Health Innovators
Health Innovators

Episode 96 · 1 year ago

Healthcare Consumerism: Growth Drivers, Restraints, and Trends w/ Brent Wright, Howard Rosen & Jeffrey Carlisle

ABOUT THIS EPISODE

There are many trends out there that play key roles in how healthcare consumerism might experience growth or restraint.

Understanding how they all work together is a bit of a challenge, but it’s one we’re talking through in this week’s panel discussion.

Jeffrey Carlisle, CEO at Pneuma Systems Corporation; Howard Rosen, CEO and Founder of LifeWIRE; and Brent Wright, Associate Dean for Rural Health Innovation at the University of Louisville join me again for another roundtable discussion of all things innovation.

Have you ever wondered how factors such as inequality, access, the FDA — or even our own understanding of the solutions we bring to market — might hamper progress or push digital health and innovation forward? If so, buckle up: this ride’s for you.

Here are the show highlights:

  • How to navigate entry into digital healthcare (0:40)
  • Understanding healthcare access and inequities (8:32)
  • Customer discovery: where’s the logic and rationality? (14:49)
  • The FDA’s role in regulations and consumerization (18:10)
  • 4 companies that make consumerism look easy (26:27)
  • What we, as consumers, can do to grow healthcare consumerism (34:51)

Guest Bios

Jeffrey Carlisle is CEO at Pneuma Systems Corporation. He earned his ScB in Applied Math/Biology from Brown University.

If you’d like to get in touch with Jeffrey after the show, feel free to reach out to him via LinkedIn at Jeffrey Carlisle or via email at JeffreyCarlisle@me.com.

Howard Rosen is CEO and Founder of LifeWIRE Group. He earned his HBBA in Economics and Marketing and an MBA in International Finance/Marketing from York University, Schulich School of business.

If you’d like to get in touch with Howard after the show, feel free to reach out to him via LinkedIn at Howard Rosen or via email at HRosen@LifeWiregroup.com.

Brent Wright is the Associate Dean for Rural Health Innovation at the University of Louisville. He earned his BS in Human Studies from the University of Kentucky and his Masters in Medical Management from the University of Southern California

If you’d like to get in touch with Brent after the show, feel free to reach out to him via LinkedIn at Brent Wright or via email at R.Wright@louisville.edu.
 

You're listening to health innovators, a podcast and video show about the leaders, influencers and early adoptors who are shaping the future of healthcare. I'm your host, Dr Roxy Movie. Welcome back to the show health innovators. On today's episode we are flipping the script again with our original og crew, our panel discussion with Jeff Carlyle, Howard Rosen and Brent right. This is our second episode and we're going to do more. So please subscribe and tune in for this incredible discussion that we're going to have. Today's topic is going to be the growth drivers, the restraints and the trends around healthcare consumerism, a topic that I think is very dear to all of us. So let's just jump into the conversation and answer the first question of what are the growth drivers? Do you think that are really the force behind healthcare consumerism that we're seeing accelerated today? Well, sir, there isn't a trend unless there's a problem. Right, so we get identify what is the what is the problem? And I think that patients don't feel, rightly, that they're getting the right care at the right value, and so I think that that drives them to look for something else and I don't know that healthcare con Sumerism is really growing all that quickly. I wouldn't assume it just because it's easy to say rapidly growing healthcare consumerism. I'm not. I'm not sure that it's true. So I'd like to I'd like to hear a little bit more about that, is, whether or not we really think it is growing. But I think it's growing out of the dissatisfactor the status quo it. Yeah, that's interesting, Jeff, in terms of it's a good it's a good response because the consumerism has always been there. Part of the issue is the tools to do it. You've got that crowd that's been the worried well that forever one in a more and more and more have pieces of information and you have those that are having a chronic a condition that they want information on. So I think it's been a pent up demand that we're still going through, even with covid all the tools that we're still working through and trying to make sense of the tools that do exist and what a providing value and not providing value. And it's so the problem was they do want more information. How do you get that more information. Now they're starting to get it. But what does it mean? Because part of it is an overload of information as well, and an overload is almost as bad as no information, because there's lots of bad information in there, and so I think that causes the satisfaction. So I think statistically, think you're right. I think you know you've seen a lot of mixed signals as to the uptake and not uptake of tell health and variety of solutions. But part of that, I think, is this dissatisfaction of what that experience is, because this is not the kind of in formation I wanted. Or was it open pivotal element to this? No, no, question. In part because because, you know, the consumers have wanted to have these kind of relationships. All the respect to the wonderful providers and pays out there, they've been the ones who've been reluctant to provide it. So it's been a push in. They'll become a pool just because the economics of the situation created it. So sometimes it comes be careful what you ask for. If you get it now, it's like okay, now do we do? What do we do? Address three COVID COVID's been a game changer and in consumerism, well, I think covid has been a game changer and how would look at consumerism, and I would most specifically call out the example of tell a health. Tell a health had been around for decades and the adoption had been blackluster. You know, you bring covid into the mix and then you start looking at what I would say would be the entry into digitization of healthcare. I made everyone in more of a corporate sectors looking at digital and looking at digital channels, and this was being looked at heavily. You know, five...

...years ago, healthcare to me, when you unpack this, consumerism is healthcare has a hard time of looking at itself as consumerism. Those who seek to innovate, looking around the edges, I think understand healthcare needs to be based on consumerism. However, if you look at healthcare systems in the way healthcare systems think, they're still very parental there. They're still very, you know, I'm monopolistic in they're thinking when it comes to the patients. Just look at records, how records are managed. But I'm going to stop there and not go into the records discussion because that could easily take up its home whole time. But I'm going to mention here a restraint that I think, when you talk about consumerism, is yes, we all see consumerism coming. We see the need for digital, we see the need for innovation, but when you look at patients themselves, often times the patients with the highest health burden may not be poised to avail themselves of digital of consumerism, techniques, of the APPS, applification of healthcare and these new tools that people are that that one side of the healthcare spectrums wanted to drive towards in the more entrenched incumbent health care system is not able to mitigate because they're still being paid on a nod model. Definitely, you know, I completely agree. It almost creates some inequities. So it's good that we're making some progress. We have some restraints that are holding us back as well, and then it also can potentially create some new challenges for us to deal with or exacerbate some of the challenges that we've been dealing with with an equity and healthcare exactly and bread when it is not mention electronic medical records, because that would take up the whole show and in fact it we take up many shows think. I think it's central. Ownership and quality and where is the locus of the medical record is an absolutely essential part of consumerism, absolutely and it's IM point part because ownership, it is whose data is this really and becomes absolute core to it and but tied to it, is something in Brent, you'd said as well. Is the business model, in the payment model, the revenue models, because ultimately, yes, it's healthcare, but it's a business. Is that, and it's the revenue model tends to drive a lot of how the business and what the interactions are and how that's going to work and affects directly the ownership of the data. What, who owns it? What's done with it? Yeah, you know, I think that what you guys are saying. As far as you know, the consumerism is always been there, the demand and and we just haven't been servicing those patients well, we haven't been delivering for a really long time and I think what covid did is it forced the hand of a lot of providers to be able to deliver that kind of debunking a lot of the myths that they had in their own mind about what could and couldn't be done. You know, I mean I think that if we didn't have covid we would still be talking about healthcare consumerism without any inching of progress for another decade at least. So we're not there yet. We're not there yet. We do, you know, might good work for those people. What we can't do it over here. Was the Stumbler of block though. Do you was it really the you don't think it was the patient. So you think it was a providers or was the payers? I think it was much, much more of the payers. Yeah, absolutely. I mean you know many providers who wanted to do things in a more efficient pay but they didn't get paid for it. So correct. Yeah, I mean I've interviewed a number of physicians over the years and had conversations with them and they said absolutely, like, I don't have to see those patients facetoface for every single visit. There's a couple of visits that we could do through digital means, but I don't get compensated the same or at all for that. And so that...

...you know that can't be part of my business model. So I think that's a keyt piece to that. And the other side is just is the technology is our inherent assumptions as to what technologies certain populations could or could not accept and which, you know, in terms of we were, frankly, we were pleasantly surprised in terms of work we worked with CMS populations of, frankly, how sophisticated the solutions they can use, like, not necessary using large bandwidth, but in terms of what those populations are capable of, where our clients are going. Well, they couldn't do this and it turned out they could have match you to great effect. So there's a lot of assumptions. have been working as opposed to anyone asking anybody in many cases. Yeah, so, Britt what are some of the things, especially because of your role, you know, as the Associate Dean for Rural Health Innovation Right. What what is your perspective on how do we how do we advance consumerism with also being mindful of some of the social determinants and some of the inequities there? I think if you're going to advance consumerism, I think, you know, how people adopt technology has to be a thought there and and meeting them where they are, you know, is in a hour long phone call yesterday and we were talking about apps and we were talking about you know, the adoption of APPs and whether or not people had the pathway or the technology even to start in that APP process. And I think that I think that we have to look at we talked about adoption in high need populations in your rural area. I have a lot of experience. I've grown up in a practice and my career is dedicating to real populations. But you know, I would encourage people to say not just rule, but disadvantage or disparate or low resource population. And you can be a low resource population in a metropolitan area. So I think that when you start thinking about innovation and consumers and you need to think maybe about least common denominators or pathways or adoption or efficiencies and how you do the workflow. I've been a victim as a physician of so many bad workflows through technology that have been brought in and people say, Oh, this is a great technology, it does something great, but it's going to cost you half an hour to an hour extra a day or it's going to cost your staff more time. People don't understand how thirty seconds, you know, adds up when you have to do that thirty seconds extra, Thirty Seconds Twenty Times a day, Thirty Times a day, Forty Times a day. There's a lot of administrated burn. Their patients have have stressed in their lives and I think that's something that people are going to have to understand, whether it's a social determined valuation, whether it's mental health evaluation, and how we meet those patients. Where we are we're really that. The drive to me in all of this is precision, and I'm not caught talking about precision genomics, but I think about precision education based on the individual patient. The data is so the data pools are so rich now, but in health care we're just not driving them toward the individual patients benefit. It's in use thirty seconds, because that's what a sorry, Jeff, no, that's what you are just saying. That's what you said. There's too much, too much information. But I would say maybe more specifically, there's too much data, not enough information. But I check. I accept that qualification, but that's absolutely correct. But just Brent your point of thirty seconds. It's interesting because when we provide solutions we actually use the thirty second rule where if it's going to take the clinicians or the providers thirty seconds more to their day we failed what we're trying to do because our objective is to save time for the patients, but also the ecosystem and for the clinicians as well, and we literally that is a measure that we use because it can't because you said you guys already working thirty hours a day. You know thirty seconds is traumatic that regard. Right.

I think it gets into the relativity of healthcare time. You know, when you when someone goes to an ear or hospital, they wait four to six hours, it seems like forever. For the people who are doing the work, it seems like that four to six hours has gone by extremely fast. And I try to talk to people who are looking at technology solutions, I when they're trying to design around the physician workflow. I've explained to him the clinical minute and you know, if you're in front of someone, if you have the clock going for sixty seconds and you can't do something, that clinical minute seems like twenty minutes. There's a magnification of time. Time is relative around clinical and counters and you just can't you can't add to the workflow. You have to reduce the workflow and that's a challenge when you're looking at technology solutions. Well, I know, I think that the technology solutions can give you back time that you're taking if they're done properly, you know, like a Duncan donut stowec through APP you know, you said, yeah, I just reduced my my interactions by ninety percent. Right, ordering, paying all that stuff is just a it's incredible, but I think a lot of applications are done without that being top of mind. Well, that's that's exactly the case. It's many of them are done. I got this great idea done in someone's base, but without actually talking to the users, the end users, and that's probably biggest failing of a lot of solutions is they go the end user once it's finished developing and then they try to force a solution as opposed to a solution that the end users actually need. Now, understandably, if you ask somebody what you need, many cases all they know is what their buzz words are. They don't know. It's capable, but that's why you need it's it really is interaction between the two to sort of develop these solutions that really adjust and people understandable sides. What are needs, what the capabilities are. I've found that with truly disruptive technologies. You really can't ask people, though. You have to watch them because if you say you know, as you know, they what people on nineteen hundred, it was a horse that ate last. They didn't want an automobile. Right, faster, faster horses, absolutely and and really get it's really more guess once you've sort of start your development process. That's why you start asking to make sure it does work. But there's no question the inspiration won't come from asking because what people know are buzzwords. Ages ago and used to be an advertising I'd going to meeting and it talks to the clients and I didn't know, maybe not much about the client or anything else, but the one thing I did know is when I ask what they wanted, that was the last thing they needed because they knew the buzz word but didn't really know understand what the kid what really are, what would help them. Well, and I think that there's a science and an art to this whole customer just customer discovery process to that we're talking about, because it's really easy to you know, kind of humor your board or your advisors or your you know, the rest of your leadership team of doing discovery only just to kind of intentionally validate the beliefs that you already had when you went into it, especially if you're already so, either financially or emotionally, invested in that particular solution or pathway. And so I think it takes a lot of humility, leaving our egos at the door, to really be able to say that I'm not the one. My opinion really doesn't matter nearly as much as our customers are target customers, and in that really the data, that customer data rules out our opinion, and I don't see that enough. Yes, you're seeing logic and rationality don't necessarily play...

...a role, right. Yeah, and too many technology solutions that are looking for a problem instead of starting off with the problem and then figuring out the solution. And Yeah, just touch to go ahead. Roxy. That's where I get a lot of calls from startup companies who they're sort of playing themselves out. I can tell within five to ten minutes that the that the product or the service is really not there. But they come to the rural area thinking, you know, always poor cells in the rural areas. You know, you know, surely if there's some bit of if I say technology and tell them let's come work with and they'll take us up on this offer. I tell people all the time. I said, if you want to make something work, come to a rural area, as if you can make it work in a rural area, you're not going to have a problem going to bigger cities, more technology, you know, driven areas and and having that work. You know, where you have a density of talent. Make it work in a rural area. I say start with us, because we'll tell you how to save money. I mean that's being frugal. I think and rule go so well together. Well, we're always going to look for a low call solution to get what we want. Yeah, yeah, definitely, all right. That's for all the listeners. Take Hey to that. Another economic part is obviously we touched on the compensation. If you if you really want to support telehealth and you've got to pay for it, right. But the other aspect of that is the transparency health care costs, and that's a very big deal to be able to and and there are quite a few trends in that direction. Good legislation. There's there's some stuff happening in that direction to allow for genuine healthcare transparency. It's not easy, though, because the complexity. You know, we went from ICD nine to ICD ten with a without any real thought as to what would that do, you know, for improved quality or improve price transparency, and it just really made things much more difficult to understand because the categorization now was so complex it needed a computer. So the whole trump price transparency is very important, but it's not very straightforward. So let's talk about that. What role is the FDA plane in consumerization and how are they either moving us along or hindering us? Well, I think the FDA in its current form may cause more harm than good because the emphasis is all on premarket approval. You know what happens in a highly controlled chlinical study with a highly control cohort, and and then once it's done, it's the wild wild west. You can do anything you want. It looked at around and said we're just going to provide transparency to users to say hey, this new device you're using, it's been used forty twozero times and there are six percent were reports on complications, or it's been used twelve times and there are six reports on complications, or it's been used forty two million times and there are six reports on complications. If you could give improved post market surveillance and relax the, I think, artificial barriers set up in premarket approval. Maybe a drug wouldn't cost a billion dollars. Right, we accepted it does. So it cost a billion dollars. Well, if you follow the clinical trials for a drug, you understand why I've talked a billion, because nothing in it makes sense. It's it's so I think FDA, if they shifted more to a postmarket surveillance model, would go a long way to support consumerism. It's an excellent point. In quite on your back to the sea...

...word Covid I think we thought perfect example the vaccines, because that was an example of where you had accelerated at the approvals, regardless, right or wrong, and it's all been nothing but postmarket surveillance that the entire world has been watching, which you've never really had in any extent like that before. And so when you seeing, oh you're getting this issue with that medication or this issue that, that's postmarket surveillance that you don't have not seen another kind of medications. So to your point in Jeff, I think it's an excellent and it's always been something we've been talking about. is in need. That's should they should be doing. Hopefully, this is actually example uple of why you need to have that in the value proposition associated with it. The Bret, you probably have much more visibility than I do and anything like that. I agree with both of these comments and I was going to give too much of a response other than I think the FDA needs to add another a and echoes the word that Jeff said, which was advice, and I wrote down notes prior to this, and it needs to be advisory. You know, you've got administration, but you really need advisory. You know, patients, I think, are looking for advice, that you're looking for that. No, don't just administrate, but advised. I love it. And and so that that's really what I think. That's really what we're looking for, because we get that disconnect and and it gets you need consumerism because consumers, consumers, don't have that direction, that guidance, that navigation that they need. So maybe the I don't want to I don't want to see another federal panel created by any means, but you know, just think about that in user and how it affects their life. I mean paste for a lot of confused patients out there, a lot of confused families. When you get into this realm and we oftentimes, when we talk about big, big areas, technology and innovation other catch terms, we forget about those, you know, people in the room and those people in the hallways that are just struggling, and we can't ever forget those individuals. Yeah, Hey, it's Dr Roxy here with a quick break from the conversation. Are you trying to figure out what moves you need to make just to vive and thrive in the new covid economy? I want every health innovator to find their most viable and profitable pivot strategy, which is why I created the covid proof your business pivot kit. The pivot kit is a step by step framework that helps you find your best pivot strategy. It walks you through six categories you need to examine for a three hundred and sixty degree view of your business. I call them the six critical pivot lenses. As you make your way through this comprehensive kit, you'll be armed with the tools, tips and strategies you need to make sure you can pivot with speed without missing out on critical details and opportunities learn more at legacy, dnacom backslash kit. Well, Brent, you got you've got people now struggling, obviously struggling with the idea of getting or not getting a vaccination for covid and at this moment in time, the FDA they haven't made up their mind yet and hasn't been cleared other than for emergency use. Right, let's hope. What? How? How are you expecting someone to make a determination with their own body, in their own money and own risk if, if the agency this supposed to do that hasn't made that determination yet? It can be very confusing, I think, confusing. Go ahead. Oh, it is, and I think when you talk about hesitancy, that's one of the top three. It always here. You know, it's still emergency. You see, it's you know, EU A and I in the other issues. I was just going to throw the CDC in there as well. Be People are looking at these bodies to provide guidance. Mean that's what they're there for, to provide guidance, advice, direction. And when they when they hesitate at...

...all, it causes people to pause and we've got a real, real issue out here and people trying to make scientific decisions when they don't have a scientific background and any hesitancy on these venermal bodies at you know, in the last six weeks I've heard had more people say I just don't trust him anymore. When you lose trust, you you don't get that back quickly. Right. And and the consumerism you get. The patients in this regard are making their own as the consumers and making their decisions. They'll right. It's they're fully empowered. Right there. Wrong. We have to go. Okay, I've got to go through all this information, all these news reports, all these online reports, because the source of information, some are better than others. After that one right, yeah, and it's extremely difficult. And even when the authorities change their minds, you mentioned earlier, Jeff, that becomes even more confusing when today something is okay, tomorrow it isn't. Then the third day will mix the two works and so yes, any go ahead. Yesterday I see a headline, you know, it says eighty five percent of the new cases of Covid or the Delta variant, and it was written in kind of a breathless tone right of it. Wow, eighty five percent. Well, I'm thinking, okay, but what's the right number? I mean, is eighty five a bad number or good number? I don't know. I mean I could make an argument that, g eighty five is not good. It should be ninety two, seventeen. I mean, who knows right? But the the idea that you throw a big number out and and people are supposed to properly interpret it. I don't know how to interpret that number. I I could. I could make an epidemiologic or mathematical argument that it should be higher or lower. I I don't know which, which way to go on it, but it's not a headline, If foot at best. So, you know, as we kind of just go back to this idea of, you know, having covid test us on what we really think is possible and what we can't do, and we're talking about the FDA and being able to accelerate the approval process and you know, this is kind of post data surveillance. Do you guys think that we are going to see more of this? Is it kind of like tell a health where it's kind of open the door and now, oh my gosh, now we're going to really reinvent this process and is it going to take a while or we're going to be inch and a long and what's going to affect that or influence it? Well, I think I think it's the number of factors. One is, again, just in terms of the the covid it's not like on Thursday they said we better find a COVID vax. Seem they've been working on the so stars vaccine for a long time. So it's been in the background sitting, but there's no funding for it. What happened was there's accelerated funding, so they're able to speed up that process now, no question. In terms of the face, the face trials are accelerated and I think there's some good learnings out of that in a number of areas which are going to be helpful to accelerate the process going forward. But it's not like they went from zero to, you know, in zero two solution that quickly. It's been in the it's been sitting the back rooms for ages in development, one former another. Yeah, just like telehealth right, been sitting in the background for a long time exactly, and then he got nice stress test by having millions of people, tens and hundreds of millions of people using the go okay, this is working, this is not. So it's creating that tweaking. But yeah, this is but now it's out there. So who's doing it well? What are some examples of companies that are really, you know, not just having patient centric plastered on their website or on their walls? WHO's the companies out there, the brands that are really empowering patients in in a meaningful way? That's that's...

...a really tough question. I think we're still figuring it out, like you've got, because I don't think we want to confuse uptake with successful outcomes, because I think we're still in that learning process. I think if you look at all the statistics, there's a peaks and valleys and how that's going as everyone sort of learning how to make it work. I think there's a lot of wage. It's a very good question and but I have one general area that I think is gone real well, and that is image transfers, that we've been able to take all your scans or MRI, ultrasound and all that and democratize it. I mean you've now got a primary care physician who can playfully educated the intelligently a look through scans seconds after they've been done and that that to me has pushed very, very high technology down to the primary care level and patients right can go home with their own ultrasound and Mriyes, and it may not know what to do with it, but I think that's the area of empowerment the general field of image management. Hmm, but that's something. It gave us a technology that existed. Is just got accelerate by pushing it down to everybody, as opposed to and and. But to your point, but it's the comfort factor of being able to use it down that primary physician and feeling more comfortable of having that kind of speed and having the tools available to them to do that. Well, there are technologies. She's super band with, you know, yes, which goes to some of the rooms, gets to some of the rural issues as well in terms of the band with that exists. You know. Roxy I'm going to dive into that question. You asked who and I'm going to take a very broad look and maybe how I preface my statement earlier. I'm going to name four companies. I'm going to name Amazon, facebook, Google and Walmart. And because when you talk about consumerism and healthcare and how that moves in healthcare. I think you had to understand the companies that understand the consumer well and I think you need to understand where technology and where age demographics are going to drive healthcare going forward. And rather than call out specific health systems, because I don't know infinitely. You know throughout the United States what programs are good, and I'm sure there's some good programs, but if you look at the scale needed to really influence healthcare and influence consumerism, those four companies come to mind, because people are going to do best with their healthcare in ways that they are influenced and I think these companies stand stand very tall in their ability to influence those who are their stakeholders and they're those who are their consumers. Yeah, I mean, I couldn't agree more. I think that there are probably many tools out there that could empower patients, could put more of that decision making in control, in their hands, but I don't think it's it's distributed or disseminated in the right way. It's not been commercialized successfully in order to really get into those hands of the patients that need them or all of the patient's hands. So there's this disconnect between oh well, I created an APP that will do this, but no one's logging into my APP, no one setting up an account. Right, it's just cobwebsite, crickets over there where. Then you've got these really you know, these big tech companies, these big brands that have really focused on consumerism and that is a key part of their business strategy and and I think that that's also one of those drivers that's happening, as we go back to that, is that as we use those brands, and in Amazon is the one that just immediately comes to mind because I think it's...

...so pervasive, is that our expectation is for all of our digital experiences to be like an Amazon experience, and I think that's driving some of that consumerism, even though you've got the push pull with the ecosystem that's kind of resistant to it. You're right, the bar has been elevated by all those applications, for sure. Yeah, yeah, and bringing the whole consumerism element into it. To your point, Brit they really are the big drivers behind that all. And with the Amazon to have Samuel L Jackson on Alexa Tominey, take your pills, more of a drivery. Do need than that? It's just genius, right. Absolutely. So let's just talk about that too as we kind of start to wrap up here. You know, how do we think the four big tech companies, you know, Alphabet, Aka Google, right, Amazon, Amazon, apple and Microsoft, how are they influencing healthcare? Are Are they you know, besides this Amazon effect or you know, do we have any thoughts around them actually getting more and more entrenched in healthcare? Well, I think there's no question they get more entrenched in a variety of ways, but in different ways. As you said. We talked about earlier. Google's Dr Google. So there's an information pathway there. With Apple, is no question they want to create a conduit in terms of through some of the various APPS, in terms of dissemination information, you'll images or whatever the case may be, through the various pieces. Amazon is a delivery mechanism. In many cases you through prescriptions, are doing now, and is that. They all have their different niches. And Ib am, I think, is infrastructure. The obviously ws you've got some pieces, but an IBM has other pieces. So I think they're all going to get involved. I think you're going to see they're going to create their own niche areas because, you know, whun healthcare was so complex caated. I think they're all taking different you know, you can't take it all on. It's you got to take on the different elements. I think we're going to start seeing over the next year or so more clearly what elements they want to take over or try to take or take dominance of. Yeah, and I definitely think that Amazon and Google are going headtohead. When you look at the stats around voice and the applications of voice and healthcare. I mean, you know, for the first time we're starting to see voice conferences. You know, even just three years ago you had a conference in a voice conference and healthcare was kind of a small piece of it. Now you're seeing these standalone voice conferences and in the big TEP companies, you know, are the ones that are absolutely facilitating that. Right. I think the limitation is certainly not it's certainly not technology. The limit limitation is how do the appropriate levels of money get transferred? So in consumerism, if you had financial skin in the game and it mattered how much you spend, but you can allocate your money to towards a service that helped you manage your medical records and help you do that. That would drive a lot of the adoption. But right now it's just it's still all to confusing. Right health care insurance isn't really insurance. It's economic redistribution with a big layer that sits between you and your doctor. Right. To me, my biggest view of my insurance company is a wall in between myself and my position and the kind of in the way. But if they really were true insurance company to cover your expenses but you had skin in the game, I think that would direct money to their right service at Amazon or Google or Xyz.

So, as we wrap up here, the last question that I have for the og group here is, you know, what is it? As we're all patients right in some former fashion, what do we need to do as consumers? Is it or is there anything that we can do to help move us? And then, as we're thinking about our audience for the show, in other health innovators and, you know, people that are part of this ecosystem, what's what is the guidance? What do we need to do to actually change this and to really make a difference? As a layer, I would say offering high deductible true insurance skin in the game for the employees as an employer offering those kinds of financially incentia or incentives to do the right thing. Just in terms of apologize for the background noise if you hear any of it, but to me it's almost heart touched on earlier in terms of for both the patient the provider, the entire ecosystem is with all these schools and you know you've got all this data, is really make sure what you're providing is actually valuable information, so there's actually valuable information for the patient, variably information for the clinician, for the provider, for the payer. Because that's what you got to get through the other day. It's fine, it's easy to make noise, lots of data. That's not that's not hard. The difficulty is that actually getting information that's actionable and valuable to people in the system. Yeah, you know you have to be a healthy agitator here and that if you're going to play and try to affect change in this health care ecosystem, you have to understand where where the other parties are, you know, and you can't do anything in health care unless you're going to be affecting someone else's business. Model and as you do that, you need if you're going to be effective and get giving advice and working as a leader. You need to temper that in your comments. I've seen too many people who could be effective leaders in health care just scorch earth, you know, lay the room and say I know better than anyone, and then they're useless, they're ineffective. Yeah, it's really hard for the multiple players and healthcare to play well, to gather, but that's what we're really striving for, is to create those perfect multi disciplinary, interdisciplinary teams. That's that's there for the patient. Again, patient first, patient first. If you lose your way, come back to the patient. They'll tell you what's wrong with them because they're sick and their need. But you won't win all your battles, but you have to stay in the game because because it's too important. Yeah, definitely. So one thing that I would just add to that that comes to mind is, you know, Co creation, which kind of ties to our earlier conversation around customer discovery, but patient co creation or, like you said, like multi stakeholder co creation, to where I'm not just co creating with the people that I'm that are paying for the solution, but I'm making sure that everybody that's involved in this, in this process, gets a seat at the table and then still elevating the patient's seat at the table, so that way the patient trumps with the payer and the provider and the employer are saying. As they sit there and we're kind of brainstorming what we're going to develop and and how we're going to bring this to market and what this user experience is going to look like. We're most people aren't doing customer discovery. If we are, we aren't doing it with everyone. That needs to be part of that process. So I think that that is going to really help move us in the right direction. Any us? Yeah, so, any other question? Any other question? To comments for our audience before we wrap up.

It was a good one point, and that is, if you're a patient who has gathered as much information as they can, you're always fearful of going in and, you know, saying that you've consulted with Dr Google, because it takes very little rejection from your doctor to not want to do that again. Yeah, so it's it's I don't know what. I don't know what the answer is. I just know that that you're not. It's not a peer to peer conversation you're having and a little bit of rejection from the doctor goes a long way to stopping that kind of dialog with the patient. That's a good point. But, but the other hand, but you've got to remember it's your health, it's fewer life and so to be able to start say the doctor is going to push back, to expect that they maybe the push back, but to push back yourself because you need this information for yourself and if you've heard something you'd like to get feedback on that. Yeah, yeah, I would say happen. Encourage patients and families always have a healthy advocate in advance. You know, not everyone can have a doctor in their family, APRN and nurse, but you've got a friend, you've got social media. My favorite calls or people who call me just to consult based on a medical work up, whether it's for them or their family, because oftentimes they find the solution or they answer for their questions just by sounding them out, because they know they're going to get someone who's calm, who all I'm there to do is listen. That ultimately, I don't have any ownership and that because it's not my care plan right. Often Times people just don't feel like they have that latitude in their care environment because offices are busy, doctors are busy, but sometimes you just need to hit the Paul's Butt and talk through that. So try to have that person identified in advance. Maybe that's the development for and for some sort of APP or or development is down the line. That together, there's definitely not enough out there for caregivers and advocates right as a huge gaping hole. Well, thank you, guys so much for me with that, Howard, that's a show on its own. Yes, exactly. That will be our next topic, caregivers and advocates. Well, thank you guys so much for joining me today. It's been another great discussion. Until next time, you see you, guys. Thank you all right, good seeing you. Thank you. Thank you so much for listening. I know you're busy working to bring your life changing innovation to market and I value your time and attention. To get the latest episodes on your mobile device, automatically subscribe to the show on your favorite podcast APP like apple podcast, spotify and stitcher. Thank you for listening and I appreciate everyone who shared the show with friends and colleague. See You on the next episode of Health Innovators.

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