The Truth About Entrepreneurship Nobody Talks About - Preston Alexander

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We have this interesting shift in culture to
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the entrepreneur is the rock star of the 1980s,
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seventies, whatever, but similar to being a rock
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star. They don't see sleeping on tour buses for
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however many days out of the year playing in
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crappy dive bars and getting $4 in tips. They
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see Aerosmith, whatever, on stage. Taylor Swift,
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on stage. And they see the outcome, not the struggle.
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Maybe this is the worst forum to say this on,
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but I low -key kind of hate AI. And don't get
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me wrong, I still retain my misgivings and suspicions
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about large health systems owning private jets
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and having bank accounts in the Caymans with
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hundreds of millions of dollars. Thanks so much
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for joining us today, Preston. Thanks for having
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me. I'm excited to be here. For our audience
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who might not have heard of you, could you give
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us an intro? Yeah, absolutely. Which I'm sure
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is most of, if not all of your audience, very
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unhearable. So I'll start not too terribly long
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ago, but maybe in the college years, as it were,
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as we sort of end up starting in our education.
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So I went to... University of Colorado in Boulder.
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Interestingly, or maybe not, just because I didn't
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get into very many colleges and came down to
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two options. One was to be in Vermont and be
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cold 78 % of the time, or be in Colorado and
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only occasionally be cold, contrary to popular
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belief. you know, it is a great school. They
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have a lot of great opportunities there, which
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I rationalized, but realistically, it was a weather
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decision completely. And so I went to the University
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of Colorado in Boulder, studied psychology and
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philosophy of all things, and, you know, had
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a really nice time, thought it was fun, but wound
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up kind of quickly thinking, I don't know that
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I love... Traditional education. Um, and while
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this is kind of interesting, it was a very structured
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box still. And so I graduated in three years,
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um, spent one semester during that three years
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abroad, which is a lot of like cool life experience.
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And then just decided to embark into the world,
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but, um, maybe partial Boulder rock climber,
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a philosophy student. I didn't really have much,
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um, in the way of. traditional business or otherwise
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aspirations after college. I went and started
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building furniture. I found myself building interiors
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of private airplanes for a short period of time,
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which was pretty fascinating. Worked in rock
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climbing gyms, just wanted to go out and just
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sort of live life and travel around and do those
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kinds of things. But interestingly, and this
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part probably interesting, and I don't know where
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it came from. Probably have to dissect my childhood
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a little bit, but While I was building furniture,
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all I could think about was, I loved building
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it. It was super fun. I still build furniture
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as a hobby. But most of what I spent my time
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thinking about was the business of furniture
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building and how do you go from your garage shop
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doing commission work here and there to something
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much bigger than that. And then when I was building
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interiors of private airplanes, that work I actually
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really did not like it all, but it was fine.
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Um, and all I could think about was how do you
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take this business to the next level? Is there
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expansion beyond private planes? Can you get
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into yachts? How do you grow faster? Where in
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the shop do you move to the airport? It's all
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this. That's all I thought about, which again,
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I didn't really have much in the way of aspiration
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along those lines, but it's all that occurred
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to me while I was in those settings. So, and
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I, at the climbing gym. I didn't think about
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that as much. I just enjoyed climbing and coaching
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and route setting. It was just fun. So after
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some period of time, I decided I like building
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furniture, but I really want to pull in this
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business thread. I had sort of started some things
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here and there, little kind of pursuits, but
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never anything substantial. And so I thought
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to myself, well, maybe I'll go get a... Corporate
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jobs will go work somewhere real for a while
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and I'll learn Just more about business hands
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-on because I was tired of school is tired of
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this and that I just wanted to go do something
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So I applied to some things but at this time
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it was 2011 2010 maybe job prospects were low
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for a rock -climbing furniture builder with a
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psychology degree undergrad not even any kind
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of garage so I sort of hatched a plan, a bit
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of a scheme. And I thought to myself, all right,
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I'm going to do this. I'm going to go enroll
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in an MBA program. And when I... Or yeah, when
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I get in, if I get in wherever it is, then I
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will maybe take a course or sort of audit a course
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or just be enrolled. Cause when I, then I can
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put on my resume, MBA candidate and I can put
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in my email things. I was like, cooked up this
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plan. I was like, all right, I'm going to, I'm
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going to show people and they'll take me seriously.
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Cause I'm going to get an MBA, which I had no
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intention of doing like at all. I just needed
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to get in a foot in the door. One thing led to
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another, and I applied here locally in Atlanta
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to Georgia State University, was offered a scholarship
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and research assistantship, and it was going
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to be paid for. So I thought to myself, all right,
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you know what? Let's just go do it. Let's just
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go knock this out. And I loved it. It was...
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fascinating. I loved learning all of these elements
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of business. And really for me, even though if
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people follow me or have talked to me here and
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there, I often say, you don't need an MBA, just
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skip it. Which I think is true in a lot of cases.
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But for me, I was starting so behind the eight
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ball and so much sort of from scratch and zero.
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And I do like learning a lot despite not really
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loving college. And I just really found it to
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be a fascinating Pursued and and really helpful
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for me. So eventually to weave long tails and
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I a couple years later have about to graduate
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and found myself working at a After applying,
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you know everywhere and in between at a medical
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device company and at the time and before since
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I haven't mentioned it I knew just nothing at
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all about health care If you had asked me what
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you know ACA stood for I'd have been like, I
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don't know Well, I have no clue. You know, all
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I knew is that I could be on my parents insurance
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dollars 26. That's about the length of it. Um,
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so, but I found myself at a medical device company
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and quickly sort of fell in love with the healthcare
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industry for a myriad of different reasons. And
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in love maybe is a weird word for it, but something
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about healthcare is drawn to for sure. And at
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the time it was a very myopic view. It was very
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narrow. We sold surgical devices, largely disposable
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to large health systems. So that's really kind
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of seeing healthcare from a super specific pinhole
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really. But still it was a product management
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job, more upstream in a very large corporation,
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did about $16 billion annually, publicly traded.
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And I sort of acted as a... general manager for
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product lines, which was really great because
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the thing I find the most fascinating about product
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management in a large company is the ownership
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over something with no functional authority whatsoever.
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So you have to make things happen, though you
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can't demand that anything happens because the
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people don't report to you. R &D doesn't report
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to you. Finance doesn't report to you. Sales
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doesn't report to you. Nobody does. And yet you
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still have to move the needle and you're responsible
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for the business results of a product or a product
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line. And I love that because it's very entrepreneurial.
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And the whole reason I kind of went back to school
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and decided to go try to work is because I always
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was thinking, how do I grow a business? How do
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I start a business? How can I make this work?
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So that was my mindset. And, and by the way,
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when I, when I started in my brain, I was like,
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all right, I'm going to go work for five years
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and then I'm going to start a company. And which
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ended up happening. Um, but you know, I got in
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and I just decided it was, I didn't know what
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it was going to be. I didn't intend on healthcare
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and it happened to be healthcare. So I was there
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in that first job for a couple of years and then
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moved to another bed device company, another
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global company in a less global role, more US
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focused, but it was more downstream. It was fine.
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It was interesting. Got a little more of the
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chops under my belt, much more marketing, much
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less product. And, you know, a few years later,
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found myself at the sort of the five year mark
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and was like, all right, it's time to start a
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company. Um, and it was, well, I know now about
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medical devices and I know about, um, you know,
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furniture making and woodworking. And then I
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was like, all right, which way do I go? Cause
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I was, I still, I loved healthcare, but it, it
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wasn't always going to be like the thing forever.
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So after much introspection and you know, pressure
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testing different things and testing some ideas.
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It was the, it was a medical device that I ended
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up starting a company around and we launched
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it. We worked on it for a little while and it
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was a piece of capital equipment with some disposable
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to it used in surgery, mostly open cases, help
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prevent unplanned hypothermia. And we launched
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it in February, 2020. So set up for tremendous
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success. I would, I would sit. come like July
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of 2020 or so, I would sit in front of my computer
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and look at this. You remember those maps of
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all the states that would like, you know, Financial
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Times, New York, they all had it and it was,
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you know, red, yellow, green, super red. I would
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literally just stare at that and check it every
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day to look at the states that were declining
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rates and which hospitals were at or lower than
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capacity and cold call hospitals during the pandemic,
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just in case the ones in West Virginia ended
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up being a decent place to start because they
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weren't doing any data reporting. And it ended
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up that our first customer was in West Virginia.
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So to make a sort of longer story short in that
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era of life, we eventually uh, sold the business
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in like a tag -along acquisition at the end of,
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uh, 2021. And, but during that time, which sort
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of has helped lead me to where I am today is,
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you know, it was the pandemic. So what do you
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do during the pandemic? You know, you start just
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kind of. pursuing other things or doing other
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things or, you know, you maybe start a podcast,
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which I did and didn't go great, or you start
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writing a lot more, which I did. And I started
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writing a lot more on LinkedIn. I had been doing
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it for a while, um, in my product manager days
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because I wanted to learn more about healthcare.
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And I thought the way I could do that was to,
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because again, pinhole myopia medical device,
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I could take to LinkedIn, write a post about
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an article that I read or something and inevitably.
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Whether it was one person, two people, 70 people,
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I would get responses and people would say, Oh,
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that's right. Or, Oh, that's wrong. Or you haven't
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thought about this or my perspective is that.
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And so I used it as a good feedback loop and
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mechanism. And I'd set up calls with people.
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I'd DM them. It was just a way for me to learn
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more and get deeper. And so that really started
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in 2017. 2020 -ish, 2021, I thought to myself,
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all right, I have extra time on my hands. I now
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have some formed opinions about healthcare because
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I've learned a lot over this whole trajectory.
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And then I started writing on LinkedIn and I
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started writing the healthcare breakdown. And
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where that sort of ties into all this and where
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it's led to today is I kind of had a throwaway
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line at some point and said, the business of
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healthcare is destroying the practice of medicine.
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You know, physicians need to take back the business
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of healthcare. um, and, and, or clinicians. And
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so that was really like the germinating of what
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is now forward slash health, because I had all
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this experience. It was business side, but I
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saw these misgivings of the healthcare system.
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Talked to so many clinicians and physicians,
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not for any sort of gain. I wasn't selling anybody.
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I just wanted to learn and understand the perspectives
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of everything. And the only thing I could like
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think to myself is This huge heavy lift, corporatization
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of healthcare is really at the crux of the issue.
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And yes, there are macro system issues at play.
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You know, capitalism in the United States, you
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know, private for -profit or publicly traded
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insurance companies dominating how, you know,
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private but for public good entities that are
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also capital constrained and need public funding
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to grow and expand and then fight with these
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big, like those machinations make it really challenging.
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But this sort of idea and like, how can I then
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work towards and position myself to help sort
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of shift that paradigm and take back quote unquote
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business of healthcare? And really the answer
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was. put myself in a position to help those who
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I believe need to be in the driver's seat. And
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that's independent clinicians, physicians, physicians
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and leadership levels, starting new companies,
00:13:33.450 --> 00:13:35.990
launching health tech, med tech, et cetera. But
00:13:35.990 --> 00:13:37.710
just getting it back to the heart. Cause you
00:13:37.710 --> 00:13:41.629
know, we can say idealistically, the business
00:13:41.629 --> 00:13:44.809
stuff shouldn't matter at all. Okay, sure. Great.
00:13:45.129 --> 00:13:48.730
Um, but in the United States, like it does, we
00:13:48.730 --> 00:13:51.330
operate in a capitalism system version of it.
00:13:51.909 --> 00:13:54.549
And. Those are just realities. And if we want
00:13:54.549 --> 00:13:57.409
to make it better, we either can just talk about
00:13:57.409 --> 00:14:00.809
how it should be, or we can work within our constraints
00:14:00.809 --> 00:14:04.210
and make something happen. So very long story,
00:14:04.509 --> 00:14:09.210
not short. I met a business partner through exploring
00:14:09.210 --> 00:14:11.889
some different digital health options. Where
00:14:11.889 --> 00:14:13.870
can we do? What's the next thing I wanted to
00:14:13.870 --> 00:14:17.799
work on? And we wanted to work together. The
00:14:17.799 --> 00:14:19.720
first thing we tried didn't really work out.
00:14:19.720 --> 00:14:22.940
It's care delivery and wound care. And then we
00:14:22.940 --> 00:14:25.820
decided, well, we sort of built a digital, you
00:14:25.820 --> 00:14:29.360
know, a virtual clinic. Maybe we could help doctors
00:14:29.360 --> 00:14:31.600
start their own clinics. And so forward slash
00:14:31.600 --> 00:14:34.139
health was sort of born out of that idea. And
00:14:34.139 --> 00:14:37.120
we've since helped a number of doctors start
00:14:37.120 --> 00:14:39.919
new clinics. We've worked with a couple of existing
00:14:39.919 --> 00:14:42.340
clinics to help in their financial side, revenue
00:14:42.340 --> 00:14:44.740
cycle, you know, different kinds of things. And
00:14:44.740 --> 00:14:49.750
we really are a consultancy that focuses on finance
00:14:49.750 --> 00:14:52.909
strategy and systems design, otherwise known
00:14:52.909 --> 00:14:54.769
kind of as operations, but it's a little different
00:14:54.769 --> 00:14:58.909
flavor, to help build amazing healthcare organizations.
00:14:59.049 --> 00:15:01.330
And that's what we do. And that's my very, very
00:15:01.330 --> 00:15:03.929
long introduction. Thank you, Preston. That was
00:15:03.929 --> 00:15:06.889
amazing. And I have a million questions. Let's
00:15:06.889 --> 00:15:10.289
go back to something you said earlier on, which
00:15:10.289 --> 00:15:13.779
is traditional education isn't for you. Tell
00:15:13.779 --> 00:15:15.980
me a little bit more about that, and how do you
00:15:15.980 --> 00:15:19.700
think about educating your kids? And something
00:15:19.700 --> 00:15:22.519
I'm kind of thinking about right now is really,
00:15:23.419 --> 00:15:25.480
me and my wife, we talk about the movement of
00:15:25.480 --> 00:15:27.519
unschooling, if you're familiar with that movement.
00:15:28.419 --> 00:15:32.220
And how can we teach our kids to not, you know,
00:15:32.240 --> 00:15:35.179
my five -year -old, she's learning math and she
00:15:35.179 --> 00:15:37.299
counts on her fingers and the teacher wants her
00:15:37.299 --> 00:15:39.679
to draw these lines to tally up the numbers.
00:15:41.609 --> 00:15:44.669
Inherently, I'm like, well, why, right? If you
00:15:44.669 --> 00:15:46.490
can count on your fingers, that works. I think,
00:15:46.870 --> 00:15:48.990
how do you kind of think about structure and
00:15:48.990 --> 00:15:52.190
systems in education and how they help us and
00:15:52.190 --> 00:15:54.870
sometimes maybe how they trap us inside imaginary
00:15:54.870 --> 00:15:58.669
boxes? Yeah, it's a great question. And I think
00:15:58.669 --> 00:16:00.690
about it a lot too. So I have a five -year -old
00:16:00.690 --> 00:16:04.129
and a seven -year -old and watching them in respectively
00:16:04.129 --> 00:16:07.889
kindergarten and second grade in public school.
00:16:08.110 --> 00:16:10.350
Georgia is all, I mean they're in a great public
00:16:10.350 --> 00:16:13.669
school, don't get me wrong, but it consumes a
00:16:13.669 --> 00:16:17.730
lot of my thinking. And I guess if I think about
00:16:17.730 --> 00:16:20.470
projecting out, there was, I'm gonna sound like
00:16:20.470 --> 00:16:23.049
a weird anecdote, but there was this show called
00:16:23.049 --> 00:16:25.450
Are You Smarter Than a Fifth Grader? Do you remember
00:16:25.450 --> 00:16:28.450
that show at all? Yeah, yeah. It was like, so
00:16:28.450 --> 00:16:30.289
everyone was like, oh, that show's, yeah, it
00:16:30.289 --> 00:16:32.490
was like funny and stuff, but for whatever reason
00:16:32.490 --> 00:16:34.750
to me - I'm not smarter than a fifth grader.
00:16:35.009 --> 00:16:37.600
That's what I'm saying. Right. That's what everybody
00:16:37.600 --> 00:16:38.740
said. They're like, I'm not part of the fifth
00:16:38.740 --> 00:16:40.820
grader. And the only thing I could see when I
00:16:40.820 --> 00:16:43.840
watched that show was how useless the information
00:16:43.840 --> 00:16:47.120
you learn in fifth grade is in adulthood. It
00:16:47.120 --> 00:16:49.539
was the only thing that ever like stood out to
00:16:49.539 --> 00:16:51.139
me. I watched it one time and I was like, this
00:16:51.139 --> 00:16:53.139
just means that you don't need to know any of
00:16:53.139 --> 00:16:56.279
this information because that's sort of what
00:16:56.279 --> 00:17:00.600
I think school becomes kind of quickly. Sure.
00:17:00.860 --> 00:17:03.039
You got to learn how to write letters and just
00:17:03.039 --> 00:17:05.710
practice it. And you have to learn how like you
00:17:05.710 --> 00:17:09.849
know, seven plus 18 equals whatever it equals,
00:17:09.890 --> 00:17:11.609
because I'm bad at basic math, because I have
00:17:11.609 --> 00:17:14.329
a calculator, you know. How to multiply, like
00:17:14.329 --> 00:17:17.309
there are basic things that I think are important,
00:17:17.809 --> 00:17:20.490
but when you get into fifth grade, you know,
00:17:20.490 --> 00:17:23.130
and I just started to see this and not every
00:17:23.130 --> 00:17:25.390
school, but a lot of schools it's like, well,
00:17:25.390 --> 00:17:28.369
we teach to the textbook, we teach to pass the
00:17:28.369 --> 00:17:30.630
tests, we have to get the right scores, et cetera,
00:17:30.690 --> 00:17:32.960
et cetera. I don't know that it's really about
00:17:32.960 --> 00:17:36.160
learning versus it's about memorization and performance,
00:17:36.660 --> 00:17:40.519
which I think becomes not a great thing for kids
00:17:40.519 --> 00:17:43.680
in the short and long term. So as I think about
00:17:43.680 --> 00:17:46.359
it, I think about projecting out and they're
00:17:46.359 --> 00:17:48.660
to their teenage and adult years and even in
00:17:48.660 --> 00:17:50.740
college, like I kind of want them to do three
00:17:50.740 --> 00:17:53.880
things and three things only. It'd be enough
00:17:53.880 --> 00:17:58.119
if they know how to think. And that incorporates
00:17:58.119 --> 00:18:00.359
a lot of things, critical thinking, asking questions,
00:18:00.460 --> 00:18:03.180
all that great stuff. If they can communicate
00:18:03.180 --> 00:18:05.380
well, yeah, so you have to know how to write
00:18:05.380 --> 00:18:08.460
the basics, but clear communication is really
00:18:08.460 --> 00:18:11.140
thinking and then just understanding how to convey
00:18:11.140 --> 00:18:15.019
it. And then if they can be kind and empathetic,
00:18:15.619 --> 00:18:18.779
do you need much else? Do I need to know the
00:18:18.779 --> 00:18:21.740
facts of the War of 1812 or what the Louisiana
00:18:21.740 --> 00:18:25.509
Purchase was? I mean, maybe, but I mean... with
00:18:25.509 --> 00:18:27.589
the rise of all technology, even without AI,
00:18:27.950 --> 00:18:29.849
like Wikipedia has all the information, a book
00:18:29.849 --> 00:18:32.029
has all the information. I need to know how to
00:18:32.029 --> 00:18:34.670
go find it, think critically about it, what it
00:18:34.670 --> 00:18:38.470
means, the inferences I can make. I never got,
00:18:39.029 --> 00:18:41.930
I occasionally got some of that in school, but
00:18:41.930 --> 00:18:44.430
really it was just, you know, I remember taking
00:18:44.430 --> 00:18:48.970
a psychiatry, psychology test in college, cramming
00:18:48.970 --> 00:18:52.630
note cards, day of, sat down. took the test,
00:18:52.789 --> 00:18:55.549
got like a 97. Someone asked me a question about
00:18:55.549 --> 00:18:58.230
it. I mean, literally three hours later and I
00:18:58.230 --> 00:19:00.549
had no idea. I was like, I don't remember because
00:19:00.549 --> 00:19:03.349
it was just such a, you know, cram. You get a
00:19:03.349 --> 00:19:05.630
nugget and then it's just irrelevant because
00:19:05.630 --> 00:19:07.730
it's not thinking. It's just the memorization.
00:19:07.750 --> 00:19:10.130
So that's how I think about education and why
00:19:10.130 --> 00:19:13.250
I didn't like it. And it's especially because
00:19:13.250 --> 00:19:16.609
I think even if it was just memorization, they
00:19:16.609 --> 00:19:20.740
lack being able to tie it to purpose. So why
00:19:20.740 --> 00:19:23.980
am I learning this? How is this going to help?
00:19:24.680 --> 00:19:26.500
You know and the only person that could ever
00:19:26.500 --> 00:19:28.059
tell you is like history teachers because they
00:19:28.059 --> 00:19:29.819
don't want history to repeat itself and I'm like,
00:19:29.819 --> 00:19:36.200
okay Maybe but yeah the lack of So what I think
00:19:36.200 --> 00:19:39.180
in modern education traditional education is
00:19:39.180 --> 00:19:42.279
a problem Yeah, it's really interesting that
00:19:42.279 --> 00:19:46.190
you know life is not a test And in terms of this,
00:19:46.369 --> 00:19:48.869
there's not a score sheet for life that's objective
00:19:48.869 --> 00:19:52.730
and traditional. And we train our children to
00:19:52.730 --> 00:19:56.750
look at their school and their success through
00:19:56.750 --> 00:19:59.490
passing tests and achieving a certain grade on
00:19:59.490 --> 00:20:03.069
tests. But that's not how even work works or
00:20:03.069 --> 00:20:05.529
even the corporate world or the non -corporate
00:20:05.529 --> 00:20:07.190
world. Like, you know, after you're done with
00:20:07.190 --> 00:20:09.650
school, it's like a different world out there.
00:20:09.769 --> 00:20:11.910
So it's funny how we train people in a certain
00:20:11.910 --> 00:20:14.029
way and then they have to live the rest of their
00:20:14.029 --> 00:20:16.789
life in a different way. Do you think entrepreneurship
00:20:16.789 --> 00:20:19.490
is innate? Or do you think this can be learned?
00:20:19.630 --> 00:20:22.789
There's something I think about is physicians
00:20:22.789 --> 00:20:25.670
ask me, you know, I want to get out of medicine.
00:20:25.930 --> 00:20:29.390
I want to launch a sidekick or I'd like to launch
00:20:29.390 --> 00:20:33.769
a company. And sometimes I ask them some questions
00:20:33.769 --> 00:20:35.789
about their appetite for risk and uncertainty.
00:20:36.349 --> 00:20:38.509
And it's clear that they don't have an appetite
00:20:38.509 --> 00:20:39.990
for risk and uncertainty. And I think that's
00:20:39.990 --> 00:20:42.869
what entrepreneurship is. Is you're excited about
00:20:42.869 --> 00:20:45.890
uncertainty and risk. and making bigger bets.
00:20:46.950 --> 00:20:50.650
Given that medicine self -selects initially for
00:20:50.650 --> 00:20:52.650
people who are not excited about those things,
00:20:53.509 --> 00:20:57.109
what advice do you have for physicians who are
00:20:57.109 --> 00:20:59.390
not inherently entrepreneurial? Do you think
00:20:59.390 --> 00:21:01.349
it can be learned or do you think it's something
00:21:01.349 --> 00:21:03.769
that's innate? I wanted out of medicine the moment
00:21:03.769 --> 00:21:06.910
I graduated, right? There wasn't this curve where
00:21:06.910 --> 00:21:09.450
I'm like, okay, I want something else. It's like
00:21:09.450 --> 00:21:12.690
I already knew I wanted something else kind of
00:21:12.690 --> 00:21:15.819
all along. Yeah, I think it's a great question.
00:21:15.839 --> 00:21:18.000
And I think it can be both, honestly. We've all
00:21:18.000 --> 00:21:20.880
met the person who you're just like, that dude's
00:21:20.880 --> 00:21:23.539
an entrepreneur. That's a, or a guy, like they're
00:21:23.539 --> 00:21:25.680
purebred, right? They're a business person. They
00:21:25.680 --> 00:21:27.519
hustled in high school. They sold candy bars.
00:21:27.579 --> 00:21:29.460
They did whatever. They laddered up to like do
00:21:29.460 --> 00:21:31.200
something different. They were constantly just
00:21:31.200 --> 00:21:33.759
like hustling to do something interesting the
00:21:33.759 --> 00:21:36.279
way they thought was different. Like, so I a
00:21:36.279 --> 00:21:39.619
hundred percent think that it can be sort of
00:21:39.619 --> 00:21:41.940
innate, but I think that it can be learned too.
00:21:42.000 --> 00:21:45.799
I mean, I think I'm sort of a, you know, a more
00:21:45.799 --> 00:21:48.740
of a learned entrepreneur than an innate one.
00:21:48.779 --> 00:21:53.059
And I think both can be equally successful. Um,
00:21:53.319 --> 00:21:55.380
perhaps on different timelines, perhaps on in
00:21:55.380 --> 00:21:57.960
different styles, but I think it can work for
00:21:57.960 --> 00:22:01.359
both. And if you ask some pretty well accomplished
00:22:01.359 --> 00:22:03.680
entrepreneurs too, about their risk aversion,
00:22:04.420 --> 00:22:07.019
I think you might be surprised to find how many
00:22:07.019 --> 00:22:09.299
would suggest that they are actually rather risk
00:22:09.299 --> 00:22:14.000
adverse and they only go into decisions that.
00:22:14.170 --> 00:22:18.029
look on the surface like there might be a significant
00:22:18.029 --> 00:22:20.950
or considerable amount of risk, but the asymmetry
00:22:20.950 --> 00:22:24.869
in the return is such that it negates to a degree
00:22:24.869 --> 00:22:29.029
the amount of risk, plus they have vetted, understand,
00:22:29.289 --> 00:22:31.890
and looked at the downside enough to know how
00:22:31.890 --> 00:22:34.309
to mitigate some of those factors. So I think
00:22:34.309 --> 00:22:37.970
that even, and whether some of them do it intuitively
00:22:37.970 --> 00:22:40.990
or some of them do it analytically, et cetera.
00:22:41.519 --> 00:22:43.680
I think the best thing you can do going into
00:22:43.680 --> 00:22:47.440
it is, and again, this is to the school point
00:22:47.440 --> 00:22:49.680
and why I think it can be hard for physicians
00:22:49.680 --> 00:22:53.640
because, you know, I spent whatever, how many
00:22:53.640 --> 00:22:58.299
years? 12, 16, 18 years in school. You've spent
00:22:58.299 --> 00:23:00.880
way more time in school. And then not to mention
00:23:00.880 --> 00:23:03.220
training, which is school -esque in a lot of
00:23:03.220 --> 00:23:04.819
ways. And you have to do it this way. There's
00:23:04.819 --> 00:23:07.660
a performance, there's sort of check boxes, whatever
00:23:07.660 --> 00:23:10.220
it's someone else's. In entrepreneurship, those
00:23:10.220 --> 00:23:12.779
things don't just don't exist. The only thing
00:23:12.779 --> 00:23:15.700
that exists, the only North Star is market adoption
00:23:15.700 --> 00:23:19.500
of your thing. And, you know, there's a lot of
00:23:19.500 --> 00:23:23.500
ways you make that work. And you have indefinite
00:23:23.500 --> 00:23:25.519
at bats. There are no strikeouts. There's no,
00:23:25.740 --> 00:23:28.140
you got this wrong one time. Bye. You're done.
00:23:28.759 --> 00:23:30.559
It's, yeah. What's your appetite to get up and
00:23:30.559 --> 00:23:33.279
do it again? Did you spend all your money? Do
00:23:33.279 --> 00:23:35.400
you care if you spend all your money? You know,
00:23:35.500 --> 00:23:38.720
whatever the thing is. Um, but I think that can
00:23:38.720 --> 00:23:41.579
be really hard to just recognize the use. Like
00:23:41.579 --> 00:23:45.619
you said, there is no test. Just go start and
00:23:45.619 --> 00:23:50.099
do it and maybe you decide. Nah, not for me.
00:23:50.359 --> 00:23:53.980
Great. You know, we, we have this interesting
00:23:53.980 --> 00:23:56.700
shift in culture to the, the entrepreneur is
00:23:56.700 --> 00:23:59.799
the rock star of, uh, you know, the 1980s, seventies,
00:23:59.980 --> 00:24:03.200
whatever. Um, And a lot of people just want to
00:24:03.200 --> 00:24:05.660
be it because they think, oh man, you know, but
00:24:05.660 --> 00:24:07.700
similar to being a rock star, they don't see
00:24:07.700 --> 00:24:10.500
sleeping on tour buses for however many days
00:24:10.500 --> 00:24:13.319
out of the year playing in crappy dive bars and
00:24:13.319 --> 00:24:16.339
getting $4 in tips and you know, all this travel
00:24:16.339 --> 00:24:18.380
and all the headache and lugging their instruments
00:24:18.380 --> 00:24:22.019
around. They don't, they see the, they see Aerosmith
00:24:22.019 --> 00:24:25.279
or whatever on stage, Taylor Swift, you know,
00:24:25.500 --> 00:24:28.470
on stage and they see. the outcome, not the struggle.
00:24:28.490 --> 00:24:30.450
And I think we've had a lot of that in entrepreneurship.
00:24:31.210 --> 00:24:34.410
So the best thing to do is say, okay, there is
00:24:34.410 --> 00:24:36.930
a possibility that I can do this, but also it
00:24:36.930 --> 00:24:40.769
might not be for me. And that's fine too. What's
00:24:40.769 --> 00:24:42.950
something you've changed your mind on in the
00:24:42.950 --> 00:24:45.089
past couple of years as it pertains to healthcare?
00:24:46.230 --> 00:24:50.069
That's a really good question. Let me pause and
00:24:50.069 --> 00:24:54.890
reflect on that for a moment. In the last couple
00:24:54.890 --> 00:24:58.029
of years, Honestly, I think the biggest change
00:24:58.029 --> 00:25:02.650
for me has been understanding systems and where
00:25:02.650 --> 00:25:06.089
healthcare exists in the function of macro systems.
00:25:06.630 --> 00:25:09.130
So I used to be very, and I mean, I still am
00:25:09.130 --> 00:25:13.069
critical, maybe just grumpy, um, critical of
00:25:13.069 --> 00:25:15.470
a lot of the players in healthcare. And I talk
00:25:15.470 --> 00:25:17.410
about it with health systems a lot and I've,
00:25:17.410 --> 00:25:20.190
I've thrown my share of darts at large health
00:25:20.190 --> 00:25:22.109
systems. And I think a lot of those are, are
00:25:22.109 --> 00:25:25.099
deserve it, but I. I start to find myself more
00:25:25.099 --> 00:25:27.160
and more pausing and reflecting on what are the
00:25:27.160 --> 00:25:31.099
conditions in which they're operating. And I
00:25:31.099 --> 00:25:32.660
mean, they're almost operating in a possible
00:25:32.660 --> 00:25:35.859
condition to not function like they do. Because
00:25:35.859 --> 00:25:38.880
again, as I sort of, I think before you started
00:25:38.880 --> 00:25:41.000
recording, sort of rambled quickly about the
00:25:41.000 --> 00:25:44.200
sort of macro systems that we operate, that healthcare
00:25:44.200 --> 00:25:48.220
operates within, a hospital exists to essentially
00:25:48.220 --> 00:25:53.890
provide a public good. but is forced to contend
00:25:53.890 --> 00:25:57.529
with large for -profit entities, insurance companies
00:25:57.529 --> 00:26:00.829
who exist solely to make money. I don't care
00:26:00.829 --> 00:26:03.210
who says what about anything. If you're in a
00:26:03.210 --> 00:26:06.789
public market exchange, you have an obligation
00:26:06.789 --> 00:26:09.509
to your shareholders first. You can literally
00:26:09.509 --> 00:26:13.210
be sued if they think you are not acting in their
00:26:13.210 --> 00:26:14.950
best interest, which is to return as much money
00:26:14.950 --> 00:26:17.190
to them as possible. And so we've pitted these
00:26:17.190 --> 00:26:19.910
two entity types against one another. And we've
00:26:19.910 --> 00:26:22.670
said to one, well, also provide a public good.
00:26:23.150 --> 00:26:25.089
And then we said to the other, do whatever you
00:26:25.089 --> 00:26:27.789
want, make as much money as possible. That's
00:26:27.789 --> 00:26:31.049
your purpose. What do you think the response
00:26:31.049 --> 00:26:32.849
in the healthcare system is going to be? All
00:26:32.849 --> 00:26:35.329
right. We're in an arms race and the arms are
00:26:35.329 --> 00:26:39.109
money and finance and size and scale and leverage
00:26:39.109 --> 00:26:41.690
and instrument and all these kinds of things
00:26:41.690 --> 00:26:43.789
that have nothing to do with treating a patient
00:26:43.789 --> 00:26:46.460
well. they have only to do with a financial battle
00:26:46.460 --> 00:26:51.099
that we've set them upon. And so that has been
00:26:51.099 --> 00:26:54.200
probably the biggest shift. And that's one example,
00:26:54.200 --> 00:26:56.880
but that's probably the most salient example.
00:26:56.920 --> 00:27:01.440
And don't get me wrong, I still retain my misgivings
00:27:01.440 --> 00:27:05.940
and suspicions about large health systems owning
00:27:05.940 --> 00:27:09.259
private jets and having big accounts in the Caymans
00:27:09.259 --> 00:27:11.900
with hundreds of millions of dollars and things
00:27:11.900 --> 00:27:15.029
of that nature. But again, sort of looking at
00:27:15.029 --> 00:27:17.029
the macro environment, the systems in which they
00:27:17.029 --> 00:27:19.410
operate, gives me a totally different perspective.
00:27:19.589 --> 00:27:21.210
It also gives a totally different perspective
00:27:21.210 --> 00:27:23.990
on, you know, the clinic down the road with two
00:27:23.990 --> 00:27:26.509
docs and how they're running things and how it's
00:27:26.509 --> 00:27:29.930
challenging, but also what their opportunities
00:27:29.930 --> 00:27:32.609
are. Because if you can design macrosystems,
00:27:32.630 --> 00:27:35.670
you can design microsystems similarly that can
00:27:35.670 --> 00:27:39.269
give you really great output and outcomes. What's
00:27:39.269 --> 00:27:42.359
the history there? Why did we decide that the
00:27:42.359 --> 00:27:45.279
organizations delivering the care need to be
00:27:45.279 --> 00:27:48.079
non -profit versus everyone else including pharma
00:27:48.079 --> 00:27:51.359
and insurance and medical device can be for -profit.
00:27:51.619 --> 00:27:54.039
Now we are seeing a shift here with the consumerization
00:27:54.039 --> 00:27:56.940
of health care. Companies like Rose and Forhams
00:27:56.940 --> 00:28:00.319
and Cerebral and there's a Function Health and
00:28:00.319 --> 00:28:03.500
there's so many of them coming up where the care
00:28:03.500 --> 00:28:06.539
delivery part of health care is for -profit as
00:28:06.539 --> 00:28:09.940
well now. So why did this happen? Do you think
00:28:09.940 --> 00:28:13.519
this change is good? for patients or consumers
00:28:13.519 --> 00:28:18.380
and yeah, would it be better if the care delivery
00:28:18.380 --> 00:28:21.359
was for profit and then pharma med device and
00:28:21.359 --> 00:28:23.519
insurance and maybe those I shouldn't be lumping
00:28:23.519 --> 00:28:27.740
them together are non -profit. That's an interesting
00:28:27.740 --> 00:28:30.660
question probably someone more Historically inclined
00:28:30.660 --> 00:28:34.480
could answer it better But I think yeah, I forget
00:28:34.480 --> 00:28:37.640
we just bash traditional education. So yeah I
00:28:37.640 --> 00:28:40.099
didn't pay any attention. No, they don't they
00:28:40.099 --> 00:28:41.579
certainly don't tell you all these things though
00:28:41.579 --> 00:28:44.519
in history class but so Funnily enough and and
00:28:44.519 --> 00:28:45.740
I will tell a little bit of history because I
00:28:45.740 --> 00:28:47.920
do know this one I might get some of the exact
00:28:47.920 --> 00:28:50.740
details wrong, but so Sort of modern day health
00:28:50.740 --> 00:28:54.240
insurance, as we know it, started with Baylor
00:28:54.240 --> 00:28:56.880
University in Texas because they had a hospital
00:28:56.880 --> 00:28:59.039
and their revenues were declining. So a gentleman
00:28:59.039 --> 00:29:01.039
whose name I forget, but I wrote an article about
00:29:01.039 --> 00:29:03.039
it. You can read it at thehealthcarebreakdown
00:29:03.039 --> 00:29:08.519
.com. He, which is I think a really great strategy
00:29:08.519 --> 00:29:11.279
is a brilliant stroke. on his part, he decided
00:29:11.279 --> 00:29:13.400
that he would go to the teachers union of Dallas
00:29:13.400 --> 00:29:16.799
and say to them for the low, low price of, it
00:29:16.799 --> 00:29:20.019
was like 50 cents a month or whatever it was,
00:29:20.319 --> 00:29:23.619
um, you can come to the hospital, stay, we'll
00:29:23.619 --> 00:29:25.920
cover your, it'll be $5. You could stay for a
00:29:25.920 --> 00:29:27.599
week and everything after that, like we'll cover
00:29:27.599 --> 00:29:30.759
it. So, you know, the details are a little, you
00:29:30.759 --> 00:29:32.460
know, whatever. And like the length of stay that
00:29:32.460 --> 00:29:35.750
it covered, but effectively he created. insurance
00:29:35.750 --> 00:29:38.490
model for his narrow network for Baylor. And
00:29:38.490 --> 00:29:40.609
if they just paid them, he was the first pay
00:29:40.609 --> 00:29:43.450
vider kind of, and there are iterations of insurance
00:29:43.450 --> 00:29:47.849
before that. This is more modern. And he really
00:29:47.849 --> 00:29:50.650
launched insurance sort of as we know, hospital
00:29:50.650 --> 00:29:53.789
insurance, part A, if you will, of insurance.
00:29:54.250 --> 00:29:56.819
And I believe it was called Blue Cross. is what
00:29:56.819 --> 00:29:59.960
he called it. And then up in, I think it was
00:29:59.960 --> 00:30:02.059
California, there was like a loggers association.
00:30:02.440 --> 00:30:05.240
And they found that, and it was a few years later,
00:30:05.240 --> 00:30:08.759
they found at the time that their loggers, obviously
00:30:08.759 --> 00:30:10.680
it's dangerous work. They were getting hurt very
00:30:10.680 --> 00:30:12.779
often. And so they didn't want to go work anymore
00:30:12.779 --> 00:30:15.359
because they get hurt. And then they'd have to
00:30:15.359 --> 00:30:17.640
pay all this, you know, doctors and this and
00:30:17.640 --> 00:30:19.940
that, and they couldn't afford it. So they thought
00:30:19.940 --> 00:30:22.900
to themselves, what if we paid, the employer
00:30:22.900 --> 00:30:27.210
paid. for the medical bills of these individuals
00:30:27.210 --> 00:30:30.029
who are working for us. They called it Blue Shield.
00:30:30.950 --> 00:30:34.569
And, you know, the physician side, the part B
00:30:34.569 --> 00:30:37.950
sort of was born out of that. And of course,
00:30:38.089 --> 00:30:41.069
the sort of the rest is really history from that,
00:30:41.109 --> 00:30:43.730
but those were the origins. And so we look at
00:30:43.730 --> 00:30:46.869
it, the point of rounding back around is like
00:30:46.869 --> 00:30:50.029
the birth of this was really one side, maybe
00:30:50.029 --> 00:30:53.490
employee protection or... benefits really, how
00:30:53.490 --> 00:30:55.589
do I get people to want to work here? Well, I'll
00:30:55.589 --> 00:30:57.670
make sure that if a saw slices your fingers off,
00:30:57.710 --> 00:31:00.450
I'll pay for the finger reattachment or whatever.
00:31:01.549 --> 00:31:03.529
And the other side was like, our revenue is declining.
00:31:03.690 --> 00:31:06.349
How do we smooth it out and make sure that we
00:31:06.349 --> 00:31:08.289
get money in, even if patients aren't coming
00:31:08.289 --> 00:31:11.690
in the door? And then they've really amalgamated
00:31:11.690 --> 00:31:13.829
since then. But then on the flip side is you
00:31:13.829 --> 00:31:15.450
have the hospitals, you have the health systems.
00:31:15.470 --> 00:31:17.690
And I think my nonprofit ends up being a misnomer.
00:31:17.880 --> 00:31:20.119
We're really talking about a tax exempt entity
00:31:20.119 --> 00:31:24.140
and they are granted their tax exemption because
00:31:24.140 --> 00:31:28.859
they theoretically, and they do, but they provide,
00:31:28.859 --> 00:31:31.660
you know, disproportionate share. They follow
00:31:31.660 --> 00:31:33.579
EMTALA. So they have to take anybody, which is
00:31:33.579 --> 00:31:35.220
a federal statute anyway. So they have to do
00:31:35.220 --> 00:31:37.099
it, even if they weren't, obviously HCA has,
00:31:37.180 --> 00:31:38.759
can't turn anybody away and they're a for -profit
00:31:38.759 --> 00:31:41.680
entity, but they, you know, they take Medicaid
00:31:41.680 --> 00:31:45.259
pay all this different stuff. So it allows them
00:31:45.259 --> 00:31:48.200
basically operate. I mean. And in a way, they
00:31:48.200 --> 00:31:50.779
still operate the same. The difference in nonprofit
00:31:50.779 --> 00:31:52.599
and for -profit is just they don't have shareholders.
00:31:52.759 --> 00:31:56.819
They can derive enterprise value. But they have
00:31:56.819 --> 00:32:00.079
bondholders because they issue debt and they
00:32:00.079 --> 00:32:03.759
trade still. And you can buy bonds, revenue bonds,
00:32:03.839 --> 00:32:06.759
for a hospital. And they get rated by Fitch and
00:32:06.759 --> 00:32:09.579
these ratings. I didn't know that. OK. Yeah.
00:32:09.779 --> 00:32:12.240
So that's really the interesting part. So nonprofit
00:32:12.240 --> 00:32:15.599
just means that they don't have shareholders
00:32:15.599 --> 00:32:18.259
that they pay out their profits to. They retain
00:32:18.259 --> 00:32:20.680
them and keep them. But then, like, if Ascension
00:32:20.680 --> 00:32:24.359
wants to open a new hospital, they cost a billion
00:32:24.359 --> 00:32:26.660
dollars, they're going to go issue a revenue
00:32:26.660 --> 00:32:30.359
bond. And private market individuals, a lot of
00:32:30.359 --> 00:32:32.099
times because they're tax -exempt, because it's
00:32:32.099 --> 00:32:34.440
a tax -exempt entity, will go and buy the bond
00:32:34.440 --> 00:32:37.109
and they raise corporate debt. And so they don't
00:32:37.109 --> 00:32:39.130
have shareholders, but all of their financial
00:32:39.130 --> 00:32:41.369
incentives are aligned to the debt that they
00:32:41.369 --> 00:32:44.170
have to issue because no one's going to lend
00:32:44.170 --> 00:32:46.069
you money if they don't think that you can pay
00:32:46.069 --> 00:32:49.049
them back. And your bond will become useless
00:32:49.049 --> 00:32:52.609
if the company becomes insolvent. So we've really
00:32:52.609 --> 00:32:55.509
created this interesting, you know, financial
00:32:55.509 --> 00:32:57.789
incentive and we wonder sort of a little bit
00:32:57.789 --> 00:33:00.869
why some of these large nonprofit organizations,
00:33:01.190 --> 00:33:03.099
a lot of it's because they have to One, they
00:33:03.099 --> 00:33:05.440
have to cover their debt, and two, it's a financial
00:33:05.440 --> 00:33:08.019
instrument. They're providing a return despite
00:33:08.019 --> 00:33:10.380
it not being a stock exchange type of return
00:33:10.380 --> 00:33:13.779
on these bonds. So they're quote unquote non
00:33:13.779 --> 00:33:16.220
-profit. They're really tax -exempt. So we think
00:33:16.220 --> 00:33:18.839
about them in this light, but they're care delivery.
00:33:19.220 --> 00:33:22.559
So it's altruistic, and there are all these regulations
00:33:22.559 --> 00:33:23.880
around it. They have to see these patients, and
00:33:23.880 --> 00:33:25.539
we have Medicaid, and you can't turn anybody,
00:33:25.660 --> 00:33:29.960
all this stuff. But at the same time, They're
00:33:29.960 --> 00:33:32.940
in this sort of amalgamated mess of everyone's
00:33:32.940 --> 00:33:35.039
chasing the dollars and all this industries around
00:33:35.039 --> 00:33:37.579
it. There's so much money going into it. Even
00:33:37.579 --> 00:33:39.200
back in the day, there was so much money going
00:33:39.200 --> 00:33:42.839
in that the industry just developed around it.
00:33:43.220 --> 00:33:46.339
I mean, and it's become this sort of behemoth
00:33:46.339 --> 00:33:48.839
and monster. And I don't know that it's, I don't
00:33:48.839 --> 00:33:50.359
think that it was by design at all. It's just
00:33:50.359 --> 00:33:52.619
a function again of a macro system in which it
00:33:52.619 --> 00:33:56.240
operated, you know, profit driven capitalist
00:33:56.240 --> 00:34:00.779
system. If a hospital sees, you know, hundreds
00:34:00.779 --> 00:34:03.579
of thousands of patients a year and they need
00:34:03.579 --> 00:34:06.319
tools to see them better and to do whatever,
00:34:06.460 --> 00:34:08.800
I'm going to go build a tool and go sell it to
00:34:08.800 --> 00:34:11.920
them. Or I'm going to, you know, make a drug
00:34:11.920 --> 00:34:14.440
and then go sell it to the doctor to sell to
00:34:14.440 --> 00:34:16.559
the patient. You know, it just, the industry
00:34:16.559 --> 00:34:20.860
was created around this incredible need, but
00:34:20.860 --> 00:34:23.280
pharma device, et cetera, et cetera, has stayed
00:34:23.280 --> 00:34:27.179
largely out of the realm of. the same type of
00:34:27.179 --> 00:34:30.639
kind of regulation, or at least maybe even more
00:34:30.639 --> 00:34:36.639
sociologically, the focus of being a public good
00:34:36.639 --> 00:34:40.579
because they were sort of an industry created
00:34:40.579 --> 00:34:44.199
to help the public good entity that already existed
00:34:44.199 --> 00:34:46.360
independent. And they just kept growing. And
00:34:46.360 --> 00:34:48.780
by the time anybody said, wait a second, it's
00:34:48.780 --> 00:34:51.099
too late because now they're multi -billion dollar
00:34:51.099 --> 00:34:53.920
companies with lobbyists and lobby arms and all
00:34:53.920 --> 00:34:57.119
this stuff. It's kind of over. You know, we can't
00:34:57.119 --> 00:35:02.260
pull that hydra back in. You said the purpose
00:35:02.260 --> 00:35:04.719
or one of the missions for forward slash health
00:35:04.719 --> 00:35:07.760
is to help clinicians take back health care.
00:35:08.739 --> 00:35:12.000
How do you think clinicians have lost their reins
00:35:12.000 --> 00:35:16.059
on health care if they ever had it? And what's
00:35:16.059 --> 00:35:19.940
your plan to help them take it back? So I think
00:35:20.650 --> 00:35:23.969
You know that the reins have been lost a little
00:35:23.969 --> 00:35:27.590
bit just because I mean really of the function
00:35:27.590 --> 00:35:32.610
of what we see now and again, it's It says everything
00:35:32.610 --> 00:35:35.590
has grown as the economy has gotten bigger as
00:35:35.590 --> 00:35:38.510
everything's been more important scale and size
00:35:38.510 --> 00:35:41.829
and money and this and that and we talk about
00:35:41.829 --> 00:35:44.829
hospitals a lot, but they're all kinds of different
00:35:44.829 --> 00:35:47.090
organizations and corporate entities and You
00:35:47.090 --> 00:35:49.789
know, Optum employs like a hundred thousand physicians
00:35:49.789 --> 00:35:53.250
these days, and it's just kind of wild, but it
00:35:53.250 --> 00:35:56.570
was the shift, the sort of maybe necessary, maybe
00:35:56.570 --> 00:35:58.590
unnecessary, maybe it shouldn't have ever gotten
00:35:58.590 --> 00:36:03.090
there, but you know, if you're busy treating
00:36:03.090 --> 00:36:06.250
patients all day long, and even if you think
00:36:06.250 --> 00:36:08.889
about it from way back in the day in the 1950s
00:36:08.889 --> 00:36:12.090
and 60s, and it was a very different model. you
00:36:12.090 --> 00:36:14.550
know, more and more people had insurance, but
00:36:14.550 --> 00:36:16.769
it was still a new thing. And it was still, you
00:36:16.769 --> 00:36:19.389
know, whatever, but they're private and you look
00:36:19.389 --> 00:36:21.670
around and you see what are the opportunities.
00:36:22.929 --> 00:36:25.369
And doctors are doing what they've always done.
00:36:25.469 --> 00:36:28.269
You're treating patients and you're seeing them,
00:36:28.269 --> 00:36:31.349
but now you're in this sort of weird quandary
00:36:31.349 --> 00:36:34.869
because someone else is now footing most of the
00:36:34.869 --> 00:36:37.750
bill because, you know, insurance became tied
00:36:37.750 --> 00:36:42.300
to employment during World War II with wage freezes
00:36:42.300 --> 00:36:45.699
in the United States, because the large employers
00:36:45.699 --> 00:36:47.800
said, well, how do we incentivize if we can't
00:36:47.800 --> 00:36:50.920
just pay people more? That was the only benefits.
00:36:51.280 --> 00:36:55.519
We can pay for their health care. And so by 1950,
00:36:56.300 --> 00:37:00.960
it was in the 40s, I think it was. 7%, something
00:37:00.960 --> 00:37:04.079
super low. People had health insurance and by
00:37:04.079 --> 00:37:06.639
the end of the fifties, it was like 60 something
00:37:06.639 --> 00:37:09.179
percent because it was all employer based. And
00:37:09.179 --> 00:37:11.440
then we've that train is gone and it's run away
00:37:11.440 --> 00:37:14.380
obviously by now. But so then you have these
00:37:14.380 --> 00:37:16.639
interesting dynamics that doctors have been doing
00:37:16.639 --> 00:37:18.480
what you've always done. Care for people, you
00:37:18.480 --> 00:37:22.079
see patients, but now their payer source is different.
00:37:22.420 --> 00:37:25.369
Who's paying them? These entities are You know,
00:37:25.590 --> 00:37:27.829
it becoming increasingly powerful and they're
00:37:27.829 --> 00:37:30.130
now want to pay because they take premium, you
00:37:30.130 --> 00:37:32.789
know, the whole calculation of insurance. And
00:37:32.789 --> 00:37:35.349
then you have more industries coming in to serve
00:37:35.349 --> 00:37:37.030
hospitals because more people have healthcare
00:37:37.030 --> 00:37:39.769
now. And can pay, you know, someone, someone
00:37:39.769 --> 00:37:42.650
else pays. So the industry is just all quickly,
00:37:42.889 --> 00:37:44.570
very quickly maturing and growing because there's
00:37:44.570 --> 00:37:47.469
so much dollars coming into it. And meanwhile,
00:37:47.610 --> 00:37:50.309
doctors are doing like what we need you to do
00:37:50.309 --> 00:37:54.119
is take care of us. And so. But people are paying
00:37:54.119 --> 00:37:55.539
them less. People are calling them more. People
00:37:55.539 --> 00:37:59.219
are pitching them things. So you need to react
00:37:59.219 --> 00:38:00.960
and you need to build a business around what
00:38:00.960 --> 00:38:03.800
you just normally did sort of as a physician.
00:38:03.840 --> 00:38:05.719
And you could just go on house calls and do this
00:38:05.719 --> 00:38:08.280
and you pay this money and whatever. And it's
00:38:08.280 --> 00:38:11.500
just grown up around it more leverage from payers.
00:38:11.659 --> 00:38:13.719
So the business just got out of control because
00:38:13.719 --> 00:38:17.909
there wasn't time. There wasn't any. ability
00:38:17.909 --> 00:38:20.389
to counteract some really quickly developing
00:38:20.389 --> 00:38:23.429
forces that were acting on the business front.
00:38:23.570 --> 00:38:26.590
And then I think, you know, by the, was it 70s,
00:38:26.590 --> 00:38:29.610
HMO introduction, you know, and then all of the
00:38:29.610 --> 00:38:32.429
different acts in the 80s and then admin just
00:38:32.429 --> 00:38:35.110
exploded. And then we see the, you know, cost
00:38:35.110 --> 00:38:36.969
curves of healthcare really shoot up like in
00:38:36.969 --> 00:38:39.829
a hockey stick because of everything that required.
00:38:39.949 --> 00:38:42.530
So I think that's how it got sort of out of control.
00:38:43.409 --> 00:38:46.719
I think it's, I don't know. Perhaps Pandora's
00:38:46.719 --> 00:38:49.219
box is open and it's impossible to close. I don't,
00:38:49.420 --> 00:38:51.840
I like to think that that's not the case. And
00:38:51.840 --> 00:38:54.420
whether it's sort of, let's just go build something
00:38:54.420 --> 00:38:57.059
outside of the current system, whether the system's
00:38:57.059 --> 00:38:59.519
going to melt down and completely break, you
00:38:59.519 --> 00:39:02.219
know, I don't know, but I just do know that there
00:39:02.219 --> 00:39:04.960
was a, there was, and we see it, we see people
00:39:04.960 --> 00:39:07.420
going back to these old ways and it's working
00:39:07.420 --> 00:39:09.900
really well for doctors and for patients. And
00:39:09.900 --> 00:39:12.780
I spent today two hours, which honestly was a
00:39:12.780 --> 00:39:14.599
little long, but. It was great. With a physical
00:39:14.599 --> 00:39:19.300
therapist whose cash only pay, and it's less
00:39:19.300 --> 00:39:22.440
expensive than if I used insurance. And people
00:39:22.440 --> 00:39:25.659
don't think about it like that, but if I paid
00:39:25.659 --> 00:39:29.780
insurance, I'd have to pay my premium just to
00:39:29.780 --> 00:39:32.500
be able to then pay for the care, which is, you
00:39:32.500 --> 00:39:35.699
know, 40 minutes rushed with three other people.
00:39:35.960 --> 00:39:37.760
And it really amounts to probably the same amount
00:39:37.760 --> 00:39:39.719
of money if I didn't need my deductible, whatever,
00:39:39.780 --> 00:39:42.300
whatever. And someone pays that deductible, right?
00:39:42.300 --> 00:39:45.019
If I've met it, someone's paying. So it's so
00:39:45.019 --> 00:39:47.239
much more expensive. And I think when people
00:39:47.239 --> 00:39:50.019
start really seeing that, seeing that clinicians
00:39:50.019 --> 00:39:51.739
are driving all of the value in healthcare and
00:39:51.739 --> 00:39:55.980
who we need, but we need them now in those positions,
00:39:56.219 --> 00:39:57.940
thinking about the business. Cause at the end
00:39:57.940 --> 00:40:00.659
of the day too, I mean, it's a service. It's
00:40:00.659 --> 00:40:03.820
an exchange of value. Um, there's altruism there
00:40:03.820 --> 00:40:07.400
a thousand percent, but it's a job. It's a livelihood.
00:40:08.000 --> 00:40:10.639
positions have been getting paid for centuries,
00:40:11.019 --> 00:40:14.139
millennia. You know, that's not going to go away,
00:40:14.219 --> 00:40:15.900
but just the business model is so broken. So
00:40:15.900 --> 00:40:17.800
we just need the clinicians to start, we need
00:40:17.800 --> 00:40:20.880
the public to sort of see what's happening, understand
00:40:20.880 --> 00:40:22.420
how the money really flows. And then the clinicians
00:40:22.420 --> 00:40:25.039
just be prepared, ready in the positions to say,
00:40:25.039 --> 00:40:27.559
all right, I can do this. I can manage the finance.
00:40:27.699 --> 00:40:29.880
I can do the operations. I can, whether you want
00:40:29.880 --> 00:40:32.699
to be a big organization or just you going on
00:40:32.699 --> 00:40:35.559
house calls, you know, four days a week, whatever.
00:40:35.920 --> 00:40:40.929
It can work. Moving back to AI and I'll ask you
00:40:40.929 --> 00:40:44.869
to kind of use your philosophy degree and I'll
00:40:44.869 --> 00:40:47.349
see if you've paid attention maybe. I did not.
00:40:48.530 --> 00:40:52.489
I got a D in biology and a D in chemistry, but
00:40:52.489 --> 00:40:54.150
still made it all the way through med school.
00:40:55.750 --> 00:41:00.889
Do you think we're pushing very fast in the AI
00:41:00.889 --> 00:41:05.690
world towards general intelligence? And general
00:41:05.690 --> 00:41:09.349
intelligence is defined by not the general intelligence
00:41:09.349 --> 00:41:14.489
of the average human, and that's maybe the terminology
00:41:14.489 --> 00:41:17.230
needs a little bit more correction there, but
00:41:17.230 --> 00:41:20.730
AI becoming the smartest human in each individual
00:41:20.730 --> 00:41:24.130
field. So playing chess like Magnus Carlsen,
00:41:24.389 --> 00:41:26.690
building companies, and there's a very polarizing
00:41:26.690 --> 00:41:31.769
figure, but like Elon Musk. Do you think we...
00:41:32.030 --> 00:41:35.030
We're making a mistake, because throughout history,
00:41:35.670 --> 00:41:38.989
we have always been the smartest species. And
00:41:38.989 --> 00:41:41.610
that's good. I think we've survived and we've
00:41:41.610 --> 00:41:45.849
maintained power, if you want to use that word,
00:41:46.550 --> 00:41:50.730
over the world. And every other, even more dangerous
00:41:50.730 --> 00:41:54.090
species like lions and tigers, we are the ones
00:41:54.090 --> 00:41:56.639
in charge. Do you think we're making a mistake
00:41:56.639 --> 00:41:58.980
by we're letting, you know, maybe opposable thumbs
00:41:58.980 --> 00:42:02.559
is the other advantage we have, but the main
00:42:02.559 --> 00:42:05.179
one being intelligence. Do you think we're making
00:42:05.179 --> 00:42:10.219
a mistake by, you know, ceding that to, and we're
00:42:10.219 --> 00:42:12.480
building something that that's going to be more
00:42:12.480 --> 00:42:17.440
intelligent than we are? I don't know. My gut
00:42:17.440 --> 00:42:21.300
reaction is yes. Like I sort of, maybe this is
00:42:21.300 --> 00:42:24.400
the worst forum to say this on, but like, I low
00:42:24.400 --> 00:42:30.500
key kind of hate AI a lot because first of all,
00:42:30.679 --> 00:42:33.579
I mean, I use ChatGPT and I find it to be...
00:42:33.579 --> 00:42:36.699
Do you mean like it's a love -hate kind of...
00:42:36.699 --> 00:42:40.099
I don't know. I kind of feel like it's just hate,
00:42:40.340 --> 00:42:42.519
honestly, because I see value in it because I
00:42:42.519 --> 00:42:45.239
use it because it's faster. I'm really bad. I've
00:42:45.239 --> 00:42:46.679
always been really bad at like internet searches.
00:42:46.760 --> 00:42:48.920
I just don't know how to ask questions well,
00:42:48.920 --> 00:42:50.909
maybe. describe what I'm trying to look for.
00:42:51.070 --> 00:42:55.070
So I find it helpful in that regard, but it makes
00:42:55.070 --> 00:42:59.010
things up. It's weirdly agreeable. It's just
00:42:59.010 --> 00:43:01.670
sort of, you know, and smarter people than me
00:43:01.670 --> 00:43:03.230
obviously have built these in multi -billion
00:43:03.230 --> 00:43:05.570
dollar companies and this and that. But I sort
00:43:05.570 --> 00:43:07.789
of think about like fundamentally too, and we
00:43:07.789 --> 00:43:09.690
started this off in like traditional education
00:43:09.690 --> 00:43:12.369
and our kids and just different things. And,
00:43:12.409 --> 00:43:14.889
you know, if I find myself sitting down to write
00:43:14.889 --> 00:43:18.869
something and I think, oh man, this is gonna
00:43:18.869 --> 00:43:20.869
be hard. It's gonna be like a few pages and this
00:43:20.869 --> 00:43:22.710
and that. And I just might, I don't even really
00:43:22.710 --> 00:43:24.929
know where to start. And then I just go, let
00:43:24.929 --> 00:43:27.630
me just see what chat GPT can come up with first.
00:43:28.110 --> 00:43:31.809
And I mean, I just don't like that. I don't like
00:43:31.809 --> 00:43:35.269
that for me. I don't know that I like it for
00:43:35.269 --> 00:43:37.409
humanity in a way. Part of me is like, that's
00:43:37.409 --> 00:43:38.869
fine. Cause I'll have a competitive advantage.
00:43:38.909 --> 00:43:41.750
Cause everyone will stop. We'll forget how to
00:43:41.750 --> 00:43:44.739
think. but in a way to see like we've been on
00:43:44.739 --> 00:43:46.519
that bandwagon we've been on that train for a
00:43:46.519 --> 00:43:49.320
long time i mean scrolling instagram and tiktok
00:43:49.320 --> 00:43:52.880
and just checking out and consumption over thought
00:43:52.880 --> 00:43:55.699
process and creation and things like that this
00:43:55.699 --> 00:43:59.420
is just sort of the next version of it i do think
00:43:59.420 --> 00:44:04.179
there's some real danger whether it's terminator
00:44:04.179 --> 00:44:07.699
3 take over the world i robot whatever which
00:44:07.699 --> 00:44:11.199
people think it is and can be and i saw some
00:44:11.760 --> 00:44:15.280
interesting studies recently about AI self -preservation
00:44:15.280 --> 00:44:19.559
and lying and threatening and blackmailing and
00:44:19.559 --> 00:44:24.179
stuff, which is real chat terrifying. But on
00:44:24.179 --> 00:44:28.719
the other side, the humanity danger of us ending
00:44:28.719 --> 00:44:32.199
up in a Wally situation where no one talks to
00:44:32.199 --> 00:44:34.760
one another, we can't think anymore, there's
00:44:34.760 --> 00:44:38.360
no social interaction. It's just me in a computer
00:44:38.360 --> 00:44:42.050
in a room because I can chat with AI or ask it
00:44:42.050 --> 00:44:44.030
questions. Cause like, I don't, I'm too lazy
00:44:44.030 --> 00:44:46.190
to figure it out or even think about it. And
00:44:46.190 --> 00:44:49.809
eventually what, how do we even know if, you
00:44:49.809 --> 00:44:51.989
know, all the great writers and content creators
00:44:51.989 --> 00:44:54.369
and they say, yeah, I use AI, but I'm still thinking
00:44:54.369 --> 00:44:57.389
I'm just helping me be more efficient and effective.
00:44:57.889 --> 00:45:01.969
And it's like the computer. Yeah. And like it's
00:45:01.969 --> 00:45:04.550
the, it's the internet, you know, or it's what
00:45:04.550 --> 00:45:07.670
a law professor who is funny and he's old school
00:45:07.670 --> 00:45:11.119
guy. He was like, yeah, my law firm, uh, I voted
00:45:11.119 --> 00:45:13.920
against having a computer in the firm. We took
00:45:13.920 --> 00:45:16.300
a, you know, partner's vote and I just thought
00:45:16.300 --> 00:45:18.980
we don't need this and this is weird and whatever.
00:45:19.119 --> 00:45:21.400
And so we think of that now as being silly and
00:45:21.400 --> 00:45:23.340
maybe AI becomes the same thing. But I think
00:45:23.340 --> 00:45:27.260
that one of the biggest dangers is the societal
00:45:27.260 --> 00:45:29.980
element of, are we going to forget how to think?
00:45:30.039 --> 00:45:31.300
Are we going to forget how to interact? Cause
00:45:31.300 --> 00:45:33.679
yeah, again, you can be the smart person who
00:45:33.679 --> 00:45:37.920
uses it to help fuel your efficiency. But one.
00:45:38.980 --> 00:45:41.840
Efficiency to what end? Like, do we need that?
00:45:42.639 --> 00:45:45.380
Or do you want to be so hyper -efficient? Like,
00:45:45.480 --> 00:45:49.079
why? At the expense of what? And then, yeah,
00:45:49.159 --> 00:45:51.980
it works now until maybe it doesn't because then
00:45:51.980 --> 00:45:54.820
it's such a crutch that you really have forgotten
00:45:54.820 --> 00:45:56.219
some of those fundamental things you thought
00:45:56.219 --> 00:45:58.480
you had sort of control over. So, I don't know.
00:45:58.719 --> 00:46:02.300
Jury's out for sure. I, you know, low -key kind
00:46:02.300 --> 00:46:04.559
of hate it because sometimes I feel like it makes
00:46:04.559 --> 00:46:07.739
me a little bit less sharp because I... I don't
00:46:07.739 --> 00:46:10.780
like to rely on it. I want to think and, you
00:46:10.780 --> 00:46:13.719
know, write and struggle through things. And
00:46:13.719 --> 00:46:16.900
it's making the struggle too easy in a way. And
00:46:16.900 --> 00:46:18.820
then what's that going to do for the future generation?
00:46:19.360 --> 00:46:21.659
Because again, we talked about it. I don't think
00:46:21.659 --> 00:46:24.900
knowing facts is super important. Certainly don't
00:46:24.900 --> 00:46:27.079
need to know with chat GPT around or whatever.
00:46:27.400 --> 00:46:31.440
Um, but thinking is important. If you put a 10
00:46:31.440 --> 00:46:35.179
year old in front of a computer with AI, they're
00:46:35.179 --> 00:46:37.679
never going to have to learn how to think. That's
00:46:37.679 --> 00:46:42.519
a problem. Let's push deeper here. If we build
00:46:42.519 --> 00:46:45.500
a world where everything is convenient and easy
00:46:45.500 --> 00:46:49.380
and you are constantly fed dopamine hits, and
00:46:49.380 --> 00:46:51.539
I do realize there's this somewhat of a hedonic
00:46:51.539 --> 00:46:53.940
treadmill where you need more and more hits or
00:46:53.940 --> 00:46:58.039
a higher concentration of dopamine maybe, why
00:46:58.039 --> 00:47:00.119
is thinking important? And this may sound like
00:47:00.119 --> 00:47:03.099
a silly question, and maybe it is a silly question,
00:47:03.599 --> 00:47:07.289
but... Why do we need to know how to think if
00:47:07.289 --> 00:47:09.889
everything is easy and AI creates this world
00:47:09.889 --> 00:47:13.050
of abundance and everything is given to us? I
00:47:13.050 --> 00:47:15.050
think that's a great question, honestly, and
00:47:15.050 --> 00:47:18.449
one that maybe I haven't even thought about too
00:47:18.449 --> 00:47:22.630
much. It's a fascinating question, actually.
00:47:23.429 --> 00:47:26.610
Because, yeah, I guess at the end of the day,
00:47:26.710 --> 00:47:28.590
but who knows? I don't know. I was going to say
00:47:28.590 --> 00:47:30.190
at the end of the day, someone's got to pull
00:47:30.190 --> 00:47:32.489
the strings or something, but maybe not. Maybe
00:47:32.489 --> 00:47:36.449
the computer just pulls the strings and we just
00:47:36.449 --> 00:47:41.690
float around in our Wally hover chairs or, you
00:47:41.690 --> 00:47:45.530
know, fluid and we're just bad dopamine hits
00:47:45.530 --> 00:47:48.750
and none of us exist and really, but we're all
00:47:48.750 --> 00:47:51.730
happy. And so maybe there's, maybe that's fine.
00:47:52.130 --> 00:47:56.869
And maybe there's a no existential crisis. to
00:47:56.869 --> 00:47:59.429
new existence because I mean if we're for all
00:47:59.429 --> 00:48:01.289
ultimately chasing happiness and there's some
00:48:01.289 --> 00:48:04.130
way that that happens and then we just but then
00:48:04.130 --> 00:48:06.829
I guess the question is and maybe maybe one day
00:48:06.829 --> 00:48:09.949
it'll be weird archaic thinking is that I don't
00:48:09.949 --> 00:48:15.769
know we are products of the earth and land and
00:48:15.769 --> 00:48:19.750
evolution and we're animals and we're you know
00:48:19.750 --> 00:48:22.849
I want to run up a mountain and do hard things
00:48:22.849 --> 00:48:25.460
and struggle and like there's There's beauty
00:48:25.460 --> 00:48:29.260
in all of those and all of the bad elements of
00:48:29.260 --> 00:48:32.800
life too, you know, and connection and this and
00:48:32.800 --> 00:48:35.300
that. And again, we could have the philosophical
00:48:35.300 --> 00:48:36.800
debate. It's like, great. Well, what if you were,
00:48:36.860 --> 00:48:39.300
you know, the brain in the vat thought experiment,
00:48:39.500 --> 00:48:41.000
what if you're just a brain in a vat and it's
00:48:41.000 --> 00:48:43.400
all just like electric feeding you all the things
00:48:43.400 --> 00:48:45.460
and you thought you did all that. Cause it's
00:48:45.460 --> 00:48:47.199
like, how did we know that like any of this is
00:48:47.199 --> 00:48:48.940
real? It's just sensory interpretations in our
00:48:48.940 --> 00:48:51.780
brain. Maybe AI gets us there and maybe it's
00:48:51.780 --> 00:48:55.559
fine. But I have no idea. But for whatever reason,
00:48:55.639 --> 00:49:01.340
the prospect feels wrong, I guess, is the worst,
00:49:01.639 --> 00:49:04.539
best answer I have. That's well said, Preston.
00:49:04.579 --> 00:49:08.599
Last question. As you're building forward slash
00:49:08.599 --> 00:49:12.780
health and as I'm building matter health, a couple
00:49:12.780 --> 00:49:16.539
concepts I'm always trying to balance out is
00:49:16.539 --> 00:49:19.469
this concept of optionality and friction. when
00:49:19.469 --> 00:49:22.389
building product for consumers, both on the B2B
00:49:22.389 --> 00:49:25.449
and the B2C side. How do you think about optionality
00:49:25.449 --> 00:49:28.329
and friction? And what I mean by that is friction,
00:49:28.670 --> 00:49:31.489
it could be in the onboarding process, in the
00:49:31.489 --> 00:49:33.769
product you're building, in the user journey,
00:49:34.010 --> 00:49:36.449
and how do you leverage friction to maybe, and
00:49:36.449 --> 00:49:38.230
this goes back to maybe it ties into what we
00:49:38.230 --> 00:49:40.670
were just talking about, is friction is important.
00:49:41.210 --> 00:49:44.650
It pre -selects users that will be successful,
00:49:44.650 --> 00:49:47.530
and it gets people to experiences and values
00:49:47.530 --> 00:49:50.639
you want to deliver. And optionality is important
00:49:50.639 --> 00:49:53.119
as well, right? And how much optionality? So
00:49:53.119 --> 00:49:55.860
you can follow maybe the Apple framework, an
00:49:55.860 --> 00:49:58.260
extent where everything is designed for you.
00:49:59.079 --> 00:50:02.320
Whereas most engineers and developers want to
00:50:02.320 --> 00:50:04.780
have a lot of optionality and maybe the Android
00:50:04.780 --> 00:50:07.980
framework where you can do a lot with it. It's
00:50:07.980 --> 00:50:10.000
clear which is more successful to an extent,
00:50:10.500 --> 00:50:12.159
if you have a Steve Jobs or if you are Steve
00:50:12.159 --> 00:50:15.019
Jobs. And you can instantly listen to a consumer
00:50:15.019 --> 00:50:17.170
and say, this is what they want. based on their
00:50:17.170 --> 00:50:19.250
problems. How do you think about optionality
00:50:19.250 --> 00:50:21.050
and friction and building forest slash health?
00:50:21.570 --> 00:50:23.070
And what are some kind of lessons you've learned
00:50:23.070 --> 00:50:25.210
from your previous companies on those two levers?
00:50:26.269 --> 00:50:28.329
Yeah, optionality and friction. So I do think
00:50:28.329 --> 00:50:31.210
about friction a lot, but maybe slightly differently.
00:50:31.510 --> 00:50:35.070
I find it in, especially in a B2B space, I think
00:50:35.070 --> 00:50:39.829
about it mostly in a sales process versus necessarily
00:50:39.829 --> 00:50:44.389
a product process. Because I find that buying,
00:50:44.510 --> 00:50:47.050
not that I made a comment the other day and I
00:50:47.050 --> 00:50:48.949
was like, really our job as salespeople is to
00:50:48.949 --> 00:50:52.190
like help the customer buy something. And it's
00:50:52.190 --> 00:50:55.170
like, duh. But if you really think about it,
00:50:55.329 --> 00:50:58.289
it can be really hard to buy something that we
00:50:58.289 --> 00:51:01.269
already want. And especially in a B2B environment,
00:51:01.969 --> 00:51:04.889
because I mean, yeah, if I'm the CEO of whatever
00:51:04.889 --> 00:51:07.230
and I can just say like, sure. But even then,
00:51:07.230 --> 00:51:09.510
if I have departments and this and that, and
00:51:09.510 --> 00:51:11.070
people are going to feel different ways, if I
00:51:11.070 --> 00:51:13.250
make decisions unilaterally about their area,
00:51:13.309 --> 00:51:15.929
so it can be hard. to buy something that, you
00:51:15.929 --> 00:51:18.489
know, you objectively think is going to be a
00:51:18.489 --> 00:51:20.409
great thing. So it's, I think about friction
00:51:20.409 --> 00:51:22.969
in those terms. It's like, how do I help that
00:51:22.969 --> 00:51:26.730
person achieve what they want, which may be buying
00:51:26.730 --> 00:51:29.250
kind of a thing. But I also, it's interesting
00:51:29.250 --> 00:51:31.349
you say it, the sort of self -selection of the
00:51:31.349 --> 00:51:34.550
friction and Apple too, to an extent, because
00:51:34.550 --> 00:51:37.750
Apple has a very specific viewpoint and their
00:51:37.750 --> 00:51:41.349
specific viewpoint did the self -selection for
00:51:41.349 --> 00:51:43.789
everybody. Pretty much. And that is, I think
00:51:43.789 --> 00:51:45.809
the friction that you mean is that, you know,
00:51:45.989 --> 00:51:48.510
for this set of people, this will create a lot
00:51:48.510 --> 00:51:51.130
of friction. It's, it's basically putting your
00:51:51.130 --> 00:51:53.289
stake in the ground and saying, this is what
00:51:53.289 --> 00:51:57.130
my company is about. And, you know, it's an identity
00:51:57.130 --> 00:51:59.769
play a little bit to say, you know, Southwest
00:51:59.769 --> 00:52:02.130
airlines is a classic example. They basically
00:52:02.130 --> 00:52:04.659
said, we're not for business travelers. Like
00:52:04.659 --> 00:52:06.860
we don't have a business class. There's no expensive
00:52:06.860 --> 00:52:09.380
upgrade thing. Like you just come on this plane
00:52:09.380 --> 00:52:13.099
and we're going to compete with you driving instead
00:52:13.099 --> 00:52:16.079
of flying. And so it was sort of more about what
00:52:16.079 --> 00:52:17.500
they weren't than what they are, but that would
00:52:17.500 --> 00:52:19.940
create friction for a business traveler. And
00:52:19.940 --> 00:52:22.619
so they purposefully introduced it to weed out
00:52:22.619 --> 00:52:24.579
the certain segments that they didn't want to
00:52:24.579 --> 00:52:26.460
serve and weren't uniquely positioned to serve
00:52:26.460 --> 00:52:29.260
and be value added to them. So I think about
00:52:29.260 --> 00:52:32.739
in those ways and maybe a little less. for forward
00:52:32.739 --> 00:52:34.119
slash health, although that probably baves me,
00:52:34.179 --> 00:52:35.679
but I think about a lot for the people that we
00:52:35.679 --> 00:52:38.619
work for, because as we do strategy work, like
00:52:38.619 --> 00:52:40.599
these are the types of questions and interesting
00:52:40.599 --> 00:52:42.380
things that you can kind of start to unpack and
00:52:42.380 --> 00:52:47.900
unravel. And then in terms of optionality, we
00:52:47.900 --> 00:52:49.579
do think about that a lot. I mean, especially
00:52:49.579 --> 00:52:52.360
as a consultancy, like if people will say, well,
00:52:52.420 --> 00:52:54.559
your consultant, what does that mean? And then
00:52:54.559 --> 00:52:57.030
it's kind of like, well, you know. A good sales
00:52:57.030 --> 00:52:59.349
move is to say, well, give me an example of a
00:52:59.349 --> 00:53:00.969
pain point you're facing in your business right
00:53:00.969 --> 00:53:03.389
now, because then you're immediately just uncovering
00:53:03.389 --> 00:53:05.150
problems and maybe they're a good fit or whatever,
00:53:05.849 --> 00:53:07.639
whatever. But you can kind of do it like that.
00:53:07.639 --> 00:53:10.099
You can kind of be anything to anybody. And so,
00:53:10.099 --> 00:53:12.920
and I find that in that realm of, you know, if
00:53:12.920 --> 00:53:15.000
I'm talking to you and I'm like, I don't know,
00:53:15.059 --> 00:53:16.980
what do you need? Like what's going on? And you're
00:53:16.980 --> 00:53:19.940
like, I don't really, like unlimited options
00:53:19.940 --> 00:53:23.219
is not helpful. And even too many options because,
00:53:23.300 --> 00:53:25.400
you know, once you identify what's the unique
00:53:25.400 --> 00:53:28.679
value that you're uniquely positioned to offer
00:53:28.679 --> 00:53:30.960
to a market that actually needs it, which really
00:53:30.960 --> 00:53:33.360
narrows it down to sort of an ICP kind of framework.
00:53:33.849 --> 00:53:36.349
And then they really only need like maybe one
00:53:36.349 --> 00:53:39.550
and a half things. And so then you saying like,
00:53:39.610 --> 00:53:40.849
well, they could use this and they could use
00:53:40.849 --> 00:53:42.889
this and they get like, yeah, but they really
00:53:42.889 --> 00:53:45.869
only need one and a half things. So give them
00:53:45.869 --> 00:53:48.349
one and a half things. And then I think a lot
00:53:48.349 --> 00:53:50.409
of companies, like if you just did something
00:53:50.409 --> 00:53:53.269
different, it needs to be like different for
00:53:53.269 --> 00:53:55.789
a different problem in a different segment. Not
00:53:55.789 --> 00:53:59.289
all of these just come in and, you know, choose
00:53:59.289 --> 00:54:01.130
your own adventure. Cause I think that's again,
00:54:01.230 --> 00:54:03.380
going back to buying friction, people are going
00:54:03.380 --> 00:54:05.420
to be like, I don't know what to do. Like, they
00:54:05.420 --> 00:54:07.599
want you to tell them what to do. You're the
00:54:07.599 --> 00:54:10.159
problem solver. So optionality is a big thing
00:54:10.159 --> 00:54:12.039
we think about for Forest Slash Health. Friction
00:54:12.039 --> 00:54:14.760
is a big thing we think about for our customers
00:54:14.760 --> 00:54:17.280
and how they're designing, developing, launching
00:54:17.280 --> 00:54:19.960
products, launching tech, you know, building
00:54:19.960 --> 00:54:23.559
clinics at the same time. Awesome. Where can
00:54:23.559 --> 00:54:26.079
people find depressed and physicians are interested
00:54:26.079 --> 00:54:27.860
in working with Forest Slash Health? Where should
00:54:27.860 --> 00:54:31.079
they recheck? Yeah, always on LinkedIn hang out
00:54:31.079 --> 00:54:34.380
there a lot. So please find me on LinkedIn or
00:54:34.380 --> 00:54:37.860
forward slash health calm Preston at forward
00:54:37.860 --> 00:54:41.440
slash health calm any of those things You can
00:54:41.440 --> 00:54:44.519
find me always open to having conversations discussions
00:54:44.519 --> 00:54:47.360
seeing how we can make help Thank you. This has
00:54:47.360 --> 00:54:50.139
been amazing Thank you so much for having me
00:54:50.139 --> 00:54:51.000
appreciate the discussion