Brad Bostic of hc1: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System

An Interview With Luke Kervin

W e need to find better ways to empower our patients with easy access to the comprehensive information they need to fully engage in their healthcare. We ask too much from our patients, expecting them to know every single medication they’re taking — including over-the-counter drugs and supplements — and in what dosages. We also expect them to be able to cite a comprehensive list of all diagnostic tests they’ve had, when, where, and by whom across all specialties. It’s an impossible amount of information for even those with clinical backgrounds to have at their disposal. Again, PHINs and precision health are viable solutions.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Brad Bostic, CEO of hc1.

Brad founded hc1 to bring the benefits of precision health to all patients after witnessing his mother lose her battle with cancer while being treated like a number. He created hc1 with a bold vision to bring the power of precise diagnostic and treatment insights into the care delivery process, believing that transforming lab data into personalized healthcare insights would empower healthcare organizations to ensure patients get optimal diagnostic lab tests and personalized prescriptions for the best possible outcomes. Today, hc1 is the bioinformatics leader in precision testing and prescribing and its hc1 Precision Health Cloud™ is live across more than 20,000 lab and health system locations.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

I have always had an entrepreneurial spirit and deep interest in using technology to improve healthcare delivery. I created my first cloud company in the mid-1990s, while attending Indiana University, and quickly became passionate about identifying and developing next generation solutions to disrupt the status quo in healthcare. This led to overseeing numerous high-growth start-ups focused on such industry movements as interoperability, telehealth and artificial intelligence.

My singular focus materialized at the outset of the high-value care movement as I witnessed the growing promise of using technology to improve the health and lives of patients while also reducing costs. I had witnessed first-hand the challenges of fragmented data across the care continuum with my mother — it’s what led me to found hc1 in 2011 and to focus on what I consider to be the heartbeat of healthcare: laboratory data. Fast forward a decade, and we have become the bioinformatics leaders in precision testing and prescribing by way of the hc1 Precision Health Cloud, a platform that brings together industry leading technology partners to personalize care and eliminate waste for more than 1,000 health systems and diagnostic laboratories. Our hc1 Precision Health Cloud is live across more than 20,000 lab and health system locations, and we are constantly seeking out new and better ways to extract value from our platform to transform healthcare and eliminate barriers preventing the broad adoption of precision health. Some of our current initiatives include exploring the roles of the “digital twin” and advancing use of Precision Health Insight Networks, or PHINs, for which my team and I have more than 20 patent applications filed.

Can you share the most interesting story that happened to you since you began your career?

When I launched hc1, I heard from a lot of skeptics who couldn’t get past the “lab-as-commodity” mentality. We proved them wrong by building critical mass through the delivery of personalized insights across hundreds of labs. When we reached this milestone, I was introduced to an expert in prescription drug monitoring and learned about their key challenges. My conversations with him about the relationship between lab data and prescribing revealed a massive, unmet need — if we could directly utilize drug screening information from labs, we could identify which patients were at risk for certain issues based on the medications they were taking, including any that may not have been prescribed but were detected by the lab test.

A few years later, I was invited by Amazon Web Services to participate in a panel on the opioid epidemic and substance use disorders at the Sorenson Impact Conference in Salt Lake City. The panel followed the showing of a documentary about two young women, from your typical middle-class families, who ended up addicted to pain medications after receiving prescriptions in a healthcare setting. During the panel discussion, I shared my thoughts on how the industry could better use lab data to get people on the right prescriptions. At that moment, it was clear that hc1 was uniquely positioned to launch breakthrough precision prescribing capabilities that could first tackle controlled substance prescribing and, ultimately, personalize all prescribing utilizing an individual’s unique genetic makeup.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

Early in my career, I made the mistake of frequently sharing ideas (many of which were not good!) with team members on an informal basis, only to find that they would assume all of these ideas were important and deserved additional consideration. I may have just thought something up on the fly, but people would assume I had given it a lot of consideration, which led to confusion across the team. The lesson learned was that the CEO of a company, more than any other role, needs to be clear on priorities and recognize that people will listen closely to your ideas. For this reason, I continuously work on improving my communications and implementing processes to create clarity for every team member about what is most important or highest priority at any given time.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Luck is when preparation meets opportunity. The harder I work, the luckier I get.” and “If it were easy, everyone would do it.”

As an entrepreneur and investor who is drawn to companies that can solve extremely complex challenges and create massive economic value, these quotes are highly relevant. You have to be extremely persistent and committed in order to succeed. And, contrary to entrepreneurial lore, nearly every major technology success is actually a “10-year overnight success.”

Are you working on any exciting new projects now? How do you think that will help people?

One area that has me incredibly excited is the whole concept of the “digital twin.” For those who aren’t familiar with it, in healthcare a digital twin is a virtual, computational representation of a patient that empowers physicians to conduct diagnostic testing and use treatment protocols that are tailored to the unique needs of each individual patient. This simulation helps determine the most proactive, preventative, and personalized approach to care. It promises to advance precision health, which I have long believed to be the answer to our current, largely unsustainable, one-size-fits-all, trial-and-error approach to healthcare and medications. My specific area of interest is how a digital twin can inform precision prescribing and advance the provision of highly effective, high-value care — potentially preventing more than 2 million adverse drug reactions and saving as many as 128,000 lives each year.

Just think about the impact this could have on a few specific areas, for example treating any of the 300 recognized mental and behavioral disorders. Patients with the same mental illness don’t always have the same symptoms. And it’s common to be dealing with more than one mental illness, which can exacerbate the severity, impact response to medications and increase suicide risks. Nor do patients respond to medications the same way. Consider that one gene, CYP2D6, impacts how well the body breaks down 25% of the most prescribed medications — including those to treat depression, anxiety, seasonal affective disorder, bipolar disorder, schizophrenia and OCD. Another gene, CYP1A2, metabolizes tricyclic antidepressants and conventional antipsychotics and can be impacted by smoking, caffeine and St. John’s wort. Imagine how much more effective medication therapy would be if the guesswork were eliminated with digital twins and precision prescribing. It would be possible to pinpoint the precise medication that offers the patient the greatest relief with the fewest side effects and no adverse medication events. And, the right medicine may actually cost much less than the wrong prescription originally “tried on the patient.”

Another example is cardiovascular medications like Plavix, an anticoagulant prescribed after coronary intervention that reduces clotting, strokes and recurrent cardiovascular events. Up to one-third of the population has a genetic makeup impacting its efficacy by changing how it’s absorbed or metabolized. Depending on a patient’s genetics, double or triple the normal dose may be needed, or it may not work at all. In some cases, lower doses are required to prevent life-threatening bleeding. Digital twins can reveal these variances in part through genetic details derived from a simple DNA swab of the mouth during a routine doctor’s visit. It is perhaps the most exciting project I’ve been involved with to date, and I know I’m not alone in my enthusiasm for all its potential.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

Of all the lessons COVID has taught the world, the critical role of data to deliver real-time insights and inform care models built on precision medicine stands out the most. Simply put, keeping critical patient and public health data locked away in disconnected databases and multiple data siloes is not only unsustainable, but potentially deadly.

Consider this: From the point when COVID-19 arrived in the U.S., public health officials lacked critical information and proactive real-time insights into the ebb and flow of the virus, denying them the ability to mobilize highly effective “localized” responses. Rudimentary infection rate reports were published days or weeks after the fact — with questionable accuracy — precluding appropriate action ahead of rapidly surging localized infection rates. And the data was reported in a macro-geographic form at the state or (at best) a county level. The lack of “hyperlocal community data” kept the world’s wealthiest and most technologically advanced nation from producing the accurate, real-time risk insights required to properly manage a pandemic.

Without proactive insights offering a glimpse into the future, the default public health response was often cookie cutter actions guided by state-level decisions that did nothing to address the unique circumstances of each demographic segment and micro-community at a “hyper-local” level. The result was a prolonged pandemic that cost hundreds of thousands of lives.

Going forward, the healthcare industry must embrace infrastructures and strategies that extract the promise of medicine built around the person being treated. The good news is that a new class of solutions — PHINs — is emerging that has the power to transform previously disconnected health data into actionable information that identifies population and individual risk and drives personalized care decisions. This type of infrastructure demonstrated its promise on a small scale during the pandemic, when it was leveraged to organize and normalize hundreds of millions of lab test results, including demographic data, from more than 20,000 order locations.

Enabling massive volumes of critical data to flow into a single dashboard, this PHIN equipped public health agencies and healthcare organizations with detailed hyper-local lab testing insights. This allowed healthcare authorities to drill down to state, county, and sub-county (local communities) views of COVID-19 testing rates, de-identified test results, key demographics, a side-by-side view of viral and antibody testing, as well as local-risk and age-group trending. That data was then used to identify communities where local resources such as PPE, ERs, and hospital and ICU beds would be strained in the next 5–21 days, allowing for a proactive response and defense against COVID-19.

Healthcare can build off this initial success with PHINs to advance and expand precision health models. By unearthing the insights from siloed data that already exists across multiple EHR, laboratory, and pharmacy systems, these solutions can provide clinicians with curated guidance right at the point of prescribing. These infrastructures can model alternative drug regimens that can then be shared in a collaborative manner through a medication action proposal — and lay the foundation for substantial ROI in terms of lives and healthcare costs.

Of course, the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

What has blown me away about the nation’s pandemic response was the unprecedented level of collaboration and cooperation we saw from some very unexpected places. Competitors set aside their quest for market share, and public and private organizations came together — often for the first time — to find a way to save lives and slowly right the ship. You don’t need to look any farther than the CV19 Lab Testing Dashboard™ I mentioned previously for an example of what I’m talking about.

We recognized early on that the hc1 Precision Health Cloud® and its reach representing up to 40% of the nation’s COVID-19 lab tests — one of, if not the, largest centralized samples available — could be leveraged to fill the information void. To make it happen, a coalition of commercial and health system laboratories and technology partners was quickly convened to create the complementary CV19Dashboard.org, to equip public health agencies, healthcare organizations, schools and families on the front lines with detailed lab testing insights from more than 20,000 ordering locations.

The dashboard’s insights are powered by more than 30 million COVID-19 viral test results and over 3.5 million COVID-19 antibody test results, numbers that continue to grow daily during the Delta-variant surge as results are received in real-time from the laboratory partners in the dashboard’s coalition. Further, that coalition addressed the real-time public health crisis presented by COVID-19 and demonstrated that the value of lab insights extends beyond the traditional boundaries of healthcare to address the extreme challenges presented by a pandemic — challenges that force extraordinary responses at the local and micro-community levels.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

First, we must overcome the long-standing issue of having critical patient and public health data locked away in disconnected databases and multiple data silos. From the point when COVID-19 arrived in the U.S., critical information and proactive real-time insights into the ebb and flow of the virus remained beyond the reach of public health officials, denying them the ability to mobilize highly effective localized responses that were our best chance of stopping the COVID-19 wildfire that ultimately consumed the nation. We must establish the standards and infrastructures necessary for the broad, yet HIPAA-secure, exchange of health information, both for a more effective and timely response to the next pandemic and also to eliminate the guesswork from patient care decisions.

Second, we must enable the transformation of previously disconnected health data into actionable information that identifies population and individual risk and drives tailored care decisions. When data barriers are eliminated, the response to public health crises improves. For example, PHINs enabled massive volumes of critical data to flow into a single dashboard that equipped public health agencies and healthcare organizations on the front lines with detailed lab testing insights they needed to inform a proactive local response.

Third, we must put into action what we’ve learned about the critical importance of harnessing and leveraging data from across multiple dimensions of healthcare — the importance of unearthing the insights from all the siloed data that is already available across multiple different EHR, laboratory, and pharmacy systems. This data must become actionable in providing, for example, physicians and pharmacists with curated guidance to model alternative drug regimens that can then be shared in a collaborative manner through a medication action proposal. With PHINs, we can save tens of millions of lives and save millions — even billions — of dollars.

Fourth, we must accelerate and normalize the practice of precision medicine — precision prescribing in particular — through delivery of precision health data at the right time in a meaningful format. Doing so can be the difference between life and death for a patient, while also lowering costs, which in turn results in an improved patient experience and, ultimately, better overall outcomes. The applications are seemingly endless: Imagine the power of comparing a nephrologist’s diagnostic testing habits against peers nationwide. Consider the benefit of aligning a patient with certain genetic abnormalities to a digital twin made up of a composite of data spanning dozens of similar patients across the country to understand what treatments are most effective and what diagnostic tests are required. The potential benefits of widespread adoption of precision health make it a true game changer.

Fifth, we need to find better ways to empower our patients with easy access to the comprehensive information they need to fully engage in their healthcare. We ask too much from our patients, expecting them to know every single medication they’re taking — including over-the-counter drugs and supplements — and in what dosages. We also expect them to be able to cite a comprehensive list of all diagnostic tests they’ve had, when, where, and by whom across all specialties. It’s an impossible amount of information for even those with clinical backgrounds to have at their disposal. Again, PHINs and precision health are viable solutions.

What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

It starts with the right industry partnerships. Technological advancement is exploding and opening doors to opportunities that did not exist even five years ago. Innovative partnerships between hc1 and technology titans like Amazon Web Services (AWS) and Snowflake have pushed healthcare to the precipice of achieving mainstream application of personalized medicine — where optimal care decisions are made based on a patient’s unique genetics and greater health determinants. When data barriers are eliminated this way, the response to public health crises improves.

Obviously greater collaboration between healthcare industry stakeholders has been a national priority for years, but, in truth, the technology now exists to further escalate and elevate these efforts. Working in tandem with federal movements related to healthcare industry IT standards, private and public partnerships have the potential to transform healthcare delivery in the U.S. We just need to embrace these opportunities and focus on the low-hanging fruit that can produce substantial ROI — such as precision health — and stop throwing money at decades-old generalized efforts that have not delivered on the high-value care front.

On the individual patient level, consumers are already demanding that providers draw on the promise of technology and personalized medicine. That’s not going to change. Healthcare organizations that deliver on this front will not only gain a competitive advantage but will be part of the greater solution to transformation that changes the unsustainable course of U.S. healthcare.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

My dream is that all people, from every background and in all economic categories, can realize the benefits of precision, proactive care, in particular its ability to help them live healthier, longer and more productive lives, which in turn will lead to lower spending and greater economic prosperity.

I am a big believer in ESG (environmental, social, and governance) investing, and view improving public health as the ultimate movement for social good. To bring the most good to the largest number of people, healthcare in the US needs to be transformed from a reactive, one-size-fits all approach to a proactive, preventative model that leverages data insight to bring the benefits of precision population health to all citizens. To accomplish this, community leaders must align with public health agencies, healthcare providers, and private industry to make a comprehensive patient profile the standard of care. Unfortunately, the data that is required to optimize care for any individual is spread across a multitude of clinics and databases, and the EHR vendors that have received tens of billions in subsidies from the government to implement their mandated software in hospitals, have done little to alleviate the issue. In many cases, they’ve made it worse through data blocking policies.

Additionally, as we’ve seen with the lack of effective data provided by the CDC for managing the COVID-19 pandemic response, we are operating our nation’s health programs in antiquated systems that don’t take advantage of today’s cloud computing, artificial intelligence, machine learning, and flexible integration technologies. I see technology and services being produced by innovators each and every day that can make this precision population health vision a reality, and I am personally committed to doing everything possible to support these critical initiatives. Now is the time to take the steps necessary to improve public health for all!

How can our readers further follow your work online?

To hear my presentations at the 2020 and 2021 Precision Health Virtual Summits on-demand, go to https://www.hc1.com/summit/ (free registration required). I also contribute articles at Medium (https://medium.com/@bradbostic) and the hc1 blog (https://www.hc1.com/blog/) I’m also on Twitter at https://twitter.com/bradbostic and LinkedIn (https://www.linkedin.com/in/bradbostic/) or connect with the company on Twitter at https://twitter.com/hc1dotcom/.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.