Innovative Strategies Often Fail…Here’s Why

LinkedIn Article by Jon Stout, published on 1/9/2017

Today is the first day of JP Morgan’s 35th Annual Healthcare Conference, a gathering of the biggest names and innovators in our industry. AbleTo will be in San Francisco this week, and no doubt one topic that will come up again and again will be innovation.

I live and breathe innovation as a central part of my role as head of strategy at AbleTo. Failure to innovate as a company would put us at risk of going the way of 98% of digital health companies that one Forbes contributor called ‘zombies,’ companies on their last legs without a path to profitability. If 98% seems surprising, you may be equally shocked to learn that only 61 companies that appeared on Fortune 500 list from 50 years ago are still in business. The case for innovation is obvious, yet somehow most companies still fail to bring innovative solutions to market. Why is true innovation so challenging? And what’s the solution?

A few years ago, I learned a simple yet powerful formula to serve as a guiding principle for any organization’s innovation strategy:

The Quality of Your Solution x Market Acceptance of Your Solution = Likelihood of Success

While it may seem obvious at first, there are countless examples of companies large and small ignoring these fundamentals. I have never built a strategy without consulting this simple formula. Companies face pitfalls when they love their product more than the market dictates, or worse, when they create a demand for their innovative offerings without the ability to execute. Execution is critical, and I’ll save that topic for another article.

Failure happens in one of two ways, by focusing only on the first part of the formula (‘Heads-down Innovation’) or by forgetting the first part of the equation altogether (‘Quicksand Innovation’).

Heads-Down Innovation: Building a Solution that Nobody Wants

We’ve all done it. We put our heads down and focus on the “new” innovative solution, a slimmer design, a faster process, a more powerful algorithm. We want to control the movement and squeeze innovation into our business so that it serves us well. But sometimes we forget to ask the obvious questions: Does anyone actually care? Do my customers want this? Will people pay more?

Take the example of Kodak. Kodak didn’t go out of business because they failed to innovate. In fact, Kodak invested heavily in innovation, leading the market in digital photography as a new industry was being born. However, they tried to shape the innovation so that it iterated on their existing business as opposed to really understanding what the market wanted. Kodak innovated with their heads down as their competitors listened to the market. Kodak’s effort to salvage their legacy film-based business spelled doom.

Quicksand Innovation: Selling Your Vision on a Weak Foundation

Understanding what the market wants is important. But if we follow our formula, we know that being able to deliver a high-quality solution is equally important. Early stage health care companies get asked hard questions from our prospects all the time: “What success have you seen at other customers? How quickly can you scale? How precise is your targeting?” I spent 12 years in a large managed care organization and shared responsibility for evaluating countless pitches from early stage companies who claimed they could help us achieve our strategic objectives. Trust me, we know when you are stretching the truth about your successes to date. We know when your ROI numbers are vastly overstated.

Be honest with what you can deliver. Be transparent as to when you can deliver it. You need to find the right partners who want to grow with you, and they are out there. If, by chance, you gain market traction on the “promise of success,” your business could easily implode when your customer starts asking to see the results. Laying the track a mile in front of the train can be done…but sooner or later, you are going to get run over.

Lesson: Focus on Both Quality and Market Acceptance Together

The ideal strategy accomplishes two goals at once, focusing on high-quality, outstanding products, and at the same time, remaining hyper-focused on ensuring that the people paying your bills embrace your innovation. Following this formula for innovation doesn’t necessarily guarantee success, but missing one piece of it may very well guarantee failure.

I look forward to reading your thoughts and stories in the comments. Do you have an innovation ‘formula’ that you can share?

Ten Ways to Overcome Holiday Stress

Unwrapping the latest in wearable tech; sharing a meal with family; driving down a snowy, winding road. For some of us, our holidays resemble the marketing and advertising common for the season. For many others, however, the reality is far different.

Source: Flickr (Andrew)

I was not surprised by the results of a holiday stress poll, conducted by the American Psychological Association. Nearly one quarter of Americans report feeling “extreme stress” during the holiday season. “Lack of time,” “lack of money,” and “pressure to give gifts” are all reasons cited as cause of stress.

It is common for individuals who have experienced depression or a significant loss to experience deeper sadness during the holidays; for individuals managing a health condition, it can be hard to stay on a healthy diet and remember to take medications on time; for those in recovery it can harder to stay the course.

The good news in that we still have some time to plan ahead to reduce and overcome stress.

Overcome stress this holiday season

Here are ten simple ways you can plan ahead and overcome holiday stress this year:

  1. Maintain healthy habits. Plan ahead to use portion control during holidays meals, limit or abstain from alcohol intake, schedule medication reminders while traveling, stick to your financial budget.
  2. Stay socially connected. Spend time with people who care about you.
  3. Set aside differences and keep boundaries in place. Family gatherings are not the best place to address prior grievances.
  4. Engage in physical activity you enjoy.
  5. Schedule extra group support meetings.
  6. Honor the memories of those who have passed.
  7. If you are religious, attend religious services and activities.
  8. Volunteer, giving to others helps us feel a part of something greater.
  9. Practice good self-care, sleep, fun and relaxation.
  10. Ask for help if needed. Reach out to friends, family or a counselor if you are feeling despair. Access the National Suicide Prevention Lifeline (800) 273-8255 or 911 in a crisis.

From all of us at AbleTo, we wish you and your loved ones a happy holiday season.

Additional resources:

  • American Heart Association: (link)
  • American Diabetes Association: (link)
  • NAMI: (link)

Telehealth for Postpartum Depression

Our culture dictates that new mothers be nothing short of jubilant and glowing, seamlessly adjusting to the changes in their bodies, their new identity and their new role in life. But for many women, pregnancy and new motherhood are not always so joyous.

Approximately 15% percent of mothers develop postpartum depression and many more experience a milder form known as ‘baby blues.’ Maternal depression carries with it many burdens on the mother, including pain, suffering, loneliness, and several other common symptoms, such as sleep disorders.

Extensive research has linked poor sleep quality, directly or indirectly, to depression. Sleep problems may be present in women during and after pregnancy as hormone levels rise and fall, which in turn may exacerbate any depression already affecting them.

Overdue Intervention
An innovative way to minimize the adverse effects of maternal depression is long overdue. At its worst, maternal depression can escalate to self-harm, neglect, and even suicide. The impacts of ongoing depression can also interfere with normal infant growth and development and in the broader context of mother-infant bonding and other family relationships.

What if an effective, quality-assured treatment solution could be made widely accessible to women suffering from maternal depression? What if that treatment solution would also reduce the need for unnecessary emergency room visits and healthcare utilization?

What if we in healthcare made it simple: reaching out to women, rather than asking them stand up to ask for help, delivering care in the convenience of their homes via phone or secure video, making someone available to talk to them nights and weekends? What if that care were delivered by real people–therapists and coaches–especially trained to deliver care in this fashion?

That is the promise of remotely-delivered, behavioral health treatment. By bringing together emerging technology with behavioral therapy, remotely-delivered programs can help break down the barriers to accessing traditional care.

Actionable Plans
Telehealth therapy offers women the chance to make meaningful changes, by quickly addressing shame, stigma, lack of time, lack of childcare or lack of social support, which can exacerbate anxiety and stress.

With the help of conveniently-delivered behavioral interventions, such as that provided by AbleTo, where I serve as chief medical officer, participants learn to recognize and manage the depression, anxiety and stress that frequently accompany pregnancy and childbirth.

Participants are empowered with actionable plans to help manage their time, arrange for childcare and prepare for a successful return to work. New mothers learn to tolerate uncertainty, cope with stress, establish better sleep patterns, and balance their responsibilities.

Furthermore, the cost savings associated with a timely behavioral intervention are substantial. Research suggests more than $80 billion is spent on depression each year, out of which direct medical costs represents only about $30 billion. The rest is attributable to lost work and productivity, including absenteeism, presenteeism, and disability.1

For maternal depression in particular, the economic impact is significant. A mother who suffers from maternal depression is likely to incur higher healthcare costs than a mother without depression. Depressed mothers and mothers-to-be can be four times more likely to visit the emergency room and six times more likely to seek mental health counseling than non-depressed women. The annual cost of not treating a mother with depression, in lost income and productivity alone, has been estimated to be $7,200 per person.2

Impactful Changes
We can do better. The onus is on us to make it as simple as possible for women to receive the high-quality treatment they need. And that simplicity can be achieved through remotely-delivered behavioral health programs. It’s time for us, as healthcare providers, to use the tools at our disposal to help women make impactful changes that will last them–and their children–a lifetime.

It’s time to break the silence, overcome the fear, and bring joy back into the pregnancies of mothers-to-be and recent births of new mothers.

1. Durso KA. Depression in the workplace: prevalence, cost and productivity impact. Employee Benefit News,2004; 18(15): 37.
2. Zero to Three Research to Policy Project: Maternal Depression and Early Childhood. Full Report. Available at: Accessed June 18, 2015.

Originally published by Advance Healthcare Network for Respiratory Care and Sleep Medicine on July 27, 2015:

Re-published by Advance Healthcare Network for Health Information Professionals on September 24, 2015:

As ADA meeting kicks off, don’t let innovative technology eclipse behavioral health factors

Reprinted with permission of MedCity News.

This week marks the start of the 75th annual American Diabetes Association national meeting. No doubt, scientists, researchers, and clinicians in the diabetes world will present novel diagnostic tools, therapeutic interventions, and management strategies. Indeed, the medical community has made tremendous strides toward the development of innovative tools to help people with diabetes. Take these incredible examples: devices that mimic the function of the pancreas, contact lenses that have the capability of sensing blood glucose levels, bluetooth-enabled glucometers, and diabetes management technology platforms that offer the promise of high-end analytics to help monitor our patients with diabetes.

Nonetheless, in our zeal to promote technologic solutions, we find the recipe for improving the health of diabetics to be missing one key ingredient: people. Don’t get me wrong. I love technology. I love data. I have no doubt that the formula of technology + data offers great promise. But you can’t replace people with technology. It’s the reality of human nature—people must be part of the solution. We cannot lose sight of these simple truths in health care:

  1. Data isn’t equal to knowledge There is that small proportion of the population, already self motivated, who know how to harness their own data. And then there’s the rest of the population—those who will undoubtedly need help to translate that data into knowledge in order to make meaningful changes in their own behaviors and their own lives.
  1. Apps aren’t equal to behavior change Strapping a device to one’s wrist or logging in to an app periodically does not behavior change make.
  1. Technology isn’t equal to people Much of the last decade of innovation in health care technology has focused on IT solutions and devices with a repeated desire to replace humans with technology. Technology is indeed necessary to remove many of the inefficiencies and inconsistencies in health care. But for some of the basics of health care delivery, we have to remember that technology does not replace humanity and that devices cannot replace people.

What if technology were harnessed in such a way that we could help diabetes patients manage their disease at the most crucial points? How would the marriage of technological tools and optimally timed behavioral modification impact patient outcomes?

These questions are top of mind, especially as the annual meeting of the ADA begins in Boston. Tech-enabled behavioral health companies like AbleTo, where I serve as Chief Medical Officer, are paving the way by identifying and engaging diabetic patients with behavioral health co-morbidities. These individuals are often “below the radar,” but turn out to be those most in need of help. When undiagnosed and untreated, behavioral issues are known to result in poorer diabetes self-management, worse clinical outcomes over time, and greater avoidable use of medical resources.

There is no debate that behavioral health issues stand in the way of medical well-being. And while we need to plow forward to work diligently toward innovative diagnostics and creative technological solutions for patients with diabetes, let’s not forget common sense. That sometimes people just need people. That behavioral health must not be a forgotten piece of the care equation. And that data + technology + people = an incredible recipe to improve outcomes and lower costs for patients with diabetes.


Proof: Remote Behavioral Change Interventions Can Be Successful

(Reprinted with permission of MedCity News)

There’s a simple truth in health care that most hold to be self-evident—that helping patients be happier and live better can indeed improve overall health. This in turn holds the promise of reducing the burden of rising health care costs in the United States. But innovative solutions that focus on sustainable improvements in health and well-being in a way that simply and successfully engages patients have been sorely needed. One challenge is that our healthcare system has been largely focused on disease with not enough focus on health. What we have traditionally failed to do successfully is truly help individuals identify the obstacles they face in making meaningful changes in their lives and then actually help them overcome those barriers.

Until now, the proof that this is indeed possible has been limited. But as a result of a successful collaboration between Aetna and AbleTo, we now have that capability and the real proof to suggest it truly works.

Take the example of a high-risk medical condition such as heart disease. According to the American Heart Association, heart disease affects more than 85 million Americans today and remains a leading cause of hospitalizations and death in the US. Additionally, the total cost of care for patients with heart disease is greater than $300 billion each year including the cost of health care but also the cost due to lost productivity. We also know that in the aftermath of a cardiac event more than 1 in every 4 patients suffers from major clinical depression, and many more likely with milder forms of behavioral health concerns or lack the resiliency or coping skills to face the challenges imposed by their new medical reality. When under-recognized and under-treated, it is well recognized that these challenges interfere with successful recovery and increase the chance of repeat hospitalizations, poorer clinical outcomes, and avoidable healthcare costs.

Together, AbleTo and Aetna have shown that successful engagement in a behavior change intervention done remotely by phone or secure video improves emotional well-being and substantially reduces the chance of recurrent hospitalizations, days spent in the hospital, and total cost of care. We know that addressing behavioral health is a necessary prerequisite to improving overall health. And what Aetna and AbleTo have shown is that we are indeed capable of delivering these types of programs on a national scale. That means we can touch people and improve enough lives in a way that will make a real positive financial impact for the system.

The promise is happier, healthier, and more productive individuals. The added benefit is a tremendous financial impact for the healthcare system more broadly. Now that is something we should all aspire to. And Aetna and AbleTo have done just that.

You can read the study in its entirety at

Caregivers Deserve More

Reprinted with permission of MedCity News.

I was struck by a recent blog piece in the New York Times entitled “Seeing the Invisible Patient” by Jane Gross. She rightly highlights the critical need to focus on those individuals so instrumental in the health of others, but all too often are invisible and ignored—the caregivers. With our aging population and the increasing burden of chronic disease, many more adults assume the responsibility of caring for an aging or ailing adult. Many may also be facing the responsibility of caring for a child in need. The Centers for Disease control reports that the number of caregivers in the United States is expected to steadily grow over the next ten years as the baby boomer population continues to age.

As a practicing cardiologist and Chief Medical Officer of AbleTo, Gross’ article and the concept of the “invisible patient” prompted me to ask what it means to have ‘caregiver burden’ and what we might do to mitigate the stresses and health consequences that result. There is no universal definition of ‘caregiver burden.’ Each caregiver experiences his or her role uniquely, and the threshold for experiencing ‘burden’ is unique to each individual. Gross is not wrong that far too often, the medical system focuses solely on the patient and not enough on the network of support, often fragile, that that patient relies on to succeed in achieving improved health. And as Dr. Ronald Adelman highlights in a recent review article on Caregiver Burden in the Journal of the American Medical Association, the emotional, financial, social, and physical stress caring for an ill adult brings can have serious personal health consequences for the caregiver. For example, a study of caregivers by The National Alliance for Caregivers and Evercare found that more than 70 percent of family caregivers report not going to a doctor as often as they should. The study also reported that caregivers had poorer eating habits and even worse exercise habits.

We need to do better.

Just this week, I cared for a gentleman who passed away after a year long struggle with end-stage cardiovascular disease. There was not one time I went by his room that his wife was not at his side. In fact, she spoke with the expertise of a physician after having spent so many days and months helping care for him. Yes, we focused on her husband. But we focused on her as well. Every day we asked her, “Have you been home yet?” “How did you sleep last night?” and “What do you need?” We reminded her that in order to be there for him, she needed to stay healthy herself. And when he fell gravely ill, a physician sat by her side in the room and held her hand.

But still, we can do better.

Caring for the caregiver is hard work indeed, and finding resources which are easy to access and of high quality can be challenging—which is why we at AbleTo are so proud to include amongst our remotely-delivered behavioral health programs one that is dedicated solely to supporting caregivers: Those so often in need and so often overlooked.

As the holiday season is upon us, I’m left thinking about these unsung heroes who continue the work at home that we providers start in the hospital. These ‘invisible patients’ who we rely on to ensure our patients comply with their medications, get the appropriate amount of exercise, and stay healthy. As November marked National Caregivers Month, and December means celebrating with family, let us give thanks and highlight those around us—the caregivers—who serve as the pillars of the health of our patients.

We must do better.

Breast Cancer Awareness Month: Pink Ribbons and Depression

The breast cancer community has done incredible work raising awareness about the breast cancer screening, diagnosis, and treatment. Nonetheless, there is much work yet to be done when it comes to addressing a major related health concern that has a tremendous impact on overall health of individuals with breast cancer – depression. Depression in and of itself is a major public health problem, but depression has an especially large effect on health when combined with a major medical illness, such as breast cancer.

The prevalence of depression in women with breast cancer varies widely, with estimates anywhere between 15-25% but perhaps as high as 50% in the earliest periods after diagnosis. These numbers are at least double the prevalence of depression in the general female population.  And while it may be challenging to face a breast cancer diagnosis in the best of circumstances, the added challenges of depression can have profound implications on overall health. Depression in patients with breast cancer may increase the chances of:

  • Difficulty coping with the diagnosis
  • Delays in getting appropriate medical consultation and care
  • Lack of adherence to medications
  • Missed treatments
  • Experiencing worse side effects from cancer treatments

At AbleTo, we recognize that dealing with cancer is hard. Dealing with cancer plus depression is even harder. Thrive, AbleTo’s program for individuals who have experienced breast cancer, whether newly diagnosed or living as a survivor, helps tackle these issues head on. Thrive gives individuals with breast cancer the tools they need to regain hope, purpose, and meaning. This translates into better self-care and that translates into better overall health and a better chance of managing the disease.

During this breast cancer awareness month, we salute the breast cancer community for more than a quarter century’s efforts in raising awareness about this disease. But we are also reminded of how much we have yet to do to tackle critical underlying issues, such as depression, that make breast cancer even hard to manage and treat.

Let’s tie that next pink ribbon around depression and get busy helping women feel better.

 Reena Pande, MD
Chief Medical Officer, AbleTo




Acknowledging Depression – Reduce The Cost of Cardiac Recovery

September 25, 2013

Reporting for HealthDay about a JAMA Internal Medicine study published Monday, Steven Reinberg writes, “Medicare costs for treating heart attack patients have swollen significantly, with much of the year after hospital discharge…” The good news is that more people than ever are surviving a formerly life-ending event; the bad is that the cost of post-discharge care – including nursing facilities, home healthcare and ambulatory care – has more than doubled in the last decade.

Sadly, extra medical spending is often less effective than finding practical ways to help heart patients help themselves. We know that individuals who exercise, eat right and follow medical advice enjoy more successful recoveries than those who do not; but we tend to avoid the question of why only some patients act in their own rational best interest. In many cases, the answer is simple – depression.

According to the American Heart Association, approximately 25% of all heart patients leave the hospital with major clinical depression, and many more likely suffer milder forms of depression. Most of these cases go undiagnosed and untreated. And since depression makes it very difficult to make the changes that support recovery, depressed heart patients are twice as expensive to care for in the year after a heart attack. The status quo is literally sickening – and expensive.

Fortunately, there are better alternatives. For the past two years, AbleTo and a national health plan have collaborated to identify, engage and effectively treat depressed heart patients. As a result, graduates of AbleTo’s remotely delivered cardiac program reduce their depressive severity by 80% and spend almost two-thirds less time in the hospital in the following six months. Our approach is just one example of a successful intervention path, but whatever the mechanism, the human and financial costs of depression in heart patients are simply too expensive to ignore.

The Economic Costs of Depression

Last week’s article in the New York Times magazine section, The Half-Trillion-Dollar Depression,” provided an interesting look at the broad economic issues associated with behavioral health disorders. Some of the startling facts:

  •  More than 1.4 million Americans are on federal disability rolls for mood disorders
  •  11.5 million American adults suffer from a debilitating behavioral health issue–resulting in $150 billion in direct medical costs
  •  All together, behavioral health disorders cost the US economy half a trillion dollars per year

On the bright side, the article also points out the benefit of behavioral health interventions on increasing or maintaining job retention, productivity and presenteeism, which is one of our goals here at AbleTo.

Diabetes and Behavioral Health News from the ADA

The recently completed 73rd Scientific Sessions of the American Diabetes Association featured several interesting abstracts on the impact of behavioral health intervention in diabetes. We are excited to see a robust clinical dialogue on the importance of behavioral health.

Abstracts included a study of the impact of mobile phone based programs in diabetic populations to improve self-care and a large study on the long term impact of behavioral health disorders on utilization and outcomes in type 2 diabetics. Last, but not least, there was an interesting analysis of the co-occurrence of obesity and depression and risk for type 2 diabetes.

The study suggested that behavior therapy for depression appears to have long lasting effects on mood and may be a helpful first step in treatment for women with depression and obesity. All of the abstracts are free and available to public.