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December 19, 2023: Rachel Trobman, CEO and Co-Founder of Upside Health joins Bill for the news today. Amazon will no longer support HIPAA compliance on its Alexa devices after launching a program three years ago for some hospitals and payers. The year 2022 is almost behind us and the healthcare industry is preparing for what promises to be a most interesting 2023. What are the top 10 healthcare industry predictions for 2023?

Key Points:

  • Patients with chronic pain need to be seen and they need to be heard
  • Another challenge with hospital-at-home is equity
  • Upside Health -


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This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

Well, I think there's maybe a an unmentioned crisis that is gonna need addressing and I think we looked at mental health in the past year across the board. Adult mental health. But I think kid mental health is really going to be an enormous hurdle that we need to be looking at. There's a a year waiting list to get a kid a psychiatric appointment.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health 📍 leaders.

Alright, it's Newsday and today we are joined by Rachel Troban, the CEO for Upside Health. Rachel, welcome to the show. Thanks so much for having me, bill. So you're a part of the Cedar Sinai Accelerator. It's how we got connected. Tell us a little bit about Upside Health and your journey through the acceler.

Yeah, so our company was part of a cohort, I think, like in the midst of the pandemic a couple years ago. And it was a wonderful experience really getting the opportunity to dig deep within a healthcare organization and really build workflows that were meaningful for clinicians, particularly on the technical side, getting access in an.

Really unusual way to the CIO's office and all of the tech and which is normally kind of a locked door until you get further in the process. At Upside Health, we're a digital health company that's dedicated to transforming the way chronic pain is assessed and treated. So we're remote care for pain care really dropping ourselves into.

Health systems or integrated delivery networks and saying, we know that pain is a big problem, but taking on additional time for a group that's already taking up a lot of your time is difficult. And so we offer a suite of solutions that help support their care. And in doing so reducing the burden that these patients cause, delivering really interesting insights that can move the patients better through the organization. And then also decreasing. We've been able to like, so decreases of morphine equivalency level and.

So during the pandemic, obviously chronic conditions, chronic pain and whatnot were managed remotely. Has that snapped back to what it was prior to the pandemic or is it still are we still seeing a lot more move towards remote?

Well, I think it's, now it's transitioning into when do we need the patients in person? I think there's still a shift, right? Particular patients with chronic pain, they need to be seen, and they need to be heard. And they need to be acknowledged because they've been pushed around a ton.

And so making sure that they have a platform in which they can do so even if it's remote. I think remote care is really a powerful tool for pain patients in particular because when you're in pain, it's hard for you to go to the doctor. And so adding this other layer is important. Particularly in a system with interventional pain doctors or specialists who can do things in a new way, making sure that those patients are in is really important. Interesting. And prioritizing that time.

All right. We're gonna try to get through a bunch of stories so we have Amazon shut down their hipaa, Alexa, HIPAA compliant programs. We have Epic launch, their new data exchange program. We have some predictions and I don't know, we'll, we'll go down that path as well.

We're gonna look at such and genes. Predictions, but I dunno, maybe we'll throw out some ourselves. So let's start with Amazon. Amazon's always interesting to watch it's one step forward, two steps back, it feels and this story is Amazon shuts down support for Alexa HIPAA compliant programs.

And April 29, Amazon paved the way for Alexa to be used in healthcare when it announced it's Amazon Alexa, HIPAA compliance skills. Kit for developers, the announcement paved the way for developers to build voice skills that could be, that could securely transmit private patient health information. They invited people in to develop on top of that, and when the program launched atrium, Boston Children, Cigna Express Scripts, Livongo Swedish Health Connect all announced skills applications around those skills.

And the Tech Giant is now no longer supporting Alexa with HIPAA eligible skills. And they say we, we regularly review our experiences to ensure we are investing in services that will delight customers, so forth and so on. Could also have something to do with the fact of the announcement. They're losing massive amounts of money in the Alexa space.

How do you gauge, I mean, cuz you know, By this time next week we'll be reading another Amazon story of moving into healthcare, and then we're reading one Coming Outta Healthcare. Is this gonna create sort of a, a, a trust gap or even a backlash with them?

Yeah. I mean, I don't buy it that they're moving out of healthcare.

yeah, no, they're absolutely, I mean, they just bought one medical.

In this space. Like I don't buy that they're looking at surprise and delight and deciding that voice recognition isn't the future. I think it's a part of locking down and controlling their own stake in healthcare. And I think it's a real loss if that they're pulling this out because I think a lot, and maybe this is what they see too. I think a lot of the future. Can be held in this voice technology. There was a, I think of a company, it was called Voice It it was also part of, like an accelerator was a part of, and they were able to do translation for people with speech impediments, people post-stroke to help communicate between their providers.

which has often been a sticking point and they worked with Amazon to do it. I also think of indications for early stroke, all those things could be really powerful. So I think from a stifling future innovation, it's, it's a real loss. I think probably from a, maybe it's just like a bottom line, but it's not gonna really impact even their bottom line to have this small little. Nope. How about you?

Yeah. And I, I think there is a trust gap that that builds with Amazon and healthcare. Not that the trust gap wasn't already there. I mean, it's like, are they a partner? Are they a competitor? More times not for a healthcare provider you should just assume they're a competitor.

That's who they are. They wanna partner with you on the AW S side. They wanna partner with you on supply chain, maybe even on medication delivery and that kind of stuff. Anything supply chain related, they wanna partner with you. But now they're starting to step into primary care. The, acquisition of One Medical clearly puts them in competing on the primary care space. So

clinic, right? Like they have their own official clinic now. Yeah. And so I think they wanna contr, they wanna control that. I mean, but on the flip side they're, I guess, doing things potentially better because they're so big than some of the other giants in the space.

There's an article about how they're the only telehealth out of 15 that was looked at, that isn't sharing information to the other giant. So like p h i now, of course, right? The other companies are doing it because either they haven't thought about it or that's how they're growing. But Amazon's not gonna do that.

Yeah these large tech companies understand the power of data and the value of data. And to the extent that they don't have to share data, I don't, I don't think they will. other inter I'll take this in this direction only cuz it's so hot right now. So you know, chat G P T three.

just underwent a major upgrade to 3.5 and we're looking at four potentially next year. And I'm, I'm just seeing loads and loads of posts and people talking about it. And if, for those who don't know the open AI platform consumes li let's just say consume like 20% of the internet or 25% of the internet and it learned a bunch of stuff.

And so now you can just naturally interact with it. and put in a question. In fact, it's open on my browser right now cuz it's so fascinating. One of the CIOs asked it to create order sets and he said he looked at the order sets and he goes, they were spot on. another person said, Hey, can you, can you write me?

Essentially it had chat G b t write a a new WordPress plugin. So it actually as an example, wrote the. and he put it out there and it worked. And he is that's the level we're now looking at with AI and chat. And the only reason I bring that up in this context is we might be looking at Alexa in two years as as your Commodore 64, it's remember when we used to talk to that thing and it would say, please restate the question. We have no idea what you're saying, or whatever. And now you're just full blown having conversations with these devices and they're talking back to you in meaningful paragraphs and sentences.

They have to be watching this, right? I mean, they have to be watching and saying that we have potentially. A, a computer in so many people's homes, can we use this similar tech? But I mean, chat, G B T is incredible. I mean, just from a communication and efficiency standpoint, we tell my team that the office is gonna be closed. You just copy and paste, right? It's like even small things, let alone the big things patient communication could change Dramat.

Yeah, I, I, I'm trying to figure out which, which way this is gonna go. To be honest with you, we use AI in our company all the time. In fact, it's based on open ai. We use a thing called Jasper AI to write things. , right? So we, put in summaries from like this conversation and we say, Jasper, give us a summary and it'll give us the bullet points. And I keep telling people it's really good at crappy first draft right now, but that's, G P T three, 3.5 looks like it's well beyond the crappy first.

Oh yeah. I mean there's, there's obviously like a formulaic component, right? We did the same thing. We said put together an article on X X, Y, Z and it was a great basic, it's no different than like the standard crap that you would just find, but there's starting to be some nuance in there, and especially as you move into spaces that aren't just write this article. You mentioned, order sets, that starts getting interesting. Yeah,

it really does. Alright. Predictions. it is an end of your show and I didn't prep you by saying do you have any predictions? But we'll start with Sach and Jane's article and he's phenomenal. I love, I read, I follow him and read his post cuz he has so many interesting things to say and provocative things to say. As you look at these. Predictions is there any one that jumps out, one or two that jump out at you that you want to discuss? And then I'll throw a couple out.

One of them is the single siloed solutions is gonna be the end of single, siloed solutions. Yeah. I think that that's true in some context. But I think there still needs to be a recognition that using generalized solutions for certain patient populations, which I think he really, he does mention in terms of like demographics, but not in terms of like disease states. Still have a, a super strong place because these generalized platforms just converting patients in that same way. But I think there's gonna be a consolidation. So what I think we're gonna see is a lot of m and a in the digital health space. I think a lot of, just creating conglomerates or platform offerings, selling into providers of different siloed.

Well, we used to look at solutions and it was interesting. We'd break 'em down into components. It's, it's my old service oriented architecture background. And I'd look at it and I'd go look. we had, oh gosh 1300 instances of 900 applications. In our health system, and we'd look at it and go, okay, how many of 'em have a component of identity?

You need to log in and whatever. And it's like, all right, 98% of them, okay, great. How many of 'em have a messaging component? They're either communicating via any kinds of messaging. They utilize a messaging platform 55% of them. All right? How many of them used? You just keep going down the, the stack and you realize we essentially, 55 55% of 900 applications.

We essentially have 400 different messaging platforms within our healthcare system. And you go, all right. What, what's a way to drive this and make it better? Well, it is to come to the smaller companies and say, look, we have this messaging platform and we have this system of record and we have this way of storing data and saying the, these are our core platforms.

We have a we have an E H R, we have an e R P, we have a C R M, we have these core platforms. These are gonna be the core platforms. We work. and then we go to the smaller companies and say, those are our platform companies. They all have a set of APIs. They all have a way for you to interact. And in, instead of us baking your system into them, we're gonna try to find a partner that integrates into our platform. So we don't have 400 different messaging platforms.

Yeah. But I also think that there's, like I was saying, , a potential consolidation of some of the secondary. So, right. You have the epics and CRMs and whatnot. But then you have the tools that are doing things for patients that these other tools aren't going to be doing, rather than working with 50 of them. having them start working together. So then there's just one message. And then should should the patient have heart disease, the this pathway is gonna be this way should the patient have chronic pain, it's going to be this way. And so you, as a healthcare administrator, aren't working with 50 different companies, but working with one.

But it's gonna be run in like more specific solutions because I think that using. Still, one generalized platform is still kind of missing the mark.

Yeah, no, I, I agree with you a hundred percent. So specifically what he's talking about, he talks private equity and venture capital feeding frenzy of a different kind.

he says the, the financial challenges that are facing the market, there's not gonna be a lot of easy money. So you'll see some companies that haven't prepared with a runway and whatnot. You'll see them start to fold and. , these private equity and venture capital companies will come in and what they're gonna be looking for is great tech at a low price that they can then consolidate into other platforms and whatnot

already happening. Like you're already, it's already underway and you can see it in all of the companies that we're gonna raise as for instance, yes. That are quickly merging. And I think. PE has a lot of opportunity.

Yeah. I did interview some VC and, and private equity people at the health conference. Mm-hmm. . And it was interesting to hear from 'em. I'm like does this kind of tightening, does this concern you? And they're like, no. This kind of tightenings. Exactly. It's like we need, they want cycles, right?

Of course. And cycles happen all the time. And it's also, it's only impacting certain phases in the cycle. So it is still not impacting. Super early stage and it's not impacting like secondary funding. It's really like in this one space, which is I think, an important, important part. Yeah.

So I'm, I'm looking at these 10. He's saying home-based care will get a closer look. So we already started touching on this. And I'm hearing more and more health systems talk about this. Different ways. I was with a group of hospital

at home

kind of stuff. Yeah. I was with some security officers and they're like, look, we're getting pushed and we've, we've gott Essentially provide the security framework around this. And so we had a great conversation around securing medical devices in the home and securing the home-based communication back to the health system and that kinda stuff. But just the fact that they were talking about that leads me to believe that there are an awful lot of health systems having this conversation. My thing on this is just. reimbursement Who's gonna pay for it? I mean, do you, are we going to see a change in models from the payers and from CMS to cover more of this and Yeah, and I think it's already

starting. It's already starting, each year they're releasing more codes that double down on this. And then a lot of the private payers are building, I think this is with a challenge, right? The private payers are building their own. Programs That do that. And so I think that's where it's gonna be a bit of a challenge because you are gonna end up with a lot of different, again, a lot of different programs run by the payers in the home.

And then that's gonna be really hard from a data exchange perspective and owning that patient. The other challenge with hospital at home is just equity, right? Like it should be creating more equity. But is everybody, is everyone home? Is everyone's home set up the same way for the internet access access,continual monitoring. That would change more and more will. From a security perspective, that must be a disaster. Right? People that live in,

yeah. We interviewed John Halamka from Mayo, and he was saying that they do a very strict assessment of the home before they approve hospital at home care.

And he was talking specifically about the Jacksonville market, and I forget the percentage, but it was pretty high. It's 30, 30 some odd. percent They, they go and look at the home and they're like, no, we, we just, we can't provide care in this environment. It's not conducive to the outcomes that we are really holding ourselves to.

And I'm wondering, as, as these, I'm not worried about data sharing as much as what you communicated, cuz 21st Century Cures is actually going after the payers and saying, you've gotta start sharing this data. I don't know what that's gonna mean yet, but I know that that's, that's already in there. But I am worried. clinical outcomes and quality because if we stand up a thousand of these, there're, there're gonna be various levels of quality and, and outcomes, I would think.

Yeah, no, I mean, I agree. And I also think what are the conditions and what are the best implications for this?

And we're just going to continually learn that. But I think what Urgent cares did really well at first and now it's just with the triple virus threat going on right now is trying to reduce some of the ER Volume and so you know how we can keep more people at home or out of the er.

is the, the other side of hospital at home. Right. So hospital at home traditionally is right, but patients potentially post-surgical, for instance, not having to stay as long. Yeah. But now how can we use, and I think some of that was done earlier or like at some point during the pandemic with the pulse OX monitors working really well.

at keeping people home until they needed to. But I guess the question is like, what are the other potential indications that can happen at home? And like you said, in a streamlined way.

Yeah. I, by the way, if people want to see this post, it's on Forbes. It's such, and Jane and I, again, very provocative, he talks about Medicare Advantage.

He talks about private equity customer segment. Talk about burnout, right? I think burnout is is interesting. I think that's number nine. Let's see. Yeah. Progress on the true underlying causes of clinician burnout, and it just requires an honest conversation of what's really causing it. 📍 📍 📍 All right. We'll get back to our show in just a minute. We are excited. We got together with our advisors and said, Hey, what do you think of webinars? And they gave us all sorts of really critical negative feedback on the state of webinars today in our industry. And they said, Hey, look, it's real simple. Community generated topics, not product centric conversations, great contributors. They want the questions to be incorporated ahead of time so they have some time to think about 'em before they come on the actual webinar. They want to promote an honest discussion. And so one of the things they said to me was, is there any way we can do this as a once and done instead of an on demand? And I'm like, absolutely. So we're gonna do once and done. We're gonna have a consistent date and time that we do 'em. It's on Thursdays at one o'clock eastern time. The first Thursday of every month we're gonna do a webinar. and you just sign up on our website, top right hand corner like you always have. We're gonna incorporate the questions, you'll get asked the questions in the form. Go ahead and put 'em in there so that we can include them. They've given us some great topics. Our first one is on January 5th and it's a priorities discussion. In fact, our first two are priorities, discussions, priorities for 2023, a CIO discussion. January 5th is gonna be with integrated delivery network CIOs. February 2nd is gonna be the academic medical center cio. So great set of conversations to have there. Some additional topics they given me addressing clinical staffing shortages the future of care spaces, modernizing the healthcare data strategy, a priorities, discussion with security officers the patient experience, consolidated medical record amongst other topics. So we're excited to kick this off. We would love to have your feedback and we would love to have you join us. Our first one, January 5th. Sign up on our website Now back to the show. 📍 📍 His number 10 though is it's funny, he's number 10 is one of those that just leaves you wanting.

To have the conversation, greater recognition that we have a leadership crisis in American healthcare. This is number 10, and I'm gonna, I'm not even gonna talk about that one. I'm gonna leave you with that one. So you go out and hit the article that's on Forbes. Rachel, how about you? As you sort of look at the landscape of what's going on, do you have any things you're looking at and saying, I don't know if it's a flat out prediction, but this is where you see things going in the next.


Well, I think there's maybe a an unmentioned crisis that is gonna need addressing, and I think we looked at mental health in the past year across the board an adult mental health. But I think kid mental health is really going to be an enormous hurdle that we need to be looking at. I mean, I just know that there's no kid psych. You can't, there's like a a year waiting list to get a kid a psychiatric appointment. And I know that they've been creating apps and other bandaid solutions, but I think this is gonna be something that's gonna have to be addressed. Head on. Either it's gonna be in the pediatric office or something is gonna change.

But you know, as a parent of two young kids, like I'm s I'm seeing this and I'm seeing this in enormous volumes. And the same kind of thing with parent burnout as it relates to the number of sick days that kids are taking. And we're gonna start seeing this as an implication in. Workforce within a hospital when your kids are just continually sick or you're gonna, on top of nurses being sick, right?

You're gonna have them just taking out, taking off in incredible numbers. And the amount of burn that this causes I think is something that's is gonna have to be addressed. I don't have a prediction in terms of a solution quite yet, but I think we're gonna see this in a.


way. Yeah, that's, I mean, that's really interesting. The thing I like that's going on is the work flexibility. I think we finally are nearing an equilibrium where it's like, Hey work can get done at home. We're getting a little better at it. And so we can give people the flexibility to be at home with their kids. And not so much in

healthcare though, I mean, I think yes, for a leadership position. But like nurses, support staff, all of those positions, they, they still need to be in person. And I think that there's gonna be a, an implication, but also even having just the emotional wellbeing. Yes, they can do it from home, but when you have parents where their kids have been sick from September to December, nons. They're not gonna be in the same head space .

Yeah. Well, I, I mean, along those lines, I, I'll say we will get a. Recurring set of news stories throughout the year around the rural health crisis. And that will continue to, to grow. We will see services cut down. We will see hospitals closed in rural areas.

We will see people talking about driving a hundred, 200 miles to the local academic medical center or integrated delivery network. So we're gonna see that crisis, but that it's not gonna be just rural. , it's gonna start to creep into, into urban, and we're gonna see services be rationalized and we're gonna see those kinds of things.

And this is all part of, I think we've started on the spiral. We, we knew the spiral was gonna be coming where it's like, Hey, you know what, this, this business model is not working and it's not working. And we've known it's not working. Hospitals really only make money in three areas, and everything else is sort of like lost leaders or just essentially services that they have to offer.

And so we're, we're starting on that spiral, and so we're gonna have to rethink. Healthcare from one end to the other, we're gonna have to rethink it. And and so these large health systems posting half billion dollar losses. It's operating losses, not, I mean, we've seen half billion when the markets go up and down, but these are operating losses.

This is. We, every patient we see we're losing money kind of situation. That's not gonna continue. They're gonna make changes. Rationalized services do those kinds of things. And then they've gotta explore different models. And so when we worry about, hey, these nurses on the floor they don't have as much flexibility.

We're gonna continue to have burnout unless we look at that and say, okay, what does this look like? Is there a remote model that the IDNs and others can provide where nurses can rotate in through these things and get some time working at home, fewer hours, so forth and so on. Again, that's a mishmash.

I think there's. Gnarly problem. We've known it's coming. We knew that the, the business model was, was flood. It's sick care. It's not, it's not healthcare. We don't we don't like the, the volume really drives things and that kinda stuff, and I think we're at the end of that model. I mean, it's too much of the G D P.

It's now losing money because we have so many people coming in and going, Hey, you know what? We're gonna take primary care. Hey, you know what? We're gonna take imaging. Hey, you know what? We're gonna take surgery. And now all of a sudden the hospitals are going, Hey, you know what? They, they don't have to come in and put a hospital down to compete with us.

All they're doing is standing up these things and taking away the places where they were making. .

And I think, well, I think what also makes things even more complicated than you think from the perspective of the patient, consumer is confusion as to like where I'm supposed to go when I'm sick and where do we look at the quality.

So do I go to the c v s minute clinic, do I go to Amazon Clinic? Who takes my insurance? When do I go to the hospital? Do I need to go to the hospital? And that's gonna further, but

isn't this where the payer does win? I mean, the first card I go for when I'm sick is, is not my is not my local health system. The first card I pull out is, UnitedHealthcare, , it says, hit this website. I hit the website and it goes, Hey, you wanna see a doctor? Go ahead and start a telehealth visit. And I go, okay. Right,

or what, what you see, right? You're not feeling well and you drive down the street or walk down the street and there's a CVS minute.

But let me ask you an interesting question. Mm-hmm. , how much of your holiday shopping, I assume you do some holiday shopping, how much of your holiday shopping did you do online?

Probably about 50%.

Yeah. Maybe I did a hundred percent.

Yeah, maybe a little bit. Maybe, maybe more. I, I was trying to be super. Super helpful this year. But it required a ton of effort and so I live in a cute town in New Jersey, and so I went to a holiday market and tried to support some local vendors, but it was, but like everyone that I was buying gifts for, I got Amazon lists from buy these things and so,

I tried to stay away from just buying from Amazon this year. Not that I wanna go down this rabbit hole, but I my son's not gonna list. I bought my son some new discs for disc golf. And I went to their website and I picked him out and they're gonna send him in. I wouldn't even know where to look for discs if I went out into the market.

Oh no,

a hundred percent. But I think it's the same. it's convenience. For sure. There's no

that brings it back to healthcare. It's convenience. Oh,

that's what I'm saying. It's convenience. It's convenience over relationship and convenience over quality at first. But then there is the financial, right? Getting healthcare in your home also in some ways is more affordable because especially if you live in an area where you have to like, A bus or as gas gets more expensive, take a car to go to a place. that's more expensive for the patient

as, as primary care becomes more and more, and I'm not being critical. This is just sort of the way it's gone. Yeah. I, I go to see a doctor. I, I go to the waiting room. They hand me the clipboard, I fill out the stuff. I just shake my head the whole time. I sit in there in a room of people that you know often are, are sick. And then I finally get to see the doctor, Hey, go, go in and sit on the butcher paper and wait for me to, to come in.

And I sit there and I wait. And then they finally come in and they give me like 15 minutes if that. And then say essentially I'm, I'm sending in a prescription.

To somebody else.

I mean, but, but more times than not, I'm still not at that age where it's like I'm at a chronic and that kind of stuff. That's a whole different category, by the way. That's not what I'm talking about. Okay. The category I'm talking about is my kids and whatnot. We get sick around this time, we need some medication. All right. I do the same thing through my telehealth visit and it's Hey, what are the symptoms? Da da da da da.

They could even say, Hey I'm gonna have some blood work done over at whatever. And regardless, I mean, the whole experience is so much better.

Oh yeah. I mean, you can be doing other things while you're on hold. Like it's just,

and, and the outcome's the same, by the way. Oh, just, yeah. Go get, go get a Z-pack and you should.

Well, and especially because right now, there's not a continual touchpoint with your primary care doctor, so it's not like you have a relationship with them whereby they understand like, what medicine would be best for you. Instead, they're like, oh, what have you been to the doctor? Oh, okay.

That's what I think needs to fundamentally change. If I were starting a hospital system today, if, if somebody gave me a billion dollars and said, start a healthcare system today, I would be looking at touchpoints. I'd be saying, okay, I need to be their trusted relationship for health and I need to be talking to them.

And look, it doesn't have to be a, a conversation. It could just be. A message, it could be, Hey, I'm thinking of buying Frosted Flakes. Is this good for me? And I'm giving them information on that. That's a ridiculous example. But but there's a lot of . What we buy in the grocery store tends to have a lot to do with the outcome of our health.

Yes. No,

I mean, it's, and it doesn't necessarily need to be you, Dr. Brown, who's having those conversations, but it needs to be associated with your. .

Yep. this is where I think technology's gonna take off. I think health systems need to think through touchpoints and instead of my health system here may have had two touchpoints with me this year, and that needs to increase by a thousand fold.

And they have to be

meaningful touchpoints. Right. It can't just be like your lab results. Yeah,

you're, here's your lab results. Go hit your portal. You can see 'em. I'm like,

or, or you haven't had a wellness visit. Like it needs to be things that builds a sense of, like you said, trust a sense of actual care. Right? When you're talking about healthcare versus sick care. Right. The word care is in there for a reason. And so I think that, that by starting there and doing it well, you'll see the implications through.

Care journey. So I th I think this is gonna be a tumultuous time for healthcare cause we started on the spiral and if you fast forward when, once you get on that spiral, fast forward about five years out, if you just project everything about five years out, c v s Aetna has really figured out their primary care model.

Walmart has launched more. Things in the parking, lots of their Walmart stores that are more integrated type of solutions. Go see the primary care doctor, your dentist, your ophthalmologist, your, you look up the

prescriptions and get some discount on your food.

Yeah, it's, it's all, it's, it's all right there. So they'll, they'll make progress there. Amazon One Medical will probably make some progress there. We'll continue to see some of the technology solutions, hospital and home and, telehealth, make some progress there. Remote patient monitoring. Make some progress there. The messaging platforms will get more sophisticated and we'll make progress there. And then all of a sudden our ERs are empty. And we saw what that did to the financials of health systems. while back, but be honest with you, I'm looking forward to the day when the ERs are empty.

Right? I mean, so that's the thing is that, so then our hospital systems for the most specialized surgical. If we look at this landscape know, there's still always gonna be anomalies. Is it the academic medical?

It's the name brand academic medical centers. And the other thing is information will, as we continue to progress over the next five years information transparency will start to become it, it's a drive Today, it's a little stop and go, but I think what we'll start to see is you're gonna be able to look in and say, , oh, this doctor is good, has good outcomes, and has a very competitive price.

We could become shoppers. I know we've been talking to that about that for decades, but there's enough momentum in a lot of different areas where we could become shoppers in healthcare and say, you know what? I'm gonna partner with. Whoever, fill in the blank. Let's just say it's c v s, I'm gonna partner with c v s because they're health related and there's one on every street corner.

They can help me with a lot of different things. I'm gonna ha I'm gonna increase my touchpoints. Maybe not a thousand fold, but maybe a hundred fold. With them, with the technology platform and the things that they're doing, and to, they're gonna essentially say to me, Hey, you know what?

You need surgery. and let us do the research for you. Yep. Go here are your three options. We recommend going over here. It's the best outcome for the lowest cost. is that, is that five years away? Is it 10 years away? I tend to predict things a little too aggressively in healthcare. It tends to move a lot slower than I think it's going to.

Yeah. . Yeah. No, it's, I, it's, it's interesting I the move to the. When I first came into healthcare 2012, I said healthcare's gonna move to the cloud and it's gonna be rapid. Well here we are 10 years later and healthcare is finally really moving to the cloud. Everything's in the cloud, and that kinda stuff.

So my, my three to five year prediction was really a 10 year prediction. So anything I say, just double it, and that's probably closer. Yeah. All

right. I, that's a good way to end the year. ,


take philosophy and double it.

Yeah. How's, how's that for hedging your bets on a prediction? Hey, Mike. And true. In five years am Mike and true. In 10 years, I don't know. My kid

said, we asked her for the World Cup. She asked who we root for and we said, well, who do you, who do you wanna root for? And she said, I normally wait to see who wins, and that's who I root.

That's a good

idea. Yeah. So I mean like, I'm just gonna wait and see what happens and say, yeah, that's what I predicted.

he's gonna hold me to it. Oh man. Well Rachel, thank you for your time. I really appreciate it. Like this stuff you're doing at Upside Health. Where can they get more information about Upside Health? Yeah.

Just simple upside dot.

You're one of the health domain names great. Yes.

Yes. It's, it's fun. And other than I feel like there's one insurance company that we were working with and they didn't take health like we put it in. It was like incorrect domain names ,

it's, it's just and they could get more information. Hey, I wanna thank you for your time today and thanks for coming on the show. Really appreciate it.

It was great talking.

📍 Bye.

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