We should be looking at businesses in other industries that are thriving because they offer an exceptional customer experience and learn from them. Healthcare consumers should feel that they are valued and that all their needs are being met when they interact with a provider. While there has been some investment in patient experience, we have not really moved the needle on exceptional customer experience. We need to flip the paradigm of care to one in which everything is about the individual rather than the system.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Ryan Van Wert, MD, co-founder and CEO of Vynca.
Dr. Van Wert is a co-founder and CEO of VyncaCare. In addition to his role at the company, Dr. Van Wert is a part-time Clinical Assistant Professor at Stanford University, where he maintains a clinical practice. Prior to Vynca, Dr. Van Wert co-founded AWAIR, Inc. a medical device company focused on reducing complications for critically ill patients, which was acquired by Cook Medical Technologies in 2015. He is frequently invited to speak about his passion for improving care delivery at the end-of-life and the process of value-driven healthcare innovation.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
As a physician with a background in critical care, I have seen scores of patients receive treatment in intensive care units, and quite a few of those patients had existing serious or life-limiting illnesses like advanced cancers and dementia and may not have wanted aggressive treatment. I have had heartbreaking experiences where I have put a patient on life support, and then, days later, a family member or loved one would appear with an advance care planning document indicating that this care did not align with the patients’ wishes. Worse, however, we learned that in many cases these individuals had never had these important dialogues with their physicians and loved ones.
Experiences like this are what drove me to co-found Vynca, with the goal of developing technology that enables individuals, families and care teams to make care planning decisions and ensure that those preferences are properly documented and available when and where they are needed.
Can you share the most interesting story that happened to you since you began leading your company?
It has been an incredible journey, and there are countless stories of healthcare leaders I have had the privilege of meeting who have dedicated their careers to providing high-quality care to people at a very vulnerable time of facing a serious illness. Seeing their passion, dedication and innovation has been truly inspiring.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
This is not a mistake, but in the very early days of the company, we were truly bootstrapped. During our first client visit, four of us ended up sharing a hotel room to save on expenses. Needless to say, we learned a lot about each other that trip.
What do you think makes your company stand out? Can you share a story?
Most Americans do not want to die on a ventilator in the intensive care unit — at the end-of-life, people prefer in general to receive whole-person care that is focused on comfort and well-being. However, if we do not clarify these preferences, the medical conveyor belt continues until the very end. We need to start normalizing discussions around future care preferences that reflect our values, choices and goals. Individuals must be able to ask themselves: What is really important to me? What do I want at the end-of-life that aligns with these values and goals?
Vynca has developed innovative advance care planning solutions that facilitate those high-quality discussions, which are critical to being able to access important services like palliative and hospice care at the appropriate time. We are enabling healthcare organizations to empower patients and have their voices heard — arming clinicians with the tools to honor patients’ wishes throughout the process of decision making, and ultimately, have the output of care be a true reflection of what patients want.
What advice would you give to other healthcare leaders to help their team to thrive?
Focus on the purpose and on the mission. Healthcare is an industry unique amongst its peers for having a real human impact, every single day, and that impact really matters to people.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked, so poorly?
The main challenge in US healthcare comes down to stakeholder misalignment, which drives up the inefficiencies in the system and drives down the overall quality of care. Although all stakeholders would agree that enabling quality, cost-effective care is their primary concern, a mix of competing factors interferes with that goal.
A big part of that comes down to the origins of how healthcare has historically been delivered in the US, which is on a fee-for-service basis. The incentive to the provider is to do more and more, and that is not always what is best for the system — or the patient. At the same time, the payer is compelled to push back on the provider for these services, which results in an administrative layer that is unsustainable (administrative costs make up 34% of total health care expenditures in the US).
In recent years, there has been a move toward a value-based model, in which payment is aligned with quality of outcomes, but the US still follows an intervention-heavy model of care. Procedures are most substantially reimbursed, and preventive and primary care are under-reimbursed. Since we under-invest in preventive care, the interventions are more complex and expensive, driving overall costs up. In addition, there are often investigations performed — such as a CAT scan for a patient where it is not indicated — that do not align with evidence-based guidelines. As a result, you get extravagant spend without the outcome associated with that kind of cost.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
We should be looking at businesses in other industries that are thriving because they offer an exceptional customer experience and learn from them. Healthcare consumers should feel that they are valued and that all their needs are being met when they interact with a provider. While there has been some investment in patient experience, we have not really moved the needle on exceptional customer experience. We need to flip the paradigm of care to one in which everything is about the individual rather than the system.
We need to create a better model for advance care planning to ensure that individuals receive care that aligns with their values and goals. There needs to be a clear articulation of those preferences in advance so people can inform the way we deliver care to them. The challenge has been that these kinds of conversations have not been normalized. That is why Vynca is on a mission to change this and make it a normalized discussion, which will lead to goal-concordant care.
We should provide consumers with more autonomy and more freedom of choice. That requires a sufficiently transparent model of pricing for individuals receiving care, so they can shop for the most effective, lowest-cost healthcare available.
We should invest more in mental health. Our chronic under-investment in this area has resulted in many downstream costs to the healthcare system, and to society as a whole. Lack of access to high-quality mental health care leads to housing instability, drug abuse, domestic violence and poverty, among other things.
We also need to make a more substantial investment in palliative care services. Right now, with the way Medicare’s defined hospice benefit is set up, if an individual chooses to receive hospice care, s/he is forced to forgo any treatments that are considered curative measures. That is a very difficult psychological decision to make. We should be providing access to palliative and hospice care that addresses individuals’ physical, social and emotional needs in a continuum that does not require that kind of stark fork in road.
Ok, it is very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
We have the policy and regulatory levers to effect change. We need to work together as individuals and communities to advocate to policy makers and lawmakers to change. It can work — Medicare has a wonderful hospice benefit because a strong advocacy push several decades ago made it happen. Now, it is time to revise and update benefits for individuals with serious illness for the value-based world.
More large employers are providing their own insurance. Today, many employees are caregivers to older parents (and many more will be in the years to come), so companies need to better support them. These companies hold a lot of influence, so they can help drive change.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
As I noted earlier, we need to invest more, and earlier, in mental health. Our current system makes good mental health care too expensive and too inaccessible for too many people. We need to integrate mental health into the preventive and primary care we deliver.
How would you define an “excellent healthcare provider”?
It is really about the customer experience. An excellent healthcare provider is someone who first and foremost puts themselves in the customer’s (patient’s) shoes. As a physician, I am struck by what a different experience it is being a patient. Whenever I receive healthcare, I find myself thinking that there are a lot of things I would change. The best providers are those who take a moment to stop and look at the person across from them and think about how they themselves would want to be treated.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
The most impactful quote is from a mentor, and it is simple: “Listen.” That one-word piece of advice speaks volumes to me and guides me in both my personal and professional life. Listening to patients allows me to better understand their needs, and thus to better serve them.
Are you working on any exciting new projects now? How do you think that will help people?
During the height of the pandemic, our healthcare provider partners called upon us to rapidly deploy solutions to clarify goals of care in populations vulnerable to severe COVID-19 infections. This made it an exceptionally busy time for Vynca, but we are fortunate to have a great team that rose to the challenge to ensure that these individuals had their preferences known in the midst of the pandemic.
I was also asked to advise on other COVID-19 related projects, from a low-cost ventilator developed by Stanford and the Chan Zuckerberg Biohub, to 3D printed nasopharyngeal swabs. At their core, both projects were intended to solve for global supply chain issues that emerged during the pandemic to better serve the needs of patients.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
The Health Technology podcast by UCSF’s Rosenman Institute is one of my favorite healthcare podcasts to listen to. They feature a number of spectacular innovators and entrepreneurs whom I find inspirational.
“Being Mortal” by Atul Gawande is a thoughtful, well written book that brought the topic of end-of-life care to the dinner table. He does a phenomenal job of weaving policy and his personal experience together in a very moving way that raises awareness of an important subject.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 
My parents were both schoolteachers, and I saw the impact they had on young people at every socioeconomic level. How we think about education is evolving, and there is an increasing recognition of the need to disrupt the traditional paradigms that exist today. Let us leverage this disruption to scale education for all globally.
How can our readers follow you online?
Readers can connect with me on LinkedIn. They can also learn more about Vynca by visiting vyncahealth.com and following us on LinkedIn and Twitter.
Thank you so much for these insights! This was so inspiring!