Not many Health IT startups get to the successful exit. This week Charlie Lougheed co-founder of Explorys now an IBM company joins us to discuss technology and the Healthcare Startup space.
Bill Russell: 00:01 Hey podcast listeners. Thanks for listening. If you're enjoying this week in health it. We just want to give you some information on how you can support these conversations to keep them going. This week in health its goal is to keep you your organization and your employees updated with the emerging thought and trends in the healthcare industry through our conversations with health care and technology leaders. The best and easiest way you can show your support just to go over to this week in health it on iTunes and leave us a review. Also, you can subscribe on Itunes, Google play, or stitcher or go over to our youtube page and subscribe and hit the notification bell. Again, we really appreciate you spending your valuable time listening to this podcast.
Bill Russell: 00:49 welcome to this week in health it where we discuss the news information and emerging thought leaders from across the health care industry. This is episode number 20 is Friday, May 25th today we talked blockchain, what healthcare care can take from Fintech and harder and wisdom for your healthcare it startup. This podcast is brought to you by health lyrics. Are your strategies constrained by infrastructure or tied in a knot of applications. Break the bonds. Visit healthlyrics.com To schedule your free console.
Bill Russell: 01:16 So my name is Bill Russell. Recovering healthcare CIO, writer and consultant with the previously mentioned health lyrics. Before I introduce our guest today, I want to share, uh, share with the audience just an exciting opportunity. We've reached milestones in the show and upon reflection, and in talking to many of you, we found that the content is relevant and timely. And now what we'd like to do over the next couple of months is get that content into as many, uh, current and future healthcare leaders as we can. That's why I'm excited to announce that our sponsor has agreed to give $1,000 for every hundred hundred new youtube or podcast subscribers over the next 90 days to hope builders. Hope builders, uh, provides orange county's most disadvantaged. You use the life skills and job training needed to achieve personal and professional success. I've hired some of these graduates at my previous employer.
Bill Russell: 02:07 And their stories are nothing short of amazing. The trajectory of their lives are on as a part of, as being a part of this program is really exciting and that's why I'm really excited to be a part of it. I hope you'll join us in sharing the show with your friends and your peers to maximize this opportunity. Okay. So today's guest is one of the brightest minds in data. Hopefully that won't go to his head. A successful health it entrepreneur who actually saw an exit, one of those rare occurrences in the health tech startup world. Uh, my good friend Charlie Lougheed is with us today. Good morning, Charlie. Welcome to the show.
Charlie Loughee: 02:40 Hey, good morning bill. It's going to be here. Thanks.
Bill Russell: 02:43 Wow. You, you, you, uh, you actually got to an exit, um, that, that really isn't all that common yet within the health tech world is it? Yeah.
Charlie Loughee: 02:52 Yeah. Not as much as it should be. A little surreal, right. And still Even today, it's still sinking, but, uh, I think we'll see more of it. I think we're seeing some maturation in the market.
Bill Russell: 03:06 Yeah. So we're starting to see some things, some things in the market. So how long has it been since uh, since uh, since the exit accident of explorers to IBM?
Charlie Loughee: 03:17 It's been just a little over three years. So April of 2015.
Bill Russell: 03:22 Wow. Uh, yeah, those were exciting times. I think I was with you at, at a conference, either the day of or the day after the announcement and uh, uh, it was really surreal on that day. You were just, your eyes were sort of glazed over like it. I mean, was that something you were really looking forward to or just something that just came out of the blue and surprise you?
Charlie Loughee: 03:47 Well, you know, I think we were growing so fast in 2014 that we recognize that we had either raise more money so that we could get presence on the coasts or either go public or do some something, some kind of acquisition that made sense. And the third wasn't what we focused on. It was really how do we continue to do the good stuff that we're doing and grow the business. But a IBM came along and kind of late in the game and we, in about nine days, we went from a term sheet to signed agreement, uh, to do the acquisition. And that was, you saw me probably the day before himss, so the day of himss. So all that happened that that weekend before, that Sunday, before that was when the close happened. And uh, so at that point we were all a little exhausted.
Bill Russell: 04:40 Yeah, I would imagine. And uh, yeah, the life of the startup. I mean, when we first started off, I think we were at my employer, we were one of the first customers, so I got to see you a fair amount. And then it really ramped up. You were flying all over the country talking to clients, uh, everywhere. So, and that's the point at which you just either need more capital or you need to, you need a bigger partner like IBM, I guess.
Charlie Loughee: 05:05 Yeah, it worked out great and I'm excited to see how the team has been doing and, and really proud of them.
Bill Russell: 05:13 That's great. So let me, let me give people some of your background. You're a so cofounder of Exploris, uh, in 2009 served as the president, I'm sorry, I pulled the bio off a website. It was probably written in 2009 because it says you're serving as, so we'll say yes. Served as president, a chief strategy officer and chief technology officer. True startup. Uh, you also served as the president of Everstream until uh, 2007, uh, cofounded Everstream in 1999 serves as its chief technology officer, executive vice president. Uh, also extensive experience with the financial services industry, having led national city corporations, consumer online banking division as well as position in PNC financial as senior vice president of the online channel for it's a fluent customer segment. Uh, had been with Everstream since 1999. Led the product strategy development initiatives prior to joining Everstream serve as vice president, electronic of electronic consumer marketplace systems at key bank national association.
Bill Russell: 06:16 Um, and then it says you're also very involved in community service chairman and member advisory board of Everstream. Uh, also, uh, uh, chairman of Galen Foundation, chairman of Saint Anns Technology Group, a advisory board member to genesis innovations. Uh, and you have your bachelor's degree from John Carroll University. That's probably the most I've ever read. If somebody is a bio, so, well it's pretty old now. I know. Well, the, the thing I wanted to really point out is, I mean you really are the data and technology person as well as an entrepreneur. So because we're going to dive into some, uh, we're going to straddle that line today of talking entrepreneurial venture, but we're also gonna go into some deep dive in some of the technical areas. All right. So one of the things we like to do with all of our guests is to give them a moment to just tell us what you're excited about or what you're working on today.
Charlie Loughee: 07:13 You mentioned being a recovering CIO. I think I'm a recovering entrepreneur. It's probably a good chance I'll relapse or fall off the wagon here. Uh, at some point, cause I'll probably do at least one more. But, uh, it's been, I've been taking a break and it's been kind of Nice, uh, spending a lot of time and my family, you know, uh, just try to catch up on some time. You miss, Two startups is a, is a big commitment and I balanced it. Okay. But, uh, there's, there's a lot of stuff. I'm, I'm again catching up on my wife. Katie and I are about to be empty nesters in the fall, so that's a little surreal, we'll have three in college and we'll have a little chance to, to do some traveling going to Europe and Africa later on this year and have a little fun there. But, uh, in terms of my professional life, I'm still staying pretty engaged. I'm, uh, doing, uh, uh, bit of it. I think, uh, a calm. Yeah. I kind of go towards the stuff that's disruptive. That's the things that generally be to the areas that excite me the most.
Bill Russell: 08:24 Most of my time actually broke up there for a second. You got to be sort of the, the robot going. So could you hit that again? Just what you're working on?
Charlie Loughee: 08:34 Yeah. Uh, yeah. I'll just start with kind of start from, I'll start from spending 10. Did you hear the part about recovering entrepreneur?
Bill Russell: 08:42 Every entrepreneur heard about spending time with the family, which is phenomenal by the way. So you spent five years doing explorers and didn't see the family. And then three years of being in the house every day. I know how that goes. And the like, Okay Dad, when do you just go back to work?
Charlie Loughee: 08:58 That's right. That's right. They're like, what are you doing here? Too many trips to Costco, uh, companies that are sort of in traditional spaces but are looking at this from a disruptive approach. And that's been, that's exciting. But I'd tell you the thing that I'm doing number spend the most time with, you know, probably 40 to 50 hours a week right now is this nonprofit called unify project. Uh, it's really exciting. It's kind of like my blues brothers project where, you know, getting the band together on a mission from God, et Cetera. It's the, are some people from my past endeavors. So Steve Mchale and Sunny Nixon and Arron Cornell, uh, we're, we're working together on it. We've got some other amazing leaders that I haven't worked with in the past, from healthcare and social services and philanthropy and financial services and education and even government.
Charlie Loughee: 09:45 So, uh, it's, it's a really neat, uh, endeavor. Uh, our board, we've gotten together, it's all the CEOs from the major, uh, organizations both health care and education and philanthropy and banking from the Cleveland area. And, uh, it's an interesting mission. It's, it's essentially, it's not an easy one. It's fixed the economy. Um, you know, I kind of just roll, roll it along for a lot of people, uh, but that a lot of people really amounts to about the top 10%. The rest are still struggling. And, uh, and the bifurcation of wealth in the u s and the bifurcation of income is continued to be a pretty big problem. And we think it's going to get even worse, not just for them, but for all of us. And, uh, and so, you know, w we started looking at the economy and in what just seems to be wrong, right?
Charlie Loughee: 10:38 The US bill spends more than anybody else's, you know, on healthcare, yet we're ranked 28th in life expectancy. We, uh, with, uh, one of the biggest spenders in education, yet we're 20th and literacy and, uh, you know, urban core less than 10 or 15 to 10% of, of those kids go off to college or secondary education. Wow. We're the most generous country on the planet. Uh, we give more to philanthropy than anybody else by far. Yet we are ranked third in poverty among the OECD nations. 50% of the US population makes less than 20 bucks an hour. And a, if you look at what's what some of the experts are saying about where they see the economy in 25 years, a project that, well over 50% of them close to 80%. In some cases we'll be out of a job because of automation and globalization.
Bill Russell: 11:38 Well now I'm depressed, so what are you going to do? I know.
Charlie Loughee: 11:41 So even, even more so, you know, so we look at it and saying, okay, what is happening with charit? What's happening with all this? In one of the other things we noticed as we sort of did this walk about, so we did this, remember we did this in health care back to see what's, you know, what, what can we help with? Well within charity, we also found that there's about $800 million, so were literally sitting on the sidelines in these charitable foundations. Uh, if you amass all the wealth together, so the bill and Melinda Gates Foundation, Ford Foundation, Clean Foundation, right? And, and you wondering why, why is only 7% of that money going to the, going to the, uh, the people in need. And a lot of it has to do the fact that in order to maintain those organizations and perpetuity and have them continue to grow year over year, they need to be able to hold back a lot of that money, invest it.
Charlie Loughee: 12:30 And usually the stock market or Wall Street, that's their mechanism for return on investment. And, uh, and, and that's really their only means of, of, of sustenance. So in addition to just continuing to get money piled in, well we looked at that and said, why can't there be a return investment for raising up our population for helping them, uh, participate in the economy and participate in the next economy as this rolls around and we believe that if you look at someone who's in poverty today, full subsidy spend, it cost the taxpayer close to $50,000 a year, maybe even a little more in some cases. You turn that around and get someone from a position where they don't have good secondary education and training. You get them into a role in computer science or data science as well, other things, and you flipped, you flip the scales pretty significantly.
Charlie Loughee: 13:21 You've got someone now who is making a living wage. They're, they're thrown off tax revenue. And so we think there's a really big Rli and we think there are mechanisms to return that Roi, but it's going to take an operating system. And what unified project is doing is implementing an operating system. We're building it and it takes visibility and transparency to data just like it didn't healthcare. That's going to take some AI and machine learning to understand all this big data and trim out the biases. And we believe it's going to take a piece of blockchain as well, uh, particularly around smart
Charlie Loughee: 14:00 in and around performance and ultimately engage those entities that can return investment back to those foundations back to those investors in social good and, um, and actually bring more money to the system. So again, what we're trying to do is, is bring about an operating system that begins to change the dynamic and bend the curve away from the dangerous position it's going in right now. So I'm pretty excited about it. The opportunity, You know, I think it's an opportunity for healthcare, financial services and technology to really do a good thing, uh, as opposed to a, always sort of be blamed for the things of the past and be concerned about the things of the future. I think there's more positivity in front of us than anything, and it's just a matter of grasping that.
Bill Russell: 14:49 Wow. Well, that's exciting. I'm looking forward to, following that and seeing how that progressed is for, uh, for you guys. I know with the smart people that you've put together, the solution is going to be pretty exciting. So let's, uh, let's jump into the show. So we have three sections in the news soundbites and then a social media close. And I'll kick us off. We each have a story. My story is, uh, given your background on, uh, the show. So why healthcare should study up lessons learned from Fintech. Uh, there's a story from health it analytics.com. Uh, let me, let me kick it off here. So, uh, clinical, uh, from the story, clinical quality, patient safety and long term outcomes will always be a top priority for healthcare providers and payers. But, uh, but the consumer experience is or should be running very close second for stakeholders across the industry. Soaring out of pocket costs for patients are leading to choosier consumers who are considering more than proximity to the local hospital when making decisions about where to seek care.
Bill Russell: 15:50 A federal efforts around transparency, availability of your data and whatnot are making a consumers out of, uh, out of patients and growing expectations that digital services for payments, communications and price comparisons will simply be available, is putting the squeeze on providers who haven't yet invested in online consumer relationship tools. So nothing new there. We're hearing, we've been here this for several years. Then they go into some numbers. 88% of patients want to be able to pay their insurance bills digitally. 68% would like to be able to clear their balances with their provider by using online tools. Yet 77% of providers are still using paper billing statements to conduct at least some of their financial transactions. In 2017 only 4% of practice leaders expressed any interest in the digital bill pay options according to the survey. Um, this mismatch, it doesn't just indicate an opportunity for digital payment companies to fill or to fill a clear need.
Bill Russell: 16:46 It also exposes a worrying disconnect between how providers view their existing processes and what their patients really want and want to experience. Earlier in 2018, a poll by NTT Data Services pointed out that 59% of patients want their healthcare experiences to align with what they're offered in retail. Half of patients said they would consider leaving their current providers if they found another option that offered more technology tools. Okay. So, so let's stop there. We'll come back to the story. But you know, the first question I want to bat around with you is, you know, let's, let's just, let's do this on a scale of one to 10. One being the patient has, uh, has choice, uh, well actually, one being the patient has no choice. They're locked in and 10 being the patient is a full blown consumer of healthcare with choice. Uh, where do you think we're at on that continuum today?
Charlie Loughee: 17:38 You know, I think, uh, I think we're probably closer to zero was the no choice is that right? What one is the no choice and what zero now, and I think we're probably close to three or four, but I think the attitudes are changing a lot and we see it everywhere and I think to healthcare just takes a little longer to catch up. Right? Uh, but I think what's happening in other spaces is going to begin to have a profound impact on the attitudes people have in health care. I mean, clearly the high deductible was a shock to the system for a lot of people as it is. At is it related to costs. Like while I'm paying a lot of my pocket, so I'm going to make some different choices about this now. But I think other things, I mean, here's something that's completely unrelated but related bill, uh, take the GIG economy, right? Uber and Airbnb and other things. People are thinking differently about, uh, things they'd never would before.
Charlie Loughee: 18:37 Right? You'd, you'd have some stranger drive you around or you stay in some stranger's house. Uh, that wasn't something we really considered to your, uh, 20 years ago, even 10 years ago in that, and that, that's changing. And you're even beginning to see some interesting innovative companies like nomad and higher, uh, who are bringing some of the gig economy to health care, particularly around a $15 billion a year market for local, uh, temporary physicians or practitioners. So, uh, I, I think, I think the, the age of having a single dimensional channel to healthcare are going to change. I think, uh, you know, you've got the other factors of all these baby boomers who have grown up around technology. They've been pretty avid adopters of technology. We'll look at this and say, I paying my bill should be easier. It would be more straight forward. Um, getting care when I want it, where I want it at the edge should be easier. And I think they'll move towards organizations and provider systems that are progressive in that manner.
Bill Russell: 19:45 Right. Well, my son had to go to my son's 20 some years old and, uh, worked for a large company and he went to, he cut his finger, had to get stitches, he went over to the, uh, emergency care and, uh, I happen to be available. So we went over so we could just hang out and whatnot. And as they're stitching them up and whatnot, they're handing them stuff like, here's your gauze, here's your stuff. And he said, they walk out of the room and he looks at me, goes, am I paying for this? Cause I don't really want it. I'm like, I don't, I don't think you have a choice. Um, so, you know, as, as I look at this, I, you know, there's, there's really two directions this can go single payer or market driven. And I agree with you today. It's really neither.
Bill Russell: 20:26 Uh, you have trends that happen. It was heading towards single payer. Now it's heading a little bit, um, you know, more towards market driven. But the reality is, uh, the consumer still has no idea how much healthcare costs. The bill doesn't reflect actual costs. Um, you know, you, you, you then run it through an insurance machine and you get another bill. It's, it, it feels a bit like playing the slots, you know, you pull the handle, hope for the best and you take whatever, whatever comes to you. There's some choice. But you know, it's, it's not based on any facts. We're, we're still not looking at price and, and uh, and those kinds of things. But, but I think the trend is, is right. I think you have a pressure from the retail world in the consumer world. And we're saying, hey, why can't healthcare be more like this?
Bill Russell: 21:10 High deductible plans are making us more, uh, I don't know, discerning. Um, and then I think medical interoperability is starting to get there. Some new options. Like my insurance carrier has a telehealth option that they want me to go to before I see even see my primary care physician. So I, I find that to be fascinating. I think we are seeing an advent of, you know, of, of really moving, but I would agree with you. I think it's a, you know, a three or four moving in the direction of building out a market, but, um, but you know, that could easily change of another election in a whatever, two and a half, three years and swings back the other direction. Um, you know, we'll, we'll have to see how it plays out. So here's another area I want to get into with you. So data is the article goes on data.
Bill Russell: 21:59 The current is the currency of these new ventures and Fintech, uh, is powering a predictive analytics, fraud detection, identity management, security protocols required to compete in this modern environment. Customer Intelligence will be the most important predictor of revenue growth and profitability in the fintech world. And translating those insights into personalized experience will be close second, without the right technologies to create meaningful, engaging experiences that exceed baseline expectations, they may soon find it challenging to maintain their revenues, especially as value based care alters their cashflow. Um, so data is new currency. Customer Intelligence will be the most important predictor of revenue and profitability. Um, technology will be central to creating engaging experiences. Um, is this a reality in healthcare or how do a better question would be, how do we make this reality in healthcare where data is actually, uh, beginning to be used to make those kinds of changes with either predictive models or new experiences?
Charlie Loughee: 22:59 Yeah, great question bill. I think in here, I think we're evolving to a data economy and it's going to be interesting, you know, what is the output of, of the American economy 20, 30 years from now data is going to be a big component of that. And we know that those that work in the data space in many ways have a much brighter economic future then those that don't. And so I think, you know, it's, it's, it's translating into a lot of different areas. When we, when we founded exploris, our whole premise was being was based upon data and how data was the real value and that it could in many ways bend the cost curve if, if used appropriately. And when I say appropriately, both, uh, morally and ethically as, as just financially in a prudent way. But you know, having spent a lot of time in the financial services sector, I tell you that that's been around a long time as well.
Charlie Loughee: 23:55 And they've seen that they've learned some very painful lessons. The 2008 financial crisis was really all about a recognition that they weren't leveraging their data as effectively as they should have. And that's why you see now, so much emphasis in fintech around things like Kyc or know your customer, the ability to predict and mitigate risk, apply AI to drive those mitigation strategies, address the regulatory requirements that are out there. And I mean, the parallels to healthcare are amazing. I was, I spoke at an event yesterday, a fintech event yesterday, and this is what came up. And it's interesting, they actually used healthcare as an example where they need to start thinking in terms of, uh, patient privacy and protection of information and whatnot. So these, these markets are so interconnected. I think, uh, you know, I, again, I think information is absolutely critical. What's ironic that one of the major reasons why people have health issues is stress.
Charlie Loughee: 25:02 And so they go in front of their doctor and they tell him about it and there's their doctor prescribes a medication that may be needed for one thing or another, that that physician in in many cases doesn't know what that's going to cost the patient. Uh, it seems like a vicious circle, right? The patient gets home and finds out that their copay or that that drug's going to cost him $500 and wind right back up at the, at the doctor's office again. So we need to think about our data. We need to be put better data in front of our practitioners, better data in front of our, uh, of, of the patients that's going to be critical to this. And I think the organizations that take that really seriously, again, we'll get rewarded with, uh, a new, a new kind of loyalty.
Bill Russell: 25:48 Yeah. So I go in for stress, I get medication, I go home, I get the bill for the medication, I get stressed, I go back. Yeah. It's, uh, I, I, you know, I find that know your customers, the thing to be very, uh, you know, cause we talked about it a lot. It's a, it's an interesting balance, right? So when you send that email to the, to the consumer and they realize, Oh wow, you know more about me that I think, you know, you may have crossed the line. So there's always that balance of we want to provide great care, um, by knowing the customer better and, uh, and being in the patient and the consumer better. Um, but you don't want to cross that line by having information that you really shouldn't or acting on information that you really shouldn't. And there's, there's that that, uh, I guess it's a, it's an ethical balance and it's also sort of a, I dunno, cultural balance of, you know, how privacy, um, how much privacy do we really think we have and how much should we be afforded, I guess? Oh, go ahead
Charlie Loughee: 27:00 all the time. Right. And, and big data and big data creates more big data. One of the things that, that I think is gonna be really important is that we have more and more metadata around appropriate and the allowed uses of patient data or consumer data for that matter. Right? So these are the, these are the situations where I permitted being used. Here's where it's completely off limits or optin models where it needs to be used. It wasn't anticipated, but it needs to be used in these ways. Am I good with it? And then, you know, again, we'll talk about it a little bit later, but that's one example of where the blockchain can show some promise.
Bill Russell: 27:36 Yeah. All right. So we're going to have to pick up the pace here a little bit. Let's kick it over to your, uh, to your article. Why don't you set it up and we'll talk about it?
Charlie Loughee: 27:47 Yeah. So, uh, one of the articles I saw this week that sort of caught my eye was an article by Brad Orelio in mass device.com and I seen a number of articles that are similar like this. Uh, this was entitled six reasons why we shouldn't bet on blockchain disrupting healthcare. Uh, and you could, you could supplant healthcare for pretty much every other industry. And it's a fair statement. It's a fair title because the amount of hype that's around blockchain is pretty deafening right now. Uh, but the article goes in covers these six topics, you know, one is the d that development is stricter and slower. I totally get it right. But the reality is in that, in that place, uh, the high stakes coding's always been this way for a long time. And a blockchain is a nascent technology. It should get better as it matures. They also, he talks about things like maintenance is very costly.
Charlie Loughee: 28:46 This is an issue with blockchain today. I think what he meant when he said maintenance and means operating costs. But man, that is definitely the case. Uh, the power consumption's right now for the standard proof of work consensus models or just absurdly high. And frankly, they're, they're horrific for the environment and, and we need some changing. Uh, the good news is is there's a lot of new technology that's on the, on the forefront things like a proof of stake, consensus models and permission models that that should improve this. He also talks about how users are sovereign, uh, in that, that the challenges associated with getting something on a blockchain, you really can't change it after that. It's a mutable for good reason. But again, that depends to some degree on the blockchain or a architecture that's being deployed not as, this is not as much of a factor for permission.
Charlie Loughee: 29:37 Networks are private networks talked about a forced upgrade is not, is sometimes not an option. Uh, there's been a lot of controversy around this. A lot of times people mistakenly think that the ethereum network was hacked last year, uh, with the Doa incident since that wasn't the case. There was actually a, just some bad code, but the bad code had a $50 million implication and that community had to come together to decide what they wanted to do. And uh, it was an interesting outcome. And then scaling, I think scaling, he talks about scaling being really hard, distributed computing is difficult, right? We've been doing it. I've been doing it for a long time. I do in other environments and I think it just boils down to the philosophy of, of MPP versus vertical approaches. But I think really bill, I said I've seen so many articles like this.
Charlie Loughee: 30:26 I think it kind of misses the point because despite all the hype, blockchain is really not the Elixir for everything and we've got to stop treating it like that. Just like Internet banking wasn't, the Elixir was going to change everything about banking in the financial space. It was just another channel. I think we need to think about the different terms. I think hybrid models where you have on chain and off chain, particularly around big data and medical records is going to be really important. And uh, and I think the real promise around blockchain, as I mentioned a little bit earlier, is it's really around three things. It's around medical record, portability and interoperability. Certainly a lot of opportunities there. Identity management, not just in healthcare but in human trafficking. A lot of spaces around that. It's a big issue today among our underbanked population and probably the biggest is smart contracts. This idea that we can have a multilateral accountability in an accountable care model, right? Not just make the medical provider accountable, but also have the patients in certain conditions along the way be required. And other entities that are involved in controlling those incentives.
Bill Russell: 31:34 So that's a great setup. So distributed. So the nature of blockchain is distributed, immutable records, smart contracts. So I want to give you five, uh, healthcare use use cases and uh, let's just go through, you know, um, uh, you know, likelihood of happening and impact on healthcare. So here are the five use cases, uh, provider licensing and credentialing. Do you think blockchain has application there and then what would the impact be?
Charlie Loughee: 32:02 I think it has incredible potential there and it would have a big impact. Uh, the process credentialing is, is slow, it's cumbersome, it's redundant, it's expensive. If you're going to get to a gig economy and healthcare, it's absolutely critical.
Bill Russell: 32:16 Blockchain based, Hie based, uh, you though between, well actually between anyone, payers, providers, whatever. But blockchain based Hie, what do you think
Charlie Loughee: 32:24 it could be? The next generation of HIE in an HIE technology is, has struggled, right? For a lot of business reasons, but some technical reasons. So I think it's got a pretty good chance. They're not as high as a as credentialing, but a decent chance,
Bill Russell: 32:38 a medication supply chain. A lot of talk about that. Uh, what are your thoughts on that?
Charlie Loughee: 32:43 Well, the question is to what degree that the consumers really care? Uh, yeah, I've heard a lot about this in the food industry, but then I talked to people and they say, well, yeah, if, I guess if, uh, generally generally people think about it. So, uh, I think it has a, the, I think it's really more regulation. I'll drive that though.
Bill Russell: 33:06 Okay. How about revenue revenue cycle and more specifically fraud prevention and auto adjudication of medical claims processing?
Charlie Loughee: 33:13 That's another one I think will be a big opportunity. Uh, you know, that, we all know that process today is fairly broken. It's extremely expensive. It's a big part of the cost of health care. So I, I, I'm bullish on that as well.
Bill Russell: 33:25 Uh, efficient prior authorizations and referrals through smart contracts.
Charlie Loughee: 33:31 I don't know. We'll see. I think we've got some pretty good systems in place to do that today. Uh, uh, maybe later. But that one doesn't come to the forefront for me. Uh, right now.
Bill Russell: 33:40 Yeah. And so I think I'm telling my clients the same thing that you're saying here, which is, um, blockchain's going to have a place, uh, how it gets implemented. It's going to be important. We need to keep an eye on it. It does have a potential to be disruptive. Um, but we're, we're not seeing that yet. Um, and some of these areas could be, you know, for some systems, you know, million dollar plays. And so that's why I'm saying, you know, don't dismiss it because it's, it is at the peak of the hype cycle. There's no, no doubt about that right now. I mean, you know, blockchain know, replacing doctors. I'm sure it's something that's, uh, an article that's been written, but it's just craziness how hyped it is right now. And hopefully, uh, you know, hopefully it'll come back down to earth, but while it's doing that whole thing with these emerging technologies, I just always recommend keep an eye on it.
Bill Russell: 34:29 Think through based on its characteristics where it can be applied. All right, so we have this section called soundbites in the sound bite sections. I'm going to ask you a handful of questions. Uh, you know, one to three minute answers and we'll just, we'll just start here. So I use a lot of people will want to know this answer. So you've, you've had a successful entrepreneurial venture and health it. Um, so I really have two questions around this. Uh, what was the one thing that surprised you as you got into health care and what's the one thing you would tell someone going into this space today?
Charlie Loughee: 35:01 Well, I think the one thing that surprised me getting the health care, not knowing anything about health care was how gracious and helpful the healthcare community was. Particularly to me and, and Steve and others that didn't have experience with it, uh, about getting up to speed. They knew that we had something offered from data. So you have to bring something to the party. We understood big data, we understood different industries, but it is a good market to be in a lot of really smart people, people that like to teach and if, if, if you give them the respect and, and, and be, uh, they'll do that. They'll coach you, they'll, they'll, they'll tell you what they need. So that is something I really do love about the, the market and still do.
Bill Russell: 35:45 Yeah. So what would you tell somebody who's just starting off their health tech firm and they're going into this space? Maybe something you've learned as they, as they get started on this, on this path?
Charlie Loughee: 35:57 Yeah, I think, you know, understand that the economics that's absolutely critical. Um, you know, you have to follow the money. You have to understand how, how these models work because you can have a great idea, great technology, but if it doesn't improve the situation for the provider, for the payer, for the patient, or at least to two of those three, uh, you know, it's, it's, it's going to be tough sled.
Bill Russell: 36:23 Yeah, like a clear message around the economics. And, uh, the, the other thing I, I do consult with a bunch of startups and one of the things I always tell them is we've really got to look at the sales cycle because almost everyone makes this assumption around the sales cycle within healthcare. And it's, uh, invariably it's double or even triple it depending on how aggressive they've been in their predictions. That's what I found. Um, so I've asked this before, but, uh, two other guest, but I was wondering from an entrepreneur's perspective, you know, what's the biggest impediment to innovation in healthcare and, and maybe what, what can we do to overcome it?
Charlie Loughee: 37:00 I think probably the biggest impediment right now is the fee for service model that just won't quit. Uh, you know, it, it, it, and, and how do we overcome it? I liked some of the things we talked about, Bill. I think the more we can push this market to a consumer model, the government's done some, right? Uh, and, and we see how easy and election can swing that once the consumer gears get going. I don't think is there any any stopping them. We won't, we won't go back. I don't think we even a back from, from value based care. Uh, it'll continue on. It's slow journey and progressive journey. But consumerism is going to, is going to be the key in my opinion.
Bill Russell: 37:42 Great. So data science is talked about as the hottest job we'd now most health systems have this canon now that we've collected all this data, we are a big data platforms. Um, you know, where can data science be applied? Where can we point this cannon at to do the most good within healthcare today?
Charlie Loughee: 38:05 I think one of the areas that I think it really is really important is artificial intelligence in the development of machine learning. Data science right now is at a state where a, or I should say machine learning is a state right now where the big data that's out there still isn't big enough and it isn't clean enough. So data scientists that understand how to clean and standardize data and then write great models around it, uh, I think are going to be in very high demand. I think that's a really big opportunity to make a big dent in the cost of healthcare and, and, and enable some pretty amazing breakthroughs. But data scientists are going to have to be at the forefront of that. And uh, there is a lot of work to do yet.
Bill Russell: 38:47 Yeah, I see that. So, um, how will technology change healthcare in the next five years?
Charlie Loughee: 38:53 Well, theres going to be a move towards consumer, especially as we get more data in front of them. I think the cost of care and making that more transparent at the encounter is going to be critical and, and the more patients see that happening and the more they'll expect it. Uh, again, I think the Gig economy is, it has a big opportunity. Health Care, particularly as, as many consumers of healthcare is they get, especially as they get older, are going to want to have that care pushed to the edges, whether that's assisted living facilities or it's the commercial population at the place of work and I think is a great, uh, uh, space for that.
Bill Russell: 39:36 Great. So if you were going to do another startup in healthcare today, so you and I are going to do a venture, uh, what areas might you be looking at?
Charlie Loughee: 39:45 Well, I think decision support, particularly around analytics and a in costs are going to be continue to be important. Like I mentioned before, I do believe that we need a better operating system, if you will. The coin another term from earlier, uh, for value based care. I think you look at the ACO projects that have, uh, have started out there if some of them have been very successful, others haven't, a lot of it has to do with the fact that it's hard, right? You've got a lot of competing elements, but I think you started getting some of that, uh, those decision processes onto a blockchain into, that become more transparent and more enforceable from an incentive and performance based payment standpoint. I think that can have a profound effect on the effectiveness of many of those programs.
Bill Russell: 40:40 Yeah, and that's where you were going with explorers, right? I mean it's, it's the ability to have a platform if you will, or you keep referring to it as an operating system, uh, for that, uh, for that today. So, all right, well we've, we've gone over time as is usually the case when I get on the show with, with uh, friends who I like talking to about this stuff. Uh, what's your social media close for the week?
Charlie Loughee: 41:04 Well, I looked at a couple of different things that were out there and one of them was a posting by Bill Gates on his top five books for the summer. And uh, two of those books I thought were pretty interesting. One was, it's called an origin story. Uh, a big history of everything by David Christian. And it's just interesting because it focuses on societies. A lot of what we're dealing with with the unify project, how complex they are weaving these insights together using this evidence. There's a lot of system and social dynamics. I've started reading this book and it's just really fascinating. And the other book was written by Hans Rosling recently passed away called factfullness, again, focuses on understanding the truth from a data perspective and how life in some respects it's gotten a lot better in other respects, has a long ways to improve. And in some cases, unfortunately it's gone backwards, but it does give a lot of hope in terms of what technology can do to turn things around.
Bill Russell: 42:06 All right, so mine is, you know, see if this one resonates with you. You know, a second grader said they wish cell phones didn't exist because their parents are on them all the time. And so, uh, you know, I know, you know, my, my wife is always saying to the kids, you know, put your phone away at the table and now they just look at her like, do you realize how hypocritical that is, yeah, she doesn't listen to this show. I'll get in trouble for that one. But, um, but it is, it is true that parents are on their phone and awful lot and for their kids. So, uh, Charlie, thanks for coming on the show. Um, you're going to be an empty nester. So there's, is there a good way to, for us to follow you? You're going to be on, on social media or something more.
Charlie Loughee: 42:44 Yeah. Always be online. So you'll be able to find me. Bill. It was great being part of this. Uh, thanks for having me on today. A great conversation.
Bill Russell: 42:52 Well, I appreciate it. So, uh, you could follow me on Twitter @thepatientsCIO health lyrics website, healthsystemcio.com. I just wrote an article on telehealth and it's imperative. Uh, I think we've reached a tipping point with the Va's announcement, uh, to forego the, uh, uh, boundaries on telehealth. Now you can see a veteran across the, uh, across the country. I think you could see that happen in CMS as well. And if that does, I think you'll see telehealth become an imperative for every health system. Uh, that's on health systemcio.com. Don't forget to follow show @thisweekinhit and check out the website thisweekinhealthit.com. Uh, and take, take a moment to, uh, follow the show on, uh, on our youtube channel. We're now up to about 130, uh, videos, uh, short segments that you can watch, a three, a couple of minutes and a great conversations with industry influencers. So please come back every Friday for more news commentary from my friends. That's all for now. Thanks.