Reza Sanai (Founder and Co-CEO, PicassoMD)

Can you explain your job to a five-year-old? 

What we want to do is streamline communication and transition of care between primary care doctors and specialists.

What excites you most about your job?

I think for me, what excites us most is the problem we're trying to solve. We're trying to get away from siloed medicine and create tangible workflows and processes where a provider, anytime they have a question about any patient that walks into our office, we can help them with real-time clinical decision support. And if they actually want to know where to send the patient if the referral is necessary, we can actually help them out on that front. So it's a real tool, designed for real providers. Also, what we were the most excited about is scaling that vision.

I think many people have either been the patient or are providers and are familiar with the concept of, I have someone walk into my office and I'm not exactly sure what to do with this patient. And with our solution, if I had a question, I could hit a button and get matched to the specialist in under 30 seconds and discuss the case with that specialist directly. That would result in better outcomes for the patient and make me feel a little bit less anxious.

It would provide a value add to me, not only from a quality perspective, but in eliminating a lot of waste in the system. If I was like, ‘Great, I don't need to send a patient to the emergency room, but I need to send a specialist, can you help me?’ It could match me with the local specialist and take that onus off my shoulders. That's a pretty straightforward value prop. I think both for the patient and providers, it's relatively straightforward with what the value that we're trying to offer to our partners is.

There’s been a lot of talk around whether generative AI can serve as a kind of specialist curbside consult replacement. It sounds like here, you’re making it easier for actual human specialists to be connected to the right person at the right time.

I think it plays a role, but in the end, I think, at this point in time, people trust other people. You would probably feel more comfortable because it's a dynamic conversation. It's not that you have to put a large language model in place to get a feedback loop. It's a dynamic conversation between two entities, one that you can establish a relationship with and then get back to in a future state.

So if you and I collaborate and you enjoy my collaboration, you and I could get linked. Then, you and I can collaborate again, and it's that relationship building, which is an important component of trust. And so facilitating that is a component of whatever relative success that we have. It’s being able to actually generate relationships on a local-first basis. To foster better clinical decision-making and referrals—that's the ultimate vantage point. It's not one or the other, it's the combination. 

Which trend will change the future of medicine? 

The obvious answer is AI to a certain degree. But I still think that's a little bit of a black box and it's going to be throwing things against the wall until we find an optimized solution. But I do think AI in regard to provider burnout is going to be impactful if we can help with documentation and taking some of the blocking and tackling of the day-to-day practice of medicine. That would be the biggest value prop from an actual behavior change for the masses. 

I hope the transition to value-based care will be part of that narrative, where we can actually financially incentivize organizations, providers, et cetera, to—in the U.S. at least—that higher quality care, more thoughtful care, being reimbursed versus more quantity. 

So, if I had to guess: I'm hopeful that AI will help with the blocking and tackling. And the second: the trend of healthcare expenditure going up and to the right is not sustainable. So we have to align payer relations with outcomes. Those are the two things that I look forward to, at least on paper.

Looking back, which trends have you missed or underestimated? 

I think electronic medical records are great for many purposes, but what ended up happening is a change in the style of healthcare. Patients have a misconception: ‘I talked to my provider, typing into their computer, that computer must obviously talk to other providers.’ And then you're like, ‘No, I have none of your information. That's just in their one computer. There's no connectivity between them.’ 

And now it's too big of a business to unwind. If I think of one technological solution that's been very helpful in some aspects, electronic medical records for documentation and for billing has been great. But it's not transferable and it doesn't create any connectivity. It actually creates more fragmentation of care. And so that's where I think I would double click on: if there's an interoperability that really happens at scale, it'll help. But for now, looking back, I'm not sure we quite mapped out this problem when it first came out.

Which MedTech initiative or startup deserves more attention? 

We're super value-oriented and really want to empower care, not for just the financially wealthy, but for those that are in underserved and rural populations. 

They're a much bigger organization than we are, but their north star is a hundred percent aligned. There's this company called Equality Health which is trying to shift provider groups that are Medicaid-heavy into value. So, it's basically trying to provide value-based care to those populations that need it most. That type of organization is something that we want to always be a part of or strive to be working with.

Also: Limber Health, which is a digital musculoskeletal value-based platform. RxLive, which is an example of a pharmacy digital solution. Those are other ones that we like as well.

Where would you put a million dollars? 

I would put it towards organizations that help Federally Qualified Health Centers scale as patient advocates. I wouldn't say it's self-serving, but what I've seen is a significant percentage of this country's healthcare is in rural and underserved markets. And if we think we have it bad in certain parts of the country, if you go to others they have zero access to specialty care.

So I would help fund Federally Qualified Health Centers that are really on the front lines, and empower them to give better care to their providers and patients. That's where I would give that 1 million. 

What's the best advice you've ever received? 

Be humble.