Business is Boring is a weekly podcast series presented by The Spinoff in association with Callaghan Innovation. Host Simon Pound speaks with innovators and commentators focused on the future of New Zealand, with the interview available as both audio and a transcribed excerpt. This week he talks to John Macaskill-Smith, CEO of virtual health company Ventures.
People aren’t standard, yet best medical practice often has to be. Treatments for conditions, and prescriptions for ailments are most often based off studies where by design they found the average need and effective dosage. But we know people are not the average. There are distinct ways different bodies metabolise for example – which mean for some the average dose will never work because they metabolise it too fast, and others as they do so too slowly. Which is part of why now there is an emerging filed of pharmacology that uses gene sequencing to understand how an individual’s body works and then equip them and their doctors with that info and understanding to help ensure the correct prescriptions are given.
It’s just one of the exciting ways to put power in patients’ hands that have been pioneered out of the Pinnacle group of not for profit companies. They are a huge force in the midlands, their members managing the healthcare of nearly half a million people enrolled with over 80 practices in Gisborne, Taranaki, Taupo-Turangi, Thames-Coromandel and the Waikato. The CEO that has driven their growth, first for the whole family of companies and very recently for their Ventures arm, is John Macaskill-Smith, who is here today to talk about using business to change health, introducing pharmacogenomics, and how you can find out more about how your body is likely to react to drugs.
Tell me how did you come to get involved in this role.
It’s a long story but I’d been working in the health sector and getting more and more frustrated with how the system really wasn’t working that well. So I jumped the fence from ‘providerland’ into a funding role and ended up working in a number of government agencies and trying to be quite pragmatic and cut through the bureaucracy and make things happen on the ground
It was in 2000, when Labour came in and shut down the national health funding authority and moved to district health boards (DHBS) and it was at that time that I didn’t want to go into a DHB which was a hospital-focussed construct.
I ended up being offered a role at a large primary care network so I stepped into that and what I’ve loved about that is that it’s an organization that has to deal with lots of people – we’ve got a hundred small business owners that we need to work with, so those GPs down the road who run their little clinic, but we’ve also got to deal with the DHBs, the hospitals, the ministry. There’s a couple hundred million dollar of taxpayer money that goes through us.
We’re constantly looking at how we can innovate to keep half a million people healthy but also keep them well, and I think the health system in New Zealand is very focused at fixing people but it’s not very good at looking at how we keep people well and stop them getting sick.
The big promise of the move to things like primary health organisations and community-based care was that it could be proactive rather than a reactive system. But it’s taken a lot of tools and learning to get there. So what kind of things have you done with technology to help enable all these small GP practices through those regions to be able to serve and kind of predict what their patients are going to need?
In health there’s so much data that we kind of have, and the way that we’ve organised the health system has really been around services. You might have a sore knee so you have a service that focuses on that, you might have diabetes so you have another service that focuses on that.
Most of that services have contained and siloed off those pieces of information so as people we become kind of recorded by the bits of our body or the things and ailments that we’ve got rather than as a total person.
The opportunity with primary care is that general practices are often the single place in the health sector where the whole thing is taken into account, so often people are coming in, they’ve got family issues, they’ve got social issues, they’ve got housing issues, and they’ve got clinical issues.
So all of that information is put in a single place, so one of the things that we’ve worked really hard to do is to say, “How can we take that information?” that’s often recorded in a server in a hot water cupboard in a little local bungalow of your GP, and make it available for the rest of the system to interact with. But also for patients to be able to have it their hands to help them self-manage – because let’s face it, we manage our own care 99 percent of the time; health services just intervene now and again.
We’ve spent a lot of time shifting people’s health records into a secure cloud environment, building open APIs and making that information available for others to be able to access.