Welcome back to Common Sense Medicine! This is a great interview with a physician who is working in the intersection of the care navigation space. Patient-centered care can mean a lot of things to a lot of people. For me, it means that patients are heard in their care journeys and feel as though they have agency in a system which is often confusing and not at all “human-centered.” My guest today is trying to change that through providing a better solution care navigation in cancer care.
Dr. Hillary Lin is a Stanford-trained, board-certified internal medicine physician and the Co-founder and CEO of Curio, a HealthTech startup addressing health equity and outcomes via Al-enabled navigation.
Dr. Lin has contributed to neuroscience and oncology with her peer-reviewed research work. She is a frequent speaker and advisor for programs, including Headstream Innovation and Cornell BioVenture eLab. In her personal life, she enjoys immersive experiences and has completed over 200 escape rooms worldwide.
[00:59] Hillary’s background in medicine, and Curio’s start
She entered medicine because she was passionate about the “human experience,” she knows how complicated life can be and how important health is
It’s about all of the aspects around health that you also have to manage when you are sick and not just the disease itself
There’s too much focus on the facts of medicine and the facts of biology and it sucked out the “soul” of medicine for her
We’re asked as physicians to remember more facts and be computers rather than a person to help guide the journey (AI can help here)
Drove her to specialize in oncology because she wanted to be deep in the process of answering existential questions, but when she got there she found out it’s mostly running in and out of bedrooms and clinic rooms. She was trained in internal medicine at Stanford and then went to Columbia for a brief time in an Oncology fellow role
You don’t get time to sit down with the patient that much
She found that she wasn’t answering the existential questions she wanted to, so she went to digital health innovation and sampled the smorgasbord of what she could be doing, and finally she landed on cancer care navigation
[06:16] What is so compelling about care navigation for patients?
Took her a long time, she was seeking for years to land in a field to innovate in
In the beginning, as a relatively new founder, like many founders, she went straight to where the problem was—when founders do this, they try and create a tech-enabled clinical platform for whatever they want to solve quickly. She thinks this is the first-order solution, rather than the final state
They found that with more serious healthcare concerns, a lot of it comes down to navigation problems / concerns. Health literacy, access, and equity are prevalent in the U.S. where we have a convoluted system. It’s very hard for them to get optimal treatment and care
[08:44] All about Curio—what is it & how does it help their end customers?
Problem they’re solving: Help patients get the resources they need in order to optimize their health
The tooling behind that (which is growing) is vast, and it’s growing in real time Shree’s note: the tooling now may be different then when we recorded this podcast in November 2023
One example of a tool is a natural language parsing tool to provide the opportunity to explain a problem and can connect to a in-person navigator to find those services, or use the AI to find them a personalized service which can help them find the solution for their specific issue
The next level of that is to guide them through the steps to get the resources that they need. Instead of having a case manager or a social worker on the line, they can use the AI to navigate the next level
The key thing to understand is a B2B company which works with health delivery platforms, non-profits, patient support services, and similar entities. 80-90% of the time, there is a human in the loop, such as a social worker or another personnel
Rather than focusing on just a patient assistance program in a specific zip code, you can use Curio to add additional parameters (i.e., age, family members, etc.) to add greater “precision level resourcing” for cancer patients
There’s also a level of communicative support which uses generative AI to help individualize to the patient’s health literacy level in an SMS or email communication
[14:35] What are patients most using Curio for?
Financial assistance is by far the largest problem which patients face with a cancer diagnosis, and financial toxicity is the main focus of Biden’s Cancer X initiative
It takes up to 80% of people’s bandwidth and mindshare. Cancer care is so incredibly expensive that people max out their deductible pretty quickly. There’s also legal type of concerns especially with their employers (i.e., leaves of absences)
In an earlier rendition, Curio was a mental healthcare company. They found that for cancer care, mental health is a secondary concern, after people are able to pay for their medications and their base needs. There are a lot more resources to tackle mental health than other issues though
[18:12] Curio’s business model
They sell to intermediaries, navigation and utilization discovery services. The ecosystem has become very bloated with point solutions for digital health that benefits administrators get burned out
Shree’s take: Curio is really trying to differentiate their navigation solution based on its personalization through partnerships. For example, if you have a MSK issue, Curio will basically tell you which piece of education you need to read for your particular issue
They use both human / automated version of finding those resources, but they prefer a partnership because then it is more intricately tied to the experience of navigating care
They use a tiered utilization pricing model for Curio’s care navigation solutions. They align well for utilization based pricing model because sometimes there’s very low utilization of those benefits
[27:16] What do oncologists think about this tool?
Trust is key to get buy-in from various providers. They are trying to establish strong relations with patient advocacy groups—this is not to just have their logo on their website, but to have relationships with them
Hospitals don’t reimburse for care navigation services, so it’s pretty awesome to see that patients are getting these services outside the hospital. Doctors don’t get paid (RVUs) based on them helping the patient navigate the system; social workers are strapped for their time. If patients find Curio or another tool, it can be a real game changer for them
They are also working on the pharma side where they are focused on getting patients more adherent onto their treatment, and focusing on patient engagement. Pharma companies want to know why patients aren’t continuing on their treatment (i.e., copay, adverse events, etc.) so it’s actually pretty helpful for them to understand where in the patient journey they are losing the consumer
[32:49] Does Curio help with finding second opinions?
They work with advocacy groups to help find second opinions for their patients. In fact, in Hillary’s opinion, a lot of doctors do value second opinions and look to get them from academic institutions (i.e., you have one oncologist at an academic institution and one in a community setting)
They are working on getting a database for clinical trials so patients can use that to find trials which are very helpful to them. Patients are very skeptical of trials, so according to her, getting patients there is 90% of the issue
A lot of the convincing happens at the education level and the risks and benefits of the trial
[40:16] What is different about Curio?
Shree’s note: I read an market map of the Generative AI in healthcare space, where they talked about how the care navigation space is becoming crowded—so I asked Hillary about her opinions in the care navigation niche
Navigation companies, such as Navvi Health, Collective Health, Auxa, and Talktomira, focus on helping employees and patients navigate their healthcare benefits and options. However, these companies face challenges like overcoming vendor fatigue and budget constraints in the current economic climate. Interestingly, these companies have the largest amount of funding in this category and the lowest amount of median funding per company, which implies the category is more saturated and less capital intensive then other patient-facing categories. We’re excited to see how generative AI can streamline user experiences, interpret health information, and guide patients more holistically, potentially reducing readmissions and encouraging proactive care.
Curio is good at patient engagement, which a lot of digital health companies have not been successful at (according to Hillary)
Each product / feature release has to be laser-focused on that particular use case—they are trying to solve problems with technology rather than with humans
A lot of care navigation companies are human first, with technology enablement, where she thinks it has to be reversed—tech first, with human enablement at points, so that it can scale
Now with generative AI, this scalable solution is now possible
[45:48] What is the future of Curio?
They are trying to provide a broader layer of tech for the vision of healthcare—a human person is more than their disease, so they have to have a broad way to access that care
Rather than becoming verticalized, they want to go more horizontal—focus on nutrition, wellness, or other places
[47:04] Why go into Digital Health?
It took her years to get her legs underneath her as an entrepreneur. She believes we’re living in a world where healthcare is stuck in an outdated mode of manual labor
Looking very closely at other industries, all other industries are moving towards this idea of personalization, but why can’t we focus that on scaling up healthcare for a lot more people?