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Featured interview: “We don’t believe there is such a thing as digital or physical healthcare; it’s just healthcare” Kalle Conneryd Lundgren, COO at Livi

For our latest interview, we sat down with Kalle Conneryd Lundgren, chief operating officer at Livi (known as Kry in Sweden and Norway). Kalle discussed the health tech provider’s offering, work in the UK and beyond, and aspirations for the future.

Hi Kalle! Can you tell me a bit about your role and background?

I’ve been with the company for two years now; my background was in physics and coding before I decided to pursue a clinical career. I became a senior consultant and associate professor of reconstructive surgery.

For the last 10 years or so I have been in management, mostly in healthcare organisations in the Nordics though I have also worked in the UK, the US and in Taiwan. Prior to this role, I was chief operating officer at Karolinska University Hospital in Stockholm.

Livi’s beginnings and aims

Our CEO Johannes Schildt started the company in 2015 from the angle of being a patient after noticing more and more troubling accessibility in Sweden, and on a wider basis across Europe. He had foresight, but I think the situation has certainly worsened since then, and he developed a technical solution to hold digital consultations with patients via video for certain  aspects of healthcare.

In the first years, he found that it wasn’t difficult to get patients to adopt the tech – they liked it, and they found that it did help them with better access to care. It was encouraging to see that many of the conditions that patients were presenting with could be handled perfectly well using digital means. There was a high level of patient satisfaction from the start. But in the early days clinicians were quite hesitant, because moving towards a more digital, remote style of care when your training as a clinician revolves around direct contact and physical touch, was different.

When the COVID pandemic happened it suddenly became accepted that digital was, and is, an integral part of healthcare for most conditions. It was no longer debated. Livi was one of the organisations at the forefront when it came to providing digital care and healthtech in Europe. We had significant scale, operating in Sweden and Norway as Kry, and in France and the UK as Livi. We had delivered 10 million patient appointments and we were seeing more and more clinicians coming to work for us. In the UK we are proud that in just a few years we are the only digital-first healthcare provider to be rated ‘outstanding’ by the CQC.

We have proven that digital can enable better access. But now we want to go deeper. We don’t believe there is such a thing as digital or physical healthcare; it’s just healthcare. In the future, all healthcare journeys, for every  patient, will have digital components and physical components. Digital when needed and physical when necessary. A combined digital-physical healthcare model is the solution to the challenges of healthcare systems and how they can improve efficiency and lower costs of care.

Livi’s offering and benefits

The Nordics is our most mature market where we have about 25 percent of the population registered with us. In principle our offering is similar across our markets, but I’ll focus on the UK offering for now.

We partner with integrated care systems or boards, or with practices, and we share the patient load with them. In some cases, we have a relationship with an ICS or practice that is technology-led, where they are using Livi’s tech; in other cases, we might be provisioning care for them with digital appointments. Sometimes it’s both. It’s worth saying that we do always have some relationship with the practice, even if we are commissioned at a higher level.

It means that a patient who is struggling to access care – for example, finding it difficult to get a GP appointment because the practice is overburdened or facing a workforce shortage – can receive care under our umbrella, in partnership with their clinic. Depending on the agreement we have with our partners, the patient might come directly to Livi for their healthcare needs, or they can be booked into our services by the ICS or the practice, so they are always in control.

We have about 60 physical units in Sweden and France,  as well as our website and app, so patients can choose how they access us depending on what is needed for their visit. We can also offer continuity for patients, with fast access to the clinician who has treated them before or perhaps someone from that clinician’s team, if the individual is not directly required. There’s a lot of choice, depending on need; a nurse visit is often a good option for patients requiring a check up, for example, or a mental health practitioner could be the ideal connection for a patient.

In terms of numbers, we have about 450 clinicians working for us in the UK and we work across approximately 1,500 practices. So far, we’ve delivered just over two million consultations and can cover over 11 million NHS patients.

AI and future of health

With regards to the innovative technologies that we hear so much about these days, we are using AI in production – but we focus on utilising technology to remove administration from clinicians, not to replace them or replace their decision-making. That is a very clear distinction.

Essentially, we are providing an ecosystem of healthcare in close partnership with the healthcare systems in each market. We always operate with them, as a partner – we don’t work in parallel to them, trying to take their patients from them and try to treat them on our own. It’s all about the partner relationship between Livi and the organisation, ultimately so that we can help to increase capacity for them at a lower cost. The NHS does not have a quality problem; it’s a great organisation and has been for many years, with high trust and a very well-trained clinical workforce. It really is a problem of capacity.

That’s a main benefit to the NHS, that they pay less for gaining more capacity. For the patient, it means more accessibility and more options for their care needs. For clinicians working for us there is the flexibility to work in a digital setting, and I think it also provides an opportunity to work within a strong and trusted community of high quality care.

Digital health: Nordics and the UK

There used to be notable differences in patient attitudes to digital health, but I think it has become more similar over recent times. The Nordics were quite mature, quite early on; so a couple of years ago, digital health was already well established and patients were already viewing it in a positive light. Now, I think we are getting there in France and the UK as well, although it is less widespread. They are bigger countries than the Nordics; but percentage wise I think fewer clinicians and patients understand what digital can offer.

It comes back to that opportunity for clinicians to work within a community, too – Livi doesn’t face a recruitment challenge within the UK in terms of bringing a GP workforce on board, rather the opposite. And many work with us and stay in the NHS –  they have flexibility.

In terms of our ambitions within the UK market; we already are a large partner of the NHS, but we want to be a bigger partner. We have the technology, we have the quality, we have the network of GPs and clinicians who work with us; we have all of these aspects in place. We can really make a difference for the NHS in tackling the current challenges around capacity, waiting times and access for patients.

Priorities for the immediate future

By March/April 2024, we will start offering in the UK what we are already offering in France and Sweden – a complete package, a ‘virtual practice partner’. Through this, we can support communication with patients regardless of the EMR system that the partner organisation sits in; insights and reporting; digital consultation; consultation reminders; remote patient monitoring and patient questionnaires; and a tailored patient app for NHS partners. It will be fully in control of the NHS partner organisation, fully in their service.

This package can be there when they need it; they can offload when additional capacity is required, either on a regular basis or an intermittent basis. We think of it as a one-stop-shop for expanding healthcare capacity for primary care.

Looking ahead: Livi in 10 years

In 10 years’ time, we would want to be the largest primary care provider in Europe and continue to provide care of the highest quality. We want to employ clinicians all over Europe – right now, we employ around 5,000 clinicians, and I think we should at least double that.

We want to be the company, in partnership with our public sector, that has changed healthcare into something that is no longer plagued by capacity problems in so many countries, but is a working, functional system.

For us to be part of helping that as much as we can, there are two policy-related areas that we would like to see improved. One is speed, the ability to get the APIs that we need and connect to partner infrastructure at a much faster pace.

Also, there is no national billing system in the UK. It is not in itself necessary, but there should be ways of how you can partner at scale. Most partnerships, currently, tend to be sub-scale; you’ll have a lot of small partnerships rather than one major overarching one. It’s great being able to help out different places with capacity little by little, but if we were to have conversations with the NHS about how we could help with this at a larger scale, that would make a difference to how fast we can increase scale and capacity within the UK system. In the short-term, I think those are the aspects that are needed, and I know from our dialogues that the NHS is observing the same thing.

That would be my hope for the future – let’s work together on what is needed and make it happen.

Thank you to Kalle for joining us and taking the time to share his thoughts.