Dr. Ashwini Zenooz, Commure, on building a more open operating system for health systems

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Dr. Ashwini Zenooz, CEO of Commure

Our guest on this episode is Dr. Ashwini Zenooz (“Ash”), CEO of Commure, a platform that enables health systems, digital health companies, and 3rd party developers to more quickly build interoperable data-driven products for healthcare. Their goal is to facilitate new clinical and operational workflows that leverage a health system’s data infrastructure to improve the patient experience, perform better in value-based arrangements, and expand access to care. Commure recently closed a $500 million fundraise across two rounds led by Human Capital and Greenoaks Capital, and received its initial backing from General Catalyst.

During this conversation Ash and I covered:

• What Commure’s mission to build a “common architecture” means for health systems and digital health builders who decide to partner with it
• How Commure fits into the growing landscape of interoperability platform companies like Zus, Olive, and Redox
• The company’s growth strategy, and in particular the role of partnerships and M&A in its future

Start to 9:00: Ash’s resume includes Chief of Radiology, CMO at the U.S. Dept. of Veterans Affairs, and CMO at Salesforce

“I see the next 10 years as the decade of healthcare, and I think we’re really going to make a dent in where we go with the delivery of care and what it’s going to mean for the patient….Once we accomplish that, I will have a lot more time on my hands to explore the world.”

• Ash started her career in medicine as a radiologist. Although she deeply enjoyed the practice of medicine, she suddenly found herself as the caretaker of a family member with cancer. This gave her a new perspective on our healthcare system and highlighted how broken it is. Since then, she found it difficult to go back into full-time medicine knowing that she could make a bigger impact another way.
• In 2015, she left full-time practice to become a Brookings Fellow in the U.S. Senate. There she worked on legislation related to patients’ access to technology, information blocking rules, and real-world evidence.
• Over the last two administrations Ash was in the U.S. Department of Veterans Affairs. It was here that she gained hands-on experience with the implementation of health technologies, directly overseeing their EHR modernization as Chief Medical Officer. (Editor’s note: this isn’t the first time on The Pulse that the VA has been described as an innovation ground — check out our episode with Jon Bloom for more on this!)
• Believing in the ability of technology to add significant value to care, Ash’s last role before Commure was at the Global Healthcare and Life Sciences business at Salesforce, where she was the General Manager before later becoming the Chief Medical Officer. Although she enjoyed building her business acumen at Salesforce, she ultimately left to be at an organization focused exclusively on healthcare. Combining this with her desire to be in a nimble start-up working on technology platforms for care is what ultimately brought her to Commure.

“I put all my bets in the technology basket. I really felt that’s where you could make a huge impact… There’s so much change you can make by changing the care model and adding technology.”

9:00 to 21:00: “Commure” means “common architecture” — an operating system for health systems

• Some quick interoperability history: The HITECH Act of 2009 provided funding to providers to accelerate the shift from paper to digital records. While it was successful in that it increased the YoY growth rate of the EMR from just 3% to 14% a year, it inadvertently created data silos between systems (among other problems). The subsequent challenges of transferring data between different providers helped sparked a new wave of interoperability conversations throughout the industry. To address these issues was the FHIR protocol, which was meant to facilitate improved transfer of healthcare data between different systems.
• However, Ash points out that FHIR really has not been a complete solution to the industry’s interoperability woes. We might have made progress in transferring data, but this does not mean that said data is necessarily presented in a useful format and context. This is where platforms like Commure’s come in.

“When they say we have this interoperable platform, what most people really mean is that they can take structured and unstructured data and move it back and forth… What you really need for an interoperable platform is more than a data-dumping tool.”

• Commure’s “common architecture” is meant to be a connective tissue allowing health systems to build useful applications leveraging varying streams of healthcare data. Specifically, Commure aims to do two tings:

1. Bring different sources of data together into one place, standardize it, and make it easily accessible to a system and relevant third parties
2. Make this data meaningful with additional developer tools for creating new workflows and applications for care

• Thus, Commure is essentially building a platform analogous to mobile operating systems like iOS or Android, which provide software developers with APIs to securely access key components of the phone’s software outside of the application being built (e.g., Bluetooth, contacts, internet connection). Also, just as Apple might preload Apple Maps but allows users to use Google’s version instead, so Commure gives its customers the option to use Commure’s built-in care applications or build their own tools.
• Ash put this in context with a case study from a children’s hospital they recently worked with: The organization was using Epic for scheduling, Cerner for data storage, another third party for remote patient monitoring, and Zoom for delivering virtual care (editor’s note: yikes!).
• This health system’s goal was to create a better experience for patient scheduling. They wanted a single interface that could combine the different data pieces and workflow components, allow providers to interact with them, and seamlessly transfer data to wherever it needed to go across the system.
• While the system asked a trusted 3rd party to create this solution, it was built on top of Commure’s platform, which allowed the 3rd party to easily access and integrate everything it needed across the system to create this new experience
• Thus, a key value proposition of working on its platform is that systems can retain more value and create new revenue sources by building tools themselves instead of buying them.

“We’re providing that capability to say you don’t have to lose your business to a third party digital health company that’s providing virtual primary care — you can do the same or you can collaborate together.”

• At the same time, Commure hopes to bring back-end integration efficiency digital health solutions that are built on top of its platform. Ash believes that this can help speed up integration and even reduce costs.

“Most healthtech companies going into provider systems are point solutions, and a lot of the commodity stuff on the back-end is redundant between multiple digital health companies. A health system or a payer is paying for this, and those costs are generally passed on to the consumer or patient at the end.”

21:00 to 30:00: Health systems will need to choose a partner for building an operating system

• Commure isn’t the only player in the space, which is home to the likes of Redox, Olive, and, most recently, Zus. These companies all offer some level of health system integration capabilities and / or third-party tooling that developers can build on top of.
• However, Ash prefers to view these companies more as collaborators than competitors since, as a platform, Commure aims to work well with any organization building integrated tools for health systems.

“Olive is doing a great job, for example, in the payments platform space… If their stuff is better and they have a way to integrate with us and they’re inside of a system, we’re going to collaborate with them.”

• Throughout the entire discussion Ash presented a consistent message that she believes the key to Commure’s success will be the openness of their platform as well as its ability and desire to integrate with what could be considered competing offerings. Her stance was straightforward on this topic: “if you’re innovating something, and you are bringing value to a healthcare system, and we exist in that space, we want to work with you.”
• Health systems ultimately have to choose their “operating system”, and Ash believes what will differentiate Commure in the long run is the flexibility and interoperability it offers its customers. It is the company’s hope that system CEOs who prioritize this objective will choose Commure.

“Whether you’re a healthcare system or a payer or a pharma company, [you have to decide] which set of tools and what stack consolidated is going to be the best approach for you. And in my mind, I think one that is more open and that’s more willing to collaborate is going to win.”

• Ash expects systems to increasingly start thinking through these decisions in the coming years, but recognizes that it’s still the early days of their adoption of operating systems.
• From her perspective, many leaders of health systems are still thinking of their EHR as the platform on top of which everything else is to be built. However, she notes that eventually some realize that the EHR is actually not well equipped for the integrations, data capabilities, and workflows that platforms like Commure were specifically designed to facilitate.

30:00 to 39:00: The role of partnerships and M&A in Commure’s growth

• This past October, General Catalyst, Commure’s initial backer, and Jefferson Health announced a partnership to tap into the “Health Assurance Network”. This network is a coordinated initiative spearheaded by General Catalyst and includes health tech companies like Tendo, Transcarent, Olive, and Commure.
• Asked what “health assurance” means, Ash describes it as a commitment to facilitate greater data exchange and integration with health systems and third parties that want to work with the health system. At the same time, there is a recognition that health systems themselves should not impede new care models that could potentially take patients out of their hospital, such as at-home solutions.
• As a member of this network, Commure will have a role in developing the set of basic rules governing how member companies should collaborate with each other and reduce the friction to building new solutions.

“This next step for us was really to come together as multiple companies to say what are we willing to do and not to do? And our role there is to be that connective tissue layer and provide that platform for innovation…. How do we bring these third parties and the intra-Jefferson system together to provide that innovation and data exchange?”

• In a blog post from May 2021, the company openly discusses how partnerships and M&A “have been and will continue to be Commure’s primary growth strategy”. A few months after that post, Commure announced its acquisition of PatientKeeper from HCA Healthcare.
• Ash re-affirms the company’s view of M&A as a strategic growth lever, highlighting its role in acquisition of talent with the unique skills that will help Commure build a stronger ecosystem for integration. In particular M&A can help Commure source hard-to-find people who are platform centric and know how to work with the EHR and other healthcare data.

39:00 to end: Wrap-up

• Speaking to other aspiring healthcare leaders and, in particular, women of color, Ash’s offered two big pieces of advice. First, is to not let people box you in. People have questioned why she is the CEO of a tech-heavy company when her background is in medicine, but ultimately she had to stick to her goals and follow her passions.
• Second, Ash is a strong advocate for building your own kitchen cabinet, an informal group of advisors she can go to for advice for different parts of her life, from being a parent to entering technology as a doctor.

“These are my trusted confidants that have known me over the years and can speak the truth. Because I think sometimes you just need it — you need to hear from somebody saying you’re wrong on this.”

• On the topic of careers, Commure is actively hiring. For MBAs they are hiring people in business development, product management, and M&A strategy. Ash encourages anyone interested in Commure and the space it’s in to check out their careers page.

To see roles Commure is hiring for, check out their careers site here.