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Dr. Greg Burrell received his medical degree from the University of Chicago Pritzker School of Medicine, and holds an appointment as Assistant Professor of Clinical Medicine at UCSF.

He is Carbon Health’s co-founder and VP of clinical product and strategy. Carbon Health is a technology-enabled healthcare that combines technology with modern clinics.

It delivers a seamless experience from virtual care to in-person care. Carbon Health is headquartered in San Francisco with clinics across California.

Interview

You started your medical career in Silicon Valley at UCSF (University of California, San Francisco). Was there something about the UCSF environment that fosters innovation? Is it typical for a US hospital setting?

They do foster innovation, but mostly in the academic sense with research and grants. The pathway that I forged was on my own, outside the UCSF walls – by attending conferences like Health 2.0 and Rock Health. I was meeting with technology founders and non-clinical people that were looking for clinical guidance for their cool ideas.

There are a small sub-set of special hospitals that are known for continually innovating in the US – like Duke and Geisinger [where incidentally David Feinberg, Google’s Head of Healthcare, came from], but they are only a select few.

I definitely think that an increasing number of doctors are interested in innovation in the US. This is especially true in San Francisco. There are a few other hubs with lots [of doctors that are innovating] such as Boston, but I do not think it is so prevalent outside of these hubs.

Tell us about your innovation journey prior to Carbon Health?

For about 2.5 years after residency I was mostly doing hospitalist work. This was shift-based, so I had time to work on something else. I was advising a few startups alongside my clinical work, and this was taking up about 25% of my time. One in particular was CareMessage whom I was working with on a more consistent basis. I was offering guidance around the clinical knowledge required. For example, what the clinical workflow might look like, and the people in the system who might use the technology.

During this time I realised that I wanted to be more hands-on with a product to really drive change in an organisation. I realised that I needed to be working closer to full-time with a company. I had been thinking about joining a company that had already got off the ground, with perhaps 25-50 people, and I looked around at several such companies. I also considered starting up on my own, but was unsure about finding an engineering team and getting funding. These were areas where I did not have much experience.

How did you get involved with Carbon Health?

I had a happenstance introduction to Eren and Tom through a friend in early 2016 [Eren and Tom are Greg’s co-founders at Carbon Health] – I really liked their vision, and we had a shared vision about what we wanted to do. They both knew engineering and startups [Eren was previously the founder of Udemy, the world’s largest online learning platform], and they were looking for a doctor to either advise them or join as a co-founder.

They had a different perspective before they met me, to focus on a behind-the-scenes platform to help clinicians work better. My advice to them was to also incorporate a patient-facing platform, because I felt strongly through my clinical experience that patients needed a better experience of care too.

One question that many in our community would be curious about is how did you transition from being an advisor to Tom and Eren to being a co-founder?

I made it clear to them that I was looking for something that I could get involved with full-time. If I could not get it from Eren and Tom then I told them that I would move to another opportunity at some point. This way, we were on the same page from the beginning. If you are advising early stage companies, like I was at Carbon Health, then you need to allow some time to figure it out and you have to be willing to understand that it might not work. There has to be a small amount of ‘free work’ you have to do [for a few weeks] to see if you like each other, if you can work together.

If you are advising early stage companies, […], then you need to allow some time to figure it out and you have to be willing to understand that it might not work.

When did Carbon launch and how has it evolved over time?

The very first step was the two months during which we pivoted to a patient-facing concept. We then worked on the patient-facing technology platform and a bricks and mortar clinic. Ten months later, in October 2016, we did a soft launch at TechCrunch Disrupt, at their startup competition. Then, in January 2017, we opened our first clinic to the public.

We were looking for ways that we could scale the technology most efficiently, so we considered providing our software to other clinics. Though we always came back to this idea that we wanted to provide a patient-centric experience. You cannot control this when giving the software out to existing clinic providers – you cannot guarantee that they would use it as you want them to. So we quickly ended that, and said we would develop the software and the clinics ourselves to create a full-stack experience for patients.

It just so happened that one of the clinic groups we were considering partnering with had a similar vision to us. They had five clinics in the Bay Area so we joined forces and went from one to six clinics. We now have 12 clinics around Bay Area and beyond too.

Carbon has adeptly combined both a physical and virtual care experience. How have your patients responded to this hybrid approach, and do different customers view it differently?

I see the virtual and physical as one experience, that is one of the value propositions that I think we are bringing. We are working to deliver this seamless hybrid care of in clinics and virtually. If you start virtual but then need to see a physical doctor, you do not need to start over [as Carbon offers both]. I think there is a human touch element to in-person that is really valuable, but there is also value in virtual care for the in-between times.

The idea for us is that it does not even have to be the traditional 4th floor of a medical office next to the hospital, but it can be next to your Whole Foods, so that visiting the doctor feels like a more natural part of of your day. We will be opening a number of retail clinics in the coming months across the country.

We have been surprised at how many populations have adopted the digital platform – the 40-60 age group and the 70+ year olds are actually really comfortable using our app. We have the highest patient satisfaction scores from them for the app. They often have significant health issues so the existing system can be very cumbersome for them. They can see the difference with our digital approach. Many of them like to see a doctor in-person initially, and then do their follow-up care virtually via the app.

We have focused most of our marketing outreach in areas where we physically have clinics for now though, as people like the combination of the virtual care combined with accessible in-person care.

We have been surprised at how many populations have adopted the digital platform – the 40-60 age group and the 70+ year olds are actually really comfortable using our app.

We are seeing an increasing number of retail clinics and direct primary care models in the US and beyond. What differentiates Carbon?

We have our developed all our own technology, which benefits both the patients and doctors. For example, this means that our doctors need only 30-45 mins of training to get set-up with our EHR. [I used a demo version of the clinicians’ Electronic Health Record (EHR) – it is remarkably smooth]. Patients also have access to an app to improve their experience of care. For example, when booking an appointment they can enter some upfront information about their symptoms. This is then shared with the doctor pre-appointment to support the consultation. This means that clinicians can spend time in the consult talking about diagnoses and treatments as opposed to gathering symptoms. During the consult clinicians can cast the patient’s notes to a large screen. Then patients can send follow-up messages to their doctor via the app after the consult has ended.

[Another differentiator is that] we are accessible to all, at a relatively affordable price point. The majority of our services are covered by insurance. So we can attract a mainstream audience, unlike some of our competitors that are more exclusive. The main access points we offer are high value. We do not intend for our service to only be available in the coastal elite cities. We are not an NYC/LA/Bay Area-focused brand. We are not like the Equinox of health [upmarket gym chain in the US] – our aspiration is to be present across the US, including in mid-sized cities such as Reno where we have recently announced some clinic openings.

What is your one big idea to improve the US healthcare system overall? 

We need to dedicate more resources towards the long term. For example, teaching nutrition to kids in schools and teaching more prevention to doctors. Incentivising everyone in the system to focus on the long-term and dedicating resources to optimise the way doctors and technology work together.

What advice do you have for doctors wanting to innovate like yourself? 

Just get out there and give it a try. Reach out to doctors working in the space that you’re interested in and find mentors. Consult at companies for free to start out, and use those opportunities to find the specific areas you’re passionate about.

Just get out there and give it a try.

About The Author

Vishaal Virani
Co-Founder

Vishaal graduated from UCL Medical School in 2011 and completed Foundation Training at the William Harvey Hospital and King’s College Hospital in London. He then worked at a start-up healthcare consultancy, Mansfield Advisors, for two years, and then as a strategy consultant at OC&C. Vishaal currently works at Ada Health.

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