Oren Oz of Nuvo: 5 Things We Must Do To Improve the US Healthcare System
The most important thing that needs to change is how we think about healthcare. We need to do more to promote health assurance — affordable, personalized, and preemptive care enabled by genomics, sensors and AI-based digital therapies that help anticipate patients’ needs and work to keep them as healthy as possible rather than models that elevate “sick care” in hospital settings. Addressing this mindset has a positive cascading effect on many aspects of US healthcare that need to change.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Oren Oz. Oren is the CEO and Founder of Nuvo. A data scientist, entrepreneur, and dad, he was inspired by his wife’s experience during pregnancy. Before Nuvo, Oren started and led a variety of entrepreneurial ventures, primarily in technology.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
I’m a serial entrepreneur whose businesses have been inspired by my growing family. After my wife’s first pregnancy, when she couldn’t find an easy way to play music for our unborn child, I launched the Ritmo Advanced Sound System — one of the first wearables — which let moms and their babies share the sensory and emotional experience of bonding through sound and music.
INVU was invented in 2014 after our third pregnancy became high-risk and we suffered stress because of outdated pregnancy monitoring and medical practices. We had been put on a tight management program requiring multiple tests a week, which meant many trips to the doctor’s office with two children at home. During this time, an inaccurate CTG reading nearly resulted in an emergency C-section. The pregnancy eventually ended with an uncomplicated vaginal delivery, but the frequent trips to the hospital and scare of the false positive stayed with me. I realized there had to be a better way to help free women from the wall and the worry and I applied my background and skills as a data scientist, inventor and entrepreneur to INVU’s creation.
Can you share the most interesting story that happened to you since you began leading your company?
There’s no single story to share as the most interesting narrative I’ve encountered since founding Nuvo has been one of ongoing discovery — a constant unfolding of new possibilities. INVU was initially envisioned as a wellness device. In order to solve the problem of constructing a compact device with the same monitoring capabilities as large in-office machines, we had to develop a completely new way to capture a baby’s very quiet, small (and moving) heartbeat in a wet environment (the womb) and distinguish it from the sounds of the mother’s body. We designed and built a platform that combines proprietary/unique hardware and software together with advanced signal processing and machine learning algorithms to overcome these challenges. While developing the technology, we discovered that we were able to capture entirely new measurements that could one day provide new understanding about the beginning of fetal origin. What’s emerging now is a telehealth platform with continually expanding potential from monitoring to decision support to a new era of pregnancy population health.
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?
In the early days of Ritmo, I decided we needed to raise Ritmo’s profile to help us raise money. To make a big splash, we rented a last-minute booth at the ABC Kids Expo, one of the biggest industry events for products for babies and kids. We had to complete the messaging, design, and construction of the booth in under two weeks and had only $2,000 for publicity to promote our booth. We decided that the best marketing we could provide for our product would be a live demonstration, so we found a very pregnant model on Craigslist to wear the Ritmo device and walk the floor passing out flyers. The response was tremendous. In preparation for our trip, we were selecting binders in which to store contact information and orders. My marketing specialist advised me that only a small one would be needed for our first trip to such a large conference with such big players but, wanting to be optimistic, I chose the largest binder. In fact, hundreds of CEOs saw our model and came to our booth wanting to do business. We filled three of the big binders with contacts and orders, including from CEOs of some of the largest companies in our business. After the second day, as I left the exhibition floor, trying to contain the number of orders and business cards, I realized that I had a looming problem: filling all these orders.
As people began to learn about Ritmo, they loved it and they wanted it. As I received hundreds of emails about when it would be coming, I realized that good problems are still problems. This experience taught me some important lessons about focus, instead of chasing every opportunity — it is important to explore and consider various paths, but it is impossible to travel down every avenue simultaneously.
What do you think makes your company stand out? Can you share a story?
As an Israeli company, Nuvo draws from a rich heritage of technology leadership that has earned the country the nickname, “Start Up Nation.” Israel began adopting sophisticated applications of computers and technology like Electronic Health Records in the 1990s — almost 15 years before the rest of the world — gathering comprehensive data that has played a crucial role in enabling Israeli start-ups to validate technologies. We have not just know-how but real-world experience embracing technology to advance our cause. Nuvo’s collaborative partnership with the Hadassah-Hebrew University Medical Center to create first-in-kind data-driven solutions to assist providers delivering personalized pregnancy care demonstrates the rich data and expertise we can access.
Second, we stand out because of our prescience. The INVU platform was born 5 years ago because of the gaps we saw in pregnancy care. While maternal mortality rates remain high, the number of pregnancy care practitioners has fallen. Healthcare has been moving toward a distributed care model for years now and a significant amount of care delivery already occurs at sites outside of the traditional health system infrastructure. However, pregnancy care still depends on 30-year-old guidelines developed before the advent of value-based care, distributed care, and the digital age.
When INVU received its first U.S. FDA clearance as the Covid-19 pandemic was taking hold of the world, our platform moved from serving an unmet need to an acute need overnight. None of us would have predicted 5 years ago that INVU would be born into this time when it was needed most. In the time of Covid, The American College of Obstetricians and Gynecologists (ACOG) released guidelines urging healthcare providers to use telehealth appointments whenever possible. These appointments, often conducted as videoconferences or text-based televisits, cannot provide deep monitoring, such as fetal heart rate. As other companies try to catch up, the INVU platform is already FDA cleared and planning to expand our offerings through clearances in more indications.
What advice would you give to other healthcare leaders to help their team to thrive?
I would tell other healthcare innovators to solve a real problem with a substantive solution. Too many innovators are not clear about what problem they are trying to solve and often produce solutions with more “sizzle than substance.” Part of the reason Nuvo is in this amazing position today, where we can help so many mothers and babies, is because we focused on substance. It is better to develop something that has a discernable impact that doesn’t need to be explained than it is to focus on creating sizzle around solutions that have little impact or worse, problems that do not really exist. Start with a goal of wanting to make an impact rather than just make money. From that starting point, the goals become clearer and teams thrive when they’re all pulling in the same direction. Moreover, it gives their mission meaning.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
The three biggest problems are lack of knowledge caused by lack of interoperability, lack of access, and misaligned incentives.
As a data scientist, I believe that solutions must be backed by evidence. The lack of interoperability between practices, hospitals, and systems make it impossible to pool the data necessary to find more than partial answers to the biggest problems with American healthcare. Without greater collaboration and compatibility, you can’t employ robust population health strategies or come up with impactful approaches to social determinants of health.
The second issue is access. American women spend a lot out-of-pocket for health care; the average new mother with insurance will pay more than $4,500 for her labor and delivery. The cost to give birth in America has been increasing without any corresponding improvement in results. This is because many are forced to pick and choose care based on their ability to pay, rather than the best available medical evidence. More than one-third of women in the U.S. report skipping needed medical care because of costs. Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care.
Women may also have limited access to appropriate preventive, prenatal and postpartum care if they live in counties with few obstetric care providers. Distance can make the recommended number of office visits difficult to comply with. In 2018, the March of Dimes reported that about half of U.S. counties lacked a single OB/GYN, more than half of the counties did not have a certified nurse midwife, and nearly 40% have neither. The shortage of providers can result in fragmented, impersonal care that does not reflect what research has shown for decades produces the best health outcomes for mothers and babies. Finally, moms are seeing a reduction in total time spent in prenatal visits.
Lastly, incentives for providers are misaligned, the fee-for-service model results in a system built to create a sicker population. Providers are compensated for performing procedures, not for keeping people well. In pregnancy care, we see this represented in the fact that about one-third of all deliveries in the U.S. occur via C-section, even though the World Health Organization estimates they are medically required in only 10% to 15% of births.
You are a “healthcare insider”. If you had the power to make a change, 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.
The most important thing that needs to change is how we think about healthcare. We need to do more to promote health assurance — affordable, personalized, and preemptive care enabled by genomics, sensors and AI-based digital therapies that help anticipate patients’ needs and work to keep them as healthy as possible rather than models that elevate “sick care” in hospital settings. Addressing this mindset has a positive cascading effect on many aspects of US healthcare that need to change.
The movement away from “sick care” recommends itself to distributed healthcare, the concept of moving some care services closer to the person in need rather than make the patient travel to care. This way a healthcare system can help to keep people healthy and in their own homes by providing the right care and support at the right time. This is something we immediately sought to address with the first generation of our INVU platform, which can remotely provide fetal wellness checks and makes the mother the point of care.
This type of thinking also accelerates the movement away from fee-for-service reimbursement toward value-based care based on patient outcomes rather than quantity of procedures. In pregnancy care, such a move would mitigate the financial incentive to perform c-sections for low-risk births without medical indication. The aforementioned collaboration with Hadassah Medical Center will initially focus on the development of proprietary clinical decision support systems that can be integrated into the INVU platform to track a number of underlying factors in an effort to prevent complications and emergencies where possible.
Under a health assurance model, providers would be more intentional about collaborating around what patients need instead of around what providers do and how they are reimbursed. For example, obstetrics as a medical field can require the contribution of multiple medical specialties such as cardiology or psychiatry, yet the structures of practices and health systems make coordination of specialists difficult. We intend to expand into collaborations as necessary to develop a proprietary pregnancy population management solution where providers and payers can leverage predictive pathways based on a variety of data inputs to provide more personalized management plans to mothers for a spectrum of pregnancy events.
Finally, the US needs to retain the gains in telehealth adoption made during the Covid-19 pandemic. Providing value-based, distributed, coordinated, health assurance to patients requires a fuller picture than what can be provided in intermittent snapshots taken in providers’ offices. Sophisticated remote monitoring is the missing piece that makes the rest of changes possible. It is impossible to ask a patient with a chronic condition to visit a provider’s office multiple times a week over the long term. It is likewise difficult to ask an expectant mother to visit multiple specialists in different locations to coordinate care. In both cases a remote monitoring session is convenient for both the patient and the provider and serves the goal of health assurance.
Ok, it’s very nice to suggest changes, but 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?
The difficulties in providing health assurance come from the barriers in the US healthcare system between specialties, systems, and stakeholders to improve care on a large scale.
While the United States is very different than Israel in terms of size and population, my country’s approach toward voluntary, multiparty cooperation among health plans, physicians, and physician groups could contribute greatly to quality improvement efforts — if even on a regional basis. Knowledge sharing of how to implement successful strategies is one step, as the small and medium-size groups in which many US physicians work face diseconomies of scale in mounting quality improvement efforts on their own. Finding a path towards metric transparency would also stimulate rapid improvements and foster goal alignment.
Payers can advance technology and telemedicine that could improve access to services by reimbursing providers for remote care, and providers should look to adopt telehealth services beyond video-based televisits. A hybrid model of care needs to be embraced as the future standard of care.
I would increase access to affordable preconception, prenatal, and postpartum care, and in some cases provide logistical support and financial assistance to women so that they can travel to receive care when necessary. One financial model that could contribute toward more democratized care is greater promotion or expansion of flex accounts to allow people, who are bearing increasing responsibility for care, to direct and choose where their money goes.
Electronic health records need to become more standardized and enable patient-centered care. Most EHR systems in the US have focused on enhancing billing, revenue, and documentation, rather than closely tracking the health, wellness, outcomes, and cost of individual patients throughout the care continuum. In order to create a system that keeps people well instead of focusing on treating the sick, patient-centered EHRs have to be readily accessible to all care providers and patients, have to be easy to input and extract data, and have to use common definitions for data. Interoperable EHRs have the additional advantage of generating pools of data that make health assurance truly possible through population health. In Israel, we have been collecting health data on our entire population for 20 years and that data has fueled major healthtech and data-enabled innovations.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
Again, without interoperability and greater coordination, the data needed to arrive at a meaningful answer to this question isn’t available. Without data to generate a deep analysis, what you have to work with are symptoms. At Nuvo, we’ve begun work to develop algorithms that might help predict perinatal mental health issues that can be integrated into the INVU platform and help the care team provide early mental health support where screening identifies higher risk.
I think that this is particularly true in pregnancy, which is a mentally and physically transformative event for the mother and child. Mood disorders start in the womb and left unchecked, can have lifelong challenges. Researchers have identified alterations in fetal and infant brain-behavior development related to maternal prenatal depression, anxiety, and extreme stress. We need to start developing technology capable of screening for these biomarkers to better direct mental health resources and care as early as possible.
Perinatal mental illness — which include depression, anxiety disorders, and postpartum psychosis — is a significant complication of pregnancy and the postpartum period that is associated with poor maternal and infant health outcomes. According to a CDC report, 13% of surveyed women with a recent live birth reported depressive symptoms during the postpartum period, one in five did not report a health care provider asking about depression during prenatal visits and one in eight reported they were not asked about depression during postpartum visits. We would agree with the CDC’s recommendation of universal screening of pregnant and postpartum women for depression.
Taking a step back, this is a symptom of the siloed approach to treatment that reflects more how care is delivered and reimbursed than what patients need. The interplay between physical and mental health is well understood in the perinatal period, but it is also recognized in a number of chronic diseases. So, the first step I would take to improve it is to improve coordination between specialties. As a data scientist, my contribution through INVU is to develop AI algorithms to help encourage this coordination.
Finally, we need to provide doctors with technology that helps them spend more time with patients. Patient-centered, rather than coding- and billing-centered EHRs, can facilitate easier collaboration between specialties and provide the information necessary to develop decision support or alert tools to enable providers to spend more time observing the patient.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider is one who challenges the past in every moment of the present to improve the future. They are willing to challenge the current paradigm, finding new ways to improve patient diagnosis, outcomes and experience while reducing physician burnout, lowering costs, and developing new payment models to reward value rather than volume.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“A prudent question is one-half of wisdom.” — Francis Bacon
To me, the art of management is the art of asking questions. If you don’t ask at least five questions, you don’t get to the bottom of it. Questions can help speed innovation by uncovering previously unidentified challenges and generate better solutions and prevent fast-moving teams from spending too much time and energy solving the first iteration of a challenge. Questions not only help us to learn; they can also help us to inspire. They can increase the capabilities and potential of your team by increasing the likelihood of an “aha” moment, which can then lead to innovation and growth.
Are you working on any exciting new projects now? How do you think that will help people?
We have completed enrollment of a study evaluating use of the INVU platform for remote monitoring of uterine activity, which will be used to support a planned 510(k) submission to expand the current functionality. The addition of remote monitoring capability for uterine activity would allow a virtual visit to include a remote nonstress test (NST), a common prenatal test that is currently given once a week or more in a healthcare setting during the final weeks of pregnancy. We are continuing to advance R&D efforts toward rounding out INVU’s self-administered monitoring capabilities to enable pregnancy care to adopt some of the changes discussed here.
Also, as mentioned, Nuvo has been granted access to Hadassah Medical Center’s large database of rich medical records including pre- and post-natal clinical information for more than 50,000 subjects. We will initially collaborate with Hadassah on the development of proprietary clinical decision support systems that can be integrated into the INVU platform with the potential to deliver alerts and relevant analytics, improve patient outcomes, and safely lower heath care costs. Providers and payers could benefit from the integration of decision support designed to improve outcomes for mothers, workflow burdens for care providers, and costs for payers. This is a particularly strong opportunity for Nuvo to offer value, as our INVU platform will enable Nuvo to develop decision support tools based on unique, proprietary data.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I enjoy classic science fiction. As an innovator and leader, I have an affinity for imagining plausible alternative realities and bringing other worlds to life. As a leader, I value science fiction for its ability to make innovations real for the reader. Science fiction also reminds the reader that the future is not set in stone. I am also a fan of Dan Brown, probably because of my love of questions. His books are typically propelled by an initial question that leads to a hunt for evidence, leading to more questions before it reaches an epiphany. Not unlike being an innovator!
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. :-)
I’m blessed to be able to personally advance the movement I wish to see — the Maternity Movement. I hope to ignite a #maternitymovement where innovators, investors, providers, payers, and parents come together to improve one of the most important journeys, the creation of a new life. Every life that’s ever been lived begins with a birth story. To create the greatest good in the world, I want to apply the best thinking and innovation to give every life a better beginning.
How can our readers follow you online?
You can follow me on LinkedIn at https://www.linkedin.com/in/oren-oz-a580776/
Thank you so much for these insights! This was so inspiring!
