Commons

Fortune's list of venture- and private-equity-backed startups using the profit motive to solve societal problems.

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Household consumption is the source of around two-thirds of total greenhouse gas emissions, according to a 2020 study. Commons is working to alter that statistic by providing consumers with information about how their spending adds to carbon emissions. The app, available in the U.S. and Canada and free to use, calculates the emissions that go into the making and transportation of each purchase and determines a user’s overall carbon footprint. It also offers personalized recommendations on switching to alternatives that are more earth-friendly, an effort boosted by its August launch of a feature recommending sustainable brands.<br />
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Commons says it has “tens of thousands” of users, including Google cofounder Sergey Brin and Game of Thrones actress Maisie Williams, who has also become an investor. Last year, the average Commons user lowered their emissions by 20% and saved $200 per month, according to the company. If everyone in the U.S. reduced their emissions by the same level, the effect would be the equivalent of taking two-thirds of cars off the road or removing emissions from the entire aviation industry, Commons says. The company has raised $13.9 million, valuing it at $50.4 million. NFL quarterback Colin Kaepernick recently signed on as an advisor.

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Guy Friedman, Co-founder and CEO, SteadyMD
Rich Roth, Chief Strategic Innovation Officer, CommonSpirit Health 

Brainstorm Health 2023 - Addressing the Healthcare Staffing Shortage 

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Addressing the Healthcare Staffing Shortage

Guy Friedman, Co-founder and CEO, SteadyMD
Rich Roth, Chief Strategic Innovation Officer, CommonSpirit Health

Right. How was everybody's afternoon? Hopefully good. Um I've been like incredibly impressed so far with all the content. Um I think this is the first conference I've been to where I just wanted to sit through absolutely everything. So um really means a lot that you're all here. Um So next up, we are having a panel on the crisis in care, the health care staffing shortage, which I think is just such an important topic, not nearly talked about enough. Um It's been called a public health crisis and it absolutely is one, this problem began before the outbreak of COVID. But the pressures and the demands of the pandemic led to so many nurses, doctors, other providers just leaving the industry in record numbers. And even now we're, we're continuing to see this trend. According to the Association of American Medical Colleges, the US will face a shortfall of 124,000 doctors by 2034. Um And this statistic doesn't even take into account the lack of nurses, dentists, mental health professionals, and just so many other providers across other professionals as well. And in addition to this burnout, there's also this rising aging population that we've talked about. Karen Lynch mentioned this, we have more seniors now than kids and the rising demand for care and problems in the education pipeline as well. Um So how do we even get people to want to be doctors these days? Um Big question that we're facing. None of this bodes well for any of us. Um So joining us today to talk about this is our fortune. Well reporter Alexa Mchale, who will be diving deeper into these challenges and potential solutions. Um With a panel that includes we Deng, the CE C O and founder of quit board health Guy Friedman, um co-founder and CEO of Study MD Rich Ross, um who is the Chief Strategic Strategic Innovation Officer at Common Spirit Health. Please welcome all of them to the stage. Well, first, thank you all for joining us and I want to jump right in as we heard in the introduction, the causes of the staffing shortage range from the education pipeline to burn out to this growing demand for care, which I wanted to start with you. Common Spirit Health operates over 2200 care sites across 23 states. I mean, do you agree with these causes? And what for you has been most top of mind in addressing right now? Yeah. Well, I mean, first of all, I remember, you know, during the pandemic when my dad unfortunately has cancer and you know, it was a time where you couldn't visit. And he lives in rural Pennsylvania. And, you know, I, I was calling nurse, you know, all the time checking in on him and, you know, one time I checked in on her and I said, hey, how are you doing? And, you know, literally we talked for 10 minutes and she cried for most of it. And you think about, you know, how caregivers went from heroes at the beginning of the pandemic to kind of villains with mass mandates and vaccines. And then all of the things that they, they do each day, you know, gun violence that we see in the news, you know, fentaNYL abuse and all these other types of things, they can never turn that off. And so ultimately, I think burnout and mental health is the largest challenge that we have and all innovations that we need to focus on really have to center there because I don't think we're going to have a stable workforce unless we're able to do that, right? And, and you bring up burnout. And we, I wanted to turn to you, your platform. Clipboard Health gives primarily nurses, nursing assistant and medical assistance the ability to uh grab shifts at health care facilities at an a need basis. And so I'm curious, you know, from your work and your perspective, you know, how has that increase in flexibility, addressed the burnout epidemic that, that rich brought up and um and, and really kind of address the ability for people and, and clinics just to stay and, and stay in the workforce. Yeah, thank you. So, the way that we've approached the problem is to offer the health care workers more flexibility in both their schedule in terms of when they want to work or if it's an AM shift or shift PM shift. You know, there are quite a few parents on the platform, a lot of single moms who have to deal with constant changing child care. And then the other uh way that we're addressing is by providing for the health care facilities, they have their own full time staff, staff, some of whom are burnt out because they have so many patients come in that they have to treat. So giving them more staff to help just more hands around the table so that the patients get better care, but the actual workforce in the facility themselves get more relief as well. Definitely. And guy I wanted to bring you into the conversation. Uh you now manage a national Digital Health Network that allows other digital health care companies is to use those clinicians across all 50 states. I mean, we've been talking a lot already about tech and virtual medicine and you know, I'm curious from your perspective, what are some of the hurdles and obstacles you know about seamlessly integrating telehealth into this care continuum and thinking about retaining clinicians as we move forward. Yeah, I mean, since we're national and we're taking appointments from all different types of lot um users from the systems to payers to self insured employers and the types of appointments can be different as well. So it could be synchronous or asynchronous. Um I think if you think about supply and demand, you wanna create a more efficient appointment uh to create more hours and more capacity for the whole industry. So in digital health, we have an advantage where we can take in all that appointment data kind of um uh like itemize it and then allow the supply to be really scaled across all the different uh all the different appointments coming in from all over the country. Um I think that's, that's like the kind of the biggest lever that can unlock it um in terms of barriers, um I think the biggest one is state licensing. So um most people know this now, but it was really not really well known, but uh the clinician, if they're prescribing needs to be licensed in the state where the patient lives. So we have a big licensing operation where we're licensing clinicians all over the country. But that's probably the biggest like regulatory hurdle that gets in the way of really, really scaling definitely and, and rich from your perspective, you know, thinking about on the ground and, and in the hospitals and clinics, I mean, how are you thinking about digital innovation? I mean, do you have examples of how that, how that looks on a daily basis, you know, say I'm going into, you know, an appointment. Yeah, I mean, I'll give a perfect example. So when you think about patients going to physicians and they're worried about their physical health and then they also may disclose, oh, my gosh, I actually have a mental challenge. I'm depressed. I am, am anxious. I'm something along those lines and the typical world is, you know, provide that you say, ok, well, that's mental, it's different. So here's a binder. Good luck, you know, you know, finding an insurance, finding a practitioner. So we've actually transformed that a bit where, you know, telephonically through an outsourced group, similar to what they're talking about, we can provide behavioral health assistance over 90 days immediately with any insurance to, to those patients. So if they're asking for help, we get them help in 24 hours versus the current system, a historic system where they may or may not ever ask for help again. And so our real goal is how do you, you know, expand that access through innovation and technology? Definitely, definitely. And after this next question, I, I wanna go to the audience. So if you have anything top of mind, um keep, keep a look out for that. Um But yeah, we I'll turn back to you. Um You know, I want to think about also addressing this crisis in the long term, right? We've, we've talked a lot today already about, you know, the aging population and um the number of Americans aged 65 older will reach 80 million by 20 40 more than doubling over the next 40 years. And so I'm I'm curious how are you also thinking about what your either platform or, you know, just having adequate staffing for seniors, especially um thinking about the next 20 to 30 years. Yeah, for sure. So I think there are a few ways worth thinking about it. Um The first is, you know, the missions of companies very much to lift people up the socioeconomic ladder. And with that in mind, we over time want to partner with other educational institutions so that we can really move up a CNA to become an and to become a nurse and really actually address some of the shortage problems from the root. So on the educational front and then the other one is a lot of careers only moving to home. So working with home health agencies and partnering with them to give the nurses who sometimes they want access to patients one on one. They like having that long term relationship, giving them more opportunities because right now we mostly serve long term facilities, some community hospitals, but not as much in the home. And so bringing some of that care in the home to, to address those seniors who want to stay home and have care delivered at home. Yeah. And guy How are you thinking about that the next 20 to 30 years? Um Yeah, I, I think um I think uh a few different levers you can pull. Um 11 big example is just moving from synchronous care to asynchronous. I think um that's a big lever that almost, you know, people ask me like sometimes for advice and how to scale. I think that's probably one of the biggest things you can do is try and move as much of the experience to an asynchronous uh model and then really save the synchronous part for like the true care and skip kind of the um intake and then on the back end trying to minimize the paperwork. Um to that, that's a real piece of the burnout is the amount of time clinicians spend documenting. So actually in a digital situation or a digital ecosystem, you can really, really fine tune that so that the the um the care is maximized and the documentation is minimized. So if you're controlling things end to end, you can really open up a lot more capacity for like true care versus um the stuff that really burns doctors out uh which is like, isn't really the time they're spending with the patients, the other stuff, right? And, and that's nearly 25% of, of their time in, in certain that's a, that's a low, I think it's even higher. Yeah, great. Um I wanted to turn to the audience does anyone have a question? Oh, I see over here. Great tim, with the association of schools and programs of public health. It, it occurs to me that we're not going to have enough people to do this work you're talking about and we need to think more about prevention. How are we going to add prevention to this? So we avoid too many people going to the hospital or having to get care. Yeah, go ahead. You know, um uh you know, I think most systems are working towards more value based care. I think it's a very, a very large question, but I would also take prevention in terms of the workforce burning out. So as an example, we um it costs us $40,000 to replace a nurse. So training bonus uh and we have to replace 10,000 nurses every single year. So that's $400 million right? Uh These are huge opportunities um to create more sustainable um professions for individuals where education is provided along the way where peer mentoring is, you know, part of the standard process, we've created something called a nurse residency where we're adopting 5000 nurses a year and providing them with this education, peer mentoring and support. We've actually spun that out and formed a company and we're doing it for Kaiser and a few others. But our hope is that prevention of the workforce is through their ability to have a healthy and well respected profession. Right. And, and you mentioned burnout again, I mean, symptoms of burnout is that really like emotional exhaustion and, and not feeling good about, about the work that you do? I mean, is that what you're integrating into these mentoring and coaching opportunities? How do you actually address that emotional mental health piece? Absolutely. All of our caregivers now have mental health. We have programs dealing with conflict resolution dealing, you know, again, all the social strains that we see, you know, in society and maybe we can turn off our Twitter feed and maybe we can turn off the news. They can't, you know, and so they're bombarded with these things. And how do you deal with that conflict resolution and how do you deal with? I would say the other piece we're working on is really trying to get new individuals from different sources and have historically come into the health care. So we've partnered with more health school of medicine where their residency site here locally, we partnered with Charles Drew, bringing in new doctors, new nurses of the community that may have a better ability to understand some of these issues and resonate. And so it's a multi pronged approach, but that is exactly the burnout. People are feeling definitely. And guy thinking about prevention and partnerships, I mean, do you have anything to add on to it? Which I would just say I'm not an expert. I think rich is more of an expert in the topic. But I would say in, in digital health, you have a lot more data more quickly. So if you're tracking the frequency of interactions and um maybe uh there is this like place where you can go, where you can theoretically see, burn out earlier and then intervene earlier. Um So I think uh in digital health, it's a, it's a, I see MD as we're a leader in this space. So I see it the responsibility of our company to really make sure we don't replicate a lot of the things that have happened in the past where clinicians like really don't like their job or their um you know, very high rates of burnout. Um So we work really hard on creating a good culture as well as preventing that with data. I'm not an expert in the topic, but I know like we can track things much more quickly. Definitely, definitely. And yeah, and I wanted to ask another question of, of each of you. We, I can start with you. Um you know, thinking about this on more of a broad scale as well. I'm, I'm curious, you know, if you can talk a little about what you have learned in the last few years, you know, during the pandemic that has changed the way you think about health care and your vision for the future of your business and the future of addressing addressing this crisis, which has had multi faceted layers as we've talked about so far today. Yeah, I think the thing that I don't know if it's a new learning but um actually many of the health care workers, they went into the job because they really do want to interact with patients, they want to provide care. And I think the condition, we've made the conditions harder for them to do that. And during the pandemic, it was highlighted that these health care workers, you know, were watching colleagues suffer or watching many patients die from COVID. And, and so I think actually the um you know, back to what you're saying about the administrative work, like many doctors went into the field because they want to care for patients, not be saddled with, you know, administrative uh just all this paperwork and similarly, with the nursing assistants of that, we work with many of them still at the end of the day, wanna have interactions with patients. So if you enable them to do that on a um work with better nurse patient ratios so they can give each patient the care they they deserve. Um I I actually think that that does help them um prevent from burn out. I mean, we hear from the providers on our platform that, you know, when they have other, other people from our platform go to the facility or they have people that they know who are there, they actually feel energized by the mission of, you know, by sort of the purpose of their work. Great. Yeah, I'll go down the line guys. You want to answer the question? Yeah. Thinking about, you know, the last few years during the pandemic and, and, and what you've learned that's maybe changed the way that you think about, about health care and the future of your business and addressing this crisis. Um Yeah, I mean, I think um how, how do you increase capacity? You can increase the number of hours available or you can increase uh decrease the amount of time it takes to see a patient like efficiency or um and I think um if you're trying to do the second one, you can't ignore like the clinician culture and uh burn out and feeling around that. You have to really build a product that takes that into account from the get go. Um So I think uh that's something like you can't just uh build the most optimal optimal system because that, that, that might not be the, the best for the doctors long term and clinicians long term. I think uh we've learned to really try and build our product with that in mind. I think the role of workforce and what people want to do is changing so dramatically. You know, I'll give two examples. One is millennial caregivers, you know, like they don't want the same job. They want to be a nurse, wants to be an ICU nurse. Next week. I want to be a cardiac nurse. Next week, I want to be, you know, on the rehab floor and like the system is not built to like transform that model of practice so quickly. And then on the other side, you know, there are more 10 staff, the traveling is so before the pandemic, about 3% of our nurses were travelers right now. It's about 25% maybe even higher. And it's fascinating when you talk to these individuals, I was talking to one nurse and she was from Iowa and she loves to hike and her partners are tired and they're basically just hiking across the country by doing three week stints here and there. Meanwhile, she's renting place in Iowa to other nurses that want to transfer that want to work there for, you know, their personal reasons. And so there's this entire network that's been created. I think it's going to be really hard to dismantle in terms of, you know, nurses preferring different types of workforce than they ever had in the past. And obviously, it's social workers and physicians, it's others. But the dynamic of what his work is changing interestingly and what is, oh, sorry, I don't wanna, I was just gonna say, and we actually see the same data where the uh over 80% of the workers on our platform work at two or more facilities and like 60% work at three or more facilities. So that choice of today, I wanna go to this rehab center tomorrow. I wanna do home health tomorrow. I wanna go to community hospital is, is real too. That's interesting and just, and just changing the way we think about work to kind of even potentially to, to help with that education pipeline and, and explaining that this industry might look different, it might look different, different to work there. Um Great. Well, that is all, all the time we have. so going to wrap up, but thank you all so much for joining on this important conversation and looking forward to continuing it. Thank you.

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