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Well, I think there are a lot of basic industry structural things that prevent us from making progress in terms. the consumer of the care is often not the payer for the care, doesn't choose the care, things like that. So the misalignment potentially of incentives like you would get with when I wanna buy something from Amazon, I'm gonna pay for that and I'm gonna choose it.

And a lot of that lack of choice really. I think really hampers us. But the other side of that, I think is a real reluctance to center on the patient. Let me tell you a story. I, I consulted with an organization that was like, Hey, we want you to talk to us about our. Shared decision making framework.

We want patients to be more involved in their care. We've got a digital system that we're gonna try to implement. I want you to talk to us about this. And they showed me the graphic that they were using as sort of like the framework for this. And the patient was not in the center, the health system was in the center, and the payer and the patient were outside of that.

And that sort of inability to think about what would actually mean if we built this around. Patient, I think is the real, is the real sort of like mindset shift that a lot of organizations have not yet clocked to.

so patient at the center, I hear that phrase all the time. I'm not sure. We understand how to do it, but isn't it also important in, in our environment today somehow the provider experience?

Oh, for sure. For sure. And that's one of the things that I also point out about that McKinsey graphic is that it's not just that every patient has a better experience with another industry when they interact, all of the clinicians do as well. Like they're just as disappointed consumers as everybody.

else Right. Like they have the same iPhone I do, and then they go into work and the like the UI and whatever system they're working is probably not intuitive. Right, right, right. And so just all of those little frictions that we haven't, that we haven't thought about at all, I think a world where the patient is at the center would have to take into account.

Like the way clinicians actually want to deliver care. Like if the patient is at the center, I'm not documenting while you and I are in the visit. Right. And that, that kind of shift, I think is one of the things that that I think is missing. Like we could, we could take a lot of the, the effort that we put in to patching workflows with technology. And instead maybe thinking about what is the way we could build this workflow around a technology that would satisfy all of these users? And a lot of organizations don't have the bandwidth to think about that at the frontline of care, but I feel like a lot of our commercial efforts are into delivering these patches.

You hear a lot of people pitch to VC groups and they're like, well, tell me what the problem you want. I'm like, have you not thought about this? Do you not have like a problem that you want to solve? And I think that sort of, can we build it instead of should we build it? Is is one of the other challenges.

We seem to be stuck in the transition here, right From healthcare to health. Preventing. And some organizations have sharp healthcare, Intermountain. Mm-hmm. Kaiser. And it's all those that have taken on risk and they get paid that first dollar. Mm-hmm. and then so they're, they're paid for health, the others are still paid for healthcare. And that transition over seems to be really daunting. Like you look at it and go, is there really incentive for us to do this thing? Cuz really what it's health caring for people. Hell out the what? We're gonna get paid less. Why are we making these advances? And you sit there and go, but that's what the consumer wants.

Right? And it's more convenient. It's where they want to receive care and all those other things. But if your model is fee for service, that that's gonna be a major roadblock. Yeah.

Yeah. No, your. Absolutely right on that. And I think that is one of the things that a lot of the digital innovations are showing very clearly that the convenience and the, I'm gonna say low effort environment that they create to receive a lot of care is positive.

People like it. They want to receive care that way. That is completely. Fit for purpose in a fee for service world, right? All of those things that they want sort of expose how we are hamstrung by fee for service.

So they have to change their business model essentially. But the other thing I wanna talk to you about is, yeah, you walk through that hall, there's 10,000 people here, some providers are here, very few providers are here, right? Mostly what's here is all these people who are looking at it going, we can dis intermediate this part or this part, or this part. Almost all of 'em have a, a digital component to it. Yeah. I, I'm not sure that's gonna help us as patients cuz we're gonna have the experience with One medical and then we're gonna have to go over to New York Presbyterian, then we're gonna have to come back to Right. We're still gonna have to stitch these things together somehow.

Well, and it all goes back to being actually patient centered, consumer centered, like thinking about what they actually want. There's a world where you could see there are certain types of consumers who do wanna break that value chain apart.

It's like, you know what? It would be better for me if I could choose different segments of this. I could get this service here. I could get this service here, whether that's pharmacy or care or something like that. And there, there could be, To them for that. But those consumers are so few and far between that I don't think there's any scale there.

Right. I think the thing that, that we have to realize is that, to your point, we were talking yesterday and you were talking about platforming. I think being able to have that sort of idea of a combined, federated shared, I'm gonna say ecosystem. I apologize for abusing jargon like that, but I, I think, I think that is more in line with what consumers are gonna want, and you see a lot of that.

Starting to emerge in what a lot of these health solutions companies are doing. You look at all of the assets they're building up, you could see a world where they've got the entire value chain. Now the integration is the super hard part there, to your point. Right. And I think part of that, like putting all that back together is that getting all of those things aligned in a row. Is actually a way bigger challenge than even having enough money to buy all that crap in the first place. . Yeah,

it's, it's interesting because we see this in other, other industries and Amazon's always thrown out there, but let, let's talk about Amazon from this perspective. Yeah. They, they have the whole experience within the four walls of Amazon, right, which is the equivalent of the four walls of the health system.

I understand complexity and all that other stuff, but they also integrate with UPS and others. That you sit and, and distributors that aren't Amazon, like, I'm selling my goods. I'm outside of that whole ecosystem as well. Mm-hmm. . And then they have other people delivering and you sit there and go somehow they've orchestrated that whole experience.

What does it take to do that? I mean, you talked about the patient at the center, but do house system leaders have to choose different areas and really focus in on that and, and really smooth out that experience.

Oh yeah. I, I, I think, I think And are they doing that? No. I mean, I think about my own care experiences. The care experience of my family, and so much of that, what we have done is we take. The frictions in healthcare, whether they're between organizations like between my provider and my payer, or they're inside a health system and we make the patient meet the connective tissue you are the one who has to carry the information from this silo to this silo.

And we impose our own frictions as an industry on the patient because they'll do the work for. Right, right. And so we think about, and that, that's sort of always how that evolves. And we're gonna have to think about ways that we can sort of skip steps for the consumer. How can we, the patient, how can we, how can we bring, how can we bring these things together in, in a valuable way that they'll want to do?

And I feel like health system leaders, you say that and they understand. But back to your original point, I don't think like the mechanism for that, certainly not with payment, certainly not in a world with very few very slim to no margin. I just think that the pressures are enormous right now. We've gotta find we've gotta find other organizations that are aligned with, with those goals and, and. Get together on incentives for us, all toge moving in that direction.

So there's business model changes and we can go down that path. But there's also I asked the question about big Tech earlier this week. Mm-hmm. and I, I guess my question on this is, okay, so patient centric interoperability. Patient centric experience. Mm-hmm. is as a, a big tech player, gonna be able to. Me to, I, I mean, take the friction out from outside and let me give you, I mean, so yesterday I was interviewing somebody from Google. Okay. And Google has shown with Meditech Expanse, they just put their search bar in there.

Mm-hmm. . Okay. And then they went back through 20 years of. And does what Google does. And so when you search for a result, it pops up in a search engine relevance, da, da da, and you're sitting there going, oh my gosh. Like, we know how to do that. Physicians know how to do that, and that's what they're doing all the time.

In the in ehr, there's how to Peggy? They're able to change the experience by just that one thing. And I think about Apple from that perspective as well. Alright. If you're telling me I'm going to be the connective tissue mm-hmm. , apple can smooth that out. They can, it would appear to me that they have, first of all, we're all carrying their phones.

Right.

They have, they have relationships with all the health systems, so they're bringing that data in. Mm-hmm. . And they, they can make the intake process easier. They could, there's a whole host of things like, do you think somebody from Big Tech is gonna, is going to make that move and, and smooth some of this out?

I think the reason that a lot of these orgs are getting into healthcare, part of the reason is not because it's not the thing that we always make fun of them for. They think, oh, they think this is gonna be so easy, haha. Jokes on them. It's not cuz they think it's easy, it's because they think getting access to.

Getting that smooth transition is so hard and they look at it and they go, of course we could do that better. And so I think, I think, yeah, I think that is a lot of the orientation that we're gonna need to have. I think the flip side of that though, going back to like business models is what is their incentive for doing that? Is it in some sort of care delivery? Like we've sort of like we can project on Amazon in one medical, about one medical being part. Amazon user ecosystem, where now it also includes healthcare services, right? Yes. Like, is that how it's gonna be? What is, what is Apple's version of that? Like, what are they actually trying to do?

They're not doing it outta the goodness of their heart. Are they trying to get you more connected to your phone and to stay in their ecosystem? And I think those are the kinds of things that if we're thinking about how does this actually work practically and in terms of business models, we now we've added another layer of complexity with like, what is big tech actually doing here?

Which is not necessarily bad, but is it aligned with all these other things that we're trying to do?

Right. And partnerships become so important as we explore that. Talk to me about the advisory board. So back when I was cio I used to receive the advisory board things. I'd flip through 'em, read the ones that are relevant. You guys also had a, like a ton of software products, right? And other things. talk to me a little bit about what you guys are doing these days.

Right now Advisory Board is very centrally focused on healthcare research. So I think the big task for us right now in line a lot with what you and I have been talking about today is really to simplify these complex issues that, like what we've been talking about is not just technology related, right?

It's not just a CIO's problem. Chief strategy officer cio, we're talking about growth, we're talking about patient experience, we're talking about clinician burnout when we talk about a lot of the provider experience and stuff like that. So when we think about what are those issues, really trying to simplify what the sort of option set is in the world, and then help healthcare leaders make better decisions.

Like I think that's the, that's the, that's the thing that Advisory board can be really useful for. I can I, I talk to, I talk to folks every day. I'm talking to you. I'm here at health. We get, we get a much broader view of what's going on, and so trying to connect people around like, Hey, you all know about rpm.

I don't need to tell you about why. That's great. But here are two or three different people who are thinking about it in different ways. Here's what they're doing and here's why they're doing it and what their objectives are. These are the things you might want to think about. That's the kind of thing I think that advisory board can be especially valuable in, especially in a world where so many of these.

Issues are cross industry. It's not just about providers anymore. It's plans and life sciences and what is the policy and what are all these VC guys doing here? Like that kind of stuff. And I think that's where, I think that's where we're headed.

Absolutely. John, I wanna thank you for your time.

Thanks so much. I appreciate 📍 it. Yeah.

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