The Exchanges

Q outside of America. And I was having this conversation off air with someone the other day. We were talking about future technology. Actually, I've decided to interview him probably in the next few weeks. And we were talking about how the pharmaceutical industry and the hospital industry have no incentive to really make it possible to prevent illness because then they would be out of business. You agree with that?

A I think the incentive has not been there in the past fully. I think a lot of the folks that work in healthcare are incentivized to make people better. I hear your, your stance on sort of the commercialization of pharma and drugs that you see, but I think something that is also changing in healthcare that I don't think a lot of like layman folks know is that the government and hospitals are now shifting the incentive model to value-based care. So what that essentially means is we're not just going to pay for services, which has been the traditional model of healthcare. You come in, You get a hip surgery, you pay me X amount of dollars. Whether that was a good hip surgery or a bad hip surgery, I still get that fee. Now we're talking about value-based care, which is you come in with an issue, and we are incentivized to make sure that we treat that issue, that you're better for it, and that you don't come back for that same issue, and we get paid. Based on how well we're treating folks. So hospitals are starting to adopt that more because there's more regulatory pressure to have a value-based model. It's slow. It's just starting. It's not ubiquitous. It's getting there. But I think that's also something that can be accelerated by folks like you and me who are consumers or patients demanding that, right? So the more education we have around value care models, And how we can demand t…

AI assessment note: “I think the incentive has not been there in the past fully.”

Q Thanks for the introduction. And definitely sounds like you have a tremendous wealth of knowledge from different aspects. I'm really excited to pick your brain about this now. So let's start with what is the current state of the healthcare tech industry? And let's ignore COVID because I'm going to ask you about that a little bit later.

A The current state of healthcare is, it's very interesting. It's going to be very hard to ignore COVID, but healthcare right now is seeing a massive paradigm shift. And by that I mean traditionally healthcare was something or a place that folks went to. You're sick, you go see a doctor. Something has happened to you, you try and get it taken care of. What's changing in healthcare right now is people's mindsets are trying to prevent illness, trying to increase wellness. It's less about once I have something happening to me, what do I need to do, and more about what can I do to keep my body whole to make sure that I stay healthy. And so there's a huge shift in the way that folks are thinking about their healthcare. It's increased engagement, and that Increased engagement is the catalyst to a lot of the technology shift that we're seeing in healthcare because patients or consumers, or which people are normally called in every other industry, are demanding certain quality of healthcare and certain aspects of healthcare that they're getting in every other field they're experiencing as a consumer.

AI assessment note: “healthcare right now is seeing a massive paradigm shift”

Q If someone wanted to come in and start a company now, what gaps do you see that people could try to fill?

A Senior care is actually something that Is definitely a vertical in the digital health industry that should get a lot of attention. And people should be asking questions around that. We have a aging population, right, in the U.S. that's going to be pretty big. We also have a distressed healthcare system and a younger generation that's going to be responsible for taking care of their parents. So a lot of caretaker, elder care tools are going to be needed. And so that's something that I think people should be thinking about and figuring out how those tools can connect to all the different players in the healthcare system. So that would probably be the second idea that I would say is Any company that's coming in, if they don't want to focus on a vertical like mental health or a vertical like senior care, if they're able to figure out how to connect all the pieces and all the folks that are in healthcare together, that's going to be invaluable. Because one of the issues with healthcare and why it's so slow and so Expensive is because the infrastructure sucks. So if you're able to connect the patient to the primary care, to their care team, to their at-home care team, to the pharmacy, to, you know, the insurance company, if you're able to have a seamless experience across all of those, and you're solving a huge issue, if you're able to do that, then you can sort of insert yourself in…

AI assessment note: “Senior care is actually something that Is definitely a vertical in the digital health industry”

Q I've been following Biden's administration and he seems to be surrounding himself with intellectual people who are experienced and capable of actually providing valuable insight and backing that up with creating a budget that allows for implementing change. I'm cautiously optimistic that Biden's administration will be able to do something that's different. So what are the pros and cons of getting into the healthcare tech industry right now?

A Pros? Capital. There's just so much capital out there. I think there's capital, and I think, you know, these days starting a company or tech company The barriers to entry are a little bit lower because of the ubiquitous nature of the internet, especially since everyone's home too. There's a lot of eyes on the internet. There's a lot of folks hoping to help solve or prevent the next COVID outbreak or the next pandemic. And there's a lot of folks out there hoping to fill up the gaps that have been revealed in the healthcare system. So those are the pros that I see. Some of the cons that I think a lot of entrepreneurs are going to Face and have a hard time, um, reconciling, especially if they're not from the industry or if they're more on the tech side rather than healthcare side is really grappling with the regulatory challenges of healthcare. It's one thing to build a tech product. It's another thing to build a health tech product. Um, and I think that's the, the beauty and the uniqueness of digital health and health tech is that what could be something that is straightforward and easily put into consumers hand. There's different considerations for healthcare. There's privacy concerns that everyone should be tackling head on from the start. There are consent questions that, you know, we need to make sure are clear and, um, readily available and understandable to consumers when t…

AI assessment note: “Pros? Capital. There's just so much capital out there... Some of the cons”

Q I was just feeling really frustrated and I had to get that out. So what are some examples of interesting companies, products and services that you've seen come out in the last year or two, let's say pre-COVID and as a result of COVID?

A In the last year or two, pre-COVID and during COVID, there's been an uptick in mental health, um, startups. I love it because it's helping with the destigmatization of mental health. And it's increasing the accessibility, and a lot of these companies are also working with insurers, which is a big issue in the mental health space, so that the coverage is there, and so that more people are taking advantage of it. So that's something that I'm really excited to see, and the differentiation that's happening in that field, mental health for working parents, mental health for the LGBTQ community. Mental health for other sub-communities, I think are really interesting, and I think a, a, a right way to, to sort of break down the barriers of trust and stigma. That's one area I wanted to highlight. Telehealth actually has been around for, for many years, actually decades at this point, about two decades, but I think the adoption of it in COVID is really showing new variations of it. I foresee like a hybrid model, not just fully virtual. You know, some in-person, some hybrid. I've recently seen also on-call urgent care. You have an emergency, and instead of calling, um, nine-one-one, or going to your local emergency room, you have an urgent care team come to your home. COVID safe. They treat you and assess you in your home, and then escalate as necessary. So that is something that I though…

AI assessment note: “In the last year or two, pre-COVID and during COVID, there's been an uptick”

Q So why don't you speak to some of these hurdles? Like I know of HIPAA, What are some of the other things that maybe most people haven't heard of these specific agencies or things you have to do to be compliant with government law in order to be able to offer services and products? Like what exactly are we looking at?

A You know, we have state regulations, um, that we have to be aware of. There's also federal ones. So you mentioned HIPAA, which is basically if you are dealing with someone's personal health information or their private information, such as You know, their name, any conditions that they have, any personal information that can identify them that can potentially be used to discriminate them for employment or any other thing like that. You need to be very Very, um, cautious about how you're handling, storing, and sharing out that data, and making sure that the partners that you're working with, the vendors that you're working with, also have robust measures. Cyber attacks are no longer a thing of will it happen, but it's, it's more of a question of when it's going to happen. I think if you take that mindset, then you know that you're going to be targeted because you have key data that Malicious people are after, and so it's important for you to maintain that safety. The other thing that it's coming up in state law, it hasn't quite come up yet at the federal level, but it's the question of data ownership. So if you're using a health tech tool, Sean, and you're putting in your health information or your partner's health information or your family's health information, who owns that? Is the company or the product that you're putting that information in then going on and further profit…

AI assessment note: “The other thing that it's coming up in state law... question of data ownership.”

Q industry. I also want to follow up on the COVID-nineteen thing first. So The question is, do you think governments and hospitals and people will actually learn anything from COVID 19 and adapt so it doesn't happen again? Because Bill Gates just recently said, if you think this is bad, and look, I predicted this, but if you think this is bad, the next one is going to be worse.

A I hope so. I'm not a fortune teller. I can't predict the future. I think, like I said before, you know, COVID has been a slap in the face. We see the response and the recovery rate and the impact of COVID in countries in Africa who have been exposed to contagious viruses. Like, like COVID, like SARS, like MRSA before, and who at first also failed at response, but learned, put procedures into place, and have had a great response to COVID- and so I'm, I'm hoping that that learned experience that we saw in countries in Africa and other countries in the world, we can Wake up and see how well that, um, helped them, and we do the same here. I, yeah, I'm, I'm hoping in this new administration that we will have a task force that is going to deal with healthcare and the different vulnerabilities that we have as a country around our system and around any huge major impacts like COVID or another, or any other virus that could come out in the future. So Bill Gates is right. COVID is one thing, The next thing is going to be worse. Viruses mutate. This isn't going to be the only thing that we see. So I hope that we learn and hope that we have the right people in place to, uh, help us.

AI assessment note: “I hope so. I'm not a fortune teller. I can't predict the future.”

Q So which of those three bodies are the ones holding back the others?

A I think it's more complicated than saying one of them is holding back general adoption. I think what is happening or has happened is that Health care is a dinosaur industry, and I think it just needs to grow up. I think technology is the way to go. I think it presents the most opportunity to democratize health care across a vast majority of people, regardless of socioeconomic status, improve health equity, and I think the federal government Needs to do its job in helping to create guardrails to protect consumers and guardrails to ensure that these products are built and tested in a safe manner. Um, especially if they're doing things that are including diagnosis, especially if they're doing things that are sharing out very personal information, genomic information. So I think, I don't want to say that it's one body or another, but I think that each one has an opportunity to bring, uh, their expertise to the playing field, and I think they just all need to work in concert together.

AI assessment note: “I think it's more complicated than saying one of them is holding back general adoption.”

Q and Central America and Asia, and I've experienced healthcare in probably 10 countries. I hurt myself a lot. I'm prone to injury, let's just say that. It seems to me like the best experiences I had were out of America, because those countries don't make health care for profit. So what do you think about that? Do you think health care should be for profit, or should it be non-profit?

A You know, I think there's value in consumerization of health Because I think there's value in the average person demanding value from the healthcare system. So going back to that value-based care model that we talked about, if we're comparing America or U.S. healthcare systems to non-U.S. healthcare systems, I think, you know, there is a difference between not-for-profit or for-profit models, but I think one of the larger issues too is just infrastructure. The healthcare system in America has very, very, very poor infrastructure. No one talks to anyone. And so I think, you know, what that causes is just a breakdown. A lot of non-US healthcare systems are usually government run. The silos, while they may still be there, have more connectors. And so you, as a patient, as a consumer, probably have a more seamless experience and a more consistent experience. Whereas if you're, if you're getting healthcare in the US, depending on what kind of healthcare coverage you have, what state you live in, what happened to you, you know, there's a variety. So I hear your statement around that. I think there is value in pushing for consumerized model for healthcare, because once the incentive is around how well we're taking care of patients and how well we're taking care of people and people have a voice in that, um, and they can demand that and they can put their efforts and dollars behind thi…

AI assessment note: “there is a difference between not-for-profit or for-profit models, but I think one of the larger issues”