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As Daniel Shaw, VP, Consumer Innovation Products at CVS Health tells us, "At the end of the day it's how you use this data. How are you looking at this data? In what ways are you interpreting it? And then ultimately getting to a place where you can make actual decisions on it.” He also explains how the voice-activated Symphony ecosystem and the Attain app can help encourage both proactive and preventative behaviors.
Healthy Conversations brings together leaders and innovators in health care to talk about the biggest issues facing patients and providers today. Every month, we explore new topics to help uncover the clinical insights and emerging technologies transforming health care in real time.
Daniel Shaw:
It isn't about just getting data for the sake of getting data. It really at the end of the day is how do you use this data? How are you looking at this data? In what ways are you interpreting it, and then ultimately getting to a place in which you can make actual decisions on it. Just knowing that I'm 42 means nothing and what does that 42 mean in the context of what we're trying to discover or what we're trying to analyze or what we're trying to understand about me?
Daniel Kraft:
Welcome to Healthy Conversations. I'm Dr. Daniel Kraft and today we're in Healthy Conversations with Daniel Shaw, the VP of Consumer Internet of Things, IoT and Wearable Strategy for CVS Health. Welcome, Daniel. Well, you've got a really interesting role and a really interesting career path as a technologist. You worked for Big pharma, you spent four and a half years at Fitbit, almost four years at Under Armour. What is it about health and technology that sparks you and is so appealing?
Daniel Shaw:
Any opportunity you have to be better, whether that's reading another book or just being able to understand your heart rate and how many steps you did yesterday. I think that's always been something that's interested me and my path has been one where I've had a chance to get to organizations right before they super duper pop and being able to see the way that those products and that consumer first perspective has been able to push them to the next level has really been fun.
Daniel Kraft:
I think I've got my first Fitbit in 2010, like the year after Fitbit launched, and that was one of the very first wearables. What were some of the things you saw within that organization that shifted over time, that had really expanded the ability for us to do quantified self, but also maybe even starting to connect to the medical side of the equation?
Daniel Shaw:
For the first thing I think is just how excited people were to be able to have something on their wrist that congratulate them for what they were doing each and every day. Fitbit was successful in my mind because it was easy to understand. Being able to give them something easy, being able to give them an easy goal and then rewarding them, even if it just was a buzz on the wrist, was something that we saw people really react to and having been there to see that growth spread into additional formats such as watches, was something that was excited to be a part of.
Daniel Kraft:
Yeah, it certainly exploded. I'm a little over wigit-tized. I got my WHOOP and my Fitbit and my Aura Ring and my Apple Watch. What's interesting now is these technologies have shifted from just the consumer and the steps to be able to give us insights, whether it's for a fall or a funny heart rate, a bigger picture perspective.
Daniel Shaw:
Nobody really understands heart rate or sleep and REM sleep and soft sleep and whatever other kind of sleep you can think of, but then being able to articulate that so it becomes way more impactful when you're able to look at yourself and say, "Oh, I slept seven hours this yesterday and my sleep was like this and then I slept five hours today and my sleep was like this. There may be something going on there that I might want to check out." And I think that's the key moving forward and being able to have those real conversations if something needs to be elevated to the more clinical level.
Daniel Kraft:
One of the amazing things about Fitbit is it will give you not just your sleep score, but how does that compare to others your age and sex and even location. I think now that there's billions of nights of sleep being sort of quantified, so this is all part of our new sort of internet of things IoT. I'd be curious, how do you describe IoT and with your role as vice president consumer of IoT and wearable strategy, what does that really mean?
Daniel Shaw:
I have a really wide ranging portfolio that consists of some consumer products, one of them being Symphony, which is a PERS device, a personalized emergency response system, and I also have a product called Attain, which is a healthy behaviors app, which uses information from your wearables along with other personalized information to create goals and aspirations for people to be able to get rewarded for healthy behavior and truly see behavior change. That's where I spent a lot of my time is not just understanding what the products can do today, whether it's your Aura Ring, whether it's your WHOOP and the 9,000 other things you told me you had on Dr. Kraft, but understanding in the context of Aetna, Caremark and the CVS retail and say how can we use some of those other resources to dip into to be able to help people live healthier and happier lives?
Daniel Kraft:
Sometimes people are incentivized by a buzz or badges or points. Others want lower prices on their insurance or help on their refills or other ways to engage them at their level, which might be different for a 17 year old with type one diabetes and a 70 year old.
Daniel Shaw:
So I think that you have a tremendous amount of opportunity to be able to look at the data to get specific around what those persons needs to be motivated, but you'd also be surprised at how much you don't need to personalize something like that. With my time at Fitbit, we would see an uptick in people's steps at 1150 when they were like 500 steps off because they wanted to have that buzz on their wrist. That's what they were striving for. Simply a buzz on the wrist. It really doesn't take much. Just an acknowledgement that you accomplished something today I think is where it starts, and then we can get to the level of how we do more or less depending on whether, like you said, it's a person with diabetes or simply just trying to be healthier today.
Daniel Kraft:
Right, You get what you measure. Sometimes it's steps, sometimes it's sleep. What are some of the things you're seeing, whether it's on the Attain platforms or others that might be different than we had available in the early Fitbit era?
Daniel Shaw:
One of the things that I'm seeing a lot is kind of heart rate and resting heart rate, so that was one of the big innovations when I showed up to Fitbit, we literally launched charge HR because there's so many things that being able to understand heart rate will allow for, so give you deeper understanding of sleep, give you deeper understanding of exercise, so I think that that addition has been tremendous.
Daniel Kraft:
Yeah, one of the values I think was going to be not just what your resting heart rate is or when you're exercising, but when you're sleeping, what might be something as simple as your average resting heart rate, which might be for me 53 or 54, but if that starts to shift to 64 or 74, something's going on and that might start to give you a nudge to connect with your primary care doc, maybe even your pharmacist to start to have a early intervention before something goes off kilter. Do you see that sort of becoming integrated into some of the CVS Health platforms?
Daniel Shaw:
Most definitely. The thing that we're looking for more than anything else is just being able to see changes in what the numbers are, right? And I think you called it out Dr. Kraft in terms of knowing what your resting heart rate is and then seeing something different. It's not different because nothing's going on. It's different because something is going on, and so how do you have that be a prompt and understanding it from the CVS side if we're looking at that data and being able to give you a prompt, again, not diagnose you, not tell you exactly what's wrong, but being able to say, "Hey, something's different and because something is different, maybe you should check it out."
For me, I know my resting heart rate is in the low sixties or the high fifties. If I start seeing it get to the high sixties, it's pretty sure that I'm going to end up being sick. Right. I've noticed that relationship for myself as I've looked at the data over the last 10 plus years.
Daniel Kraft:
CVS has hinted at some pretty big ambitions in the digital and digital health space. What role do you and your team play in this sort of evolution and helping folks see what's possible and what kind of skillsets do you bring from your prior roles?
Daniel Shaw:
One of the great things that I bring to it is that I'm not a Aetna person. I'm not a Caremark person. I'm not a retail person. I'm truly a CVS Health person, and I think that has allowed me to take an enterprise approach to all the stuff that we come up with. Not just looking at what the device and what the offering can do today, but looking at how it could impact across the enterprise. That has been one of the biggest things that we have gotten from our CEO is, "Hey, how do we actually take advantage of all of the power that is in CVS Health?"
The second thing, and it's just my background is really very much been in consumer marketing and in consumer focus, so being consumer obsessed, not about trying to make things cool just for the sake of being cool, whether it was Under Armour or Fitbit, LeapFrog, even Eli Lilly where I work with Connected Care and Insulin saying, what does the consumer need? What does the consumer want, and also how do we talk to them a way that's going to be maximum impactful, not talk to them in a way in which they're not going to understand?
Daniel Kraft:
Given the enterprise is so large and touches such a large percentage of the US population, how do you think about tuning the message based on age, culture, language, incentives, favorite color given that many folks interact with health information, whether it's consumer or medical in different ways?
Daniel Shaw:
The first thing I talk to my team about is what personalization actually matters. So yes, it would be great to make sure that every person's favorite color shows up when they open up the app. I would love that, but is that really going to impact them in a way in which we're trying to affect their health and wellness? When you really look at personalization, nobody needs 8,000 different things. Yes, I'd love to believe that Daniel Shaw is the most special person of all, but you know what? I like to win, so figure out how to show me that I won today or that I beat yesterday that I did better and I'm good. And I think that there's a lot of people who think that way. The biggest thing for me is making sure you take a step back but really understand what that end user wants, what that end user needs, and then being able to give them those things that matter most to them.
Daniel Kraft:
Some of our wearables don't need to be FDA grade to track our steps and our sleep to have an impact or connection to our clinicians. How do you think the next few years, let's say the next five years or decade will sort of blend the consumer and medical market and the connection to the caregiver, the clinician?
Daniel Shaw:
So as we start thinking about the next couple of years and how that's going to change, I think the biggest way is how we are able to print out and show the data, right? And how we're able to integrate it across multiple platforms. Some of the more complicated, more expensive devices that we're seeing come out WHOOP, Aura, they are pushing the limits in terms of their level of specificity and their ability to actually really get data that we can really feel comfortable in.
But until then, if it's not FDA approved, I think being able to look at those changes, being look at those adjustments relative to one another could still be impactful in terms of being able to make those decisions to help people live healthier lives.
Daniel Kraft:
I sort of imagine the clinical visit of next few years where you don't come in and ask 20 questions at night or how are you feeling last month? It's going to be downloaded from your wearable or your smart home. What are some of your thoughts on sort of in the internet of things and connected devices going beyond the wrist for example?
Daniel Shaw:
I think a good example of going beyond the wrist in terms of connected devices is the product that we have, symphony. I had a situation in which my grandmother was elderly but still wanted to maintain that independent living and she was not going to put a thing around her neck that wasn't cute baby because that wasn't her thing. So being able to have something in her house where I know that if something happened, she'd be able to call out to them to be able to get that emergency response person to show up, but even more so being able to have other sensors in the house that could show me things like is she going outside? How's the temperature in the house? Being able to track if she fell. Those are all things that made me feel more comfortable to be able to help her continue to maintain that independence but still take something off of my heart because I'd be devastated if anything happened to my Grandma Joan.
Daniel Kraft:
That's a great use case. Maybe you can kind of explain that platform a little bit more and how do you see it evolving?
Daniel Shaw:
It's a centralized unit that goes in the middle of the house that has this cellular connection, so they can actually call out, think about falling and say, "Emergency, emergency." And then an actual emergency response person will come and help you. They not have to worry about having a phone closed or having to go grab or push a button, but in addition to that cord base, it also attaches to sensors around the house, being able to monitor that and then also being able to monitor whether or not people are opening doors and windows or not, just in case you have someone who may have some of those mental things that allow them to accidentally walk out the door or go away.
Now it opens up a whole new world of how do we give you access to some of the other enterprise-wide things that we have. Is there a way that we could think about integrating with Caremark so now you could do your prescriptions at the same time? I can call my grandmother through the app to make for a much more seamless experience and really have higher impact on the person's life.
Daniel Kraft:
It's not about, yeah, any one data feed. It's more of an integrated platform. Continuous data that can be proactive and personalized can play a role for elder care or for a whole number of acute and chronic diseases.
Daniel Shaw:
That's the place where we're all trying to get to is the predictive part, right? So do we see different changes as we look at these sensors in their gate and how they're walking and how they're moving around, which can be predictive of something, and then I'm able to make those adjustments to prevent it from even going down in the first place.
Daniel Kraft:
All right, and that takes a tremendous amount of data and learning from thousands or millions of users. As you know, Fitbit was acquired by Google or Verily and they're in the midst of doing Project Baseline, looking at I think 10,000 or more volunteers looking at their wearable data, their genetic information, their medical records to understand what some of these digital fingerprints and digital exhaust biomarkers might mean. Anything that CVS and Aetna is doing to sort of learn from the power of the crowd when appropriately sharing this data.
Daniel Shaw:
When we think about something like Attain, we are definitely looking at the wide population that we have in terms of getting their information around their day-to-day usage, and one of the great things about Attain is that it combines kind of that day-to-day wearable usage, that personalized demographic data and then your claims data. So when we give a suggestion to say, go get a flu shot or get a COVID boost, we can confirm whether or not it's happened, and so I think the best way that allows us there is really being able to influence behaviors, see what works. Think about a company our size, the world is our oyster in terms of what we'll be able to do when we have that permission and really being able to run that data in an impactful way.
Daniel Kraft:
Can you give us a bit of a one-on-one on how Attain works?
Daniel Shaw:
So Attain right now, some people refer to it as a health and wellness platform, but it utilizes your wearable data along with the app that we have and it gives you daily engagement around kind of healthy behavior. I got once a day it told me to take a moment of mindfulness, but then in addition to that data, we also have your claims data because it's a product that's offered through Aetna, and so now I can give even more specific suggestions. So I got one a couple days ago that talked about getting my teeth cleaned, right? Then being able, the fact that they come back every single day when we hit them with the big stuff like, "Hey, go get a COVID shot. Go get a flu shot. Have you got them boosted yet?" It's all impactful because we have that relationship there.
We only have it on iOS for the past three years. We're going to move that to the Android app, so now we'll be able to get the full population.
Daniel Kraft:
I'm sure you get this question I certainly always do is how do you and your team think about consumer health information being stored, made useful, shareable, but also addressing some of the often common privacy concerns?
Daniel Shaw:
Privacy is always going to be our number one concern. Dr. Kraft, I won't even call it concern. Our number one point of contention. people are trusting us with this information and trusting us with this data. It's not a fine line. It's a very stringent line and not something that we'll ever, ever, ever lack on and never slack on in that particular space.
Daniel Kraft:
Lots of learnings in that space. I think early on, far before your time at Fitbit, there was a platform using Fitbit that let you self-report your data, including your nocturnal or sexual activities.
Daniel Shaw:
Dr. Kraft, that was of legend when I showed up, they made sure to talk to us about that one.
Daniel Kraft:
Another interesting one was the military finding out that you could determine where the military bases were based on folks running patterns based on the wearable devices, so unforeseen circumstances from our digital exhaust.
Daniel Shaw:
And I think the big thing there is that it's ever changing Dr. Kraft, right? And so it's not just about how do you make sure you try to prevent these things to happen, it's how you react to them once you find out what's going on there too. I'll be honest with you, what it looked like when I joined Fitbit seven years ago is crazily different than what it looks like today in 2022, and I think that that's one of those things that we have to keep being adaptable as more information and more opportunities present themselves to do something with this data that comes to us.
Daniel Kraft:
Right, and not just the data that comes to us. A lot of the power and potential is for each of us to opt in to be a bit of a data donor so that we're kind of creating that Google map sort of ways of health where everyone's sharing and learn from that. I think there's a lot of analogies on how that can come together on platforms using Fitbit, other wearables, inside-ables, home-ables to kind of build a better health knowledge ecosystem that can be really tuned to the individual. What are you seeing that's really excited you about the sort of wearable space or the next generation?
Daniel Shaw:
Because of my time at Fitbit, Dr. Kraft, the stuff that excite me are the basic things like there's always going to be the niche stuff that's able to kind of be predictive, but it's really how people are using these basic features, steps, heart rate, sleep, and using them in different ways. I think it's how are we going to use that information that we have? Think about something like Quip, the connected toothbrush and how they're going to use that to be able to change how we think about dental and being able to service your teeth. I read a study the other day that being able to use heart rates, some people were able to predict COVID in end users because they were using some of the information that we have right now.
Daniel Kraft:
A lot of that's not just the raw data, but turning that, as you said, into information in a way that becomes actionable insights, whether it's getting to bed earlier, improving their sleep, or to signal someone that they might have the flu or COVID based on changes in respiratory rate, temperature HRV, kind of that personal check engine light.
Daniel Shaw:
I love that you said that Dr. Kraft, because it isn't about just getting data for the sake of getting data. It really at the end of the day is how do you use this data? How are you looking at this data? In what ways are you interpreting it? And then, ultimately getting to a place in which you can make actual decisions on it. Just knowing that I'm 42 means nothing. What does that 42 mean in the context of what we're trying to discover or what we're trying to analyze or what we're trying to understand about me?
Daniel Kraft:
And also to start nudging people in healthier behaviors, being proactive and preventative. I've heard of some life insurance companies even giving lower premiums. If you're walking near 10,000 steps some day on average? Are you starting to see some of the ability within CVS or Aetna not to be too big brother, but to align incentives?
Daniel Shaw:
We are always looking for ways to be able to quantify how people are being healthier, right?When I worked at Fitbit, we did this giant program with Target where they literally bought their entire employee base a Fitbit, right? They're not doing that just because it's cool. Yes, they probably are doing it somewhat because it's cool, but they also know that being able to encourage their people to live healthier and happy lives and get up and moving is going to help them on the back end.
Daniel Kraft:
We have many physicians and health care providers listening today. Anything else that you might want them to know about wearables that they may not have heard of?
Daniel Shaw:
As I think about kind of health care providers and what I want them know, it's not so much about what's coming next, it's just about being able to utilize what's available to you. I do believe that the information and the data that you get from these devices that are available today and will be available will be something that will be able to help you. Again, it's less about the products that are out there and more about, Hey, how do we get comfortable with this information and figure out how we can integrate it into this overall solution that we're trying to get together? Because the goal is to get people healthier, and I do believe that the data that you can get from these devices as they exist can allow people to be healthier.
Daniel Kraft:
Yeah, and it requires clinicians often to engage with the devices, the data, the feedback, and integrate that into their own workflow. I see a not so distant future where today you can start to prescribe some apps that might replace or go with a medication. There's already a lot of solutions out there. I've actually been building a new platform called digital.health. That's the domain where you can go and have a bit of a digital health formulary for clinicians to find out some of these solutions. The trick is how do we integrate that in both consumer and the blend with medical.
Daniel Shaw:
For sure, and that was one of the things that we talked about at Eli Lilly a lot. One of the great things or bad things about being diabetic is that when you come in on day one to meet your doctor, they give you a treatment and then you come in on day 90 and then you either pass or fail With these devices and being able to integrate into people's life flow, you actually get a chance to see and understand what happened on day two through 89 so it doesn't become a black box and you have some level of information to be able to make decisions and tailor treatments to other people. And so that's how I look at these devices and look at these integration and look at these connections is so that when I come in on day 90, it's not pass or fail. It's you had a tough sleep this week, or that month I see that you were up and about in eating X, Y, Z. And I think if we can be able to really figure out that and you get a chance to truly see the full person, not just what they tell you or what you see in those once or couple of times that you meet a year, then we can come up with solutions that are actually going to help them be healthier, which again, is everybody's goal.
Daniel Kraft:
From intermittent and reactive sick care to continuous and proactive health care. Given that CVS has an incredible number of pharmacies and pharmacists, are you starting to see the possibility to use some of these consumer or other wearables and devices as part of their medication management and the pharmacist even playing a role into this realm?
Daniel Shaw:
So that's a tremendous amount of opportunity to have these pharmacists in play, and we've seen the impact that they've been able to have over COVID. Stuff that we never thought they could do, now they are central and vital in terms of getting some of these things done. I'm so excited about what that future could hold, and I'm glad to have a little part of that in my role.
Daniel Kraft:
Well, there's a famous quote, the future's coming faster than you think. So Daniel Shaw, VP of Consumer IoT and wearable strategy at CVS Health, thank you so much for joining us today on Healthy Conversations.