Chief Medical Officer, Uber Health

Uber created a division about five years ago now called Uber Health. The idea was to build a set of products and services focused specifically on the needs of the healthcare system — so it wasn't just a rideshare service. The vision is actually to use the resources Uber has to enhance the health of populations.

What that means is it goes beyond being just a rideshare service. We have the potential to create a marketplace for services related to the social determinants of health. Instead of needing a ride and having my Uber app, needing a meal and having Uber Eats or some other app, needing medication delivered and having something else, needing someone to come and fix a leak in my roof and having something else again — instead of going to five or six different places to meet those needs, we can go to one place and meet them more efficiently and effectively.

So a patient, a caregiver, a care manager from a health plan, or a nurse working in a clinic can log into the Uber dashboard today and set up a ride. If I need a ride next week, the nurse at the clinic can order it for me — I don't have to order it myself. Especially in older populations, this is why it's so great to be a geriatrician working with Uber Health: mobility is a fundamental gap for many older people, and it becomes more challenging as they get older.

I used to give lectures on the ethics and legal issues around managing older drivers, because to drive safely you have to be able to see, move and think all at the same time. As we get older, it's more likely we can't do all three at once the way we need to. That's why some older drivers are at risk — and many, many of them are not, of course. So Uber as an alternative is a huge opportunity to fill a gap in transportation, and also to simplify access to all these other services.

You need to create product designs that actually meet the needs of older adults. And first of all — who is an older adult? It used to be 65: the point at which you're retired and now you're old. But we all know retirement ages are going up. And if you think about it from a functional perspective, it's usually 75 when we start to see functional decline, cognitive decline, and so on. Geriatricians in practice still see people in their 60s, sure, but mostly it's people in their 70s, and really their 80s and 90s — the frail older adults who are the focus of most geriatricians.

So you have to understand that there's a large group of people we might think of as older adults — retired, 75 or 85 years old — who are still more than capable of using their smartphone, pushing a button on the app and ordering a ride. But there are different ways to manage this. There are other companies Uber works with where, instead of an app, you just call a phone number and they take care of it for you. Or, in the case of Uber Health, the care manager or the nurse in the clinic can order the ride. So there are ways to create different interfaces that let people access these services more directly.

Another company I work with is called Intuition Robotics. They're an Israeli company that makes companion robots for seniors — devices that sit next to the older person. Unlike other smart speakers in your home, this device, which is called ElliQ, will actually initiate conversations. It'll ask, how are you doing today? It'll remember that in the morning you said you weren't feeling well, and in the afternoon it'll ask, are you feeling better? What did you have for lunch? It has conversations and interactions.

So ElliQ is potentially becoming that platform that connects older adults to the outside world. If you need to access Uber, you can say to ElliQ, hey, I need a ride, and ElliQ can take care of it. For seniors in particular, voice interfaces are especially promising, because you don't have to be able to see, you don't have to type anything, you don't have to worry about pushing the wrong thing on your app. So I think the future is a lot less keyboards and phone-based apps, and much more of these digital agents interacting with older adults — using voice recognition and machine vision to make it easier for them to access services when they need them.

In an ideal world, people would be getting out of their homes, interacting with friends and family, addressing their isolation and loneliness more effectively. Unfortunately, there is a significant and growing number of people today who are isolated, who are lonely, who don't have the ability to access their communities the way they used to. And so technology becomes a way to expand access, create a dialog, and engage people in real time.

Is ElliQ a substitute for human interaction? No. But from the user data, there are people who are thrilled to have ElliQ in their homes — because even though it isn't a person, ElliQ is not judgmental. ElliQ only does the things that person wants it to do. It lets them interact with the outside world through trivia games or music. It helps with mindfulness exercises, it helps people exercise physically, and soon it'll be able to create video links between that person and their families directly — so they won't have to worry about Zoom links crashing, or Wi-Fi, or all the rest of it.

So technology can be both a replacement and a facilitator. For people who lack access to human interaction, it can be a replacement — although not as good. And it can be a facilitator, because it more directly connects people so they can see each other and talk to each other without having to deal with complex technology.

I'm an independent consultant, so that's basically what I do — and I find it to be great. The freedom and the autonomy are good. The real risk with the gig economy is if there aren't enough gigs, or the people you're gigging for aren't paying you or aren't treating you well.

The reality is we have a shortage of physicians and a problem with access to care. Think about behavioral health as an example: here in the US we have a ton of psychiatrists and psychologists, but they just don't accept insurance, so they're not accessible for many people. There's also the case that in certain kinds of psychiatry — geriatric psychiatry, child and adolescent psychiatry — there simply aren't enough specialists. So if you can more efficiently match the time that person has to devote to their professional work with the consumers of that work, you can start to address access problems.

You can have a system where people are moonlighting — but instead of moonlighting in a hospital, they're working for a telehealth company. Someone has a problem, wants to talk to a doctor, goes online and is connected to one. They don't have to go to urgent care, they don't have to go to their primary care doctor. And it's better than a phone call in some cases because, as you know as a clinician, a picture's worth a thousand words — looking at someone, you can often get a sense of how they're feeling.

There's another company I work with called Luna that does this for physical therapists. Physical therapists can make house calls if they choose — the technology allows them to make five or ten visits a week on the side. It's helpful for them, and it's great for the patients, who get care delivered in the home instead of having to go to a clinic. I think the big opportunity for technology in the future is to be more and more able to bring care to the patient, instead of bringing the patient to the care.

We're not there yet. I was talking with a potential client the other day, and he raised the concept of touch — telehealth is limited because some people need to be touched. You need a throat swab. You need to lay hands on an abdomen to see if it's an acute abdomen that needs surgery. You need a CT scan. So we need to figure out how to bring more care to people in their homes and communities, in a way that minimizes the challenges we currently face with equity and access. Home-based services can actually overcome some of those barriers, because everyone can access care in their home — if you have the technologies and the people to make that happen.

The growth of services like hospital at home is another example. In the US it's just starting, whereas in the UK you've been doing it for decades — same in other parts of the world. Now the technology is so much better: you have remote patient monitoring devices, better logistics to deliver medications in real time, community paramedics and EMTs who can stop by and hang a bag of antibiotics or fluids while they're doing their rounds. The better we get at moving staff and using technology to make them more efficient in the home, the bigger a difference all these technologies will make for patients.

Well, we don't have surge pricing for appendectomies — at least not yet. I'm not sure it's something I'd look forward to. Although I guess if I were willing to have my appendectomy at 2am, I might get a better price on it. Then again, studies show midnight surgeries have worse results.

Joking aside, the issue is how you pay for healthcare, and whether it's price-sensitive or not. And the truth is, yes, it's price-sensitive. If you want care that's quicker, higher-technology, more expensive to deliver, you're going to have to pay a premium in some cases. It's not surge pricing the way ride-sharing apps do it. But there very much is a situation in the US where, if you're a dominant health system in a particular market, you can charge higher prices to the health plan because there's simply no one else they can buy that service from. So we don't have surge pricing, but we definitely have market-power-related pricing.

The same is true for the health plans. They can charge more from their customers — the employer group or their members — and they can also drop the rates on their provider partners because they have market power. So there's a lot of price sensitivity and cost-shifting here in the US because of market power and market dominance. The ride-sharing example is just a more real-time version of what's happening in a capitalist system all the time.

First of all, thank you — I'm not sure that's the case, but hopefully it is. My clients would probably say it is. I think it's really about thinking through where you are, what your focus is, and what you really want to accomplish. Even generalists have to focus from time to time to become really, really good at the things they do all the time.

For me, the areas I focus on have to do with clinical product development and strategy, business development strategy, and thought leadership — blogging, podcasts like this, webinars. Those are things I've done for a long time. So even though there's variability in the specific niches a particular client needs, those core areas of functionality are very much part of what I do. That's why I don't always feel I'm starting something totally new every time I go into a new client — although I certainly am starting a new project.

I'd also say, clinically speaking, that we're not always as bound or narrowed as we need to be. I used to moonlight in a long-term acute care facility on weekends. One time a patient's feeding tube fell out, and they had a rule that you needed radiologic proof — so normally you'd send the patient to the ER for an x-ray. Now, I always think of sending a patient to the ER as a loss; as a geriatrician, I keep patients away from the hospital unless they absolutely have to be there. And this wasn't an acute medical issue — the feeding tube had just fallen out.

So the Chief Medical Officer of the facility called me and told me all I needed to do was go downstairs to an x-ray suite. They called in their x-ray tech. You take a big syringe, take a picture, inject air into the tube, take another picture, and look at the air bubble in the stomach. If it's big enough, you don't have to inject Gastrografin — the contrast agent — to see what's going on. So I did that. It turned out the tube was seated in the right place and everything was fine. But I never imagined I'd be spending a Sunday afternoon injecting air into a feeding tube and taking an x-ray.

We're only bound by our sense of what our limits are. I'm not ready to go do cardiac surgery, of course. But could I suture? Could I do joint injections? Could I do much more than I currently do? Yes — with supervision, with practice, and with support. Recently, when I started making house calls again, I went through training with one of the medical directors from the house-calls company: if you're going to suture someone, how do you do that? If you're going to give IV injections, let's review that. You still have to make sure your skills are up to speed and get signed off. But we are only bound by what we really think we can do — and we can often do way more than we think, many things outside our current comfort zone.

I'm still learning to be a leader. I think that's the most important lesson: you always have to be learning. That's true whether it's about leadership, or injecting air into someone's feeding tube, or how to run a good meeting with an effective agenda where everyone's heard. Those are skills you constantly have to be honing and improving — a lifelong learning task.

I want to talk specifically about physician leadership, because I think that's a huge challenge, at least here in the US. No one goes to medical school with the desire of becoming the chair of the department, or the medical director, or the Chief Medical Officer. We go because we want to take care of patients — do surgeries, prescribe medicines, listen to people and help them heal. So when someone says, oh, I want to be the Chief Medical Officer, most of your colleagues go, what? Are you selling us out? Are you betraying us?

Having been in many unpleasant conversations with physicians about contracts, payment rates, quality measures, and changing electronic medical records, I totally understand why most people wouldn't want a job where you're responsible for implementing all of that. However — if we don't have effective physician leaders who can advocate for patients, who really put patients first, who can bring a clinical and business perspective to balancing the needs of patients with whatever the organization is trying to accomplish, then we're not going to be effective. We need physician leaders who are good at engaging and leading other physicians, working in teams, and influencing the systems of care that actually deliver the healthcare people get.

I think you're exactly right. We used to joke that the medical directors were always the people who missed the meeting where they appointed the medical director — when they asked for volunteers, those people didn't say no, so they got stuck with it. That wasn't always the case, obviously. But that's why more and more people are pursuing MBAs, or JDs, or MPHs earlier in their careers — realizing they have the opportunity to make a difference beyond one patient at a time.

That's the really amazing thing about being a physician leader in an organization: the impact you can have goes beyond the relatively small number of patients you see in your clinic. Instead you can impact populations of patients across a whole geographic area, or a service line, or whatever level of organization you're leading. That's what made me want to become a physician leader — this idea, going back to advocacy for patients, of making sure they get the best quality, at the lowest cost, with a good experience for them and for the clinicians responsible for their care.

And we know we're not doing the best we can — that's the frustrating thing. We're spending huge amounts of money, investing massive resources, and still struggling to provide even basic care for many kinds of illness: pediatric diseases, vaccinations, fall-risk assessments in geriatrics, helping people get the glasses and hearing aids they need. We're constantly faced with opportunities to improve. And to be someone who makes improvements, you need the skill set of leadership: leading your team, working with and influencing other clinicians, and working with your business colleagues and even investors to help them understand why they need to structure things a certain way — not only to make patients' health better, but to ensure they're getting value for the dollars they're investing.

My son will be 20 in May, so this is not a theoretical question. He's a sophomore and pre-med. A lot of my physician friends ask, why would you tell your son to go into medicine? It's so difficult and frustrating, with the electronic medical records and the documentation and all the rest of it. And all of that's true — it is a really difficult profession. It always has been, because you're helping people who are often very sick and suffering, many with chronic diseases you're not going to be able to cure. Our patients will die. Some of them will die after horrible amounts of suffering. That's the reality of being a physician.

You see people at their most triumphant, after they've recovered or healed. And you also see them suffering, when they can't recover. The opportunity to have that kind of relationship — where you're really helping someone get better, or, if they're dying, helping them die a peaceful death without suffering — those are some of the most amazing responsibilities you can have as a human. It's hard for me to imagine there's a more important thing you can do with your life than to help people through these challenges, to be there with them through the good times and the bad, and to help them make sense of it as they're going through it.

So I tell him all the time: you don't have to go to medical school. If you decide you want to do something totally different, absolutely fine — it's up to you. But if you go into medicine, these are the rewards: the opportunity to be there with patients and help them heal. Or, if you're an administrative physician like I am now — I don't see patients very often, but we talk a lot about the things I'm working on and how we're trying to make things better for older adults, easier for people to access care, new models of care that make it easier for people to heal, get better and stay healthy.

He understands that this is such an important mission — an opportunity to impact people, and to constantly be challenged yourself to grow and learn and get better. So my advice is always: if medicine is something you're considering, whether as a physician or a psychologist or a nurse, listen to that. Try it out. See if it works for you. Because the reality is it's no longer a clinician-only world. If you decide you want to stay in healthcare but don't want to see patients, you certainly can. But it's just an amazing opportunity to influence people and to be there for really important parts of their lives. It's a privilege, I believe, to be a physician. So that's my advice.

Thank you.