The Redox Podcast 45: WebMD’s Ann Bilyew on Why Scale Matters in a Shifting Market

Posted February 16, 2022
By Miona Short

Redox Podcast_Ann Bilyew – WebMD: Audio automatically transcribed by Sonix

Redox Podcast_Ann Bilyew – WebMD: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Ann Bilyew:
But what is much more straightforward and ultimately potentially impactful is to put more decision-making power in the hands of consumers. So I think we’ve seen a lot more progress in, on the side of consumer-driven healthcare, in terms of simply having patients have more control over how their dollars are spent, being responsible for more decisions, and ultimately in charge of their personal outcomes.

Niko Skievaski:
Welcome to the Redox podcast, where we explore the intersection of healthcare and technology with some of our industry’s most notable contributors. I’m your host, Niko Skievaski, in my day job, I’m the co-founder and president of Redox, where we’re on a mission to enable the frictionless adoption of technology and healthcare. We started the show to share what we’re learning and hopefully allow you to skip some steps as you embark on your journey through making healthcare a little bit better. So without further ado, I welcome you to the Redox Podcast.

Niko Skievaski:
As a consumer, I found myself on WebMD exploring potential diagnoses or catching up on the latest COVID happenings. In fact, I’m not alone in this. About seventy-five million people visit WebMD per month, making it one of the most utilized sources of healthcare information out there. This scale enables WebMD and Internet Brands, who’s their parent company, to serve patients and health systems across the entire continuum of care. On today’s show, I get to go deep on this with Ann Bilyew, who heads up healthcare for Internet Brands, including WebMD and Medscape. We discuss why scale matters to health systems as the market shifts towards looking at patients as sovereign consumers, we discuss how startups feed into these trends, creating alternatives for patients and putting pressure on incumbent healthcare providers to step up their game. So without further ado, here’s Ann Bilyew you on the Redox podcast.

Niko Skievaski:
And I’d like to start with the question of your role at WebMD and a little bit of your background and how you got to that position.

Ann Bilyew:
Yeah, you bet. So I am SVP of Health for Internet Brands, is the parent company of WebMD and Medscape, and I’m the group general manager for our provider-facing and payer-facing businesses. So everything that we sell to healthcare providers, health systems, other sorts of providers, and payers is in my rubric.

Niko Skievaski:
Nice. It sounds like, it sounds like a large jurisdiction. Can, can you just describe a little bit of the product mix that falls under the Internet Brands? I think it’s an interesting sort of conglomeration of companies, so just understanding kind of how they all fit together.

Ann Bilyew:
Internet Brands is the leading vertical-focused provider of web-based marketing solutions for businesses and media websites for consumers. In 1998, Internet Brands really, really helped create the internet as a marketplace, and that has been a leader in automotive, health, legal, and travel, really focused on perfecting the use of data and analytics to devise tactics that enable consumers to find and connect with the right solution or service provider. And then, with the acquisition of WebMD and Medscape in 2017, healthcare became our largest and fastest-growing vertical, and we now have dominant audiences and reach for both health-oriented consumers and providers.

Niko Skievaski:
Nice. So I think of WebMD as the website that I end up on after I Google random symptoms that me or my family might be experiencing. But of course, it is so much more than that and really expanding into facilitating the entire patient journey, well beyond that discovery portion. Can you expand on what that looks like and discuss WebMD’s vision in that space?

Ann Bilyew:
So WebMD is the number one provider of information for consumers seeking information about their health and to help them make decisions about the health of themselves or of a loved one. So in any given month, we have 85 million unique visitors coming to WebMD to help them find information to make good decisions. Now, rightly or wrongly, we know folks have a health concern oftentimes before their spouse, before their child, before their parent, almost certainly before their doctor. Coming to WebMD to do some research or coming to WebMD to get information, coming to WebMD to understand what might be happening with them. So we very early on in the patient’s journey, are developing a trusted relationship with that, with that consumer. So in terms of building on that related to how we help providers and health systems, hospitals, and payers, we’re starting that dialogue very early on with the patient and sort of starting an active care journey. And so when we looked at what we could do with, you know, on behalf of health systems and providers, you know, we could help them reach patients as they’re making a decision about whether to seek care or when to seek care and with whom to seek care. So we’re, we’re right there in the mix, right with those most important decisions are being made and we acquired Pulse Point earlier this year, we had we have the ability to reach those same consumers that are making those decisions wherever they are on the, on the web. So access to 90 percent plus of the U.S. population and we can identify those who are actively seeking care and begin a dialogue with them.

Niko Skievaski:
And what does, what does Pulse Point do?

Ann Bilyew:
Pulse Point is a technology company and a programmatic exchange that unifies the digital signals that signal intent on behalf of a consumer or a healthcare professional, and then combines it with real-world data to produce a rich, multi-dimensional view of that individual. We can then use that data and insight on behalf of our clients to reach and engage these important audiences really in the right contextualized moment as important decisions about care or about referrals are being made.

Niko Skievaski:
Interesting, so you get a lot of patient eyeballs and trust built through the traditional WebMD kind of website that consumers know, Pulse Points helps, Pulse Point helps you identify where that patient might be in the journey, and where they are in the web. And then the business model that you’re discussing is using that to drive business into healthcare organizations, and presumably, they pay you for that?

Ann Bilyew:
Yeah. So I’ll walk you along the, the whole sort of set of solutions that we have because there’s not one, one singular business model there. So we’re catching patients, right, very early on in their journey on WebMD-owned properties through Pulse Point now, basically run a web, and then when we acquired two other companies, a company called … and a company called the Wellness Network, those companies brought us right to the point of care. So … is embedded in almost two thousand hospitals, deeply embedded in their EMR, with patient education and patient engagement solutions. The Wellness Network is the largest network of on-site TV solutions for hospitals, right, so largest healthcare network. So we’ve got access to over three hundred thousand TV screens in hospitals, in patient rooms and waiting rooms, and other active parts of the environment. So which is more than a third of U.S. hospital beds. So we’re at very early on in the journey, we’re embedded during the active course of care. And then we have a solution called Direct to Patient, which is our messaging solution, which enables us to reach the patient with information relevant information to them, post active episode. So sort of maintaining that relationship throughout the active episode of care and following it. So we call that our discovery to recovery platform. So what we’ve built is, the first, I think, unified patient experience throughout the entire journey. And it all starts with the ability to reach consumers at scale, right? And then we’re reaching patients at scale through our, our … And our TWN networks. And then again, we’re reaching patients at scale with our direct-to-patient solutions, so it’s all about being able to deliver content, deliver information and engage patients at scale.

Niko Skievaski:
Gotcha. And it sounds like a lot of these pieces have been put together through acquisition. How are you thinking about, like tying the patient experience into all of the solutions? Do you, do you have a unified patient identifier that you pass through? Like, how are these different types of products working with each other to enhance the experience more than it would just be on their own to standalone products?

Ann Bilyew:
Yeah, that’s a great question. So we are, we’re working to tie this together so that there is a, so the health system is speaking with one voice or the hospital is speaking with one voice to that consumer throughout that entire journey. And we’re really the only company that can do that. We’re really the only company that can put the patient at the center and be with them through the entire journey, right? There’s people out there that try to do patient acquisition, you know, programs, there’s people out there that have patient education, there’s point solutions out there that are serving up content, pre and post-care, but nobody’s put together that whole package. Now, to support that, though, and to create a truly unified experience for the patient, you need almost hyper-personalization, right? You need to know what content, in what format, on what platform, at what time, in what language, so there is a hyper-personalization that’s required to really deliver relevant content to the patient that’s going to be impactful and influential and feel frankly relevant to them. And that is all backed by massive data sources, which we’re again the only company that I know that’s, you know, position, in a position to build.

Niko Skievaski:
Yeah, that’s really interesting. I’m just thinking about having worked with many large hospitals and health systems like who in those organizations is the one that cares about the communication to the patient across the entire journey because it’s not the doctor necessarily, right? It’s like, yeah, who is essentially the one that wants to put all of this in place, like, I guess, your counterpart on the healthcare organization side.

Ann Bilyew:
Yeah. So increasingly, health systems are thinking about the patient journey this way. And so they’ve, you know, they’ve put somebody in charge of that, right? Because historically you’ve got the head of marketing, the chief marketing officer, that’s, you know, talking to us about patient acquisition, branding solutions, referral management, we also leverage our massive audience on Medscape, massive physician audience on Medscape for referral solutions. So but that’s usually the, you know, the head of marketing. And of course, you have your head of clinical that’s talking to us about our patient education and patient engagement solutions, that’s the CNIO or the chief nursing officer or the CMIO, CIO, to some degree. So they’re talking to us about our clinical solutions. But, increasingly, health systems are beginning to put those things together and think about the patient experience in totality, frankly, as most other consumer-facing industries and consumer-facing businesses do. And they’re putting in place a chief experience officer or somebody who’s really charged with thinking about a unified patient experience from discovery to recovery. And those are the sorts of folks we’re talking to.

Niko Skievaski:
Gotcha. Yeah, this is, it seems very cutting-edge, and that healthcare organizations are starting to think about their patients more as consumers who have choice, who need to be, who need to have a really consumer-oriented experience. I’d love to get your take on kind of how these patient engagement strategies are evolving and where does WebMD be in the suite of products kind of fit into that evolution of how patients are becoming more, more engaged in their healthcare?

Ann Bilyew:
Yeah. So, you know, I’d say that health systems just to pick up on one comment that you made, so health systems are becoming more sophisticated about this because they have to, right? They’re under so much pressure in terms of the massive consolidation and whatever sort of regional market they’re in, but they’re also under pressure by these new well-funded, capital-backed startups that are creating new health models and that are beginning to actively compete for patients and actively compete for patients with a digital-first mentality, right? Because they’re, they’re starting out as you know, they don’t have any of the constraints that a typical health system would have or hospital would have with its legacy system. So they’re starting with a digital-first mentality and they’re well-funded, increasingly public, so under a lot of pressure to grow, and they’re putting tremendous dollars behind their patient acquisition strategies. And then you’ve got the really big guys, of course, like CVS and Walmart and others, Walgreens, and now they’re, they’re saying now our future is not as a pharmacy, our future is that as a, you know, patient care solution, broadly speaking. So hospitals are under siege from a lot of different angles, not just their traditional health system competitor down the corner or down the street. So we’ve got to up help them up their game.

Niko Skievaski:
Just to add on this, this is a trend that has always made me kind of scratch my head a bit because on one hand, the healthcare industry as a whole, we’re trying to move more towards value-based care, right, where we have a comprehensive view on a patient and can help direct that. And large healthcare organizations are best positioned to take risk on patients and have that holistic view, potentially. Meanwhile, we have these consumer-oriented type companies sprouting up. Do you see well, and as the consumer-oriented companies are sprouting up, they’re often very niche players, right? It’s a very specific telehealth visit for a specific type of med that a patient might be looking for, which is totally outside of their, of a value-based arrangement and outside of a sort of holistic view on a patient that a large health system might have, and so that competition, I feel like, is not only pulling patients out of a large health system for certain types of care, but also moving more towards a fee-for-service sort of model. And so are these at odds? Is the move towards value based care at odds with a consumer-focused or a consumer-oriented experience in healthcare?

Ann Bilyew:
So, Niko, I would frame your question really is two competing movements about how care is going to be paid. For at the end of the day, both value-based care and consumer-directed healthcare are really about trying to ultimately control costs, but I think one is more realistic today and ultimately probably more powerful. So first, there is this value-based care concept, which is really trying to align incentives between payers and providers and in-center pay for outcome rather than activity. Sounds like the right thing to do, but it’s actually enormously complex, requiring substantial investment in sophisticated systems integration and analytical tools that are, quite frankly, beyond the current capabilities of most, of even the most integrated health systems. That complexity is part of the reason it’s been very slow to scale. But what is much more straightforward and ultimately potentially impactful is to put more decision making power in the hands of consumers. So I think we’ve seen a lot more progress in on the side of consumer-driven healthcare in terms of simply having patients have more control over how their dollars are spent, being responsible for more decisions and ultimately in charge of their personal outcomes. You certainly see that with planned designs that emphasize patient responsibility today, including HSAs, various forms of deductibles, co-pay, co-insurance, et cetera. So I guess I’d say of the two strategies, consumer-driven healthcare has certainly had a bigger impact today than value-based care, so whenever you give consumers more healthcare’re going to make decisions as consumers always make decisions: based on convenience, value for their dollar, and the quality of the overall experience, which means they need good information, has to be easy to get an appointment, means it has to be easy to get access to the information they need, means it needs to be easy to pay a bill, it means all of those things and more.

Niko Skievaski:
For sure. So one of the, you know, our audience and a lot of the people that we work with at Redox are a lot of the smaller vendors who are carving out their niche in the digital healthcare ecosystem, and the evolution that I have observed for many of them is that when they start their companies, they often have a very large vision of the impact that they want to make in the space. But just because of the market constraints and their funding and their ability to go to market, they have to sort of narrow to basically a very niche product and they get to market with that niche product. And over time, their choice is either to expand and start to go after that vision or just go deeper on that niche and kind of get more market penetration. A lot of them, and I feel like sort of my tenure of this startup community, a lot of, a lot of the other folks who started companies, you know, six, seven, eight years ago now are starting to either be acquired or merge or have more substantial partnerships. I think it’s really interesting, from your perspective, you have been very acquisitive and from a buy side, when you think about needing to sort of complete the picture of your vision of how you want to provide services in the space, how do you think about whether you want to acquire something or partner with an organization or build it yourself with all of the resources you have? Like what goes into that decision and when does it make sense for you to move on one versus the other?

Ann Bilyew:
Yeah, so it really, there’s multiple factors, right? And every deal is is unique. I mean, we have, I think we’ve got 6,000 employees at this point, probably between three and four thousand of them are developers of some sort or another. So we have tremendous capability around our own, you know, product development, our data capabilities, our analytic capabilities are. So I mean, we’ve, we can build whatever it is, where we need or want to build or we think is going to be strategic for us. But if something is going to get us to market faster or get us into a new market faster or give us a big chunk of a market meaning a nice installed base, which is, you know, clearly what … and TWN have brought us that saves us time and that saves us money, right?

Niko Skievaski:
Mmhmm. So it’s really about if they have a footprint in the market that is not easily replicable. So it’s not necessarily about the widget they built, it’s about who is using that, and is that something that is easily replicable or not?

Ann Bilyew:
Yeah, right. And our, you know, are the customers using it in a meaningful way? I mean, Niko, before I joined here, I was in, you know, I ran a company for almost 10 years, I was in, I was a partner at a private equity firm for another 10 years before that, all healthcare. I’ve seen so many companies develop really great solutions, but they’re far too narrow and with the, you know, sales cycle and the complex, complex sales cycle of a, of most healthcare institutions, these companies end up, you know, I call it death by pilot, right? They get a bunch of really small pilots proof, proof of concept pilots and one hundred hospitals, and they never get beyond that, and that’s where they die, right?

Niko Skievaski:
Why do they get stuck in that pilot phase? Because the idea is you get a pilot, you you prove that it works, and then hopefully that can parlay you into a paid contract at the next organization or even at that same one that did the pilot with you.

Ann Bilyew:
That’s why we’re so different, right, because we help health systems operate at scale, right? So if you can go in and you can bring, you can, you can give them a solution that helps them solve a really big problem and solve a really big problem for them quickly and easily and at scale, that’s a whole different conversation than when you’re, you’re getting a director of IT to agree to try something out for a few months to see how it how it works, right? Scaling beyond that is, is really hard once you get into that pilot mode because there’s no reason to end the pilot, there’s no reason to scale the pilot and to do a pilot’s easy. You probably only needed one or two people to be your champion in the health system. Meanwhile, the people who really write the big checks probably don’t even know they’re there.

Niko Skievaski:
Pilot purgatory is what, we’ve referred to that as.

Ann Bilyew:
A pilot purgatory, death by pilot, same thing. Yeah, same exact thing.

Niko Skievaski:
Yes. Yes. Just thinking about the history of healthcare technology and adoption from health systems, I feel like we’ve gone through this, this motion of, early on, we had sort of technology and I’m talking like 70s, 80s, 90s even, we had technology sort of bubbling up as it was being developed in and applied to healthcare. And then what meaningful use did, at least in my mind, and I was at Epic during, during the meaningful use era, what I saw that kind of do was bring the best of breed era to an end. And really a lot of the vendors who were in the best of breed world combined together to create this thing called an EHR that was defined by the government and a few vendors went out and became huge because of that, Epic included and Cerner and Allscripts, Athena, all of you know, going down the line. And that was largely, I would say, 2008 to 2018 or so, that decade of, just the meaningful use era of like, how can we adopt this EHR and use it meaningfully, supposedly, and then I feel like after that or kind of coinciding with that, we, we saw that emergence again of new technologies being developed and these niche technologies, the emergence of digital health in a modern sort of Web 2.0 way, using, using the internet and more modern technologies. What you’re talking a lot about is going to a healthcare organization with a, with a large scaled enterprise product that has data network effects that, that health systems can benefit because of the scale. Do you think that we are moving back, like the pendulum’s swinging back towards what health systems are looking for now and needing is that enterprise solution because they had so many of these pilots, they feel also like they’re in pilot purgatory and not really making any progress because of small point solutions like, yeah, what is your take on where the industry is from, from these trends?

Ann Bilyew:
Yeah, no. I think as far as healthcare organizations get larger and larger, they need to deal with scale providers, right? Because if you think about the administrative time and hassle of dealing with a bunch of point solutions, right, and then to the question you asked earlier about, how do you create a unified patient experience if you have a bunch of point solutions? And you’re orthopedic service line is using, you know, one texting platform and your, you know, your onc service line is using another because they really like that one. And there’s, you know, there’s, there’s no ability to, to scale that and get real leverage from those, you know, from those capabilities. And then you’ve got to have a great data platform, right, that supports all of that, that helps you, helps you get back to what I was talking about earlier, which is radical personalization, really understanding that, that patient not only in terms of their interactions with you, but what their digital footprint looks like, what do they do online? How do they, how do they search for care? How do they, you know, what are they doing on your site hospital? So putting all of that data together requires a scale solution. And then if you really want to have impact in your market and achieve, you know, enduring market share gains, you know, you’ve got to deploy those solutions, again, at scale in your market and having, you know, a bunch of different disconnected point solutions isn’t going to get you there.

Niko Skievaski:
Yeah, certainly. And it’s, it’s not something that a startup can create, like within a year or two, right? It’s a, it takes time to build that. Which brings me to another sort of trend that I think is quite interesting. You know, really over the last decade now, we’ve seen record breaking numbers every single year in venture capital investment in the digital health space. I think that’s going to continue just looking at the markets right now. There’s a lot of money out there that investors are looking to deploy in healthcare in these sorts of technologies. So if we’re seeing demand shift on the health system side to want more, more enterprise, more complete solution, what are investors going to do with their money? Or are they are they just going to keep funding startups and like, we’ll still see the continuation of more and more companies come to market and not really make much progress?

Ann Bilyew:
I think it’ll be a combination of the two. So this is not the first wave of digital health funding, massive dollars flowing into digital health, … the late nineties early 2000, that was a huge wave, you know, sort of funded by venture being attracted by the, you know, internet, early internet days. There was a massive wave of funding and call it 99 to 2001-2002 timeframe, huge dollars, huge valuations, very frothy, looks a lot like today. Maybe the fundamentals are a little better today, but what happened is you have massive consolidation. You know that, that follows that because not all those companies are going to survive. So you’ll have massive consolidation and then you’ll have a bunch that, you know, that that don’t ultimately make it.

Niko Skievaski:
Do you think we’re on the beginning of that massive consolidation or will we see, continue to see more new things created before that happens?

Ann Bilyew:
Oh, Niko, I don’t, I don’t think we’re there quite yet. I think we have a few more cycles to go in this wave. There are a lot of really innovative things companies are working on, but I do think that ultimately the market will pick some winners in the major categories, but that will take some time, just like EMRs. I mean, Epic was founded in 1979 and was a tiny little company for arguably the first twenty-five years. Now, I do think that things in our market move faster now. But building winners still means being patient and requires ultimately being able to operate at scale.

Niko Skievaski:
Yeah, yeah. And from my perspective, the interoperability space is still, we’re still fighting for, it makes a lot of sense for there to be a single or maybe a couple groups that help everybody in that space, kind of like utility. And we haven’t seen sort of a clear winner yet, necessarily without patting, patting myself on the back, which, which brings me to the question of where does Redox fit into this? So we’ve partnered together. But how do you think about Redox fitting into your ecosystem and enabling some of this?

Ann Bilyew:
Yeah, for sure. So it gets back to that point I was making about radical personalization, and reaching the patient where they are. And to do that, it requires, requires a lot of data and it requires integration across, across the systems infrastructure, right? So we need to know a lot about the patient, about how they consume information, about their demographics, about their clinical history, if we’re really going to deliver to them information, that’s going to have the most impact. In order to do that, we need to have those sort of pipes in place, right? And we could do that hospital by hospital, by hospital, or we could, again, do that, hopefully do that at scale with with a company like Redox. So what we’re using Redox for is to go into our health systems and say, let us, let us build out your digital ecosystem, right, let us, let us help you do that. We need those pipes, we need that data, right, for all of this patient engagement, all these patient engagement solutions, and you can, you can also use it for, for other things over time. But we’re going to help lay that road. We’re going to help build those pipes, use whatever analogy you want to use around infrastructure, we’re going to help you build out that digital infrastructure because we need it to continue to scale our business.

Niko Skievaski:
So if I was to look at this sort of feedback for Redox in our, in our business model and value propositions, it sounds like the partnership is really about because Redox already has all of these pipes laid in thousands of healthcare organizations around the country, which makes me reflect back on, early on when we were just getting started, we had, we had none of this network. And so for us, our value proposition has really evolved from at the beginning kind of being like your outsourced integration to now, essentially, the outsourced integration value proposition wouldn’t have, we wouldn’t have been able to work with WebMD with that value proposition because you would have just done it yourself, you have thousands of developers, you have more developers than the whole size of our company, but it sort of took a transition in the value proposition to a network for that to actually start to make more sense.

Ann Bilyew:
Yeah, 100 percent. And to get that, it gets back to what I said earlier, what do we care about? We care about speed to market, right, and we care about scaling quickly. So anything that helps us do that is attractive to us, whether it’s, you know, partnering with a company like Redbox, acquiring a company with a strong installed base or great content corpus, whatever is going to get us to market more quickly, at scale, get us to market at scale.

Niko Skievaski:
Nice. Well, I am honored for the opportunity to get to work with you all and super excited that you partnered with us and, you know, hoping that we can live up to that, those expectations to help you scale quickly. I’d love to just end with a question kind of, a higher level question about, you know, we all work in healthcare, it is a, it is a tough industry, it feels like it’s slow moving, sometimes, what keeps you motivated in this space, having, having been in it for as long as you have and the experience in all of the stories you’ve seen like why do you stay in healthcare?

Ann Bilyew:
You know, the people that work in healthcare are amazing, right? And what brings them to work every day, I’m talking about the clients we serve, what brings them to work every day is so admirable, right? And if, if we can continue to make their job easier, if we can continue to help them do their job better, which ultimately serves the patient’s best interest, and that’s, you know, that’s, that’s being a force for good.

Niko Skievaski:
Nice. I love that. I feel like that’s the one thing that brings us all together around healthcare. There’s, rarely anyone talks about the profit motive, and it’s so much more about how can we, how can we do good for the industry that’s going to touch all of us at some point in time. So I love that.

Niko Skievaski:
Thanks again to Anne Bilyew, you and the folks at WebMD and Internet Brands as a whole. Here at Redox, we’re humbled to have the opportunity to support some of the biggest names in health tech, by playing a small part in making healthcare a bit more efficient, accessible, and equitable space. And if you’re listening, you’re part of this movement, so thank you for the work you do. This has been Niko Skievaski, and thanks for listening to the Redox Podcast.

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WebMD is usually the resource you run to after noting a random hiccup in your body, but in today’s episode of The Redox Podcast we get to see how WebMD plays a part in the bigger picture of delivering healthcare. Niko chats with Ann Bilyew, the Senior Vice President of Health for Internet Brands, the parent company of WebMD and Medscape. They discuss the organization’s recent acquisitions supporting their focus on personalizing the patient experience, how patient strategy is becoming a more consumer-oriented experience, and whether value-based care is inherently competitive with a consumer-focused model.

“Putting all of that data together requires a scale solution, and if you really want to have an impact in your market and achieve, enduring market share gains, you have to deploy those solutions, again, at scale in your market. Having a bunch of different disconnected point solutions isn’t going to get you there.” 

– Ann Bilyew