David Genetti of Astarte Medical: 5 Things We Must Do To Improve the US Healthcare System
By: Carly Martinetti
Tags: Healthcare Technology, Startup, Wellness, Healthcare, Leadership

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

My degree is in Molecular Biology, but I have spent the bulk of my career building and running financial services technology companies. While fascinating and challenging, I felt compelled to return to my educational roots and put my experience to work in a way that can make a lifelong and profound impact on our most fragile patients, preemies. Helping babies thrive in the first 1,000 days is a career path that checks all of the boxes.

I have known the founder and CEO, Tracy Warren, for over 20 years and having the opportunity to join forces on an exciting and impactful project was a perfect fit for the next chapter in my career. We bring different elements to the table and are able to learn from each other on a daily basis.

Can you share the most interesting story that happened to you since you began leading your company?

It is a cumulative experience. We have been incredibly fortunate to speak with the brightest minds in our field. While there is convergence on how we should provide nutrition to our most fragile patients there is not a unified consensus. The amount of variability in the decision-making process and the application of the standard of care is incredibly interesting. We believe we can advance this with our analysis.

In many ways this is not surprising. Medicine is making fantastic advances in being able to allow babies born as early as 22 weeks gestational age to survive, but now need to help them thrive. This is ground breaking territory and the science behind how to feed this new category of patient is evolving as expected and we hope to provide solutions to support that evolution.

Being at the table as this discussion is taking place is definitely one of the most interesting things that has happened to me, not only since I began with Astarte, but possibly in my professional career.

Can you tell our readers a bit about why you are an authority in the healthcare field?

I am not a doctor, but I do have a scientific background as well as a technology background in highly regulated, complex industries, including healthcare. I believe that the future of healthcare is going to increasingly rely on cross functional solutions from diverse and talented contributors. The intersection of approaches that have proven effective in other industries and progressive medical practitioners will be a powerful movement.

What makes your company stand out? Can you share a story?

Astarte Medical is the only precision medicine company using software and predictive analytics to improve outcomes during the first 1,000 days of life, with an initial focus on preterm infants. NICUtrition® by Astarte Medical supports feeding protocols, practice and decision-making in the neonatal ICU with a suite of digital tools and diagnostics designed to standardize feeding, optimize nutrition and quantify gut health.

We are building one of the world’s largest libraries of poopy diapers — along with clinical data and sequencing. That is not something most companies can say.

Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?

We are applying machine learning to the largest library of longitudinal microbiome sequencing data combined with clinical data factors to provide risk scores that can inform care givers and dramatically change the course of care and outcomes for the tiniest of babies. We are not taking care out of the hands of doctors and nurses; we are empowering them with insights that are only available through our technology. We are doing this without the need for sequencing in the clinic, resulting in real-time decision support at a greatly reduced price point. Simultaneously we are providing clinical tools to improve satisfaction and quality for patients, care givers and parents.

What are your “5 Things I Wish Someone Told Me Before I Started” and why.

This is my fourth start-up, so I had a pretty good idea what I was getting into, and to be clear, I joined a company that Tracy Warren and Tammi Jantzen had started. Having said that:

Just because you have started companies before doesn’t mean you’ll have all the answers. Every day I am reminded that I have a lot to learn, from those around me and from my routine mistakes. There is no place for smugness in the face of new challenges. Working with smart successful people also illuminates the shortcomings of some of the approaches I have taken for years. Be humble and open to learning new ways of tackling and solving problems and accept that there may be better techniques. Remain coachable. There is still a gender gap in VC and VC funding for women led companies — you’ll be surprised. I was surprised to see the depth of this gap having worked with strong female leaders and seen the impact of gender diversity in leadership throughout my career. Tracy and Tammi both had venture capital careers before launching Astarte Medical and have been successful in raising money. They are powerful forces and are actively changing that dynamic. I am fortunate to be teamed up with two successful and strong women, but I have now witnessed first-hand an ongoing gender gap in the VC and VC funding space. I may have been naïve coming into this company. As Tracy has said, no CEO or founder should have to lead with “I’m female” — focus on the business, the opportunity and commit to maintaining the same expectation of return that other (male-led) ventures aspire to. The field we are opening is even more fascinating than I thought — don’t get distracted. This is great on the one hand, but there are not enough hours in the day to chase down all of the exciting ideas we are generating. As some of our first sequencing data was coming out of analysis, we had to consciously control how deep we would let our team members that were not on that part of the project dive into the discoveries. The need to stay focused and keep the team focused in the face of exciting science and results will be an ongoing task that I did not anticipate having to tackle. My own curiosity requires self-discipline as well. When exciting things are happening in other groups, we can congratulate them, then get back to the tasks that need to be tackled. All Start-ups are not created equal. Many principles are universal — it is going to be hard work, long hours, and challenging problems that need to be tackled with limited resources. A small team all pulling in the same direction is a powerful force. There are also dramatic differences. Astarte is not only building software; we are also performing novel research in the lab. The combination of these two projects that seem diverse are actually coupled and that dynamic has created massive opportunity but also unique challenges. A clear need and a perfect solution are not enough. We have identified a clear medical need and have developed a perfect solution that routinely praised by practitioners and our potential customers. That is not enough, there are many hurdles that need to be cleared. You cannot settle for having solved the problem that you identified in your business plan. Execution requires fighting through an endless list of intermediate challenges that do not make it into the plan.

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?

Interoperability is a big issue. We have mountains of electronic medical record data, but the ability to liberate it to allow for innovation is incredibly limited. Even within a single hospital system it can be a major challenge to effectively share data. Innovation is stifled when institutions do not have the capability or capacity to provide useful access to critical information in a timely fashion. The US market is dominated by a few players and there has been a successful effort to sequester the data within their silos. The current reimbursement system is primarily reactive — treatment as opposed to prevention. It also creates a system where a sick patient is now thrown into a financial quagmire in order to receive the treatment that is required, and the incentives to provide or deny that treatment are at odds with each other across stakeholders. Greater incentives for routine and preventive health measures will pay dividends. Quality of Care is not a primary driver. While there is a movement by some institutions and organizations putting an emphasis on quality it is not a universal driver in the current system. Our medical professionals are overburdened. The introduction of medical records systems held great promise. The results have been mixed. The need to “chart” effectively has been abdicated to technology that is not always effective. The burden of using some of these systems simply to record the basic data removes clinicians from the bedside for too long and does not result in better care and often does not result in better charting. There is a sense that adding traditional annotations or notes to the extensive clinical data that is required would be too much and the sense is that future shifts can simply look at the EMR data. Americans are bad patients. Medicine is intensely personal and when it comes to our own medical treatment or that of family members, cost is no option. Additional tests or treatments are often demanded. Clinicians are increasingly compensated by their institutions based upon patient satisfaction survey results. Denying a borderline diagnostic to a demanding patient may have a significant impact on that patient’s satisfaction. We like our bigger houses, our bigger cars and our bigger medicine more than most of the other countries in this report.

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?

Support Innovation — We have some of the brightest minds on the planet, but the barriers to entry for even moderate improvements through innovation solutions that can change healthcare are extremely high in the US. Mandate interoperability standards. The current state of data sequestration is unhealthy. We have worked with significant institutions where they did not have a resource on their team that was capable of navigating their own EMR data in a way to provide fairly simple data extracts for innovative projects and reporting. Bring the regulatory approval processes up to speed with technology. The regulatory machinery is well oiled for devices and pharmaceuticals, but Software as a Medical Device is still an immature field for regulatory bodies and once again creates a time and cost barrier to bringing new solutions to market. The amount of uncertainty creates a massive split between incredibly well financed, large organization and innovative small companies that could make a big impact if they had a clear roadmap to success. Return the power to practice medicine to the doctors and their patients, reimbursement rates and schemes are often prime drivers of treatments. Support this relationship with quality decision support tools. It has been demonstrated that standard protocols and check lists improve results. Clinical decision support takes this one step further by incorporating real time information to support a provider’s own training and intuition. It also can support conversations with patients regarding unnecessary treatments or diagnostics. This is a more effective technique than having to navigate the financial impact of a particular course of action. Focus on Quality care. The goal should be to provide the best quality care possible, and while I firmly believe that our medical professionals strive for this, the financial incentives are not always aligned and are occasionally directly opposed to this standard. You will get what you measure. If reimbursements are tied to length of stay, you will get increased length of stay. If payments are tied to outcomes, you will get better outcomes. Value based and risk sharing models have strong promise to help re-align incentives.

Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?

We need to support and advance The Office of the National Coordinator for Health Information Technology. Most importantly we should be supporting, or even requiring that EMR providers make open accessible API’s actually available within the context of the HITECH Act. While many may claim that there are available, they are really claiming that they exist — access is a practical issue requiring financial commitments and a registration process that can take up to 18 months. The availability of useable API documentation is often hidden behind this process, making the art of “what is possible” for innovators a guessing game. Standardizing and publishing API documentation would go a long way towards allowing innovators to develop solutions that can improve outcomes, reduce cost, raise satisfaction levels and reduce burden on our clinicians.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

I am a big fan of not only scientific research, but also the history of science itself. Understanding those that made breakthroughs in the past is inspiring. The drive, tenacity, and genius, that they applied to the problems of their times, often in the face of opposition and adversity, serves as a tremendous source of inspiration. I recently introduced my son to an old favorite, Longitude, by Dava Sobel, which is fantastic history of one scientist’s 40-year quest to solve a complex scientific problem in the face of political and mechanical challenges. We need to continue to challenge the status quo and not give up when the rest of the world appears to be opposed to our ideas.