The Reverse Mullet Healthcare Podcast

Silver Bullets, Not Solutions In Search of a Problem with Rich Mulry and John Beadle

• BP2 Health • Season 1 • Episode 15

Share episode

What would it take to revolutionize healthcare as we know it? Join us as we sit down with Rich Mulry, president and CEO of Northwell Holdings, and John Beadle, managing partner of Aegis Ventures to find out the work they are doing towards that mission. Through the Digital Consortium, they are tackling some of the most pressing challenges in the industry, such as clinician burnout and health equity. This episode makes it clear that Digital Health isn’t dead, there just may be more creative alternatives for funding and development to make solutions silver bullets, not solutions in search of problems.

 Rich shares his belief that REAL change can happen if we take advantage of the technology solutions that exist and custom tailor them both to meeting consumers and patients where they are. While John also doubles down on technology adding that it needs to more closely link the design, development and implementation of solutions with the challenges that those are experiencing within the health system on the front lines.

 Rich and John share their some of their pass-times, expertise, anecdotes and deep insights into the strategic focus of their organizations, making this a must-listen for anyone interested in the future of healthcare technology and investment. They discuss the critical need to integrate wellness and prevention into healthcare systems, ensuring better community health outcomes by addressing social determinants like diet, exercise, and access to care. This episode sheds light on the broader ecosystem of policy, insurance, and access barriers, and how health systems like Northwell are uniquely poised to influence community health through innovative solutions.

 Everyone knows that technology is reshaping the healthcare landscape, not just for patients but for providers too.  But building collaboration is essential for effective healthcare innovation, and this episode explores the complexities and opportunities within this space. Learn about the importance of developing baseline infrastructure, fostering top-down alignment, and the role of providers on the front lines. Rich and John dive into the challenges of organizational change management and highlight the value of learning from failures. They also discuss the importance of trust, the potential of AI, and the successful strategies employed by Aegis in developing solutions closely aligned with provider systems. Tune in to understand how these industry leaders are driving meaningful change and fostering a collaborative environment for digital healthcare advancements.

Dave:

Welcome to the Reverse Mullet Healthcare Podcast from BP2 Health. Today we're in the studio in the Big Apple talking with Rich Mulry, president and CEO of Northwell Holdings, and John Beadle, managing Partner of Beegis Ventures. This is another first for us. I got to say that we're at a guest studio. I'm here in person, my co-hosts are remote and so I really appreciate Swerve over here making it all work for us, and also we have not one, but two guests in the studio and we'll get into why that is here shortly. But before we do that, who are we? Why are we here? More importantly, why did we name our podcast the Reverse Mullet Healthcare Podcast?

Ellen:

Ellen. Well, since we had some technical difficulties and Justin can't join us today, it's you and I, you'll take it and so I would have played Justin on this episode as well, which could be scary. So we want to be relevant, informative and creative, but we also want to be entertaining and have fun, which won't be as much without Justin, obviously. So it's party in the front and business in the back like a mullet, but reverse.

Dave:

Yep, we're your hosts. I'm Dave Pavlik, justin Politti is offline and we have Ellen Brown remote. Yep. We're passionate, innovative and collaborative, and are committed to solving our industry's most pressing issues together with our clients. We have a combined 90 years experience pressing issues together with our clients.

Ellen:

We have a combined 90 years experience. Not only does that make us sound really old, but it also shows me why I'm really excited that John and Richard are on the episode with us.

Dave:

Yeah, and I'm excited to be in the room with them.

Ellen:

I'm sure you are.

Dave:

You're a little jealous, aren't you? You got some FOMO happening.

Ellen:

I'm really jealous, but here I am. I mean, I'm legit jealous when I was putting everything together for this episode and I went back through what Rich and John are doing together and now with a larger group. It's completely aligned to what we do at BP2 Health in terms of real change and this episode and in this podcast in general. So I'm really excited.

Dave:

Okay, well, without further ado. I mean we got to roll along here, so let me formally introduce our guests. We'll start with John Beadle. He's the co-founder and managing partner of Aegis Ventures, a New York-based venture studio focused on companies that improve patient outcomes, reduce healthcare inequities and transform how health tech is innovated and deployed. John leads the studio's efforts to tackle healthcare's biggest challenges, from clinician burnout to health equity and financial sustainability. Most recently, john spearheaded the creation of the Aegis Digital Consortium, a group of nine leading health systems that will partner with Aegis to build and scale companies that solve their most pressing challenges. So there's the connection, john. This is the connection.

Dave:

John was also the architect of Aegis's $100 million partnership with Northwell Health. To date, the partnership has resulted in the launch of four new companies. John has quite the tenure in the investment world, including APL Group, a global private equity firm, and Aegis's sister company, john Lang Group, which is an international infrastructure investor and investment banking with Bank of America and Merrill Lynch. He's a Harvard alum, where he focused on the US business government relationship, with an emphasis on health policy, and his master's in global affairs with Tsinghua. Am I saying that right? Tsinghua, yeah, tsinghua. I was not even close Tsinghua.

Dave:

Yeah, I was not even close Tsinghua University in Beijing as a Schwarzman scholar.

Ellen:

So I have to digress for a second and say that, John, I'm going to have to talk to you offline because my son, although he's only 15 and a rising sophomore, he absolutely loves global affairs and wants to go to China next year to school and is studying Mandarin as well.

John:

So when I saw this on your bio.

Ellen:

I was like clearly I need to talk to John oh, amazing, would be thrilled to talk to him.

Dave:

He's studying, he's studying Mandarin.

Ellen:

He is. How did I how?

Dave:

did I not know this?

Ellen:

I was going to say you know me and my kids and family. We're always doing weird things.

Dave:

All right, well, let me introduce Rich. Yeah, rich, so, but in the family. We're always doing weird things, all right. Well, let me introduce Rich, anyways. Yeah, rich. So, but without further ado, why don't you jump into Rich's?

Ellen:

background yes, I was just about to, because it's just as impressive and it's clear why you guys have been solving problems together so effectively.

Dave:

So Rich Mulry is the president and CEO of Northwell Holdings, the for-profit division of Northwell Health, new York's largest health care provider. He spearheads initiatives that generate sustained value for the Northwell Health enterprise, focusing on three key areas venture investments, commercialization of internal innovations and the cultivation of strategic commercial partnerships. He gets to create alliances with private sector organizations and nurtures innovative ideas within Northwell, driving advancements in patient care and creating diverse revenue streams for the health system. So now you can see.

Ellen:

I literally have found two more unicorns in health care. I thought that may be the case and I clearly feel that way.

Dave:

You did Well. Rich has more than 25 years of health care administration and operations experience. Previously, he served as the senior vice president for operations within Northwell Ventures. He has had two stints at Northwell, most recently joining in 2015, but also from 2003 to 2007. Prior to 2015, he was with Catholic Health Services of Long Island, where he was senior vice president over physician network strategy. He was also executive director and CEO at University Physicians. He is an alum of St Michael's College and he has a master's in public health policy management from Columbia University.

Ellen:

So Justin was supposed to say this, but I think there's a well-known movie quote which is we are not worthy. That comes to mind. Justin would say it's so much better than me yeah, Justin always throws in.

Dave:

Yeah, never mind, let's not commiserate over the fact that Justin's not here.

Ellen:

No, but we'll throw in some phones, just so everybody knows the fun that he's got.

Dave:

He's missing out. He'll get over it. Yeah, he can listen to it later.

Ellen:

So because we have to stay true to party in the front, even after all of our technical glitches, which I appreciate everyone's patience with, but that's what we get with a guest studio. So I want to hear about what you all like outside of the office, which I know is hard, because there's was a CEO of a major health system and he also happened to live on a farm where he raised and showed miniature donkeys.

Ellen:

I doubt that either of you have any miniature donkeys, given that your office is right in Manhattan. But I'm going to start with you, rich. I understand that we might be pretty darn well aligned, because I happen to also be an avid road cyclist, as well as mountain biker, and I love to travel the world, and I think a number of your bucket list destinations are places I love. So tell us more.

Rich:

Yeah, when I moved to Manhattan my dream of opening that llama farm kind of had to die.

Rich:

Had to readjust on. But cycling there was room in even my first apartment for a bike. So it started years ago when Price Waterhouse. We formed a team mostly to do fundraising and a little bit of team building, and it was just a wonderful experience for everybody to kind of go out for a couple of days at a time. It's been great going up back and forth to NIAC over the years in Manhattan and then down the Cape. So something I aspire to to kind of get back into. We've really had a lot of fun with what we've been doing, but it has consumed a lot of time. But for the cycling, though, fortunately I'm pending a knee replacement, so I'm giving myself just a little bit of time to come back into that.

Dave:

You had the knee replacement or you're going to.

Rich:

No, I have two new sources of revenue for Northwell the left knee and the right knee.

John:

So I'm looking forward to that soon.

Ellen:

It's good You'll be supporting your own health.

Rich:

Absolutely Any way we can help.

Ellen:

And how about travel?

Rich:

Yeah, I've refined my bucket list and really committed because I'll have a milestone birthday coming up. But I really aspire and have long wanted to go to Japan.

Dave:

Yes.

Rich:

How I really aspire and have long wanted to go to Japan.

Dave:

Yes.

Rich:

Really, with today's technological breakthroughs, I will be 30 by the time this airs. It'll be great. Yeah, I really wanted to go to Asia. Japan was top of my list. It's been there for too long. I really want to go to Thailand and I just found out a couple of friends are moving to Fiji, so that may offer an opportunity just to visit and learn a little bit more.

Ellen:

But the may offer an opportunity just to visit and learn a little bit more, but the list is long.

Rich:

With. Those are the top three. Okay, all right.

Ellen:

I recently. I went to Japan last summer and Singapore with my family and did Thailand right before COVID. In fact, almost didn't get home, Thanks to COVID.

Dave:

With Ellen, it's like where's Waldo? We're always trying to figure out where's Ellen. Well, I welcome any tips.

Ellen:

I actually have the web domain wherearethebrownscom. Excellent, because we spent a year and a half in an RV before children 20 years ago, and it was before travel blogging was a thing, and so we had a website that showed where we were in our RV, of course, that's long gone, but we were in our RV. Of course that's long gone, but we still have the domain Excellent. Nice, yes, so go ahead, Go ahead.

Dave:

Ellen.

Ellen:

Well, no, I was just going to say so now, John.

John:

Yeah.

Ellen:

No, donkeys no donkeys.

John:

Unfortunately, I'm jealous about the donkeys, maybe someday, but I I spend so much time either in a conference room under bad fluorescent lighting as rich alluded to, or in the back of an airplane that anytime I can really love to get outside hiking, cycling. I'm actually doing a big 100 mile bike race at the end of this summer, which I am severely remiss in preparing for, so I'm hoping I find some time to do that. So it's called the pan mass challenge in boston. Okay, it's only 100, it's called the Pan.

Dave:

Mass Challenge in Boston.

John:

It's only 100? It's only 100. So you don't have to prep. I need to get ready, but I'm severely delayed in doing that, unfortunately, so it's on my list of near term things to do. Was also a competitive golfer for a lot of my younger life. Got recruited to play in college, so I still get to play in some pro-ams occasionally, which is always fun. Got to play with the number one golfer in the world a few weeks ago actually Scotty Scheffler in a pro-am, which was a lot of fun and really interesting to do. So always great to get to see those folks up close and personal and just how incredibly talented they are. But anything outdoors, anything sporting related, I tend to really enjoy.

Ellen:

So how do you handle the pressure with those pros?

John:

It's a good question. I think I'm able to tap into a little bit of my old competitive golfing spirit, where it doesn't really faze me very much, and the thing you realize pretty quickly is the pros could not care less how you play. They are just out there getting ready for their week and so whether you shoot 68 or 108, they're just out there to have fun so and they're trying to prepare while we're out, you know, enjoying ourselves getting to watch them. So I think that helps me a little bit. But I think people get very nervous going out there If I if I could just get over that.

Dave:

going out and golfing with the neighborhood guys the ones that go out a couple of times a month and I go out a couple of times a year I'm just worried that they're like looking at me like this guy's terrible. It's a tough game and you know you don't want to get up on the tee and flub it, which I do anyway. But good for you and you're you're big into the Boston sports teams.

John:

Right, I am big into Boston sports. Go Celtics. It's been quite the run there. It's so a shame that Justin is not on.

Dave:

Justin is such the Celtics fan, Apparently in his house he can't even watch the games with his family around anymore. Everybody's just too fed up with how intense he is and how serious he is about the Celtics.

John:

I'm a bit of the same.

Dave:

He's got to go watch them by himself somewhere.

Ellen:

Well, his son plays college ball. Oh amazing.

Dave:

Yeah, he's a basketball.

Ellen:

He's a three point maverick.

John:

Very cool.

Ellen:

I have to talk to.

John:

Justin about that another time. I'm a huge basketball fan, yeah.

Ellen:

Oh my gosh, you guys would have taken the entire. Maybe it's better he's not on. Yeah, so we'll be talking basketball All right, Listen all I want to do is talk travel and hiking and biking. So you know there you go.

Dave:

So all right, in the interest of time I hate to be a bad guy We've got it, we've got to get, we've got to transition from our party. Oh wait, oh shoot, I forgot I have. I have gifts for you guys. I got a reverse mullet healthcare podcast mug for you. Oh, amazing.

John:

Thank you.

Dave:

And. I have one, and I have one for John as well.

John:

I have they're not mugs from different places. Look at this beauty right there.

Dave:

Amazing.

John:

I love the logo.

Dave:

It's an oversized.

John:

I got to show everyone the logo. It's pretty cool. Yeah, it's very cool.

Rich:

I work for not-for-profit. I don't get swag. This is great.

Dave:

It's the best kind of swag you can get, man. So you guys know that our platform for the podcast is affecting real change. We say that real in all caps and so we want to start by asking both of you what you think can affect real change. And, rich, how about you kick it off?

Rich:

Yes, Speaking from the health system perspective, real change will have to be sustainable. When we look at what our challenges are in healthcare, most of the systems across the country are facing similar challenges. We have compressed margin, we have a much more competitive workplace where we're trying to recruit and retain resources across the enterprise, and we're really competing with outside forces, those that think they can do healthcare better, that intervene and intermediate and fragment care. And I think we're really competing with outside forces, those that think they can do health care better, that intervene and intermediate and fragment care. And I think we're at an opportunity now if we really want to sustain meaningful change in advance. We need to take advantage of the technology solutions that exist and really custom tailor them both to meeting consumers patients where they are.

Rich:

They're used to that in every aspect of their life, maybe with the exception of healthcare and really doing it in a way that's super sensitive to the people who provide those services, Because usually one's at the expense of the other. Something that's convenient for a patient often floods a doctor's email box, often adds 15 clicks to a nurse's encounter on a computer. So we're trying to re-engineer the way that we can flow out care. It's still let the patient get an answer, the most meaningful answer, in the best way possible. That doesn't always have to tax resources, and so when we're looking at change, we really want to have the intersection of those worlds where we can try to become successful commercially but also be able to then meet the needs of our patients and providers at the same time.

Ellen:

So when we talked before the podcast episode Rich, and so before I move to John's answer to the question, one thing that kind of struck me was your point that health systems have bypassed wellness and prevention and sort of this aspirational need and aspirational overlap. Can you talk a little bit more about that before we jump over to John?

Rich:

Sure, you know, when you look at health systems, they're one of the safety nets of society and they receive all people and, in terms of a health care or your health, what ends up happening is they often end up seeing people at the very end of a cycle where you may not have been able to address a chronic illness. You might go way back and way back in the food chain. You might not have taken care of what you needed to do all along in terms of diet, of what you needed to do all along in terms of diet, exercise, access to care and services, preventative care, and so I think health care organizations have an opportunity to try to back that up. I know at Northwell, under our CEO, michael Dowling wants to take it right back to the community, because we know that your health outcomes are often determined in which zip code you're born. How do we take that and really just try to reverse, engineer it and let the healthcare system, which really we're there to serve?

Rich:

But patients are only in a healthcare system for very short periods of time. The rest of the time is when you live your life and the determinants of your health are affected. So we want to be able to play a more integrated role in everybody's lives, and I think it's important. It's part of a larger ecosystem that involves policy, that involves you know how reinsurance works, and involves how we have at barriers to access to food and care. But health systems play a very unique and important role in that process, and I think we're trying to use this technology that we're developing also that allows us to meet those goals too.

Dave:

Yeah, and I think we'll get. We'll get more into that as we as we continue the conversation.

Ellen:

So, john, you had me at food. Food is health right, so anybody who ever reads anything I put on LinkedIn knows that that's always a theme that I follow.

Dave:

So, John, your turn. What, what will?

John:

affect real change. So, speaking from the company creation perspective, I think it really comes down to more closely linking the design, development and implementation of these solutions with the challenges that those are experiencing within the health system on the front lines. A lot of folks forget that digital health is a really nascent industry. You haven't even really had a digitized record meaningfully advanced until the last 15 years or so, and I think the first wave of health tech innovation was very much.

John:

A lot of solutions that were developed in Silicon Valley that were what we call a solution in search of a problem, that were somewhat divorced from the reality that those on the front lines were experiencing.

John:

I mean, when you don't even have, for example, the ability to send text messages to patients and you're trying to design a wraparound digital front door powered by AI.

John:

Sometimes you need to meaningfully put in place baseline infrastructure before you could start to think about cutting edge next generation solutions. And so for us, it's really all about how do you create a nexus in an ecosystem where one these technologies can converge, but, more importantly, you can bring in health systems, payers, retail players, pharma, med tech to work more closely together to develop these solutions and ensure that they're going to get meaningful adoption. And as we look at what we've tried to create and I know we'll discuss this in a lot more depth it's a greater linkage between the end users and those who are developing these technologies, and the way you do that is by putting those who are building the companies with those that are going to use them from day one, co-developing them shoulder to shoulder, which can take a bit more time but ends up resulting in a lot more meaningful adoption and driving of outcomes once you actually have the technologies on the ground implemented.

Ellen:

Yeah, so you mentioned to us previously that providers are a big goal of yours, sean, in all of this, and that, of course, is music to our ears, so I'd love if you could talk a little bit more about that under the construct of this real change and collaboration and the idea of building it where it is versus Silicon Valley building it in a silo building it in a silo, sure.

John:

So there's been a lot of different approaches to health tech innovation over the last decade. In particular, one I think speaks to direct to consumer, putting all the power in the consumer's hands, trying to create everything digital. I think our perspective is much more aligned with the view that providers are really the tip of the spear. They are delivering care at scale, they're operating in such a way that it aligns with reimbursement dynamics and how care is actually delivered across the country, and so for us, rather than disintermediating or seeking to replace what providers are doing, it's really all about how do we come in, empower those activities, help them face the challenges that they know they're facing, and I think something we've seen as we've gone into all of these different health systems with which we're partnered is they really understand their problems very well.

John:

They often don't know exactly what they need to do to solve them, but that's where we really come together to develop those solutions, and often it requires a combination of technology services, change management, and I think that's where, as we've developed our partnership, for example, we've developed very complementary skill sets to think through what are the types of things that are best done outside the health system so you can move more quickly, you know, recruit best-in-class talent, get things that have a meaningful chance of scaling nationally, while still leveraging all the best-in-class resources that providers have to access, whether that's data, which has been a huge focus of our partnership, the ability to test and implement solutions, the ability to go to frontline workers, access them really readily, which Rich and his team have done an amazing job of facilitating for us. I think the combination of those things can produce solutions that drive a lot more impact.

Dave:

Sounds like you've got to figure it out.

John:

I wish it was that easy. Well, what are?

Dave:

some of the challenges and or the biggest challenges and barriers that you face in these efforts.

John:

There's lots of challenges, but I think the one I would probably highlight is one you need top, you know, top down level alignment with the C-suite and the CEO.

John:

I think that's incredibly important and it's certainly an area that we focus, but you also need really strong sponsorship and alignment with those who are actually going to be implementing the solution and using it on the front lines. I think a lot of the big failures that we've seen in health care and health tech have come down to those in the C-suite really wanting to do something but not understanding what the reality is on the ground. And so for us it's both top down and bottoms up, and we've had a lot of examples of situations where you may have CEO level buy in and desire to do something, but you go to the team that's actually going to be sponsoring it and you see they have 10 other projects underway. They're totally overwhelmed, they don't have the baseline infrastructure in place to do it, and in those situations it's often better to just say it's not worth the hassle right now. Let's go somewhere where we're going to be more welcome and where we can get something adopted more quickly.

Dave:

Yeah exactly.

Ellen:

So you really do listen to that group to prioritize. Because I think that's one of the biggest barriers sometimes is how do you balance reconfiguring what's on that list right, reprioritizing what's on that list, versus walking away and saying there's something else we can solve for?

John:

Yeah, absolutely. I think it's incredibly important to us, one of the things we most look for when we're going in and deciding which projects to do, and the nice thing for us is, I think there's a lot more demand for our time and resources than we have the actual ability to do on the ground. So if we look at 20 projects it may be we find five where there's both C-suite alignment, alignment within the business unit or the service line, and where we think that you can actually build a scalable business, and so it doesn't actually tend to be that difficult to find places where you're welcomed and folks want to work with you.

Dave:

Yeah, that's great Rich. What about you? What are some of the biggest challenges or barriers you face in your change efforts?

Rich:

Yeah, it's very similar to what John said. But when we say top down, bottom up, we're really talking about health care organizations being highly matrixed. And what does that mean? You know we have financial pressures that we're trying to solve for with solutions. We have executive sponsorship and then we have the front end staff, the leaders.

Rich:

Everybody needs to feel as if they're part of that solution, that the win is a collective win, which is very important, and it's often, as John alluded to, it's at the risk of having something else not done or having some type of other solution put on the back burner while you're trying to re-engineer and try something new. And people you know you have to remove, I think, a sense of risk aversion from the system. And you know how do we do that. We've been taught to do that within our own system, really by building trust. So the ideation process that John mentioned and working through the problem to get to the solution through that process you're building a relationship, which that's the secret, I think, to how we're going to be able to be successful. People will follow what they trust and in our system, or most systems, that takes time.

Rich:

It's not something that can be done overnight, but it also builds on a track record of success, and I think that we've had iterative wins over time. And I think that we've had iterative wins over time. So I think, in terms of change management, organizational direction and use of very minimal resources because, you know, we're in the middle of putting in a new medical record at the same time, so everything else has to be pencils down. How do you fit in these solutions that are going to be mission critical to serving the goals of the organization, that are going to drive the financial returns that we also need to be sustainable and, at the same time, you know, really allow everybody else to be a very have that as a positive part of their work experience?

Ellen:

I think of John Corris when you were talking about that because he wants to actually see a conference happen around failure.

Ellen:

He calls it the failure conference, where people get together and, instead of just standing around talking about how great they are, they actually share the learnings that they've had from their failures. And I think that's his point is that's part of trust is that we're trying to do the best that we can. And these are big bets, these are big risks, and if you're too scared of failing at one because your organization is going to throw you to the wayside, that's a problem.

Rich:

Negative learning is the most powerful learning. I've learned most of my career through that mechanism, I think. But I think the most powerful thing is exactly what you just said, Ellen you have to have forgiveness. Our CEO will know, our CEO will allow you to make mistakes. Just don't make the exact same mistake three times in a row.

Ellen:

Then it's the definition of insanity, exactly.

Dave:

Then it becomes a problem. We're going to try to make that failure conference happen someday.

Ellen:

Yes, we are. We're planning something similar. We actually have kind of a deal with John Hold on. Yeah, I have kind of a deal with.

Dave:

John. Hold on. Yeah, John is. Oh, did you talk about this?

John:

We're going to have our first conference of all the digital consortium members in September, okay, and a big focus is going to be around best practices and things that you've learned, and so, as we put the panels together, that's going to be a huge area of focus is what are things that have gone well, but, even more importantly, what are the things that haven't gone well and what can everyone learn from that? And I think, as we look at the reason why so many provider systems joined, it's really to access that incredible brain trust. There's no reason to repeat mistakes if they've already happened at other healthcare systems, and I think the beauty of the model as well is that, since all these systems are regional, they're not competing with each other in the same way that companies do in other industries, and so the ability to come together and learn from the other leading healthcare systems in regions that did not overlap with your attachment area we thought was a really powerful mechanism for learning and accelerating growth.

Ellen:

So all right, so you're taking me where I want to go anyway.

Dave:

So, thank you, yeah, you may want to invite Tampa General down there.

Ellen:

I know Johnny wants to talk about failures. I think you need to have John as a guest at your digital consortium to talk failures.

John:

That's a great idea.

Ellen:

Yeah, he's great. I mean, I'm sure you've talked at some point, he's a unicorn on my list.

John:

They're doing amazing work.

Ellen:

They are and they're regional, much like we've've talked about. So I mean, let me jump into your point about collaboration. So I mean, at BP2 and our firm, we've done a lot of work over the years with collaborations and, as I said to you when we first met, like we mad props I know I sound a little bit, you know, I don't know my verbiage isn't necessarily proper, but that's how I feel. I mean we feel your pain and I'm sure everyone that's listening to this episode will want to know how the Northwell, aegis and now the Digital Consortium is succeeding when so many similar collaborations have failed.

John:

To Rich's point earlier, I think, at the end of the day, healthcare is about people caring for other people, and it's built on trust, and so I think, from day one, it's really been all about relationships and building complementary skill sets within Aegis and ensuring that those skill sets want to partner with the health system in the right way.

John:

I think, when you look at a lot of how Silicon Valley companies come together, the ethos is all around move fast and break things, and I think that can work when you're building solutions that are in other, less regulated industries, and it's worked incredibly well in a lot of situations.

John:

Healthcare really is, though, about people's lives at the end of the day, and there have been situations where software being implemented incorrectly can literally kill people.

John:

That's the type of thing that is at stake, and so a totally different approach is required to be successful in that.

John:

That's the type of thing that is at stake, and so a totally different approach is required to be successful in that, and I think one of the lessons we've learned as we've built out the organization has been you need to hire a very specific type of person who wants to build in that way, because it can be frustrating for those who want to be moving fast and breaking things all the time, because that's just not the way that you can build things in healthcare.

John:

But I think the way that we've tried to approach all of this is, if you can do this in a deliberative way and you have a playbook and a blueprint for building these companies in partnership with large health systems like Northwell, then every health system is different, of course, but there's always going to be common lessons and approaches that you can leverage as you do this over and over again. And having the right people in place, building the right relationships, making sure that you're approaching it in a way that aligns with the values and processes of your customers and partners, I think is what's enabled us to succeed with Northwell, and I think it's what's enabling us to succeed with these other partners.

Ellen:

So it's a little bit of kumbaya. I would say so I actually, when you kept saying the break things, it made me think how there's probably a number of people listening, thinking how snarky that they were. Well, health care is already broken um, but you're absolutely right that people's health is at stake. Their, their lives are at stake in this, and it is very serious so so common theme, trust, um what.

Dave:

What are some other attributes that make a health system a good partner in a collaboration like this?

Rich:

I think this is for rich well, you know what I was just thinking yeah, I was looking at right was I not absolutely save ellen I was seeing it through my good eye, absolutely no.

Rich:

I actually think what John was saying, though, relative to, instead of saying, health. You know, health care is broken too. There's a humility that has to be present in your partner, and I think that that's going to be that. They don't know everything. And that's where the tech companies come in with lots of different point solutions and they've built something and they I'll use a phrase a horse in a hospital. They just come in and think it should work without really understanding the true nature of what needs to be thought of the considerations, because it's built in a vacuum. But you know, health systems have to have also a humility to know that they can't do this all by themselves.

Rich:

We've tried for years. We're very, very good at what we do, we have deep expertise, we have a lot of insights and know-how. What we lacked was the ability to take something beyond our four walls, because we didn't have all the skills we needed in our walls. And that's where I think the partnership comes into play. That becomes crucial, because the combined skill sets, the combined thinking and I think the alignment on values is really, really critical in terms of and that comes from a respect and I think what we've seen so far with the success at Northwell is going to extend to the other digital consortium members, because these relationships also have been built over the last year and a half. As these discussions have taken place with John and his team and then looking to us to validate is that really what happened? Did that really? You're vouching this is really going to work, and so that's kind of how we work. Promise, yeah, exactly. Prove it, yes.

Ellen:

Yeah, or else it goes into the failures bucket.

Dave:

There you go, Right exactly.

Ellen:

So I want to talk about shiny objects a little bit, especially as AI and some of our previous episodes. We've bantered, baited AI in healthcare and I have to say that after going to Vive a few months ago, I had a different take on AI. I'm on board in a couple of ways now I don't even want to say begrudgingly, but one in particular would be really when it comes to staffing and burnout and healthcare worker burden. So, John, there's been a lot of failure in AI and healthcare. How do you think this moment is different? I?

John:

think it's different for a couple of reasons. If you go back to the first major wave of AI innovation, it was around 2014,. Creation of covnets, lots of computer vision technologies. Most of those technologies were highly clinical and highly regulated, which creates two major challenges. One is on the clinical side there's always a greater risk aversion because there's so many safety implications and so much more challenging to get these technologies rolled out. And then, on the regulation side of things, fda didn't really have a framework for evaluating these technologies, and so the process moved incredibly slowly.

John:

And then you often needed to overlay that with reimbursement dynamics, where if you were deploying these clinically, they needed to be paid for somehow, which involves a lot of lobbying to different colleges and professional societies, then making the case to the payers, having the right ROI, et cetera.

John:

So you end up having a kind of multi-tiered go-to-market strategy, even once that's done, since you first need to sell to the hospital, then from there you need to sell to whoever is leading the service line and then after that you need to actually get clinicians to use it, to get paid. And so there's a lot of challenges stacked there that I think resulted in these technologies and solutions not being widely adopted. From there you saw things like IBM Watson, where there were a lot of big promises made but the technology was not advanced enough at its core to meet those challenges. What I think is incredibly unique right now is most of the tech that I see driving meaningful adoption and we've built companies that are doing this is neither clinical nor regulated, and so it's mostly administrative. And to your point earlier, ellen, about burnout, staffing et cetera, where we're seeing real impact is in automation that actually works. It's not the olive kind of automation where it's just decision trees.

John:

It is language models that can be fine-tuned to specific tasks, and then this new technology called AI agents that can actually execute really complex workflows in a structure that looks very similar to how human beings execute those types of work. And so I think, as we've seen these technologies actually used on the front lines one, they actually work. Two, they can be deployed very quickly and, three, they don't have the same risk profile as a lot of the clinical technologies that we've seen before, and so I think we're incredibly bullish about how quickly as a lot of the clinical technologies that we've seen before, and so I think we're incredibly bullish about how quickly that a lot of this adoption can happen, because there's just so many challenges in healthcare and I think provider systems will be able to see much faster ROI than with a lot of what's come in the past.

Ellen:

So is AI agent an open source solution as well.

John:

So there are AI agent frameworks that are open source. I think our view, though, is that those will not likely work in healthcare for most workflows, because it all comes down to with what level of accuracy do you need the solution to perform? If it's something where, 80% of the time, it's fine, because you're just querying information, for example, and you have a check in place, then just using some of the open source frameworks can be okay, but I think a lot of what we're doing is in spaces like pharmacy, discharge planning, supply chain, procurement, call center, where you want it to be a lot more accurate and highly technical.

John:

Yeah, highly technical and also highly specific, and so what we're doing is fine tuning those agents to specific workflows, and I think you can get to really high levels of accuracy when you do that. So most of our systems are closed, not open.

Dave:

Okay.

Ellen:

So let's go back to collaboration again. How important is collaboration and achieving transformative change in the industry? Rich Yep.

Rich:

So, I think collaboration is the new currency for us to be able to affect meaningful change, because, you know, we've learned at a micro level within a health system and a very complex.

Rich:

But what I'm really excited about is the fact that we're going to be doing this now with other health care systems who are like minded leaders in their region.

Rich:

As John had said, they're not afraid to invest in innovation, not afraid to break a few eggs in the test environment, but really being allowed to share our collective learnings and be able to advance.

Rich:

I mean, there's an opportunity here for us to come together to share the use of some technology that's going to allow us to scale these solutions much faster, which is really, really exciting but to learn and improve collectively and iteratively, as each one of us does so. And so I'm really, really thrilled that we're going to be able to have this more accessible, open, collaborative effort. It's not just we're sharing deal flow about a potential investment in a point solution. We're really looking at our problems the same way, looking to each other to see. You know, not everything's going to be, it's not a blueprint that's going to be just imposed on each organization, but it's really taking that thinking and that approach and trying to, you know, implement it and overlay it with your own strategy in your own organization. But I think having this collaboration at the base of it and these open and continued dialogues that are now accessible to us in a much more open way because of the consortium, I think is going to be key.

Ellen:

I have a collaboration question. So how do you deal with the inherent sort of internal politics that can conflict in these consortiums? It's something that we've seen a lot. Even though everybody wants to roll up their sleeves and work, there's still this little bit of territorial or? Well, this is how we do it, and getting past that is really challenging.

Rich:

You know, I think it depends on, each system is going to want to make their own brand and make their own mark in the industry in its own way, and every one of them does certain things exceptionally well and there's always going to be room for that. I think, when you look at the myriad problems that we have, there's plenty to do together. That doesn't necessarily have to be competitive. We're all sitting scratching our heads about lots of us use the same technology, same EMR. How do we have the following 10 problems and we still haven't been able to fix them? I think that that's the areas that we need to focus, and everybody can look at their own particular set of problems and try to focus on those. But I think that that's the areas that we need to focus, and everybody can look at their own particular set of problems and try to focus on those. But I think the toolkit's getting pretty robust. I don't know, john, how you feel about that.

John:

Yeah, completely agree, rich, and the other thing that might be worth highlighting as well is participation in the digital consortium is, at its core, a one-on-one relationship between Aegis and that health system.

John:

That relationship needs to work before you can bring each system to work together, and the way we've tried to structure it is so each company is an opportunity, not an obligation, and so every single company will involve every system working on it.

John:

But we think we have enough diversity across fee for service versus value based care, urban versus rural, those with health plans and those without health plans, et cetera that we can always find at least three or four who want to pursue a particular solution, and that's typically enough, given that most of what we're doing is large enterprise B2B software, and so that is enough to get you close to product market fit in a place where you're ready to scale into a lot of other systems, and so the way we've tried to structure it is you are only obligated to participate if you want to. It needs to be something that aligns with your individual strategic plan, your priorities, your innovation roadmap, et cetera, and if not, there's no pressure to do anything. We really want it to be something that is accelerating a plan you already have in place, versus something that's being imposed on you.

Dave:

All right. Well, in the interest of time, I think we talked about this.

Ellen:

Wait, wait wait yes. The voice from afar.

Dave:

Wait, wait. We're waiting, Wait wait, don't tell me.

Ellen:

We're waiting, Wait, wait. Don't tell me Very quickly, John. Why don't you share just one last little piece about the digital consortium? I feel like you deserve another couple minutes, because it is a really impressive endeavor that I think folks will want to learn a little bit more about than maybe how we've covered.

John:

Sounds great. So just to cover a little bit of background on it, when we partnered with Northwell, starting a couple of years ago, the goal was always to create a reproducible blueprint in a system for being able to partner with a healthcare system to start with a problem that they're facing, work backwards from that problem, develop a technology that best meets it and can solve whatever challenge that we were going in to originally solve, deploy it successfully, develop the right framework for ROI and proof of concept, and then very quickly bring it out to a number of other healthcare systems so that you can try to scale these solutions faster, cheaper, with a much higher success rate, because they're so closely aligned to the challenges that the healthcare systems we're partnering with are experiencing every day. And so, as we built these first four companies, I think we came to the realization the model worked very well. We've obviously refined it over time and it continues to get better and better, and we expect that that'll continue to be the case as we do it with more and more healthcare systems. And so we brought the digital consortium together, because we wanted to have a formal framework in place to be able to have different provider systems collaborate for particular problems that meet their individual strategic plans and goals, and so the way it's structured is we'll continue to develop companies alongside one or more provider systems. We'll bring those solutions to the other systems in the consortium for co-development opportunities, investment opportunities and customer opportunities, and they can pick, based on their individual needs, which solutions that they want to deploy.

John:

The goal is they'll do many over time and that Aegis can really serve as a comprehensive digital transformation partner as we continue to build trust and as we're more successful, so that we can replace a lot of the point solutions that Rich highlighted and become a vendor of first choice and a partner of first choice, while also giving health systems a commensurate share of the upside, given how much value that they're adding and enabling these technologies to be deployed at scale. As Rich could speak to much more than I could, most of the time, when a health system participates in a particular company's fundraising round alongside a customer commitment, they're getting 1% at a very high valuation, and they're putting a lot of time, energy and resources in, and so we've tried to really flip that model on its head and create a new paradigm for how these technologies are innovated and, in the process, give provider systems a lot more of the upside relative to the amount of contributions that they're making.

Ellen:

So we're very excited. I was just going to say, when you were talking, a couple of things that really stand out to me. The power of what you've done is one. A while ago, you hit on a lot of people in Silicon Valley, I don't think have a respect for what health systems deal with on a day to day basis and the complexity, but there are so many layers and disconnects on the financial side and complications that make the environment what it is, in which we have to operate in healthcare, broken or not. It's the reality and I appreciate that you recognize that and how you've created Aegis.

Ellen:

I think the other piece that you've pointed out is you're giving access to regional players, to true innovation for what they need to solve, for what they need and a voice and that's really powerful and a diversity that takes into consideration, like you said, rural versus urban health system versus health system that owns health plan right. I think bringing together multiples in that is super powerful. And I think, finally, I just I really appreciate your last statement, which is you understand the complexity of health systems, investing and you're giving them a real place at the table and not making it sort of this impossible thing, because I think traditional PE and VC is expecting an unrealistic multiples earnings everything for these startups when it comes to healthcare, because of the complexity of our industry, and I just really appreciate what you've done to reduce some of those hurdles. So I'm done, dave.

John:

Yeah, it's very kind of you, and you pitched it better than I could. I think I should make you the new front person for Aegis.

Ellen:

No, no, I just I really appreciate it.

Dave:

It's exciting work and we'll be watching and wishing you much success.

Ellen:

So now, you have to tell me if there are any unicorns that need to be added to our list? You can either tell us today or offline.

John:

Let me think about that.

Dave:

There's so many unicorns that I think it would be hard for me to prioritize them. There's so many that are not unicorns. It can't be that many that is true?

Ellen:

Well, I already owe you a call anyway. Perfect, I'm done, dave, I promise.

Dave:

That's okay, rich. Rich, do you have something to add to that?

Rich:

No, I think.

Dave:

Before I bring us in for a landing.

Rich:

No, I think John said it perfectly.

Dave:

All right, we're coming in for a landing then. So we usually ask our guests one of two questions to close out. Since there are two of you, we'll let you choose one of the two each. So, behind door number one is Do you have the door? Yeah, no, I don't have sound effects right here. What's your? Buy the world? A Coke moment, right? Or if you could leave a legacy in healthcare and make a big difference, what would it be? That's door number two. Who wants to start?

Rich:

I'll do the buy a world a Coke, because I was actually old enough to watch the commercial and if Justin were here, we'd probably break out in song.

Dave:

I'd like to teach the world. You're a braver man than I am. Yes, we're going to do rounds.

Rich:

Yeah, it was on one of the three channels that we got back then.

Ellen:

It was really really wonderful.

Rich:

You know, when we think about that it's I mean, I know the intent of the commercial was about bringing peace and equality, but I really do think that there's something to be said by that, even within the healthcare industry itself. And what we've tried to be ambitious about is really serving the people who live in our communities and how do we do that? And I think we've embarked upon this journey with Aegis and it's really sparked an opportunity for health systems to think more broadly about how they can try to affect change. But the by the rule to Coke is to continue to think outside the box, to continue to take chances, but really just keep in mind and in focus that we're here to help serve our communities as well as make sure that we're serving the people who take care of those people every day.

Ellen:

That is perfect. We could totally break into song now.

Dave:

No, I just realized. I was just thinking, you know, when we go worldwide here with the Reverse Mullet Healthcare Podcast, we might get a cease and desist.

Ellen:

We're ranked 10th globe, 10% global.

Dave:

Yeah, but we might get a cease and desist from Coke. I'm just saying.

John:

I'll pick your number two for variety.

Dave:

Okay.

John:

So, as we all know, we're all going to get sick at some point.

John:

We all want empathetic care that responds to our needs, and I think one of the things that most scares me about where we are as a healthcare system is just the unprecedented level of burnout and dissatisfaction of frontline clinicians, and so one of the things I often track is what percentage of medical school students at different top medical schools are still practicing 5, 10, 15 years out, and, as I've been surveying a lot of the clinicians who work on our team, 15 years out, you're often in the 40s that are still practicing, which is a tragedy, and so I think, for me, a lot of the technologies that we're advancing are meant to try to re-engineer the experience of delivering health care to those frontline clinicians who are delivering care at scale and who we're all going to rely on.

John:

The need for those folks is going to only accelerate over time, as you have an aging population, and I don't think it's going to be possible to get enough into the workforce unless we meaningfully improve that experience, and so if I could do one thing as we build out all these companies, it's to try to make life every day much easier, better, for those heroes that are delivering care at scale and who we all will need, you know, when we inevitably get sick. That's fantastic.

Ellen:

We'll cue the sound effect of applause.

Dave:

John Rich, thank you so much for being here. This has been a lot of fun.

Ellen:

We really appreciate you coming down?

Dave:

I know, we're ending a little later than we expected, so we really appreciate it. I'm Dave Pavlik.

Ellen:

I'm Ellen Brown, and Justin Politi is with us in spirit today.

Dave:

So we're the partners at BP2 Health your best chance for real change. As you can tell, we can talk about this stuff all day.

Ellen:

Drops a line through our site at bp2healthcom and so now, john and rich, you can see why we were so well aligned, because our tagline, long before we met you, was your best chance for real change and that's like in your bio. So love it, it was perfect.

John:

Thanks guys thanks again, take care.