The guy from Amazon

Providence has intentionally recruited about 30 percent of its current management team from outside of health care. One of them is Aaron Martin, senior vice president of innovation at Providence. Prior to joining Providence, he led self-publishing at Amazon and was on the Kindle team.

Aaron is a former Amazonian with a self-deprecating sense of humor. In describing some of his early experiences at Providence trying to develop innovations at scale and at speed (just like at Amazon), he recounts that he was initially told by some older health care hands, “OK, Amazon guy, but it doesn’t work that way in health care.”

With Hochman’s unwavering support, Martin’s team (including many former Amazonians and some hotshots from Salesforce) brings to Providence the sensibilities of the world’s largest online retailer, including the ability to learn from online experiences with big data and to run sophisticated customer- and provider-facing online pilots in real time. It launched a new member website for its Boeing ACO in weeks, not millennia, as we normally do in health care.

Martin’s team follows many of the principles he learned at Amazon. For example, he told an HX360 audience, “We write the press release first.” This means they get very clear on what they are trying to achieve and what would constitute success, then they specify how it will be achieved. Afterward, they write an internal “working backward press release” that explains to customers or clinicians why the product will be valuable to them.

Another Martin aphorism: “There are no extra points for originality.” Martin described his unit as the “pay attention team,” a group that works within the many ministries and regions in the Providence system and looks for solutions, identifying those worth diffusing. This is a key insight about successful innovators: Innovation is about solving meaningful problems, not novelty. Great innovators understand that.

Way too much health care innovation is about pride of novelty rather than successful problem solving. (That applies to much clinical innovation, too: It may be novel and have statistically significant effects, but it really doesn’t make much of a difference that is detectible to human beings. Some, but not all, of the new crop of specialty pharmaceuticals are pricey exceptions to that rule.)

Focusing in

While the overall strategic focus for innovation at Providence is on population health, digital health and core clinical operations, there are a number of specific initiatives that are worth highlighting:

Platform strategy. Martin described three platform strategies that have topped the agenda this year:

  • Clinical collaboration platform for Providence clinicians via secure telehealth and an internal social network, allowing medical staff to treat patients at a distance, provide expert consults and trade clinical best practices.
  • On-demand health care platform to help consumers access information (through email and telehealth) as well as support consumers receiving home care, retail care or care in alternate sites.
  • Consumer engagement platform to enable communication and connection across episodes of care with software such as Providence’s Mom and Well Baby app.

Patient experience. Amazon sensibilities are being brought to bear across Providence as it in innovates to enhance the consumer experience — whether for patients, healthy people or health plan members. A key challenge is to make the health system easier to use and relevant in people's daily lives. All of us who use Amazon, Uber or OpenTable yearn for their simplicity in health care.

The Boeing accountable care organization. Providence, along with Presbyterian Healthcare Services in New Mexico, is an early pioneer in direct-contact ACOs with employers. Boeing and Intel are tough, sophisticated, data-driven and demanding enterprises that expect extremely high performance from their suppliers, and health care is no different. Providence is winning the business and trust of Boeing employees in part through its digital innovation agenda.

“We own a high school. … We can learn from them.” With a wry smile, Hochman pointed to the fact that Providence owns and runs a Catholic high school in Burbank, Calif., and suggested there is no better way to understand the behavior of future patients and health care workers than to understand the digital behavior of teenagers.

Walgreens partnership. Recognizing the retail revolution in health care, Providence has partnered with Walgreen Co. and in a first for the retailer, will own and operate clinics in Oregon and Washington Walgreens stores with plans to open in 25 of them over the next 18 months.

Migration to risk. Providence has operated a health plan in Oregon for nearly 30 years. With more than half a million at-risk lives, mostly in that state, Providence can use its expanded geographic footprint through its merger with St. Joseph to offer an ACO and direct health contracting to many more self-insured employers in the West. Providence’s commitment to migrating toward risk was evident when Hochman told HX360 attendees that the health system tries to “disconnect reimbursement from delivery” and work with “[primary care providers] and clinics to create compensation models as if we are under risk.”

Genomics, too. Providence just announced that the Institute for Systems Biology is joining the health care system and that noted genomics researcher Leroy Hood, M.D., who leads the institute, will become Providence's chief scientific officer. Hood’s pioneering focus on scientific wellness based on personalized medicine using genomics and big data will provide Providence and St. Joseph with exciting new avenues for their innovation agenda.

Looking ahead

There are a few key health systems in the country that are market makers, not market takers. They shape the future through their strategies and the big bets they make. You know who you are. When it comes to innovation at scale, Providence is a system to watch, especially as it enters its proposed partnership with St. Joseph. The Washington-based system will be a major and growing force in the health care market and will teach us all how to bring in fresh, innovative thinking from outside the health system. We need innovation at scale.

Ian Morrison, Ph.D., is an author, consultant and futurist based in Menlo Park, Calif. He is also a regular contributor to H&HN Daily and a member of Health Forum's Speakers Express.