Deborah Kilpatrick, Evidation Health, on enabling patient participation in health outcomes

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Deborah Kilpatrick, Co-CEO of Evidation Health

In this episode, we interview Deborah Kilpatrick, Co-CEO Evidation Health. With a network of over 4M individuals across the U.S. and a platform that gathers key real-world data from patients’ day-to-day lives, Evidation is on a mission to enable and empower everyone to participate in better health outcomes. Since its founding in 2012, Evidation has raised money from investors like B Capital Group, Revelation Partners, Rock Health, McKesson Ventures, Sanofi Ventures, Section 32, and G Squared. It has also worked with a range of players in healthcare, from pharma companies like Sanofi to tech heavyweights like Apple to physician societies like the American College of Cardiology.

Start to 11:00: From F-22 Raptors to leading a healthcare company

• It started with fighter jets: Deb’s first job out of college was working on Lockheed’s F-22 Raptor program, where she fell in love with computational technology as a means of advancing R&D to the bleeding edge. Later as a grad student at Georgia Tech, she focused on computational techniques to study arteries as they develop disease. This formed the basis of her early post-grad career and move into healthcare.
• Seeing the power of healthcare analytics: Deb ended up going into molecular diagnostics at a company that was enabled by the completion of the Human Genome Project and the resulting emergence of capabilities to understand genomic information. There were now new computational platforms for diagnostic and therapeutic development. Deb began to believe that it wouldn’t be long before people discovered ways to harness data to guide R&D and therapeutic decisions. Today this is a core underpinning of Evidation’s business.
• Co-CEO model: Deb was introduced to Christine Lemke, co-founder, in 2014 through GE Ventures. They led Evidation together from the onset, with Deb as CEO and Christine as President. After several years of running the company this way, they moved to a Co-CEO model as Evidation embarked on its next phase of growth. It was important to Deb that everyone, from customers to investors, saw the two as equals in the CEO role.
• Deb attributes the success of Evidation’s Co-CEO model to three factors:

1. Skillsets that are complementary and necessary for the problems that the company is trying to solve
2. Natural comfort with a collaboration style involving significant transparency and joint decision making
3. Different “swimlanes” of responsibilities built on trust

“We’ve got swimlanes carved up in a way that allows each of us to really thrive and be challenged by the day-to-day leadership challenges we face. Because of our mutual areas of expertise, we’ve just got a huge amount of trust that the other one is going to handle those things.”

11:00 to 19:00: Evidation “activates” patients through research participation

• Evidation’s stated mission is to empower everyone to participate in better health outcomes. On a more tactical level, the company does this by making it super easy for patients anywhere to participate in a truly modern research ecosystem (more on that later). Patients can access this platform, called Achievement, through anything with an internet connection (phone, web, etc.).
• The bigger picture: The company sees this mission as a way to activate patients so they engage in and contribute to their health. Directly, the data patients contribute to the platform powers deeper insights into health outcomes. Indirectly, this motivates patients to become more interested in their health journeys within an evidence-based ecosystem.
• How it works: Anyone (yes even you!) can join the Achievement platform — go here for the iPhone app and here for the Android version. From there, you can contribute your health data to research sponsored by biopharma and tech-enabled companies. Privacy is a key focus for the company — your data is permissioned for specific use, meaning that Evidation does not share your data with a sponsor unless you opt into that study. Participants are paid for their contributions.

“It gives [participants] a way to contribute to something bigger than themselves on a scale that simply wouldn’t be possible where they are limited to just brick and mortar clinical research.”

• The data iceberg: Evidation’s focus is on the “invisible” data that has traditionally been inaccessible. Our current health system is good at capturing the top part of the iceberg — episodic data that characterizes health and disease, like visits to your doctor, lab results, and prescriptions.
• However, this constitutes only part of the information that could be helpful for assessing health outcomes. Much of the data that would be reflective of what drives outcomes is happening in the daily life of a person (e.g., activity levels, sleep quality). By harnessing the power of real-time data generated by our phones, smartwatches, or other sensors, Evidation seeks to capture and sort through this massive, once hidden part of the iceberg below the water in order to get a better picture of a person’s health.
• On building trust: Evidation has been remarkably successful at building trust with their participant community. First and foremost, Deb attributes this to meeting patients “on their terms in the context of their daily life.” This includes both their day-to-day schedules as well as how they interact with technology.
• In addition, Deb re-iterated the importance of not only obtaining consent for initial data use but also re-consenting for each new use case, which is very different from how our data is typically used by many other companies

“The vast majority of companies, even if they’re getting consent right on the front end for collection, are not always going back and asking for consent for subsequent use. This is incredibly important for healthcare and for healthcare-related use cases, and we’ve benefited from having architected our system that way from the beginning”

19:00 to 23:00: Building a diverse patient network

• Today, it is reported that less than 5% of the patient population has ever participated in a clinical trial. Deb acknowledges that, to an extent, this may be attributed to the challenges of brick-and-mortar trials and not necessarily a fault of the system — there is a limit to how far someone might be willing to travel in order to participate in a trial.
• However, this has consequences on access, participant diversity, and the influence of key social determinants of health. For example, according to a recent FDA report, 72% of trial participants in 2019 were white, which is clearly not representative of the populations that new therapies are meant to treat. Decentralized approaches to clinical trials, like Evidation’s, can therefore address some of these challenges by democratizing access.
• Across its 4.1 M patients, Evidation’s Achievement network currently includes over 30 different therapeutic areas, a wide age distribution (there are participants well into their 80s who are engaging with Evidation’s technology!), and a majority female gender mix. Looking ahead in 2021, Deb hopes to grow their 50+ population even more and continue diversifying across dimensions like level of education and race.

23:00 to 35:00: Recent growth and partnerships

• Impact of COVID: Given its decentralized model, Evidation did not experience a meaningful interruption to its business. In fact, their pipeline grew significantly as they saw the marketplace become increasingly receptive to products built around a decentralized healthcare ecosystem.

“For us it wasn’t about trying to adapt to a new model because of COVID — it was watching the world adapt to our model because of COVID.”

• Achievement for Heart Health: In December, Evidation announced a new partnership with the American College of Cardiology, which Deb considers “one of the most important things that happened for us as a company in 2020.”
• Given Evidation’s mission this makes a lot of sense. The ACC partnership represents a major step towards the goal of “activating” patients by providing them with resources to better understand and improve their health. This was highlighted in their press release:

“Individuals can share activity, sleep, blood pressure, and symptom information, including permissioned app and wearable data. Participants will also receive personalized, evidence-based educational content on topics like heart medications, nutrition, and stress management from CardioSmart, ACC’s patient engagement program, which includes a library of cardiovascular health resources, as well as patient navigation tools to guide provider visits.”

Click here for Achievement for Health Health site

• Expanding the model: Deb sees potential for a model similar to that of the ACC partnership working in other therapeutic areas. She highlighted a few criteria for success:

1. Conditions with clear care pathways that already exist or can be developed
2. Conditions with therapeutics or lifestyle modifications that are known to be effective
3. Conditions that involve daily management over a long period of time (potentially throughout the patient’s life)

• Deb called out autoimmune conditions (e.g., multiple sclerosis) as an area that meets all these conditions such that patients could meaningfully benefit from tangible tools to leverage insights from their data to improve their health.
• CNS conditions and movement disorders could also benefit from this type of model.

35:00 to 42:00: The role of the health data ecosystem in the future of care

• Personal health tracking has grown rapidly over the last several years. From the Apple Watch’s EKG to Levels’ consumer-targeted glucometer, there are more options than ever to collect health data on a real-time basis.
• Looking into the future, Deb envisions a world that might combine these sensors, data collection / analytics platforms, and care delivery to create an ecosystem that can deliver health outcomes more effectively. She offers the Teladoc-Livongo merger as evidence of the market’s shared belief in this future:

“[The merger] tells me that people are getting this — that people are understanding where you find synergy between measuring outcomes and measuring health, and the underlying way of using that evidence as a way of clarifying patient journeys, measuring patient journeys, and creating new care pathways that are patient directed.”

• On value-based care: While the transition to value is indeed a slow one, Evidation has seen payers genuinely excited about using data to better understand outcomes. Pulling on her time as an engineer, Deb likens the current state of value-based care to the early days of using computational modeling to design planes. At first it was all about exploring what the technology could show you, but it wasn’t long until we advanced these techniques to develop faster planes.
• Mitigating information overload: I posed a futuristic scenario where providers have access to movie-like dashboards with real-time information on a patient’s entire set of health data. While powerful, my concern has been how a provider might make sense of all this information. Fortunately this is something that Deb and the team at Evidation are being thoughtful about.
• As more and more data becomes accessible, Deb says they must focus on only the most relevant parts. This is precisely why co-creation was important to the development of Achievement for Heart Health — Evidation wanted to ensure that clinicians were involved in determining how real-time data could be translated into clinically relevant care.

“The physician dashboard can’t just be accurate information about what’s going on with the patient, it has to be relevant information based on the measurement. The harder part is making sure we understand what’s relevant.”

42:00 to End: Wrap-up

• Advice to aspiring healthcare leaders: First, leaders need to be genuinely committed to improving patient care. At the same time, it is immensely important to understand the incentive structures in healthcare. On that last closing point:

“If you want to be in this part of the ecosystem, I think you really have to start by understanding how money flows through the system.”

Evidation is hiring! Be sure to check out their careers page for more information on open roles.