Augusto Digital Insights: Featuring Dr. Kyle Hoedebecke, Medical Director of Oscar Health

Brian: Welcome to the Augusto Health IT Digital Insights Podcast. I’m your host Brian Anderson. This episode is part of our healthcare focus, where we highlight digital innovators that are changing healthcare for the better. This episode’s guest is Dr. Kyle Hoedebecke. He is the medical director for Oscar Health. Oscar is the first health insurance company built around a full-stack technology platform and a relentless focus on serving its members. He’s also an angel investor and a mentor with a focus on healthcare technology, things like wearables, AI, AR/VR, 3D printing, energy, IOT, bio-pharma, a ton of stuff. And he brings a wealth of knowledge and experience to share. I’m looking forward to this conversation. Welcome to the show Dr. Kyle.

Kyle: Thank you so much Brian for having me here; it’s a real pleasure.

Brian: I want to drill into your background a little bit. I think when I first got introduced to you, I learned a little bit about your background, and it’s super impressive, it’s super deep. Maybe just highlight some of your history and what led you to the focus that you have right now?

Kyle: Yeah, I definitely haven’t taken a traditional physician’s pathway. I started off going through the U.S. Military Academy at West Point, where the focus definitely is not healthcare or anything along those lines; it’s leadership and infantry and anything related to battle. So they do let up to 2%—my year was just 1%—of the class go directly to medical school. So I made that cut, went directly into the Uniformed Services University, which is the only active duty medical school in our nation. So we like to call it America’s Medical School; we also like to call it the best school you’ve never heard of, so it’s a fun little misnomer there. But it’s an amazing, amazing school, we get to work across all branches of the military to include public health service, which technically isn’t military but is a uniformed service. I went on and did my specialization in family medicine and did some positions kind of back and forth between infantry units, like the 82nd Airborne and the actual Army Medical Command. That took me all over the world and I had the chance to work in and with physicians in about 120 different countries around the world, so that was quite unique. I finished up my time in the military leading four different clinics in Korea. Fast forward to today, I’ve just spent the last two years with Oscar Health so I’ve been with them since I got out of the military. It’s a real transition from the pure clinical and leadership practice to a payer side where we’re still able to make differences and systemic changes on a large scale just on the other side of the coin, so that’s what I’m doing these days. Having a little bit more time on my hands and not having to be on call or work so much on weekends, I’ve really been able to follow my passion, which is innovation—especially within startups in the healthcare space. My personal goal when I leave this earth, I want to have made our healthcare system better through implementation of improved systems, as well as technology for better population health here in the U.S. and abroad. So I think being involved in these startups and really pushing the envelope both as an investor as well as an advisor in these startups is not only fun, challenging, engaging, but it’s also really my passion.

Brian: That’s awesome. A purpose man, it just kind of sets everything up, doesn’t it? And it’s like, you definitely have purpose. Hey, I’m curious, just a couple of more questions on your background. Is it true that you know four languages at this stage or do you know more?

Kyle: It is. So it’s funny because my first language… I was born in San Antonio, my parents were dual military, and then we moved to Germany when I was only a couple months old and I was there through about kindergarten, first grade. My parents again were dual military so there was a lot of time at work, and I spent time with the nannies and just went up through the German school system. I have lost most of that, unfortunately, but at the same time since I’ve become an adult I’ve been able to really pick up Spanish fluently—we speak that at home. Brazilian, Portuguese, a little bit easier than continental for me but either one is fine. And then the final language is called Guarani, which is an indigenous language from the center of South America—from the Paraguay region where my wife is from—and we also speak that at home. I wouldn’t be surprised if you’ve never heard of it. I never had before I went to Paraguay either. But it is a language where we have some interesting words that come directly from there like the word tapioca, so if you like your bubble tea or Boba tea, tapioca or tapioca pudding, it comes from that language. The word piranha comes from that language; a lot of animals and plants are from that area. Beyond Greek and Latin, it is the third most common so I guess the most common after those two languages for naming species and genus because the Amazon basically is right there and there’re so many plants and animals.

Brian: That is interesting.

Kyle: Yeah, so those are the four languages I speak. I dabble in a couple others, but mostly just enough to get myself in trouble.

Brian: And then, how many degrees do you hold?

Kyle: So I have my medical degree from the Uniformed Services University, so that’s really my clinical foundation—that and I have my board certification. Those are my real foundations clinically, but you’ll find that medical school doesn’t teach you anything about business. And I would argue also in general, unless you do some sort of business degree, our school system doesn’t teach you anything about business—which is why we are as a society so much in debt. So I went on after my clinical side and I got a master’s in MBA so master’s in business administration, it was a dual degree with master’s of science and leadership and that was paid by the military. I had a couple of more credits left so I said, what’s something similar I can do where I can get some partial credits towards the third master’s and use up the last of that, I guess, credit that I had with the military? So I got an MPA, which was a master’s in public administration with an emphasis in health care. About half of those credits were similar to the other two master’s I already had, so I really only had to take six more classes instead of another 12 classes to get that. So I was able to sneak out three master’s degrees where most people would only have one with the same amount. And then at the end of my time in Korea I was placed in charge with another doc to really set up our telemedicine capabilities there. So in Korea, we had maybe, I’m just kind of guessing,120,000 retirees active duty in all branches with their family members. And then we also have a lot of Korean armed forces that work with us and we take care of some of their medical needs as well, and then the civilians that we work with, like DOD civilians. There are like 120,000 people who were taken care of and we only had one dermatologist for all of those and I can guarantee that was not sufficient. Same thing for occupational therapy, so it’s physical therapy for the arm, we have one for the entire peninsula. So instead of making those individual providers run around the entire peninsula we, I guess not we, but way above me decided to set up telemedicine which I mean made a lot of sense and we kind of got tasked with that, we got voluntold if you will, and I was like telemedicine or I can talk to you over audio visual platform but I had no idea how to set that up. So to get smart on that really quickly I actually looked up if there were any master’s in telemedicine. I said let’s do this officially if I’m going to have to learn about it. And I found two: one in Norway and one out of Rome. So the one in Rome actually lined up quite nicely with my schedule and I took my master’s in telemedicine and e-health at the same time I was setting up this telemedicine in Korea. I handed that off before I left, I didn’t get to finish that project but got to initiate it. But that’s I guess the story of how I got my fourth master’s, so now you know kind of how and why I got this.

Brian: Yeah. It’s awesome. It’s very ambitious and it shows how much work you’ve put in behind the scenes. And you were a family practitioner for what, 10 years? What was that like and what kind of led you to leave that and to go into Oscar Health?

Kyle: Good question. There were a few factors. So on the clinical side we were, especially my last several years, I had several hats so I was part of the inpatient coverage for both pediatrics and adult medicine. I was seeing patients on the outpatient front as well, and then I was leading four clinics so that was a lot of work. Very fulfilling, very challenging, but at the same time I think I probably burnt myself out just to be honest about that and that’s something that I don’t think in general we ever want to admit as doctors that we have a limit, but I think I probably reached that limit. And I was not necessarily looking to get out of the clinical setting as I was searching for certain civilian jobs as I was transitioning. I was looking for a leadership job because I wanted to employ the clinical as well as the management and business know-how. And those are pretty much chief medical officers, regional medical directors, just medical directors so I was typing in all these things and up popped a medical director at Oscar Health, and I said, what the heck is this? I think I applied and actually went onsite to interview. This was back in 2019 before COVID. I went onsite in person just out of curiosity because I had no idea what I was getting into. And I really, really enjoyed the team, it’s extremely nice, the work is satisfying, there’s a lot less pressure in the work I do which is really nice. And then the pay is very similar and the hours are much better so it’s pretty much a win-win all around, and I got to experience another aspect of health care.

Brian: And it’s interesting because Oscar is a pretty new insurance company in terms of insurance companies, and they’ve said they’re built around a full stack technology, but what does that mean? And how does that benefit Oscar?

Kyle: Yeah. It’s a very unique viewpoint and vantage point. So our CEO Mario (great guy), he comes from that computing and engineering background whereas, Oscar as an insurance company you need to have that clinical background.

So we find ourselves saying that we’re half a technology company and half an insurance company. We even use verbiage like re-factoring healthcare. I’ve never used the word refactor in my life until I came to Oscar and I probably use it every single day now, but just applying thought processes and principles of that world into healthcare. And then two tangible outcomes and benefits that we have is that every member who’s an Oscar member has free telemedicine as many times as they want. So that is quite unique in and of itself, I’m sure that other insurances have brought that on more heavily since COVID but that has remained unchanged before, during, and after COVID for us. And then we also have a concierge service that will guide you and handhold you if need be through the process of either claims or getting a medical request, getting a specialty referral. Because, you know what? I have four degrees and I can barely understand how to do it and I’m a physician. I can’t understand how the average American can get through this. It’s just a complete mess to tell you the truth, so having somebody to help guide you through the labyrinth that is our medical system is quite nice.

Brian: Yeah. It seems like insurance companies especially kind of recognize that. And I worked with insurance, a payer who was focused on a health navigator program. I think it’s probably similar to what you’re talking about the concierge service. And it’s just navigating this stuff and it’s complicated, these systems are big, there’s lots of different providers. It’s figuring out how much this stuff’s going to cost, it’s not super transparent. And then, yeah, a lot of people that are in the system seem like they’re aging and that’s a big part of the system too, so there’s maybe some confusion there around just, how the heck do I navigate all this stuff? There’s so many reasons I imagine.

Kyle: That’s a great point as we transition online as well that there is a potential of digital divide in that the newer generations might be able to pick it up really easily. But I mean, I guess my grandmother before she died recently was able to manage an iPad and iPod and everything pretty well, but still there’s that digital divide, not only from those who are not native, Wi-Fi is all their life, as well as just the access to internet is still an issue even within our country.

Brian: Hey, let’s transition a little bit into these investing and trends. So when did you start with the angel investment journey? And I’m going to start there and then maybe highlight some of the types of companies that got you interested in it and where you bet on them.

Kyle: About the same time, so the last two years really, as I started getting out of the military. So access beyond California is really, in my opinion, the next kind of big hub of innovation technology. And we see a lot of those moving from California—the Elon Musk’s, Tesla, etc.—here to Texas, so I found myself really surrounded by that. I think initially to start it off people saw my profile and said, oh, would you be interested in being a mentor or an advisor? And really at the initial onset I was lucky enough and fortunate enough to come in contact with a gentleman who just lives right down, not technically down the street but five, 10 minutes away from me, who just happened to co-found a little company called Teladoc. It’s now the biggest telemedicine platform in the world and is worth almost $40 billion, so yeah, its co-founder lives literally right down the way from me.So his name is Mike Gorton, and he kind of took me under his wing and has gotten me involved within a couple of accelerators and incubators, and the rest is history and just has taken off from there. And then as a doctor, healthcare kind of just gravitates towards me and I really enjoy using technology to fill those gaps where we don’t have enough physicians. So, I mean, if you think about it, we all know there’s not enough physicians per capita and that’s part of the reason we have PAs and nurse practitioners. But even including those practitioners, there’s not enough to meet demand. And we can’t physically be everywhere. It doesn’t make sense for a neurosurgeon to be in the middle of nowhere in Nebraska because they can’t use their skill set, but he or she can have access to patients in those areas using these technologies.So yeah, that’s kind of my forte and things that I’m working for that really take telemedicine, which at the beginning of COVID was just something like this right here, this great audio visual but it has its limitations. So it’s really things that augment, just this audio visual platform is what I see as the next step. And then there’s some just things out there that are bringing costs down, bringing more access where we previously didn’t have access to different aspects.One of my investments is 3D printing of pharmaceuticals. You literally have a 3D printer that sits on your desk, you can plug it into the wall or if you’re in the hurricane for Puerto Rico, you have a generator, you plug it in the generator, you literally have a pharmacy anywhere you want now where you have a generator, so things like that.I wish I had that 3D printer when I was in the middle of nowhere, Korea, up on the demilitarized zone in North Korea and otherwise just had maybe a handful of medicines. If I could have made my own medicines right there on the spot that would have been really helpful. I’ll mention this just because the news came out yesterday, so another really cool company, that I’m both involved in as an advisory, partner owner, and angel investor is called Covimro. And the idea behind Covimro is if we’re looking at our COVID-19 ball here, these spikes are where our current forces are going after our current immunizations, but those spikes are the same thing that change every couple of weeks, it seems, and you’re hearing, what is it now? The Delta variants; then the next time it’s going to be the Gamma variant, God knows.But why are we going after a moving target when we have this envelope here, the ball court part that doesn’t change? So we’ve actually come up with a nutraceutical that we’ve just released information that our animal studies show a very nice viral load reduction in our third virus now; so we have COVID-19, HIV, and now influenza in a live animal model as well and no safety side effects at all. So something you can take orally, no side effects recorded to date, and it’s got a three log reduction viral load which is a very good viral reduction. These types of things that are coming from people that are outside of healthcare, the inventor of that is outside of healthcare, so just thinking of it in a new way.

Brian: And let me ask you a couple of questions real quick. So on that, let’s talk about the Teladoc in telehealth, what do you see in there? Right? A lot of people are familiar with Zoom and that platform, but what are people doing in telehealth that takes it to the next level?

Kyle: There’s a couple of ways to add on additional information, so the more data points you can get the better. So we have our smartwatches that can go in and connect to EMR, so electronic medical records, and update those automatically. We can have those monitored by a health team for people who have abnormal heart rhythms, like echo fibrillation, or maybe they’re really at high risk for a heart attack or something along those lines. There’s a company out of Baltimore that has a really awesome just like the round stethoscope head, and you can have that anywhere in the world. A patient can have a training of, I’m sure it takes one to two minutes to train them, but basically place it in the right locations on the chest and that data can be sent, it can be heard synchronously or asynchronously. And then again, you can even throw those sounds and add them into the health part as well.

Brian: In those examples, do you see those as direct to consumer or do you see those as the facilitation to be able to set up more virtual clinics where it’s closer location to people and those devices are there and you can run a doctor’s office with a real minimal staff or something like that—because you can support them more decentralized? Do you see those scenarios or do you see them more like they are targeting consumers?

Kyle: So I see that the wearable is definitely going to be more towards the consumer. The stethoscope, the portable stethoscope, ICE, which I believe is called Felix, I see that more being covered by insurance and then having that increased ability to have primary care cardiologists, pulmonologists, since they all use it, so have additional data points.

Brian: And they can basically prescribe it and it gets shipped to you, right? And then you have these tools when you’re on a telehealth call. So it’s much more engaged, right? They’re getting more data from the body. I suspect there might even be cameras or something like that because sometimes it’s medical grade cameras so they can see things in places.

Kyle: I mean, another interesting model is having strategically placed medical assistance—so people who don’t have medical degrees but they’re trained on the equipment and then do a telemedicine visit. It’s as if you and I were the doctor and patient and then have that clinical assistant there in person at a much lower price point, so you could still get those added data points as needed. Ideally that assistant wouldn’t need to be there in the near future but I think while we’re trying to figure out these other aspects that may be a way to do that as well.

Brian: Yeah. We have a client by the name of HealthBar and they are doing a lot of innovative things like that: drive up clinics where they could do an injection or a task while you’re sitting in your car. And I continue to see all of this proliferation of stuff that’s outside of the traditional medical system and the traditional “you have to go to that big regional hospital to get in front of a doctor,” right? You can get that care in many different ways and probably a lot more affordable ways too, right? And for people who are involved in paying the bills. it’s probably a lot more affordable.

Kyle: Yeah. There’s that interesting company out of Waco, Texas called ScriptCo and they’re a 100% online pharmacy, zero insurance, but they have a really interesting model. They make their money on subscriptions, so you pay basically a half year or four year subscription and a couple of hundred bucks, but they pass their exact same cost onto you. And I have never seen, it may not be a big deal for Tylenol, Motrin and things like that, but you get to people who are at rheumatoid arthritis and they’re on injectables or severe, I don’t know, ulcerative clients, whatever it may be, where insurance is charging you thousands of dollars a month for these, this company could get people without insurance the exact same generic medicines for pennies on the dollar. So I’ve been really impressed with ScriptCo.

Brian: What about that 3D printer again? That’s an interesting concept, the pharmacy in a box in a sense, right? How advanced is this technology? Is this the real thing? It prints a wide range of drugs, you can buy it today?

Kyle: You can buy it today, you can. It’s about $15,000 and you literally have the different components, which if you ever look at a medicine that you buy at the store you get as a prescription, you could have a good by date or sell by date or don’t take them after this date. And usually medicines when they’re already made are only good for a couple of years and then you’re technically supposed to throw them away. These components, when they’re separate, usually last 10 years. I think they’re good a lot longer separately which is really nice. But yeah, these printers are being used around the U.S. right now little by little. It’s really nice. But for a couple of reasons, one, usually you need a pharmacist, someone with a pharmacy degree and they’re not cheap to compound, especially medicines that are not common. So compounding is literally doing it by hand; we have to measure everything. From my understanding, pharmacists compounding medicines have to be within 10% of what they say the concentration is. So if you’re saying, this medicine is 100 milligrams, it could be 90 or it could be 110. So for me just kind of looking at it, that’s a lot. So I want something a little tighter, so these machines can get it within 2%, so much, much more precise than the current standard of care. Additionally, you just need, again, a technician to push some buttons and then it all pops out so you don’t even need a pharmacist to have this machine whereas you would need a pharmacist.

Brian: Where are you seeing that kind of stuff applied right now?

Kyle: So the big ones are going to be urgent cares or emergency cares that are separate from hospitals, so they don’t have their own onsite pharmacy. So that’s really nice as we get, we mentioned our population is getting older, a lot of medicines need to be dosed. If you don’t have full liver function or full kidney function, you have to drop down the doses because you’re not able to break down and get rid of the byproducts of those medicines as much. So there’s what’s called renal dosing or kidney dosing rate for those who have kidney failure. Also kids: so in this given adult dose of Tylenol, that’s why there’s kids Tylenol, and pretty much almost any medicine you have to give a separate dose to kids. They’re not just little adults, so that’s a huge thing. And then something I never thought of or realized is that almost all of veterinary medicine is compounded because you can’t even necessarily give these different breeds of dogs the same type of medicine much less a dog to a parakeet, to a cat, to a mongoose, to a lizard. So almost 100% of veterinary medicines are compounded as well.

Brian: Yeah. That’s interesting. So in general, these technologies seem like, over time, they have a big chance of helping to drive down the cost of healthcare and making healthcare much more universal for people, right? I mean, there’s got to be so much technology in this space. We do a lot of work in interoperability and the way that you start to see how companies, not only the fact that they’re exchanging information, but now how you can database it and you can query it and you can use it in applications and APIs. It’s been a long jam for a long time in healthcare, with all these paper records and stuff. It’s now continuing to get more and more digitized and it’s just going to continue to accelerate. What do you see 50 years down the road? I know it’s a long purview but you’d be someone to answer something like that. What’s it going to be like for a patient?

Kyle: So I think we’re going to be focused… and we’re already heading that way now… right now it’s fee for service. I hate to say this, but if you keep someone sick, the more times you’re going to see them, the more you’re going to get paid. That’s kind of our model right now and that supports keeping someone sick. So it’s not sick care, it’s healthcare, right? So we want to keep you healthy. So we’re really focusing and starting to focus on quality, we’re starting to focus on prevention, which is something we should have done the whole time. It’s not sexy but you know what is sexy? Keeping people healthy and driving costs down, to me that’s very sexy. So that’s where I see us moving over the next couple of decades. I think right now we still have to get through the limitations on the numbers of physicians and other providers that we have available, compared to the population we have—and still not meeting the demand. We need to just make it okay to instantly get support. Really it’s going to the doctor to have those checkups, and I’m guilty of that as well. If something’s not wrong, I’m probably not going to the doctor. I know a lot of people live by that thought process, but if we could really detect earlier as people become a diabetic… if they see these risk factors like you’re at a very, very high risk for diabetes, let’s work on reducing a couple of those risk factors and then you could, hopefully it’s not prolonged, just totally reduce that ability or reduce that likelihood of going into diabetes or heart failure, high blood pressure, so it’s really I think knocking those out. And another trend that’s quite interesting is precision medicine, which is really looking at each person differently. So when I was in medical school and still probably today, you say, this is the first line medication for hypertension, but it really should be dependent on a lot of different variables for each patient: their other comorbidities, where they live, their lifestyle. It’s really going to change how one should be treated for any disease really. And then we’re also able to take advantage of those genetic components, so really if we know that I would have to do a genetic test and I have a higher propensity for prostate cancer or a heart disease, then we could really use that information decades and decades earlier in order to help prevent those things.

Brian: Yeah. And it seems, I mean, just like this COVID-19 vaccine, right? That mRNA technology, I mean, that’s just in its total infancy. I know it’s been developed over 30 or 40 years but the first real usage of it was COVID-19 and it just seems like there’s so many of the, what you just mentioned, with the DNA test. I mean, you give the DNA test and then you could have a very specialized vaccine made for you that fixes long-term issues with you. Do you see it going to that level at some point?

Kyle: So, I mean, I’m not sure if you’re familiar with CRISPR technology, but they’re gene cutting and adding. So that’s going on now to help with the idea of really solving some of these genetic issues. So, I mean, there’s a double edged sword there. so they can do a lot of good but then you also have the whole eugenic side and potential bad things can happen as well where you change, God forbid, an intentional change to this COVID-19 virus where we put in, not we, but some bad actor puts in more variance, RNA, DNA, whatever it may be to really make this thing even more of an issue than it is today.

Brian: Yeah. There’s a lot of unforeseen consequences with these technologies, right? And so much power and so much potential for that power to get misused too or accidentally used. But healthcare is a fascinating space these days, it seems like it’s accelerating. People like you on the forefront of it and working inside of it, making the difference and we appreciate you and appreciate working with you and thanks for your time in this interview, Kyle.

Kyle: Absolutely. My pleasure Brian, anytime.