Health Innovators
Health Innovators

Episode 96 · 2 months ago

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


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

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

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

You're listening to health, innovators,a podcast and video show about the leaders influencers and early adopterswho are shaping the future of health care on your host Doctor roxey movie. Welcome back to the show healthinnovators on today's episode. We are flipping the script again with ouroriginal og crew or panel discussion with Jeff Carlyle, Howard, Rosen andrent right. This is our second episode and we're going to do more, so pleasesubscribe and tune in for this incredible discussion that we're goingto have today's topic is going to be the growth drivers, the restraints andthe trends around health care consumerism, a topic that I think isvery dear to all of us. So let's just jump into the conversation and answerthe first question of what are the growth drivers? You think that arereally the force behind health care, consumerism that we're seeingaccelerated today. Well, certainly, there isn't a trendunless there's a problem right, so we got dentify. What is what is theproblem, and I think that patients don't feel rightly that they're getting the right care the right value, and soI think that that drives him to look for something else, and I don't knowthat health care consumerism is really growing all that quickly. I wouldn't assume it justbecause it's easy to say rapidly growing health care consumerism andthat I'm not sure that it's true so I'd like to I'd like to hear a little bitmore about that is whether or not we really think it is growing, but I thinkit's growing out of the dissatisfaction the Standards Clo, it's inten jeff in terms of it's a good,it's a good response, because the consumerism has always been there. Partof the issue is the tools to do it. You've got that crowd. That's been theworried. Well, that forever one o more more more had pieces of information,and you of those that are having a Catia condition that they wantinformation on so thin, just been a pent up demand that we're still goingthrough, even with Covin all the tools that were still working through andtrying to make sense of the tools that do exist and what a providing value andnot providing value. And it's so the problem was, you knowthey do want more information. How do you get that more information nowthey're starting to get it? But what does it mean? Because part of it is anoverload of information as well, and an overload is almost as bad as noinformation, because there's lots of bad information in there, and so Ithink that causes dissatisfaction. So I statistically you're right, I think youknow you've, seen a lot of mix signals as to the uptake and not uptake of tellhealth and variety of solutions, but part of that, I think, is thisdissatisfaction of what that experience is because this is not the kind ofinformation I wanted, or was I so I in a pivotal element to this. No, no question in part because you othe consumers, have wanted to have these kind of relationships. All therespect to the wonderful providers and payers out there, they've been the oneswho've been reluctant to provide it. So it's been a push and now became apull just because the economics and the situation created it. So sometimes he comes be careful. Whatyou ask for, because you get it now, it's like okay!Now do we get? What do we do in rent got re Ovid OVID's been a game changerand in consumerism, Belli. Think coved hasbeen a game changer and how we look at consumerism, and I would mostspecifically call out the example of Tellah Tela Health had been around fordecades and the adoption had been black luster. You know you bring Covin intothe mix and then you start looking at what I would say would be the entry inthe digitization of health care. I mean everyone in more of the corporatesectors, looking at digital and looking at digital channels, and this was beinglooked at heavily. You know five years...

...ago, healthcare to me when you unpackthis consumerism is health. CARE has a hard time of looking at itself asconsumerism, those who seek to innovate. Looking around the edges, I thinkunderstand: health care needs to be based on consumerism. However, if youlook at healthcare systems in the way health care systems think they're stillvery parental. There they're still very you know a monopolistic in theirthinking when it comes to the patient. Just look at records how records aremanaged, but I'm going to stop there and not go into the records discussion,because that could easily take up its hole whole time, but I'm going tomention here a restraint that I think when you talk about. Consumerism is yes,we all see consumers and coming we see the need for digital. We see the needfor innovation, but when you look at patients themselves often times thepatients with the highest health burden may not be poised to avail themselvesof a digital of consumers and techniques of the APPS amplification ofhealth care and these new tools that people are at that one side of thehealth care spectrums wanted to drive towards and the more intrenchedincumbent healthier system is not able to mitigate because they're still beingpaid on the note model. Definitely you know I completely agree. It almostcreates some inequities. So it's good that we're making some progress. Wehave some restraints that are holding us back as well, and then it also canpotentially create some new challenges for us to deal with or exacerbate someof the challenges that we've been dealing with with inequity and healthcare. Exactly and be, you want Freno not mention electric medical records,because that would take up the whole show and in fact it would take up. Manyshows Iki, think it's central, the ownership and quality and where is thelocus of the medical record, is an absolutely essential part of consumerism. Absolutely andit's important part because owner it is whose data is this really and becomesabsolute core to it and but tied to it as something in Brenton. You said aswell is the business model and the payment model in the revenue models hasultimately, yes, it's health care, but it's a business. Is that and it's the revenue modeltends to drive a lot of how the business and what the interactions areand how that's going to work and affects directly the ownership of thedata and what who owns it? What's done withit yeah, you know, I think that what you guysare saying as far as you know, the consumerism has always been there. Thedemand and we just haven't been servicing those patients. Well, wehaven't been delivering for a really long time and I think what Ovid did isit forced the hand of a lot of providers to be able to deliver thatkind of debunking a lot of the myths that they had in their own mindabout what could and couldn't be done? You know I mean I think that if wedidn't have Ovid, we would still be talking about health care consumerismwithout any inching of her progress for another decade, at least so, oh we'renot there. Yet we're not there. Yet we, you know, might go work for thosepeople. Well, we can't do it over here. Who was the stumbling block, though youwas it really the you don't think it was the patient, so you think it was aproviders or is of the payers. I think it was much much more of the payers. Yeah, absolutely I mean the manyproviders who wanted to do things in the more efficient play, but theydidn't get paid for it so correct yeah. I mean I've interviewed a number ofphysicians over the years and had conversations with them and they saidabsolutely like. I don't have to see those patients face to face for everysingle visit. There's a couple of visits that we could do through digitalmeans, but I don't get compensated the same or at all for that, and so youknow that can't be part of my business...

...model. But absolutely that's a keep piece tothat and the other side is just is the technology? Is Our inherent assumptionsas to what technologies certain populations could or could not acceptand which you know in terms of we were frankly, we were pleasantly surprisedin terms of work. We work with CMS populations of frankly howsophisticated the solutions they can use like, not necessarily using largeband with, but in terms of what those populations are capable of whereclients are going well, they couldn't do this and it turned out they could atnatually to great effect. So He's a lot of assumptions have been working asopposed to anyone asking anybody in many cases yeah so brat. What are some of the things,especially because of your role? You know as the Associate Dean for RuralHealth Innovation Right. What? What is your perspective on? Howdo we? How do we advance consumerism with also being mindful of some of thesocial determinants in some of the iniquities? They are, I think, if you're going to advanceconsumerism, I think you know how people adopt technology has to be athought there and and meeting them where they are. You know, is in a hourlong phone call yesterday, and we were talking about haps and we were talkingabout. You know the adoption of APPs and whether or not people had thepathway or the technology even to start in that apt process, and I think that I think that we have to look at. We talked about adoption in high needpopulations in no world area. I have a lot of experience. I've grown up and Ipractice and my career is debted Kitty to to real populations. But you know Iwould encourage people to say not just rural but disadvantage or discret or orlow resource population, and you can be a low resource population in ametropolitan area. So I I think that when you start thinking aboutinnovation and consumers, and you you need to think maybe about least commondenominators or pathways or adoption or efficiencies, and how you do the workfloat. I've been a victim as a physician of so many bad work flowsthrough technology that had been brought in and people say. Oh, this isa great technology. It does something great, but it's going to cost you halfan 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 haveto do that. Thirty seconds, Extra Thirty Seconds Twenty Times a day.Thirty Times a day, Forty Times a day, there's a lot of administrative burden.there. Patients have have stressed in their lives, and I think that'ssomething that people are going to have to understand whether it's a social,determined evaluation, whether it's mental health evaluation and how wemeet those patients where we are we're really that the drive to me in all of this isprecision and I'm not caught talking about precisgenomics, but I think about precision education based on the individualpatient. The data is so the data pools are so rich now, but in helter we'rejust not driving them toward the individual patients benefit. I get. I only use thirty secondsbecause that's what me act so sorry, Jeff! No, that's what you are justsaying: that's what you said there's too much too much information, but I would say, maybe more specificallythere's too much data and not enough information, but I ha. I accept that qualification. Now,that's absolutely correct, but just Brent. Your point to thirty seconds isinteresting, because when we provide solutions we actually use the thirtysecond rule where, if it's going to take the clinicians or the providersthirty seconds more another day, we failed what we're trying to do, becauseour objective is to save time for the patients, but also the echo system andfor the Ploniton as well, and we mitely. That is a a measure that we use,because it can't, because you said you guys- are already working thirty hoursa day. You know thirty seconds is...

...dramatic in that regard right, I thinkit gets into the relativity of health care time. You know when you, whensomeone goes to an er or hospital, they wait four to six hours. It seems likeforever for the people who are doing the work. It seems like that four tosix hours has gone by extremely fast, and I try to talk to people who arelooking at technology solutions. I, when they're trying to design aroundthe physician workflow, I 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 twentyminutes, there's a magnification of time. Time is relative around clinicaland colors, and you just can't you can't add to the workflow. You have toreduce the work flown and that's a challenge when you're looking attechnology solutions. Well, I know I think that thattechnology solutions can give you back time that you're takingif they're done properly. You know it s like a Duncan donut lip through APP.You know you say now. I just reduced my my interactions by ninety percentordering paying all that stuff. It's just a it's incredible, but I think alot of applications are done without that being top of mind. Well, that'sthat's exactly the case. It's many of them are done. I got this great ideadone in someone's base, but without actually talking to the users.The end users, and that's probably the biggest failing of a lot of solutions,is they go to the end user once it's finished developing and then they tryto force a solution as a post to a solution that the end users actuallyneed now. Understandably, if you ask somebody what you need many cases, allthey know is what their buz words and they don't know what it's capable. Butthat's why you need it. It really is interaction between the two to sort ofdevelop these solutions that really adjust in people understandable sideswhat are needs, what the capabilities are. I've found that with trulydisruptive technologies. You really can't askpeople, though you have to watch them you, because if you say you know, asyou know, they what people in Nineteen hundred one was, of course, that ateless. They didn't want an automobile right after faster horses, no,absolutely and really get it's really more. I guess once you've startedstarting your development process, that's when you start asking to makesure it does work, but there's no question. The inspiration won't comefrom asking because what people know or buzzwords ages going used to be an advertising. Igo into a meeting and I talked to the clients- and I didn't know- maybe notmuch about the client or anything else, but the one thing I did know is when Iasked him what they wanted. That was the last thing they needed because they knew the buzz word, butdidn't really know. I understand what the kid, what really are, what would behelped them well, and I think that there's ascience and an art to this old custom of jus customer discovery process tothat we're talking about, because it's really easy to you know kind of humor, your board oryour advisors or your. You know the rest of your leadership team of doingdiscovery only just to kind of intentionally validate the beliefs thatyou already had when you went into it, especially if you're already so eitherfinancially or emotionally invested in that particular solution or pathway.And so I think it takes a lot of humility, leaving our egos at the doorto really be able to say that I'm not the one. My opinion really doesn'tmatter nearly as much as our customers are target customers and in that reallythe data that customer data rules out our opinion, and I don't see thatenough. Yes, you sing a logic and rationality,don't necessarily play a role...

...right, yeah and too many technology solutionsthat are looking for a problem instead of starting off with a problem and thenfiguring out the solution, and yet you ave touch trackhead b roxy.That's where I get a lot of calls from start up companies who they're sort ofplaying themselves out. I can tell within five to ten minutes that thatthe product of the service is really not there, but they come to the ruralarea. Thinking you know all these poor cells in the rural areas. You know you know, surely, if there's some bit,if I say technology and tell them, let's come work with them. The they'lltake this up on this offer. I tell people all the time. I said. Ifyou want to make something, work come to a rural area is, if you can make itwork in a rural area, you're not going to have a problem going to biggercities, 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,say start with us, because we'll tell you how to save money, I mean that'sbeing frugal. I think, and real go so well together. We we're always going tolook for a low call solution to get what we want. Yeah Yeah. Definitely all right! That'sfor all the listeners take heed to that. Another economic part is obviously wetouched on the compensation. If you, if you really want to support, tell a health, then you got to pay forit right, but the other aspect of that is thetransparency, health care, CASS and that's a very big deal to be able to,and- and there are quite a few trends in that direction- good legislationthere's a there's, some stuff happening in that direction to allow for genuinehealth care transparency. It's not easy, though, because the complexity, you know we went fromCD, nine to ID ten with a without any real thought as to whatwould that do, you know for improved quality or improve price transparency,and it just really made things much more difficult to understand, becausethe categorization now was so complex. It needed a computer, so the whole truck price transparency is veryimportant, but it's not very straightforward. So let's talk about that. What role isthe FDA playing in consumerist on and how are they either moving us along orhindering us? I think the FDA in its current form maycause more harm than good, because the emphasis is all on pre market approval.You know what happens in a highly controlled chemical study, with ahighly control cohort and and then once it's done, it's the wild wild west. Youcan do anything you want. I liked that around and said we're just going toprovide transparency to users to say, hey this new device you're using it'sbeen used forty two thousand times, and there are six percent reports oncomplications or it's been used twelve times, and there are six reports oncomplications or it's been used forty two million times, and there are sixreports on complications. If you could give improved post market surveillanceand relax the, I think artificial barriers set up in pre market approval.Maybe a drug wouldn't cost a billion dollars. We accepted it does Oh, itcost a billion dollars. Well, if you follow the clinical trials for a drug,you understand why I cock to billion, because nothing in it makes sense itjust it's. So I think FDA. If they shifted more toa post market surveillance model would go a long way to support consumerism. It's an excellent point in quite on Yoback to the sea. Word Covin. I think we...

...stop a perfect example the vaccines,because that was an example of where you had accelerated f the approvalsregardless. You know right or wrong and it's all been nothing but postmarket surveillance and that the entire world has been watching which you'venever really had in any extent like that before, and so when you seeing Ohyou're getting this issue with that medication or this issue that that'spost market surveillance that you don't have not seen another kind ofmedications a so to your point, Jeff, I think it's excellent and it's alwaysbeen something we've been talking about is in need. That's should they shouldbe doing. Hopefully this is actually an example of why you need to have that inthe value proposition associated with it to Brent. You probably have muchmore visibility than I do in anything like that. I agree with both of these comments andI wasn't going to give too much of a response other than I think the FDAneeds to add another a and that Cos the word that Jeff said, which was advice,and I wrote down notes prior to this. Then it needs to be advisory. You know,you've got a administration, but you really need advisory. You know patients,I think, are looking for advice, they're looking for that, no don't justadministrate but advise I love, and so that that's really what I think.That's really what we're looking for, because we get that disconnect and andit gets uneedas ISM, because consumers, consumers don't have that direction-that guidance, that navigation that they need. So maybe I don't want to. Idon't want to see another federal panel created by any means, but you know justthink about that in user and how it affects their life. I mean pater a lotof confused patients out there a lot of confused families when you get into this realm, and weoften times when we talk about big big areas, technology and innovation. Othercatch terms we forget about those- you know, people in the room and thosepeople in the hallways that are just struggling. We can't ever forget thoseindividuals, Yeah Hey it's Dr Roxy, here with a quickbreak from the conversation. Are you trying to figure out what moves youneed to make to survive and thrive in the new Co vid economy? I want everyhealth innovator to find their most viable and profitable pivot strategy,which is why I created the Co. Vid proof, Your Business Pivot Kid. Thepivot kit is a step by step framework that helps you find your best pivotstrategies. It walks you through six categories. You need to examine for athree hundred and sixty degree view of your business. I call them the sixcritical 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 sureyou can pivot with speed without missing out on critical details andopportunities, learn more at legacy. Hyphen Daco back kit well breath you got you've, got peoplenow struggling, obviously struggling with the idea of getting or not gettinga vaccination for ovid and at this moment in time, the FDA theyhaven't made up her mind yet and hasn't been plaire other than for emergencyuse right that. So what I? How are you expecting someone to make adetermination with their own body and their own money and on risk? If, if theagency this supposed to do that, hasn't made that determination, yet it can bevery confusing, I think I sing go ahead. Oh it is, and I thinkwhen you talk about hesitancy, that's one of the top three that I always hearyou know it's. Dell, emergency use, it's you know! U A and the in the other issues. I was justgoing to throw the CDC in there as well. I mean people are looking at thesebodies to provide guidance. I mean that's what they're there for toprovide guidance, advice direction and when they, when they hesitate at all,... causes people to pause, and we'vegot a real, real issue out here and people trying to make scientificdecisions when they don't have a scientific background and any hesitancyon these venerable bodies. At you know, in the last six weeks I've heard hadmore 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 and the consumers are makingtheir decisions. Ye Right, they're, fully empowered right there wrong. Wehave to go okay. I've got to go through all this information. All these newsreports all these online reports, because he, the source of information,some are better than others yeah and it's extremely difficult, andeven when the authorities changed their minds, an you mentioned earlier, Jeffthat becomes even more confusing when today something is okay tomorrow, itisn't, then the third day will a mix, the two works and Soyes I er, but yeah yesterday Isee a headline. You know it says eighty five percent of the new cases ofCovenor, the Delta Varian, and it was written in kind of a breathless toneright of it wow. Eighty five percent. Well, I'm thinking. Okay, but what'sthe right number I mean is eighty five, a bad number or a good number. I don'tknow I mean I could make an argument that gay five or not good should beninety two, seventeen I mean who knows right, but the the idea that you canroll a big number out and and people are supposed to properly interpreted. Idon't know how to interpret that number. I could. I could make anepidemiological mathematical argument that it should be higher or lower. Ithink I don't know which which way to go on it, but it's not a headline thefont at best. So you know, as we kind of just go backto this idea of you know, having Ovid test us on what we reallythink is possible and what we can't do and we're talking about the FDA andbeing able to accelerate the approval process, and you know thisis kind of post at a surveillance. Do you guys think that we're going to seemore 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 isit going to take a while or we're going to be inching along and what's going toaffect that or influence it? Well, I think I think it s the numberof factors. One is again just in terms of the the Covin it's not like. OnThursday they said we better find a coved fact seem. You know, they've beenworking on the the SARS vaccine for a long time, so it's been in thebackground sitting, but there's no funding for it. What happened was thereis accelerated funding, so they're able to speed up that process? No, noquestion in terms of the face the face trials were accelerated and I thinkthere's some good learnings out of that in a number of areas which are going tobe helpful to accelerate the process going forward, but it's not like theywent from zero to. You know: Zero to solution that quickly. It's been in theit's been sitting in the back rooms for ages in development, one form oranother yeah, just like tell a health rightbeen sitting in the background for a long time exactly, and then he got nicestress test by having millions of people or tens of hundreds of millionsof people using they go okay. This is working. This is not so it's creatingthat tweaking, but yeah the sister, but now it's out there so who's doing it. Well, what are some examples of companiesthat are really you know not just having patient centricplastered on their website or on their walls, who's the companies out there, thebrands that are really empowering patience in in in a meaningful way. Wow...

...that that's a really tough question. Ithink we're still figuring it out like you've got becauseI don't think we want to confuse uptake with successful outcomes, because I think we're still in thatlearning process. I think, if you look at all the statistics, there is a peaksand valleys and how that's going as everyone started learning how to makeit work. I think there's a lot of wet, it's a very good question, and butI have one general area that I think it's gone real well and that is image transfers that we've been able totake all your scans or MRI ultra sound and all of that and democratize it Imean you've now got a primary care physician who can playfully educatedlyintelligently a look through scans seconds after they've been done andthat that to me has pushed very, very high technology down to the primarycare level and patience right can go home with their own ultrasound and m reyes, and it may not know what to do with it. ButI think that's a big area of empowerment, the general field, animage management m, that's something that gains atechnology that existed is just good accelerated by pushing it down toeverybody as opposed to and but to your point. But it's thecomfort factor of Bein able to use it now that primary physician feeling morecomfortable having that kind of speed and having the tools available to themto do that. Well, there are technology to sue to band with you know, to go to some of the route as get to somethe rural issues as well. In terms of the bad with that exists. You Know Rocksey, I'm going to diveinto that question you ask to, and I'm going to take a very broad look andmaybe how I preface my statement earlier. I'm going to name fourcompanies, I'm going to name Amazon, facebook, Google and Walmart, andbecause, when you talk about consumerism and health care and howthat moves in health care, I think you have to understand the companies thatunderstand the consumer well, and I think you need to understand wheretechnology and where age demographics are going to drive health care goingforward and rather than call out specific health systems, because Idon't know infinitely, you know throughout the United States whatprograms are good and, I'm sure, there's some good programs. But if youlook at the scale needed to really influence health here and influenceconsumerism, those four companies come to mind because people are going to dobest with their health care in ways that they are influenced, and Ithink these companies stand stand very tall in their ability toinfluence those who are their stake holders and there, those who are theirconsumers yeah I mean I couldn't agree more. Ithink that there are probably many tools out there that could empowerpatients could put more of that decision, making and control in theirhands, but I don't think it's distributed or disseminated in theright way. It's not been commercialized successfully in order to really getinto 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 dothis, but no one's logging into my APP. No one setting up an account right.It's just cob, webs IC crickets over there. Where then, you've got these really.You know these big tech companies, these big brands that have reallyfocused 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 wego back to that- is that as we use, those brands in Amazon is the one thatjust immediately comes to mind, because...

I think it's so pervasive is that ourexpectation is for all of our digital experiences to be like an Amazonexperience, and I think that's driving some of that consumerism, even thoughyou've got the push pole with the ecosystem, that's kind of resistant toit. You're right, the bar has been elevatedby all those applications for sure, yeah, yeah, yeah and and bringing thewhole consumerism element into it. To your point Brit, they really are thebig drivers behind that all and with Damazin to have Samuel l Jackson onAlexa Termini take your pills, a more of a droll. I ready need than that, andit's just genius right absolutely. So, let's just talk about that too, as wekind of start to wrap up here, you know how do we think the four big techcompanies you know, alphabet AK, a Google right, AMIS, Amazon, apple andMicrosoft? How are they influencing health care or are they you know? Besides this Amazon effect, you know: Do we have any thoughts around them actually gettingmore and more entrenched in health care? Oh, I think there's no question. Theyget more entranced in a variety of ways, but in different ways, as you said, wewould talk about earlier googles, Dr Google, so there's an informationpathway there with apple there's, no question: They want to create a con toit in terms of through some of the various apps in terms of disseminationof vernation images or whatever the case a be through their various pieces.Amazon is a delivery mechanism. In many cases you know food prescriptions intodoing now and is that they all have their different niches and an Ibam. Ithinks infrastructure, like obviously ws you've got some pieces, but I IBMhas other pieces. I think they're all going to get involved. I think you'regoing to see they're going to create their own niche areas, because you know who no healthcare wasso complicated. I think they're all taking different. You know you can'ttake it all on you got to take on the different elements. I think we're goingto start seeing over the next year or so more clearly what elements they wantto take over or try to take or take dominance on yeah, and I definitely think thatAmazon and Google are going head to head. When you look at the steps aroundvoice and the applications of voice and health care, I mean you know. For thefirst time we were starting to see voice conferences. You know, even justthree years ago you had a conference and a voice conference and health carewas kind of a small piece of it now you're, seeing these stand alone, voiceconferences and in the big tub companies you know, are the ones thatare absolutely facilitating that right. I think the limitation is certainly notit's, certainly not technology. The limit limitation is how do the appropriate levels of moneyget transferred. So in consumerism, if you had financial skin in the game and itmatter how much you spent, but you could allocate your money towards aservice that helped you manage your medical records and helped you do that.That would drive a lot of the adoption, but right now it's just it's still alltoo confusing. I health care insurance isn't really insurance. It's economic redistribution with the biglayer that sits between you and your doctor. Right to me, my biggest view ofmy insurance company is a wall in between myself and my positionand kind of in the way, but if they really were a true insurance company tocover your expenses, but you had skin in the game, I think that would directmoney to their right service at Amazon or Google or x y E.

SO, as we wrap up here, the lastquestion that I have for the O G Group here is: You know what is it as we're allpatients right in some former fashion? What do we need to do as consumers? Ishe or is there anything that we can do to help move us and then, as we'rethinking about our audience for the show and other health innovators? Andyou 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? Is it er, I would say, offering you know, high deductible, TrueInsurance, skinning the game for the employees asan employer or offering those kinds of financially incentive or incentives todo the right thing just in terms of apologize for thebackground? No, as if you hear any of it, but to me it's an we sort of touchon earlier in terms of for both the patient and the provided. The entireecosystem is with all these schools, and you know, you've got all this. Datais really make sure what you're providing is actually valuableinformation. So there's actually valued informationfor the patient verily information with the clinician for the provider for thepayer, because that's what you got to get through because the end of the 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 andvaluable to people in the system. Yeah. You know you have to be a healthyagitator here and that if you're going to play and try to affect change inthis health care co system, you have to understand where, where the otherparties are, you know- and you can't do anything in health care unless you'regoing to be affecting someone else's bisness model and as you do that youneed, if you're going to be effective in giving advice and working as aleader, you need to temper that, in your comments, I've seen too manypeople who could be effective leaders in health care, just scorch earth. You know, leave the roomand say I know better than anyone and then they're useless, they're,ineffective, yeah. It's really hard for the multiple players in health care toplay. Well together, but that's what we're really striving for is to createthose perfect, multidisciplinary interdisciplinary t t that's there forthe patient again: patient first patient pers. If you lose your way,come back to the patient, they'll tell you what's wrong with them, becausethey're, sick and they're in need. But you won't win all your battles, but youhave to stay in the game because because it's too important yeahdefinitely so one thing that I would just add to that. That comes to mind isyou know, Co creation, which kind of ties to our earlier conversation aroundcustomer discovery, but patient co creation or, like you said, like multistakeholder co creation to where I'm not just co, creating with the peoplethat I'm that are paying for the solution. But I'm making sure thateverybody that's involved in this in this process gets a seat atthe table and then still elevating the patient's seat at the table. So thatway, the patient trumps with the payer and the provider and the employer aresaying, as they sit there and we're kind of rain storming what we're goingto develop and and how we're going to bring this to market and what this userexperience is going to look like where most people aren't doing customerdiscovery. If we are, we aren't doing it with everyone that needs to be partof that process. So I think that that is going to really help move us in theright direction in yeah. So any other question anyother question comments for our audience before we wrap out.

I go in that is, if you're a patientwho has gathered as much information as they can you're, always fearful ofgoing in, and you know saying that you've consulted with Dr Google becauseit takes very little rejection from your doctor to not want to do thatagain, yeah, so it it's. I don't know what I don't know what the answer is. Ijust know that that you're- not it's not a peer to peerconversation, you're having and a little bit of rejection from the doctor,goes a long way to stopping that kind of dialogue with the patient. That's agood point but the other hand, but you've got to remember it's your health,it's to your life and so to be able to start say. You know the doctor is goingto push back to expect that they may be the push back, but they push backyourself, because you need this information for yourself and if you'veheard something you'd like to get feedback on that yeah yeah, I would say how encouragepatients and families to always have a healthy advocate in advance. You knownot everyone can have a doctor and their family APRIN and nurse, butyou've got a friend. You've got social media. My favorite calls are people who callme just to consult based on a medical work up, whether it's for them or theirfamily because oftentimes they find the solution or they answer their questionsjust by sounding them out, because they know they're going to get someone who'scalm. Who All I'm there to do is listen that, ultimately, I don't have anyownership in that, because it's not my care plan, but often times people justdon't feel like they have that latitude in their care environment, becauseoffices are busy. Doctors are busy, but sometimes you just need to hit the palsbutton. Talk through that so try to have that person identified in advance.Maybe that's the development for an for some sort of APP or or our developmentis down the line that tother's there's, definitely not enough out there forcaregivers and advocates right is a huge, gaping hole. Well, thank you guysso much a sore with that. How art that's a show when it's old, yes,exactly that'll, be on next topic, caregivers and advocates. Well, thankyou guys so much for joining me today. It's been another great discussionuntil next time. You see you guys. Thank you all right, good seeing youthank you. Thank you so much for listening. I knowyou're busy working to bring your life changing innovation to market, and Ivalue your time and attention to get the latest episodes on your mobiledevice automatically subscribe to the show on your favorite podcast apt, likeapple podcast, spotify and stitcher. Thank you for listening and Iappreciate every one who shares the show with friends and colleagues, seeyou on the next episode of Health Innovator.

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