I'm like, okay, who's going to tell the patient about it?
David S. Williams III (16:19):
That's right. Who's doing the intro?
Dr. Jhaimy Fernandez (16:21):
Who's doing the intro,
David S. Williams III (16:21):
The training.
Dr. Jhaimy Fernandez (16:22):
And a lot of times, your healthcare institution, if they're a grid healthcare institution, they're not in the picture because they're not performance primary care. It's still the person person interaction. And if you want to reach those underserved communities, you have to go to the doctor. Latino communities specifically. There's really two, three people you trust the most. Your priest, your doctor, and your mom.
David S. Williams III (16:48):
I don't think that's different around black, the priest part, your pastor. Your pastor, your pastor. But yes. Okay, keep going.
Dr. Jhaimy Fernandez (16:54):
Yeah. So I get really pumped up about it because if are like doctors, doctors are such a black box. SAR founders come to me, and then the first thing I said, they roll their eyes. They're like, oh my God. They're like, doctors are the hardest.
David S. Williams III (17:08):
Oh, that's my bias. Doctors are the hardest. But I think what you're encouraging me to recognize is that there seems to be a new generation of doctors now who are embracing these digital technology tools, not only for themselves, but certainly on behalf of patients. And so it's up to the innovators, the startup founders, to try to make that world happen, create the environment, create the tools that are able to be used by the clinicians as well as the patients, and don't focus necessarily on one or the other unless it truly is only for one or the other. I would say that is from a business startup founder as a business perspective, you also want to say if you're going to build something for the consumers, then you're building for them to not only use it, but probably pay for it, because that's a direct consumer model where the consumer user is the right focus. But if you want to have something where you are working with health systems, you're working with doctors, you're working with others to distribute and to introduce your solution to consumers as users, then you have to balance those needs and that process in your design.
(18:22)
So that's my message from when I'm hearing from you, I have made those mistakes. We talk about an overlap, which is overcoming obstacles. There you go. You're talking about a real obstacle. You have to include the doctor in your thinking.
Dr. Jhaimy Fernandez (18:35):
You have to.
David S. Williams III (18:36):
So this is how you overcome obstacles.
Dr. Jhaimy Fernandez (18:40):
Yes. Yes. And I want to say Rick, because overlap, you're helping seed ideas come from the seed, from the community, which I love. And your founders are really dedicated to helping these underserved communities because that market for digital health is untouched. The penetration is minimal. And the reason why is because people say it's so hard. There's a need, but it's so hard. What is so hard about it? I see about 30 patients a day. People cannot get an appointment for me to see me for 60 days out. There's a need. There's a market. We just haven't penetrated it. And I'm giving you that key. That could be the driver. And I have an example. For instance, ambient ai, ambient scribing, right? It's been geared out at academic health centers. Edd, like you mentioned, is the largest FQHG in the country. We have multiple service lines. We have our inclusive care for the elderly. We have over 80 clinics. That includes family medicine, a woman's health, pediatrics, inclusive care for the elderly, our PACE program.
David S. Williams III (19:55):
One of my old clients.
Dr. Jhaimy Fernandez (19:56):
There you go. Yes. But we really started as a community clinic in 1969, our visionary founder, Costa Rocha. It started around the AIDS pandemic when Latino people with AIDS and HIV weren't getting care and said, no, that's not right. We should be able to receive the care. Soon, expanded from that point of view, saying, how can we give people the care that they need? And from there, have been able to ride every wave of healthcare to be a very resilient health system, to meet patients where they are and build that trust for them. So now people come to AltaMed for their dentist, for their kids, and when they're pregnant, when they're elderly, we have vans that can go to people's homes, pick them up, come back in. We are really serving the family. That's one of the, that I've really loved about AltaMed, and I'm so excited that I get to work you there because now we're reaching a new level, right? AI and Digital Health. In the past year, we've been hearing about ambient AI scribing that's helping physicians take notes. So a physician walks into a patient room, I walk into my patient room, I bring my phone. The first thing I do is ask my patient for consent. Is it okay if I use my phone to record? It'll help me with a note. I haven't had one patient say no.
(21:18)
I start the recording. It records. I get to see one-on-one with the patient. It's been really great. When we first rolled out this technology, we went partnered with a bridge, which is actually one of the higher end ambient AI companies, and also very pricey. But ultimately, because of our size and our weight, we were able to partner with California Healthcare Foundation,
David S. Williams III (21:40):
Which one of our sponsors, our main sponsor, yes. Thank you. CHCF.
Dr. Jhaimy Fernandez (21:44):
Yes. Who also sponsored our pilot of a bridge in fq, hc, the very first one pilot. And the first time we launched, out of the 300 providers, 200 providers signed up. And now
David S. Williams III (22:04):
That's fantastic. I mean, it's amazing how if you approach the needs of the clinician of the doctor in this case with what they need, the adoption can be quick and the benefits can be conferred quickly too. Talk about that. Talk about what using that technology for you changed in how you were approaching your time with the patient in this time. I've got a number of questions here, but let's jump on this right now.
Dr. Jhaimy Fernandez (22:29):
So it's been a marvelous partnership. Dr. Eric Lee, who's the director of Clinical Informatics, and our team has been really instrumental in making sure, first of all, ambient AI was prepared to meet our patients. So we serve majority of non-English speaking patients. So that was a priority. We were not going to partner with any institution that didn't do a really excellent job at that and abridge us an excellent job at translating Spanish speakers, our Russian and Mandarin or other really common languages. And also meeting. So that was a patient need. Now meeting the clinician need federally qualified health centers. As you know, there's a shortage of primary care doctors across the country,
(23:10)
And the amount of very, very sick patients we see is just astronomical. And that note writing is such a burden on clinical time. So being able to delegate that to the scribe has been really a game changer. Now, when I come into my patient room, I'm here present with my patient. It has made all the difference for them. We are still looking at the preliminary data, see how it's affected our patient satisfaction scores. But just giving you anecdotal stories from clinicians that we've had, it is just been really, really marvelous. We have Spanish speaking clinicians who English is their own second language to say, I spent extra time just trying to formulate my thoughts in English on the note, and now I don't have to
David S. Williams III (23:57):
Have do that. Now,
Dr. Jhaimy Fernandez (23:58):
Clinicians that say I leave at 5:00 PM and I get to have dinner, right with my family,
David S. Williams III (24:04):
We haven't even gotten into the entire squeeze of doctors based on the economics of healthcare. That wasn't even on my list of questions for you, but that's matter of fact. I don't want to go down that rabbit hole. But it does make one really important point, which is the present in time and the moment with your patient, and how much more quality that interaction, or what higher quality that interaction has as a result of having just an AI-based scribe.
Dr. Jhaimy Fernandez (24:37):
Exactly. Exactly. And the reason why I bring this up, it's not saying every founder should build a new AI scribe. I think that market is being really saturated at this point. But what I'm bringing it up is, what I've noticed is that, again, bringing up that critical 10, 15 minute appointment time that I have with my patient is again transformed. The first thing that I do when I say, hi, I'm Dr. Fernandez, I confirm this is my patient name. So the third thing I do is ask 'em if I can use subscribe and ask for consent. I am bringing up digital health at the start of our conversation, and my patients have said yes. So if you look at Ed sees about 700,000 patients a year. Wow. Two thirds of our physicians signed up to utilize the product in the first week. We're still looking at the data, how many physicians continue to use it, but roughly, let's say majority of our clinicians, that means majority of our clinicians serve the majority of our patients. So majority of our patients are experiencing ai, right? Experiencing ai, experiencing the effect and the benefits of ai, which I think is just so powerful.
(25:48)
So when we think about new AI technologies, a bridge is obviously ambient listening. That's been a problem, a very, very clear problem that we've had for a very long period, long time, and we're seeing the effects of being able to address those. But there are many other problems in healthcare.
David S. Williams III (26:05):
Indeed, indeed. It's interesting. My interaction with AltaMed has been, they were my first major major clients, and I worked in pace, so on the senior care side. And the major issue was could we get our seniors, our PACE participants into the center enough? Because PACE is a day center centered program, and the idea around PACE is that if you can see that patient in that day center and then give them a number of tools and obviously all of these things, but you allow them to have their pt, their primary care
Dr. Jhaimy Fernandez (26:40):
Dentist,
David S. Williams III (26:41):
Eating and dentist, all of those things can in the center plus the social interaction with other seniors, you can change trajectory because these people are frail. They're nursing home eligible. You can change their trajectory. You can keep them at the highest level of function longer, which is outstanding. The issue was false people don't fall in the day center, they fall at home. So what they wanted Care three to do was come in here and talk about your innovation model. What does that look like for extending into the home, what we're doing into the center,
(27:16)
Right? The idea is can you work with family caregivers or home care providers who are professionals and see what we can do to help people not fall at home? Because we're doing all of the structural things that we can do in center around their care, their physical therapy and occupational therapy, making sure that they can stand on their own or use their tools like your Walker appropriately. What they were finding is that their home environment had debris in the way. So that means you're going to fall if you don't have a clean house. So how can you impact that setting? And so Care Three brought a solution. We said, why don't we create an action plan that's derivative of your care plan, but it really focuses on the things that happen at home. Exactly. And it engages the family caregivers. And we did two things. One, we obviously had the app technology that we could then bring on board, but we did training to your earlier point with the clinicians, with the interdisciplinary team members, to then onboard and train the family caregivers or the home care providers so that they would know how to use the technology, and the seniors knew that it was being used. So the texting back and forth between the family caregiver and the doctor or the nutritionist or the dietician or the PT also could be done as part of that home-based interaction.
Dr. Jhaimy Fernandez (28:38):
So you were using my theory before I had it.
David S. Williams III (28:40):
I was, but I'm a lot older than you, and so I have had a lot more time to develop these theories and get them into practice. But AltaMed has been innovative in the past. It's not that they weren't, but I want to point something out and I want to say something because you won't, which is how you got into the position in the first place. Dr. Jamie, she told me this story and I was floored because I know the CEO of Ed and it was something that just doesn't happen. So you were at a conference and you were speaking
Dr. Jhaimy Fernandez (29:10):
At UCLA, actually
David S. Williams III (29:11):
At UCLA, and you were speaking, and you were talking about your thesis. You were talking about the story of how you were introduced to digital technologies and impact they can have on patients as a clinician, and as the story goes, he was in the audience and came up to you afterwards and offered you a job on the spot, right? Right. I have that right? Correct.
Dr. Jhaimy Fernandez (29:35):
Well, we came up to each other. Okay,
David S. Williams III (29:37):
Fair enough.
Dr. Jhaimy Fernandez (29:40):
But yes, and I think the reason why it worked out so well is so AltaMed has an extraordinary IT department. We are an epic shop, and last year was awarded the Epic 10 stars.
David S. Williams III (29:58):
Oh, wow.
Dr. Jhaimy Fernandez (29:58):
Which ranks us as the top 3% of all Epic users in the country. So our president had just come back from Epic and seen really that
David S. Williams III (30:11):
Part I didn't know.
Dr. Jhaimy Fernandez (30:12):
Yeah. The effect and the power that we can have with technology. And I am just so honored to be part of this team because when you're talking about bringing top notch technology to a federally qualified health center, it's such a privilege. It really is. And to be part of this team that's just so determined on bringing the same level of technology as let's say, an academic health center like a Cedars or UCLA would have to our patients. And that's really the vision of AltaMed is really providing quality care at no exception,
David S. Williams III (30:45):
Which ties into what we're doing at Overlap. And this is a key thing that I think needs to be said, and that is this. A lot of the technologies in the Silicon Valley model that get developed by startup founders are built for the affluent. They're called early adopters because they can afford to be. What we're trying to do at overlap is to flip that over on its head and say, are there technologies that can be developed? Companies be built by helping people who don't typically get technology built for them? And what you are talking about as a champion is that you have seen how this can work in real time.
Dr. Jhaimy Fernandez (31:31):
Oh, yeah.
David S. Williams III (31:32):
You can see how you've developed not only a thesis, but you've put it to practice and continue to do that every day. And that's something that's powerful for people to just see and understand this is real, and there are going to be more and more Dr. Jamie disciples among the provider ranks. And that is my next question, which is how do you get more doctors, more clinicians in general across different practices of therapy and care to use technology so they can be champions and provide that higher quality, not just high quality already at high quality, but it's higher quality, get that benefit that technology confers to the patient? How do you build up that group of disciples of Dr.
Dr. Jhaimy Fernandez (32:21):
Jamie? Oh my goodness, David, it seems like exactly what my other hats. So part of being a family medicine doctor is that we are working the care team. So working with others is very natural. I can't get my job done without it. So especially at Harbor UCLA, we have an extraordinary program of really high-end clinicians who will work with county. We go to the ends of Earth to get something done, and it's just been so passionate. But part of our model was having a summer urban health fellowship program with a pipeline program for passionate students from underserved community, high school, college medical student and residents who mentor each other and try to get them to CHE doctors. And we have had many doctors actually at Harper we're like, yeah, I was a SUP student before.
David S. Williams III (33:14):
Oh, wow.
Dr. Jhaimy Fernandez (33:14):
Yeah. So super powerful. So one of the things I did had the opportunity to do a residency, which was just natural because we had high school students and college students in our clinic all the time shadowing us. And I was like, can I teach you to be a digital navigator? Learn to about digital health? And I realized that a lot of the students I was teaching, there were even UCLA students who were doing our program, they themselves, because coming from underserved committees, they themselves had never done a telemedicine visit. So I was teaching them a tool. They were like, oh, I can do this with my family. And then I started thinking, I was like, oh my goodness, how many more just in medical education, our clinicians themselves haven't experienced it. How are you supposed to do this? So of course, I kept tagging that and tagging it. I realized it was a lot more than I knew. And a lot of even the academic healthcare professions in my clinic hadn't done a video visit. I was teaching 'em how to do it.
(34:11)
Then I was like, have you guys done a continuous glucose monitor? Oh, no, no, no, we don't do that. I was like, why not? Let's try it. And they're very open to try. And of course, the younger generation was even more. They're like, yeah, I'll wear it for two weeks. They became experts in it. So what I started building was a curriculum to teach younger students, premedical students about digital health. Literally just the basics. And now that turned into a concentration. So I spent a whole year doing this. So I actually graduated with a concentration in digital health equity, the first one
David S. Williams III (34:44):
That had to be new. I was going to say that had to be new.
Dr. Jhaimy Fernandez (34:47):
Had to be new. And that's all because after COVID, the American Board of Family Medicine decided we're not really preparing our family medicine doctors to meet the need of the future. So they got rid of six months of our curriculum and just made it empty and was like, okay, programs, figure it
Dr. Jhaimy Fernandez (35:05):
Out.
Dr. Jhaimy Fernandez (35:06):
Really. What do you want to teach your students? So I kind of rose my head and was like, I want to learn this. And my really great mentor, Dr. Teresa Navarre was like, okay, Jamie, let's figure it out. So I was able to do this digital health work during residency, became the digital equity leader of my clinic, went to conferences and was bringing information to family medicine.
David S. Williams III (35:27):
I was at the conferences. That's where we met. That's you met. That's right.
Dr. Jhaimy Fernandez (35:31):
Yeah. And you saw my students.
David S. Williams III (35:32):
I did. I did. And it's interesting because it was like the world was opening up to a new generation of people who understood that this is where everything was going. When I talked to a lot of the same folks, a lot of your colleagues who are in the program, I was floored at one, how committed
Dr. Jhaimy Fernandez (35:55):
Aren't they so cool?
David S. Williams III (35:56):
Committed? They were to make this. Oh yeah, are you kidding me? I was like, I got to follow you on Instagram, and I got to make sure I'm understanding what different things that you're talking about. This is a movement. It is. And I believe it needs to progress. And so that's why I'm so interested in wanting to having you on the overcast here. So then I'm checking my
Dr. Jhaimy Fernandez (36:17):
Questions while you do, lemme tell you one story.
David S. Williams III (36:20):
Oh yeah, please.
Dr. Jhaimy Fernandez (36:21):
So this turned into a nonprofit with my co-founder, Gigi Mcg, who's also a family medicine doctor at just graduated from Kaiser Santa Rosa. And we've really created a system where we bring premedical students in, teach them the basics about digital health. They end up being subject matter experts in family medicine of this, even if it's just the basics, right? Yes. Not as much as the technology or business person would know, but more than what a typical family medicine education provides you more than doctors would know. So that's valuable. Now, this person acts as that almost tech guru of the clinic
(36:57)
And then acts at that in-between person who can understand the problems that clinicians are having, the problems that patients are having, and know how to talk to the IT department to get those things done. This group of individuals, and I specifically love working with premedical medical students, residents, because you're in a position where your career trajectory is only going to grow. So everybody asked me, right? Oh, Jamie, did you ever think of not being a doctor? Why did you have to do that now? We said, no, I had to be a doctor. And I tell all the students that I work with, no, you still have to go to medical school. And my students are always on the med school track. One of 'em just got accepted to medical school last month, which I'm super proud of. One of my other students is in the pathway. She started her own healthcare startup. Wow. Yeah. Got a contract with HealthNet, really excited as part of the LAR a accelerator. So you can see how we're just, this InBetween section is so valuable. And a lot of my students, let's say they're young, inexperienced, whatever, their college degree, a lot of 'em have master's. They are serving as really key consultants to startups in the seed field.
David S. Williams III (38:11):
Wonderful.
Dr. Jhaimy Fernandez (38:11):
Very, very key. Very valuable. And now I've transferred this curriculum into elective for family medicine residents. I had my first family medicine resident from Alto Medcom do the elective with me. I teach them basics. Now he's starting to draw back Kaiser once he graduates, but he's like, Jamie, I approach my patients differently now. I start seeing medical problems as having digital health solutions. And he's like, what jobs can I have right now? Only the jobs that are available are family medicine. Doctors see patients every single day. No, that is not the future. What doctors want. That is not the future. And we are at a shortage of primary care doctors and primary care doctors address about 80% of patients' needs, but only about 15% of the population of doctors that were graduating. Where AI comes into place. And why I think every AI founder should know a family medicine doctor is that you need to partner with the family medicine doctor to learn how to amplify their skillset to manage populations.
David S. Williams III (39:16):
Absolutely. Say that one more time.
Dr. Jhaimy Fernandez (39:20):
Each founder and overlap needs to partner with a family medicine doctor because they understand the life cycle of a patient to be able to amplify their effect to populations.
David S. Williams III (39:34):
That's the key.
Dr. Jhaimy Fernandez (39:35):
That really is the key, and that is what our healthcare system needs. Medical education is changing rapidly, but not at the rate that you need it.
David S. Williams III (39:45):
Take note. But that does transition me into the startup world, the ecosystem, the founders. You said something and put in air quotes earlier, which was, I hear everybody say healthcare is hard or doctors working with doctors is hard. In my experience, healthcare is hard from an industry perspective, dealing with innovation, dealing with technology in general. In general.
(40:18)
So we're talking about an environment that has been two things. One, resistance to technology, and two, partially because technology can sometimes work against medicine from a liability perspective. So these are some of the obstacles that I know founders face because I have faced them. What advice do you have for founders? Let me back up. One of the adages in digital health around the founder community and the startup community is you can get piloted to death by different healthcare organizations, health plans, large health systems, and so forth. And so one of the things that we're trying to do at overlap is help overcome those types of obstacles. You've already talked about scribe transcription around and using ai. Can you talk about other areas that you see that could be fertile for entrepreneurs to help in your practice and practices for other doctors who are like you, who embrace technology, what things should be gaining traction? We already know that telemedicine has traction. Can you talk about some areas where you see opportunity?
Dr. Jhaimy Fernandez (41:37):
Sure. So when we're looking at population management, we're thinking about a family medicine doctor that can do that. There is a lot of space in diabetes, diabetes care, chronic disease, self-management care. And I know that's something that you really specialize in as well. Absolutely. Right. It's longitudinal care, but being able to meet our patients where they are. So right now, right, AltaMed, we do a lot of weight loss.
David S. Williams III (42:02):
Oh, perfect.
Dr. Jhaimy Fernandez (42:02):
Right? Weight loss is a big, big, big industry right now. What I've found is that when I prescribe a weight loss medication on a patient, I want to see them in four weeks because I want to see what their side effects are if it's working, but guess what? I don't have availability to see a patient in four weeks.
David S. Williams III (42:23):
Are there copays also that for those patients that might come up in those four weeks?
Dr. Jhaimy Fernandez (42:28):
Yeah, some of them do. Yeah.
David S. Williams III (42:30):
Those
Dr. Jhaimy Fernandez (42:31):
Are barriers. Those are barriers, right? Obstacles. So access is a barrier. And where I think a lot of healthcare status go wrong is it's like, oh, that's okay. I'll go direct to consumer and I'll have just sell to them. But okay, that's fine for patients that can pay for it. But the patients that I work with, the market that is untouched is the patients that will not spend extra money because they don't have it.
David S. Williams III (42:53):
They're living in survival mode. Remember, this is what we're talking it as the crisis
Dr. Jhaimy Fernandez (42:59):
Every
David S. Williams III (42:59):
Day. We're always living in what others would say is crisis.
Dr. Jhaimy Fernandez (43:03):
Exactly. So I'm having to, instead of up titrating a in four weeks, I end up doing it in three months. And I'm like, oh my goodness, we're losing critical time. Right? So one of those movements that we're something we're trying to iDate at Ultima is how do we do a weight loss clinic and do some ad hoc? So ult, born out of COVID has a very, very robust virtual urgent care, which we call Ult Me now that actually competes with Teladoc Hims and hers, but it's part of our care network. So the reason why that's so powerful is that when I have a patient that's just got released from the ed and I'm like, oh my goodness, you went to the ed. Next time you have this thought, why don't you call one of my colleagues in AltaMed now? And they're like, what?
David S. Williams III (43:53):
I'm
Dr. Jhaimy Fernandez (43:53):
Like, let me give you the special number, and it's the number we have on our website. But everybody,
David S. Williams III (43:57):
ED is emergency department for those who are, for those founders who are listening. And we say, ed, a lot of people say, er, that's kind of the old language, if you will. It's the emergency department. Just wanted to just jump that in. But yes, going to emergency rather than urgent care, even locally. But now there's virtual urgent care that also, and I know this will change economics and access
Dr. Jhaimy Fernandez (44:21):
And access, and the reason I bring this up is because a lot of startup companies, it's really hard to penetrate. I get it. It's really hard. And even in AltaMed, we're very protective over patients because we value their trust. We have gained their trust, and we are very particular who we partner with, what their intentions are, because we want to make sure that we provide the best care. So I think in a lot of healthcare systems right now are in that build or buy situation and the argument to buy, I think the threshold to buy is getting larger because you're realizing if you are building a model based on data from X, Y, Z, that's not necessarily representative of our patients. Right.
David S. Williams III (45:07):
Right. That is interesting. So we're talking about the ability to use large language models that are typically, statistically speaking, dealing with the mean. Maybe we're talking one or two standard deviations from the mean, but you're serving a client base that are the two tails. Exactly. And that is something where those models are not representative of the experiences and inclusive of the experiences in which if AltaMed were to build its own model from its own data over time, it would be far more representative for people to use internally.
Dr. Jhaimy Fernandez (45:41):
Exactly. Exactly. So I feel like in this ecosystem with the new AI leaders, part of me is like, how can you help them build internally? And maybe it's not that you have all the answers on your new product, but it's what you bring is the expertise.
David S. Williams III (46:02):
So now we're talking about lived experience being something that's marketable, or if you will,
Dr. Jhaimy Fernandez (46:07):
Yes, but also your technical expertise. You have technical expertise. Building LLM, stratify do that, right? A lot of federally qualified health centers do not have a robust IT department. There's just not existent, right? So I'm talking about fractional expertise, lending your expertise to our institutions and being like, well, let me help you include this. Let me help you build that. And that is a value because we might not have the resources to pay you full time, but maybe here and there, if you can solve little problems here and there, and maybe we start, right? Because AI revolution, it's not singular. It really isn't. It's going to require that collaborate, radical collaboration
Dr. Jhaimy Fernandez (46:54):
And
Dr. Jhaimy Fernandez (46:54):
Healthcare systems specifically clinics know that they don't have that expertise. But I think the solutions that we're being offered right now is that, buy my suite, give me money. And I'm like, I can't give you everything because that's not what I need.
David S. Williams III (47:09):
Our investor base for most startups today, and it has been probably for the last decade, have been B2B SaaS super enterprise heavy, and in healthcare even more so because that's where the money is. If I can get a subscription every single month from a large health system, a health plan, and ed, I am winning.
(47:30)
I've reduced my investor's risk because now I have a cashflow that comes straight from a strong entity in the community. The issue that we're facing is that pressure on our side. What is interesting from what I'm hearing you saying is two things. One, understand the clinician's role in the patient's care. Two, understand population management. That can be helpful. And I'm putting domains here, of course three, we're talking about the longitudinal understanding of the patient experience for the clinician, but also for the patient. Because what you're saying is we're now getting to onboard them onto their portal. So not only can they message me back and forth for better access, but one of the things that portals also have is your longitudinal data for lab
Dr. Jhaimy Fernandez (48:15):
Tests. Exactly.
David S. Williams III (48:16):
Right. So at least I can see my own data, and as I learn more, as I go up the literacy curve ladder as a patient, I can be more engaged. So when you're talking about what do startups bring, you're now saying, can we help in these domains help that interaction between the patient and the clinician? And where in that life cycle, where in that process can we enhance? Because by doing so, we will hit that consumer and change their ability to manage themselves as well as make that time more efficient and effective for the doctor.
Dr. Jhaimy Fernandez (48:57):
AI is innovating our technology, but also innovating the way we can sell. Got
David S. Williams III (49:03):
It. Yeah. That's the message I want startups to hear, because there's also the second part, and you missed it, but you're making up for it right now. Our kickoff event, and one of the things that came out of our kickoff kickoff event was a panel that said, what is important for industry and how can startups help? But one of the things that came out, well, actually two of the things that came out that are important that you're really hitting on is this idea of understanding the experience. But the other one was the relationships with champions. Two things. The startup founders, the team needs to have champions, and they need to have good relationships, which means you have to understand their needs. What I'm asking you as a champion is how can we as founders identify who those champions are, and then who do you know? It's like how can we find more and more of those champions in these companies? Because they'll also give us the intel that you're giving here on the overcast, which is why you need to listen to Overcast. But that is gold. Having the person internally in these organizations who are willing to champion for you. Puja, Atal at Health Net is the Chief Health equity officer is a champion.
Dr. Jhaimy Fernandez (50:28):
She is,
David S. Williams III (50:28):
But she's also protective
Dr. Jhaimy Fernandez (50:31):
Exactly
David S. Williams III (50:32):
As well. And she's also a medical doctor, really cares about the patient experience. So how can we as founders find other champions in these organizations that we want to serve?
Dr. Jhaimy Fernandez (50:45):
The reason why you can't find them is because we don't have a medical ecosystem to build them. And the reason why I spend so much time talking about medical education is because that is where you need to go. AI is so new. Usually technology penetrates doctors. We're the last ones. The last ones. But if you could find a really great resident who is going to become a doctor, who are, healthcare institutions are creating new roles just like mine, straight out of residency, because they know that's needed, that person is valuable. So for these startup founders and overlap, you are at UCLA. I mean. That's right. That's right. You're in the ecosystem. And I think when it comes to building that relationship, I go in and I'm very curious, but I have a lot of my pre-medical medical student friends who will not go to a tech conference. I don't even know what they're talking about.
David S. Williams III (51:49):
Yeah. Wish they had that in their residency.
Dr. Jhaimy Fernandez (51:53):
No, and that's what Alma first does. So nonprofit, right? We build that kind of technology. But I think there's a sense of patience that has to come from both sides
(52:02)
Because, and as the earlier you get in your medical school path as a premed student, you're still learning, you know, don't know things. As a medical student, you're a little bit more resident, more as a clinician, practicing. Oh, I know it. And that's kind of like the mantra of the culture that's been set. And of course, it's always varied and you come here and there, but I think that if we start earlier on with the positions that are ready to absorb this technology, the learners, the residents, you're going to find that within one or two years when you are ready to scale, because it's going to take some time, let that partner, let that clinical champion go into their career, come into these spaces, keep providing that feedback, and we're building this together. We really are. And I think it's okay to be patient with our learners.
David S. Williams III (52:56):
That's great advice.
Dr. Jhaimy Fernandez (52:57):
It really is.
David S. Williams III (52:58):
I think that's a good thing to make relationships with residency programs. But then also, if you were to say, we met at conference, what conferences would be excellent to attend, where we might interact with more of these potential champions?
Dr. Jhaimy Fernandez (53:15):
So that is a great question because usually I end up going to tech conferences, and I'm the only, that's why I bring my posse, my group of students, and we all, were wearing purple. You'll see us and we become a presence of doctors, and we're asking these questions. And then they'll go up to the different booth and they'll be like, is this in Spanish? Is this this? And they'll thump tech companies. And you're just like, oh yeah, I can't even use this. I can't even use this. And they're quickly writing companies down and they're coming to me. They're like, Dr. Fernandez, nobody's really doing this.
David S. Williams III (53:48):
Interesting.
Dr. Jhaimy Fernandez (53:50):
And then I go to family medicine conferences. So last year I went to STFM, society and Teachers of Family Medicine. They had one session of AI and healthcare care. It was packed.
David S. Williams III (54:04):
I was going to say oversubscribed, I hope
Dr. Jhaimy Fernandez (54:06):
It was packed. And the presenters were academic based, but what they were sharing was about maybe a year or two less
David S. Williams III (54:16):
Kind of behind where
Dr. Jhaimy Fernandez (54:17):
It's not their fault, it from a different point of view, but it wasn't necessarily, it was more research based, wasn't necessarily meeting the applicable, what can I get from this session that I can use tomorrow? Right? Right. So this year, SDFM, American Academy of Family Medicines are actually asking for submissions.
David S. Williams III (54:40):
Interesting.
Dr. Jhaimy Fernandez (54:41):
For technology and digital health. So it's getting there. We're asking the questions and we're inviting people to come. I think don't know which tech companies will come. But then when you come, don't come in like, oh, let me solve your problems. Come in wanting to learn about family medicine. Because when a company comes and sounds like people will come and try to sell me a product every day, I'm like, I'm not even starting with the lens of I want to buy.
David S. Williams III (55:10):
Right?
Dr. Jhaimy Fernandez (55:11):
As a clinician, I'm not even in the position to buy. I don't control the budget. I don't do any of that. Right. An operator does that. So I understand you need that. But what I am in the position to do is help you explain that value proposition. And I think that translation is what a lot of a companies are coming in and are, at least for me, they're kind of appearing very flat and it just,
David S. Williams III (55:36):
Oh, no. It's a complete disconnect. Yeah, it's a complete
Dr. Jhaimy Fernandez (55:38):
Disconnect. Absolutely. It's a complete disconnect. And
David S. Williams III (55:41):
We're trained to go at you versus go with you. The whole idea is selling is saying, I have to sell this solution. I've got my pressures on the back end. I've got the things that say I have to reach these goals. So I'm walking in and I want to sell to you. But what you're saying is, and we're talking Dr. Jamie, but we're probably talking about most people, if you look at the to build, look,
Dr. Jhaimy Fernandez (56:03):
I'm the one that's open to listening,
David S. Williams III (56:04):
Right? Exactly. But you can also be an internal champion to make the introductions to the people who will get you through the procurement process, get you through the contracting. But they have to have a reason. They have to have an understanding. And if I'm just trying to sell you on how my solution will change your life without asking you what is it that you need and what are the things that are your pain points, what would you like to have fixed? Then I haven't made the relationship with the champion. Right. I'm hearing themes, and so I want to bring them out.
Dr. Jhaimy Fernandez (56:41):
Please, please. Yeah. I think it's because I hear diabetes, AI companies will come to me and be like, oh, that's great. And then I'm just left with, okay, but I don't see a path forward. And I wonder if this company would be like, okay, well, what is your everyday day look like? Because me, as a medical student, as a doctor, I went to medical school. I know how to treat diabetes and how to treat it. I was not trained on how to make pitches to operations leaders. That's not what I think of first.
(57:12)
So if you could have a startup founder could help build, understand what my workflow is, understand what it is, and help build those opportunities, and then put that monetary value so that when I talk to, because I also, right, as a champion, I'm having trouble talking to my operational leaders and then showing them, no, this is, because they'll ask me questions like, what's the RO I? And I'm like, oh, I mean, yes, let me figure that out. But I wasn't taught how to figure that out. I don't know what their language that they're looking for. So as a physician champion, I'm really translating three fields. The patient, the AI that's coming in, the operational leader. So that's a lot.
David S. Williams III (57:51):
I want people to go back and rewind just that segment on how important it is to help give the story to the champions that they can use with their operational leaders. We assume, I'm telling you, we assume that that's all easy.
Dr. Jhaimy Fernandez (58:10):
Well, I wish, and I'm sure I could learn it, but I sure could learn it, but I can't go to school forever.
David S. Williams III (58:16):
But most people, what I'm getting at is that that's still not in healthcare specifically the role of the physician. It's not the role of the physician to say, I'm going to evaluate the technology by it's economic feasibility. It is, how does it impact my workflow? How does impact my time? How does it impact my patient and my ability to deliver the best care? Those domains one can expect as a founder, that's where the physician is going to be most expert. If they're a champion, though, you do want to help them tell the story of how this helps. Not only all of those things, if you don't have those things you're not having the conversation. That's what I'm hearing from you. You don't cover those domains. You'll never get a sale because you'll never advance further than the conversation. But when the things that one of the resources that startup founders can deliver is this is the financial impact, this is what our data can be, the financial impact. Here are things that bolster the story for those people that you'll have to pitch internally and then also offer themselves the ability to pitch with you
(59:33)
To go to the meeting and just say, this is what we're talking about. So I want founders to hear this.
Dr. Jhaimy Fernandez (59:39):
That sounds like a breath of fresh air,
David S. Williams III (59:41):
Right? From the champions to say, just provide some help and don't just try to get into contracting. Don't just try to push, push work with the relationship. A good friend of mine from high school classmate in fact is the chief growth Officer at Heartbeat Health. And they are a virtual cardiology clinic. A lot of the same themes, shortage of cardiologists, massive demand. And one of the things that she champions is I have to understand what the impact will be for all of the doctors that we onboard when they're using the technology.
(01:00:19)
And then when we are trying to have contracts with health plans, and even as an outsource provider for other provider groups, we have to understand their trust. What's their brand? How do we make sure that our brand and their brand work together and strengthen each other and don't put that at risk. And she's talking about this from the provider's perspective because of that care and the patient. So she goes through a similar kind of thought process with other health systems when they look to contract with them because they fully understand the impact that they can have on that trust. And all of those domains that you talked about that you have are what build the trust. All the things I talk about, what's my day? What are my pain points? What could be helpful? How could I get better? How can I be faster and more efficient and more high quality care? That's where they're selling and they're being very, very successful.
Dr. Jhaimy Fernandez (01:01:20):
Wow. It seems like I need to meet this friend.
David S. Williams III (01:01:22):
She lives here in la
Dr. Jhaimy Fernandez (01:01:23):
Oh, perfect.
David S. Williams III (01:01:24):
And she is going to be a future guest on the Overcast.
Dr. Jhaimy Fernandez (01:01:28):
Oh, awesome. Even more reason
David S. Williams III (01:01:30):
To
Dr. Jhaimy Fernandez (01:01:30):
Keep listening to,
David S. Williams III (01:01:31):
She was at the kickoff too. It was amazing. She was on that wonderful panel with Dr. Mattel from HealthNet. So I tell this story because when you're, I'm just reflecting back to you and showing what success looks like. So for all the founders out there and all the startup companies, you can do this. You can,
Dr. Jhaimy Fernandez (01:01:53):
We want you to do it.
David S. Williams III (01:01:54):
And we talked about how hard it is, but it can be done. And when it's right, it ends up being scaled. And that's also where we're going. How can we scale? So this is great. I wanted to give you carte blanche. What would you tell, and we've kind of, I think talked about this in circles, but I wanted to get it in directly. What do you tell startup founders that you interact with and what would you tell our audience? How do you break through and what are the key things that you want them to know to do? And I want to just package that for them here because we're going to wrap up soon.
Dr. Jhaimy Fernandez (01:02:40):
Okay. Come to clinic with me.
David S. Williams III (01:02:44):
That's
Dr. Jhaimy Fernandez (01:02:44):
Great. Every pre-medical or every student that says, Dr. Fernandez, how do I get into digital health? I was like, come to clinic with me. Because for me, digital health happens in those 10 minutes when I see my patient. And I've offered this to startup founders and one of 'em said, oh, it's too complicated. I can't get my volunteer credential and all these things. And I'm like, you know what? Okay, fine. And I stopped there. I
David S. Williams III (01:03:11):
Would do that in a second. Are you kidding me?
Dr. Jhaimy Fernandez (01:03:13):
Yeah. But does it take time to get a volunteer, a badge, your skin test? Yes. But you know what? That's necessary. And with people that don't do those steps, I already know they're not.
David S. Williams III (01:03:27):
Now wait, that what you just said is a litmus test.
Dr. Jhaimy Fernandez (01:03:33):
It's a litmus test.
David S. Williams III (01:03:35):
Yeah. You are not willing to do what's necessary and so I can't work with you. No. Then it's like you've gotten in your own way as a founder in a
Dr. Jhaimy Fernandez (01:03:44):
Way. And they're different and on things that are uncomfortable, but that's how me as a doctor is going to feel using your technology.
David S. Williams III (01:03:54):
She's dropping gems right now. People, okay, so that's one thing. Go to clinic with you. That's a huge thing. By the way, if you could get, Sarah Ponders could get that understanding of what it's like and all of the different pieces and be able to ask questions and be able to fully visualize and see what is happening.
Dr. Jhaimy Fernandez (01:04:14):
So I'm going to give you an example of an organization. This is very well epic. We just did a first however patient experience immersion trip where they had developers come into clinic with us and they're seeing how the front office, how the staff uses RDU e check-in. And they noticed that the front office staff was calling people to confirm their appointment. And then they were like, but did this person checked in on the phone? Can't you see on the thing here? It says eCheck. And they checked in and the nurse said, oh yeah, but we still call our patients. So I'm standing there about patient experience and thinking, oh my goodness, there's these patients that are getting these text messages to confirm, but then they're also getting a call, some of 'em getting like it's too much, it's being annoying. And then with three of us, we're just sitting there and we're like, we all have the best intention, but what the patient experiences can be abrasion or something negative. And I still haven't untangled that problem yet. I'm working on that. But I think it really shows that if this technology work should not be your KPI,
David S. Williams III (01:05:26):
Right? Right. But what you're getting at is that's an identification of one area of improvement that would help the clinic help the patient on both sides of experience. There have to be other solutions to that. Epic could say, Hey look, and then I can understand why they would say, you have the data that says they checked in. You don't have to call them. But is it being surfaced correctly? Is it getting to the workflow of that particular person?
Dr. Jhaimy Fernandez (01:05:51):
Really is, is there trust within our healthcare system institutions who their KPI is no-show rates, so let me just do more and I understand them, right? Sure. Because if I call that person, that'll be more personal. And I'm trying to do right now for the AI and the new tools we have is how can I stratify populations to say maybe for older people, 65 and older, they do need a call and let's stop the text messages. Maybe for people 20 younger, they don't need the call. But now with ai, we can do that and do patient preferences. And I'm really pushing technology. I mean if somebody here can help me do that and start stratifying personas of
David S. Williams III (01:06:28):
This is population health management right here. This is one of the
Dr. Jhaimy Fernandez (01:06:31):
Domains where
David S. Williams III (01:06:32):
There's opportunity
Dr. Jhaimy Fernandez (01:06:33):
Communicate with them. Yeah. That's the problem that
David S. Williams III (01:06:38):
I'm
Dr. Jhaimy Fernandez (01:06:38):
Currently trying to untangle.
David S. Williams III (01:06:39):
These are great. So what you've actually preempted, one of the other questions I had, which technologies should be onboarded more, should have more traction because that pain point is there but isn't yet. And it sounds like in that population health patient experience, something in that domain and space, there's probably some opportunity.
Dr. Jhaimy Fernandez (01:07:04):
And honestly this is why big companies like Epic have such an advantage and Cerner and those legacy companies and they're bringing in AI systems that are already integrated. So when they say integration, it's really hard for us to make an argument of going with an external vendor.
David S. Williams III (01:07:21):
One of the things that's hard for technology founders is Epic is the EMR being super expensive. And so being seen as another technology, which is often then seen as another expense is one of the obstacles from a health tech perspective of making deals. Where I'm hearing you though is look, you have to go to the green spaces where even the epics can't play because as large as they are, they can't do everything. They can't do everything. And then on top of that, I think the thing that I have found with Epic, because I've had these run-ins with Epic with Care three as a founder is what they do. They do well and they're entrenched, but when they don't do something, you absolutely will get trial. If it meets those domain needs that you're talking about, you'll get at least a pilot. And if you succeed in that pilot and you do something that impacts the clinician experience, patient experience, the population health in this case opportunity, you can spread like wildfire. And we're just trying, I think as founders to find those spaces.
Dr. Jhaimy Fernandez (01:08:38):
Yeah. Well I think to build up your point, it's like when you think about clinical care, right? It's the EHR. We think of a doctor providing care, but then there is a partner section. So there's the EHR clinical care and then there's the telecommunications, the phone book. But there's this sweet spot in between that's very small. That's that patient experience engagement part. It's almost like a little operational and a little bit of bridging the two that's, I don't know what to call it. I don't know if AI is that thing, but that's where I spend majority of my time.
David S. Williams III (01:09:16):
And you don't feel like necessarily the system in place are
Dr. Jhaimy Fernandez (01:09:20):
Addressing those? I'm always trying to bridge. I'm trying to, okay, epic comes to here now how can I get it here? And this telecommunications comes here, but how can I get it here? And I think these are trying to build nice or where we use nice as telecommunications, bringing agents, AI agents and things like that. But I don't think they're at the level where they'll be as effective with our patients yet. Maybe they won't be, but they service our call agents to make their job more efficient. Will it service the patient experience? I don't
David S. Williams III (01:09:50):
Know.
Dr. Jhaimy Fernandez (01:09:51):
I don't know.
David S. Williams III (01:09:52):
Some of this would come out if people would do a day visit with you. These are the kinds of things that you would come up as you would go through the day, oh, this is this area of bridge that I need. This is something that I wish I had something that could do this. It really is
Dr. Jhaimy Fernandez (01:10:07):
Because even AltaMedly, we're so good hearted, we have five technologies that do the same thing. So it's like, why would I spend more money on another technology? I won't. And it's so much I spent my time just deciphering what they do and they all have advances. So I'm like, we have to develop a whole committee just to decipher what they do and then translate that to operational. So when we're talking to our operational partners, why would you spend more time,
David S. Williams III (01:10:37):
Right? Trying to figure out technologies here. This is amazing to me because where we don't get enough of these conversations, and this is why we have you on the overcast, is because we don't get enough access to the champions to tell us the real,
Dr. Jhaimy Fernandez (01:10:51):
Those we're busy,
David S. Williams III (01:10:51):
The reality that
Dr. Jhaimy Fernandez (01:10:52):
We're busy, do we? Absolutely right? We're wearing 10
David S. Williams III (01:10:54):
Hats, but this is the gold, these are the gems that you're dropping that we need to understand. And I think this idea of when you have found a champion one, how do you find a champion, which you talked about residency programs, conferences, you talked about the academic conferences, but even the tech conferences, when you're meeting with some of these
Dr. Jhaimy Fernandez (01:11:13):
Doctors, I'm happy to invite pre-medical students to overlap.
David S. Williams III (01:11:17):
Yes, please do. Because I think that that would also help understand the workflow that doctors have,
Dr. Jhaimy Fernandez (01:11:24):
Charles,
David S. Williams III (01:11:24):
Pre-medical students residency programs, those are the groups that are, I think driving change and having a different perspective
Dr. Jhaimy Fernandez (01:11:34):
And expecting healthcare to look different
David S. Williams III (01:11:37):
And also be reflective of the people served,
Dr. Jhaimy Fernandez (01:11:41):
Which
David S. Williams III (01:11:41):
I think is the thing that AltaMed probably does best.
Dr. Jhaimy Fernandez (01:11:44):
We do,
David S. Williams III (01:11:44):
We do here in Los Angeles and among FQ nationally,
Dr. Jhaimy Fernandez (01:11:48):
And we're growing and we really are. We had a really successful, my Vote, my Health campaign, which you're very familiar with, we've been able to capitalize on that physician influence.
David S. Williams III (01:11:58):
My vote, my health is empowerment. Empowerment and access in one.
Dr. Jhaimy Fernandez (01:12:05):
Yes. Getting, telling, checking people's civic health. That's right. You go into the
David S. Williams III (01:12:09):
Clinic. That's right.
Dr. Jhaimy Fernandez (01:12:10):
And doctors asking you to register to vote and vote. And we've been able to move local elections and really serve as a blueprint for other community health centers. So my perspective is if we can do that with voting, we can do that with digital health.
David S. Williams III (01:12:26):
Mic drop. I think that's it. Dr. Jamie Fernandez, thank you so much for being our guest on the inaugural video recorded overcast episode. I hope you'll come back and talk to us again when we onboard an overlap founded company into AltaMed for Pilot.
Dr. Jhaimy Fernandez (01:12:51):
There
David S. Williams III (01:12:51):
We go. And we could talk about that with that company's founder to show that progress is happening and how much of a champion you are.
Dr. Jhaimy Fernandez (01:12:58):
I look forward to it.
David S. Williams III (01:12:59):
Well thank you so much.
Dr. Jhaimy Fernandez (01:13:00):
This has been so fun. Alright.