Healthcare Innovation and the Telemedicine Revolution

Patrick Daly:

Hello, this is Patrick Daly and welcome to Interlinks. Interlinks is a program about connections, international business, supply chains and globalization and their effects on our life, our work and our travel over recent times. On today’s program, we will be talking to Christian Milaster, founder and CEO of Ingenium Digital Health Advisors in Annapolis, Marilyn in the US. And Ingenium enable health providers to provide the best care in the most efficient and cost-effective way. Christian will explain all that to us in due course. Christian himself is originally from Hamburg in Germany, but has been in the US for quite a number of years and I think back and forth as well. And we’ll ask him about that. So welcome Christian, and thank you very much for being here with us today.

Christian Milaster:

Thank you so very much for having me, Patrick. Really appreciate it to be here and talking about the things that are very valuable to me in my professional life.

Patrick Daly:

Excellent. Delighted. Delighted to have you. So could you give us, to start off maybe, an overview of your life and career to date? How did the young German lad from Hamburg turn into the CEO of a healthcare sector consultancy in the US?

Christian Milaster:

Well, as I always mind me, jokingly say, it’s maybe because I liked wine and tea and not coffee and beer. Maybe that’s what brought me over to the US. But no, I was always very interested in things. And so in 1988, I visited the US for 10 weeks and I basically, yeah, I just fell in love with the spirit and the flexibility and always had this dream of going back. And then in 1998, I had a chance and followed it, followed a woman too. But yeah, and then I ended up in the US in 1998. So 25 years now in the US and I stumbled into healthcare in 2000 at the Mayo Clinic in Rochester, Minnesota, in the Midwest. And that’s really, was my introduction to healthcare. I was trained and almost raised as a German engineer with an engineering mindset, did software engineering, but I got an engineering degree and then started working for IBM Global Services and then made it into US, was mostly on the software engineering side.

And then really got interested and fell in love with the mission and the complexities of healthcare. As engineers, we like to solve problems, or at least I like to solve complex problems. I like to find the best solution that satisfies all the different requirements. And so after I shed myself from the programming world, I focused on requirements engineering and on project management. And then stumbled with one project into the world of remote physiological monitoring with a continuous heart rhythm monitor 20 years ago. Continued to have exposure into virtual care delivery, telehealth, video visits. And then in 2012, finally had an opportunity to shed myself from the golden handcuffs of a large academic medical center and fledged my entrepreneurial wings. And so I founded Ingenium in 2012, ran it as a solo consulting firm for the better part of the 12 years. And then in recent couple of years, started building it now out into a boutique consulting firm where we focus on enabling the delivery of extraordinary care.

Patrick Daly:

Okay. So we come back to Ingenium in a minute, but I’m just curious to pick up on some of the topics you’ve touched on there. So you’re a German, you’ve fallen in love with the US and you’re an engineer who has really now become a businessman. So what have been the pros and cons say of being an engineer and becoming a businessman? And what kind of cultural differences did you find either positive or that you struggled with being a German in America?

Christian Milaster:

Very, very good and interesting question. So it’s interesting that you would describe me as a businessman, and I guess I am since I’m running a boutique-

Patrick Daly:

Yes, you are. You are.

Christian Milaster:

But how you do one thing, you do everything. So I’m applying engineering principles to the way that I run my firm, the way that I designed this. We have processes, we have systems, we have data. We’re always looking at optimizing and systematizing. So again, that’s where I’m coming from. And so everything that I do, it’s all around the optimization of systems. Because really, what I should have gone to school for is systems engineering because that’s really how my mind works, is I always look upstream, downstream at the whole complexity of the system. But really, what has emerged here over the last… I was always looking for how can we be more effective with engineering solutions? And what frustrated me is that there’s a lot of great technology out there that is not being used in the way that was intended by the engineers. Sometimes, it’s because engineers never studied the requirements, never asked the physicians, never asked the nurses what they want. They just came up with this great, brilliant idea in their own little chamber. And I’ve been guilty of that in the past when I developed software.

And so that was one part of the frustration and that’s led me to requirements engineering. And then I was really frustrated about these great solutions that are out there and clinicians are not using them, patients are not benefiting from them. And that’s really when I became a change management agent. Really a change management expert, helping organizations to design the workflows and the training to integrate all the different technologies that are out there. And so we’re really focusing now on accelerating the adoption of digital health innovation in healthcare because that is, I think, what’s going to save healthcare and what’s going to solve a lot of problems. So yes, so I have to be a businessman in order to land business and to run a business. Still at heart, it’s about figuring out how we can help organizations to use technology to deliver more extraordinary care. And then we’re building all these other systems behind the scenes, our methodologies, our approaches and other mechanisms. So that’s the part on the business part.

Patrick Daly:

Yeah. And then the cultural differences as a German in America?

Christian Milaster:

The cultural differences. Well, my first long-term relationship was with an American. And so basically, I did not speak German much anymore. And I just immersed myself into the culture. I really studied English [inaudible 00:07:10] idioms and expressions and just remained curiosity. But then, yeah, America is an interesting culture because it’s this multicultural environment. It’s not the stew that people talk about. There’s independent cultural subsets everywhere. And now, I’m married to somebody who was born in Vietnam, and that’s another subset of the cultures. But what it brought me is, the people that I associate with here in the US that are from my friends all have an international component. Because there’s something that happens when you live abroad, when you either live in a different culture or you’ve been exposed to different cultures.

Case in point, you referenced that in the introduction, I spent a three-year cultural sabbatical, as I call it, back in Germany. So when my girls were three and five years old, we went to Germany with my wife. And so they got to learn German, they got to meet and spend time with their grandmother so that there’s a relationship there. And it was really a study in cultural background so that they have part of a German identity. But it also helped me to realize how different I have become and how more worldly or more aware of different cultures I have become to the point that I didn’t really quite fit in anymore. And I now even have an English accent when I talk German, which is really, really funny to me to hear that feedback. But yeah, I guess, after 17 years.

Patrick Daly:

Okay. So the accent you’re using to speak English is leaking into your German, is that what you’re saying?

Christian Milaster:

Yeah. Yeah. So now when I speak German, it sounds German to me, but people say no, some pronunciations or some words, phrases are just much more English, which is really, really funny because the only German I talk to is now a little bit to my girls, but mostly with my mom.

Patrick Daly:

Yeah. I think a lot of people who have moved to another country and immerse themselves and taken on the language and taken on the culture will relate very much to what you’re saying. I spent 10 years living in Spain and married to a Spanish woman 34 years. And I know exactly what you’re saying. I know exactly what you’re saying.

Christian Milaster:

But I think just moving as a German to America really helped me, right? It’s just because you’re looking at people differently. You can really merge the best of both worlds, the American entrepreneurialism and the American flexibility and immediate friendliness. Then married that with some of the German principles of systematic approaches and getting a lot of work done and all of that. And so I’m just, yeah, I’m trying to find to be very conscious about marrying the best positive parts of both cultures so that I can enjoy doing what I’m doing.

Patrick Daly:

Maybe I’ll ask you about the current work of Ingenium and then we look at maybe this fascinating journey where you’ve moved from being a solo practitioner to leading a boutique consultancy. So how would you describe the work that you do now as Ingenium and how are clients better off after having worked with Ingenium?

Christian Milaster:

Yeah. Ultimately, it’s about what I mentioned a few minutes ago about the adoption of digital health innovation. That’s really the intersection of healthcare delivery and technology that we focus on. Obviously, as we all know, there’s a lot of value to be gained just by improving, just by documenting processes, by following processes, by continuously improving them. But we do that, we teach our organization that, or we share how this could be done with organizations that don’t have traditionally done that in the past under the guise of introducing video visits or under introducing-

Patrick Daly:

So your clients, are they insurance companies? Are they clinicians or are they healthcare providers or all of the above?

Christian Milaster:

Not all of the above, but yes, a very good question. Obviously the healthcare ecosystem is very huge and there’s a lot of players in it and the organizations that have engaged us and that we’re targeting are healthcare delivery organizations, so health systems, health centers, behavioral health agencies, primary care clinics, multi-specialty clinics that want to deliver care to their patients at a distance. And that’s their focus. And now, it’s veering into using digital health tools and digital therapeutics tools, especially in the behavioral health realm. There’s a lot of innovation that is available that people are trying to integrate. We also are working with digital health vendors and specifically with digital health startups because once they’ve developed the solution and they even sold it, how do you then actually implement it in a way that everybody actually gets the benefits from it? And so we’re working with healthcare delivery organizations and with the digital health vendors and startups.

Patrick Daly:

And in the US exclusively, or do you work internationally as well?

Christian Milaster:

I’ve had some international engagements. I’m always open. I’m not marketing actively and I’m not as much networking actively internationally, but we’ve done a few international projects over the past 10 years. But right now, our core expertise that we’ve built out is mostly around the American healthcare ecosystem.

Patrick Daly:

Okay. And in terms of similarities or differences with regard to the inroads of digital health between Europe and America, are they on a par? Is one ahead of the other?

Christian Milaster:

Well, Europe is a very fragmented… The ecosystem when it comes to the option of digital health, you have tremendous early adopters that are just nailing it, like the Scandinavian countries, the Baltic States, and then some of the other Eastern European countries as well. Hungary comes to… I think it’s Hungary, or it’s some other country that have really taken an nationalistic approach almost to really integrate buying into digital health and really investing into digital health adoption knowing that that can solve a lot of problems. And so I always cite examples from Denmark and from Sweden and from the Baltic States that are really at the forefront. Germany, I’m ashamed to say that digital health… There’s a lot of talk about it, and there’s a lot of actually politicians that get involved as well. And maybe that’s the problem. I don’t know. I’m too far removed now.

But one of the challenges that we encounter in the US is that clinicians are very conservative when it comes to changing the way that they deliver healthcare. And rightfully so, because you’re not dealing with changing an oil filter or something like that. You’re dealing with people’s lives, you’re dealing with a livelihood, you’re dealing with a quality of life. And so a mistake has huge consequences beyond other industries where you can make a mistake and then it’s costly, but usually not deadly or not sickly. And so that’s where I really see the big difference.

Patrick Daly:

And the business benefits that clients get from working with Ingenium. What would you say are the top two or three?

Christian Milaster:

Well, at the core, there’s a shadow industry that’s being built up here in the US because the US is so entrepreneurial. There’s a lot of other players that are now meddling in healthcare delivery. It started with the self-insured companies in the US, larger corporations are self-insured, meaning they pay for the health insurance of their employees. And so they have an incentive to lower the cost. And so they’re looking for innovative ways to do that. And Amazon has looked at it. There was a partnership between Amazon, Berkshire Hathaway and JP Chase Morgan that was formed to look at optimizing that. And so there’s this parallel healthcare delivery system that’s being formed. But a lot of America is rural, and a lot of America has these rural hospitals, rural health centers, rural health clinics that are serving quite a large part of the population, but they don’t have the technology.

They may not have high speed internet, they don’t have the digital literacy. Yet, they need that access to care as well, which is one of the big project programs we’re currently working on in rural Washington state. And so the benefits is really for the health centers that are not embracing digital health technology is to beef up their skills and experience in using that. So they can, if you want to say, fend off the competition or that they can serve the same patients that otherwise would go to these other startups. Because there’s also no startups that are catering to the retirees and are offering a virtual first care experience. Why get up from your armchair if all you need is to review your test result or have a conversation with your doctor, you can do this just as well virtually, and then go in if you need to.

So this whole model of virtual first is being embraced by the venture capital funded service delivers, but it’s opposed by the traditional clinicians in the existing healthcare system. And I’m scared that the whole American healthcare system will fall apart if the traditional healthcare systems don’t figure it out. Because right now, the new innovative companies are skimming from the top. They’re using the most lucrative patients. And one example, Amazon tried something, Amazon Care, it didn’t work. And so after three years, they shut it down. You cannot open a hospital in a town of 15,000 in the middle of nowhere and then try it for three years and then close it down. So with these virtual companies and these innovators that have innovative DNA, so that’s the problem that [inaudible 00:17:52]. So the benefit that we’re providing is really dragging them and helping them, guiding them into the future, and really doing it in the right way so they can integrate healthcare delivery without giving up any of their core values of high quality care.

Patrick Daly:

Okay. You mentioned earlier your journey from a solo practitioner to now leading a boutique consultancy. So a couple of questions around that. Why did you do that? How did you do it and what does it look like now?

Christian Milaster:

Thank you very much. Yes. So I started out as a solo consultant and had a number of engagements, but I realized very quickly that it’s a lonely world out there, and I’m very extroverted. I enjoy working in teams, I enjoy working with other people because it makes me better and it helps me to bounce off different ideas and build on other people’s ideas and vice versa. And so I’d already sought out opportunities to collaborate with other people, but business was maybe just enough to provide to support myself. And then COVID basically changed everything because everybody had to do telehealth and video visits and try it out. Now, 80, 90% had a bad experience because it didn’t really work. Nobody was trained and nobody was educated. But now, people are realizing it’s something that’s here to stay. And I fully believe that in 10 years time, 80, 90% of outpatient care will be provided virtually first before you have to come in.

And so now, there’s more of an opportunity, and that allowed me to bring in more people. And I’m still running a pretty lean organization with freelancers and with subcontractors, but some of them are working for me substantial hours. So I basically did it in a safe way. But so far, the success has been that… And I stopped doing it in a transactional basis. In the initial years, it was here’s a project, I need you for this, let’s do the work together. And then we’re engaged in a large program that continues to turn our projects over time. And so that gave me enough confidence to actually made a commitment to a number of people. So I now have a team of 15 people that I’m engaging on a part-time basis, and they’re international. So that includes a graphic designer, that includes the social media coordinator and then they’re domestic, especially on the consulting team. And they work two days a week on average, or four days, five days a week on average.

Patrick Daly:

And how has this changed your own day to day?

Christian Milaster:

Well, it has freed me up to do the other things that I really enjoying. That’s the business development, that’s the marketing or as I call it, the awareness creation and the opportunity creation. So the ability to do the networking and build the relationships, look for new offerings. So I’m an entrepreneur, so I like to start things and I like to do things, perfect them, make them really well, and then move on to the next thing. And so this has really created me an environment now in which we can launch new services, have new offerings. I’ve worked on them a few times, and then I hand them off to a great team that is more than happy to run with them and do them while I then focus on looking at new service lines, new markets, or even just serving the existing markets with a service offering.

Patrick Daly:

So you are becoming, or you have become a businessman and an entrepreneur, and you have had success, but we all know that success is not a straight line, and everybody faces setbacks in their career and in their life. So how do you approach setbacks and what do you do or what do you think, or what do you say to yourself to get yourself back on track?

Christian Milaster:

Well, the most beautiful thing these days is that I have a team. When I had experienced setbacks eight years ago and I was just by myself, that’s sent me in days and if not weeks or something, even months of, I wouldn’t say depression. It wasn’t clinical depression, but definitely, self-doubts and low energy. And so then in 2017, I finally realized I need an accountability partner. I need somebody that I meet with and just share what I’m committed to be doing. Goes back to Stephen Coveys from The Seven Habits of Highly Effective People: Principle of Making and Keeping Small Commitments to Yourself. That is the simple exercise to build on your own self-confidence.

But since I’m so extroverted, I needed that to come externally. It wouldn’t come from me internally. And so yeah, I hired somebody six years ago to be my daily accountability partner, and we met for an hour every day and just went over, here’s my to-do list, here’s what I plan on doing. Here’s what I still need to do and just help me to get organized. And next day, we would do it again. And in one form or another, I’ve had a daily accountability partner that I meet with for an hour, hour and a half to get everything done from proposal writing to speaking engagements, tracking, to awareness creation and newsletter writing. So I have a whole team now. So I’ve designed it around my own personality. And so it’s the degree of self-awareness that I’ve achieved over the last 15 years to know what makes me tick and what ticks me off, that I could create a system around that, that would make it productive for me.

Patrick Daly:

Excellent. So in all of that, what’s the most important lesson you’ve learned through that transformation?

Christian Milaster:

Know thyself. You need to, right? What works for you, may not work for me, may not work for somebody else. You really got to really dial into your own personality. What makes you drive? What is that motivation that you seek in order to accomplish successes in life? And then just systematically design a system that plays to your strengths and that compensates for your weaknesses. The other mindset that I’ve had is, I said, I’m going to clone myself with people who are even better than the things I’m great at. So rather than saying, “Okay, I need to replace myself with one person.” I said, “No, let’s take the seven parts or the 12 parts that I’m really good at,” because otherwise, I wouldn’t have come that far. “And let’s replace them with people who are even better at those things.” And that’s the mindset I’ve had for three, four years, and I’ve now succeeded.

I can look at all members of my team and they all have something that they do way, way better than I could ever do them. So I’ve reached my limit at some point. And so then I seek out for somebody who does it even better. That satisfies my desire for quality and for excellence. It also does not take away anything from my ego because I admire somebody who does things that I understand really well and does them even better. And so I think, that was a breakthrough mindset shift for me in order to be able to extract myself out of the delivery work or out of any part of any work. And that’s now my mindset, is I’m going to build up this business development process or the awareness creation process, and I’m going to optimize it, and then I’m going to hand it over to somebody who does it even better than I could, and then I’m on to the next thing.

Patrick Daly:

Excellent. And then when you’re not working or thinking about work, what kind of things do you like to do in your spare time?

Christian Milaster:

I’m a musician. I love to play keyword. I play keyword piano. I play in a small cover band here in the neighborhood. We have a few gigs a year, so nothing too ambitious. All kinds of music from the ’70s to the 2020s. And then obviously, I’ve got two daughters and my wife. So spending time with the family, getting together with them, and in particular, reading with my girls every night to spend some time.

Patrick Daly:

Are you reading or listening to anything currently that’s particularly inspiring that you’d like to share?

Christian Milaster:

Well, I spend most of my personal reading time on nonfiction, and there’s a ton of great books that I’ve read. I started reading again, the Four Agreements, which is some Toltec wisdom, and they’re really profound and I need to go back to them. And then with my daughters, I read the Harry Potter series for seven, eight years. We read them twice. That was a great starting point. The reading and writing skills are very good in terms of their assessments, but now, we just picked up a new book called The Covenant of Water, and the language used by the author is just absolutely phenomenal. We have to oftentimes look up three words in one section, one paragraph, one page, which is nice when you read it on a Kindle because you can just long click the word and you get the definition. So the Covenant of Water, beautiful story, beautiful imagery, and definitely, I know it’s an investment in my daughter’s ability to express themselves and to articulate themselves in years to come, and it’s also helping me to get even better at English.

Patrick Daly:

Excellent. Well then, on that note, Christian, many, many thanks for being here with us today. It’s been an absolute pleasure to chat with you.

Christian Milaster:

Thank you, Patrick. Really enjoyed being here. Thanks for the very insightful questions.

Patrick Daly:

And thanks also to our listeners for tuning in again today and be aware that if you enjoyed this episode, you can find a full series of over 130 episodes of Interlinks on Spotify, Apple Podcast, Acast, and other major podcast platforms. So until next time, keep well and stay safe.