Much of the discussion at Health 2.0’s Provider Symposium on Sunday was focused on innovation within the healthcare system. But the lessons Virta CEO Sami Inkinen shared from his company’s journey amounted to a different message: Sometimes it’s easier, or even essential, to innovate outside the traditional healthcare system.

Inkinen’s startup makes the controversial claim that it reverses Type 2 diabetes. The Virta Health platform puts patients on a behavior-based program built around the ketogenic diet — a regimen that’s effective but typically hard to get patients to stick with. That’s where the second component, continuous remote care, comes in. A team of doctors at Virta coach and follow up with patients to keep them on the program.

In his keynote, Inkinen shared lessons learned from interactions with the healthcare system, and many of those lessons had a common theme: it’s challenging to fit disruptive technologies into existing systems and infrastructures.
 

“In 2014 we were ready to start seeing patients and we partnered with Carolinas Healthcare System,” Inkinen said. “We went in and said we have this wonderful way to deliver care, we call it continuous remote care, and a new treatment, but we have to train your physicians to use our tools. And I got the question ‘Ok, your potential outcomes sound amazing. What do we need to do?’”

The health system wasn’t happy with the answer to that question.

“[I said] Your providers have to look at the data five times a day for each patient, interact with the system five times a day, make decisions, and get back to the patient,” said Inkinen. “The response was ‘No way. It’s impressive, but we might get there in about 15 years.’ And I almost cried, but given I had started a company before I knew this was part of the experience. But the lesson for me was, if you want to fundamentally change the processes and protocols that providers follow, the fastest way there is to build what I call a full stack company. Hire your own providers and train them from day one.”

Inkinen learned a similar lesson when the company started trying to monetize the company.

“I said, it’s good we’re a full stack company because we have all these doctors and they’re licensed in 15 different states,” he said. “We’ll just get paid like everybody gets paid which is ‘Bill the CPT codes’. Well there are no CPT codes for checking someone’s data 15 times a day for 10 seconds at a time, or interacting with a patient or making a decision about insulin levels or insulin doses.”

The company ended up building an at-risk business model, charging payer partners if on a patient level if an only if the company delivers savings.

“So what was the lesson there? If you have a new care delivery model, it probably cannot shoehorn easily, perhaps not at all into existing business models,” he said. “So you need to build a new business model too.”

And Inkinen learned the same level when it came to electronic tools to manage patients’ treatments, finding that EHRs weren’t well set up for Virta’s process either. Once again, the company made a big investment to build its own.

“What I’m absolutely sure of is that continuous remote care, with the right protocols, can deliver absolutely transformative outcomes,” Inkinen said. “…[But] these companies will also have to be built almost fully from the ground up. You have to change the processes from the ground up and be more of a full stack company, and you probably need a new business model or else you won’t get paid.”