Health Innovators
Health Innovators

Episode · 1 year ago

How Startups Can Create Value as They Navigate Healthcare's Shift to Risk-Based Models w/ David Johnson

ABOUT THIS EPISODE

There are record amounts of investment into healthcare and provider-based services – but to get your slice of the market, you’ve got to be better, faster, and smarter than the big, traditional players.

Successful innovators are zeroing in on the weaknesses of today’s healthcare industry and making them better. And by “better,” we mean working toward a model that caters to the demands of the changing landscape: better outcomes at a good value to all stakeholders, with a strong focus on the customer experience.

In this episode, 4Sight Health CEO and author of The Customer Revolution in Healthcare: Delivering Kinder, Smarter, Affordable Care for All, David Johnson shares his insights on:
  • How the market is shifting toward risk-based models that demand better value
  • How new innovators are adapting to the shift and changing the game
  • Tips for startups (and bootstrapped upstarts) to stay competitive, including a strong early adoption strategy

 

Guest Bio- 

David Johnson is a speaker, writer and CEO of 4Sight Health. He is the author of The Customer Revolution in Healthcare: Delivering Kinder, Smarter, Affordable Care for All.


For more information, visit https://www.4sighthealth.com/ , and buy the book here.

Welcome to Coiq, where you learn howhealth innovators maximize their success, you're working on somethingbig, something like saving something world changing. Yet ninety five percentof health, Innovation Fail and real lives are on the line. That's whylaunching is not enough. Commercialization is the most criticalyet overlooked stage of the innovation process through candid conversationswith health, innovators, furly adopters and influencers you'll learn the fivecomponents of the Coi q early adoption strategy. So if you want to changelives and dominate your market, why not give your innovation the best chance tosucceed? I'm your host Docor Roxsey founder of legacy DNA, an internationaldeath selling author of how health innovators maximize market success, andnow, let's join the conversation. I maximize your success. Welcome back to the show coiq listenerson today's episode. We have Dave Johnson with us. He is the CEO for foursite health and he's authored a book called the customer revolution andhealthcare that just came out a couple of months ago. Welcome to the show Davewell. Thank you delighted to be here. Howyo Doo meet all of your audience.Yes, so you know before we get started, tell folks a little bit about who youare and what you do sure. Well, I've got a little bit of anunusual background. Roxy I was an English literature mater in college anda Peace Corps volunteer in Africa andthought I wanted to do international development for a career and went backand got a degree in public policy t it at Harvard and one thing led to another, and I endedup as a healthcare investment banker, which was a surprise, nobody more thanmy own twenty five year old self and had very successful healthcareinvestment, banking career working on behalf of large health systems. From Ibet your parents were surprised from the Pacorno that career right, yeah,yeah yeah, you know when I was going to the peacecorps. My Dad tried te everyway you could think of to talk me out of it an so im soin or s this track. Ithink he was secretly grateful yeah. So I was very successful banking career,thirty billion and bond issues and so on, but you know took twenty five years,but what I realized was T. I think what I really am as a journalist and I'V sofor the last five years and had my own company foresight, health, written twobooks and produce a lot of thought: leadership on market driven, healthcarereform and in some ways this complex nuance industry that we work in, Ithink sometimes requires lie literary sensibility, Cultural Sensitivity,public policy, acument and market knowledge, and I use all those prisonsto to think about and reflect andhopefully comment intelligently on, the industry, stilr yeah. Absolutely it's avery diverse background. So I'm yeah no kidding, I'm excited about today'sconversation. So how would you describe this rollercoaster of health care novation these last few years, what's happening innovation. One Way to look at is there are recordamounts of investment from both private equity and venture funding, going not only into healthcare servicesbut into provider base services, and I think the smart money believes there's enormous opportunityto deliver the right, careright time,...

...rightplace at the right price by being better, faster and smarterthan the current Yuo providers in the system. One of the ways I look at it roxy is,if you imagine a two by two grid, with duration of care on the x axis, goingfrom episodic to ongoing and then care uncertainty going from Loto high on theYaxis. You end up with H. Four boxes and lowerleft is high degree, low, low risk episodic sohigh degree of certainty of a good outcome that, to me is routine orcommodity care, and probably seventy percent of e healthcare falls into thatbucket po go up which is high risk, but episodic something like a hearttransplant. You know that would be, and then upper right would be high risk and ongoing. That's the realsolution, chop kind of stuff, complex care, comoreabidities and then lowerright would be the not acute chronic care, and I think health systems and the industry overall,you know sort of the traditional players are trying to be good at all ofthat and end up, not necessarily being good at any of it. We've got pockets ofexcellence, so they're trying to be all things to all patients, and I believethat what the marketplaces is doing is picking spots where they believe theycan outperform the current system and it's a pretty low bar in many cases, soyou're seeing the rise of these enhanced primary carecompanies, gree eer companies that are really doing a better, faster, cheaperwith with with greater customer service. You kind of think about that specialtycare. The emergence of high volume focus factories, taking vilume out ofhospitals, putting it into amblitory centers, with special lice expertise. Think of the lower right, which is thenon acute chronic and we're seeing all the big retail chains sort of moving inthat direction, CBS, Walmart and so on, and then upper right is for the male clinics of the world. Butkind of the question I always have is: How many of those do we really need wehave where I am in Chicago. We have six places that do hard transplants. Onlyone does more than twenty five most tosingle digits. I can't think of a less sufficient way to do it with with hoice outcome.So I think, when you think about how the markets reacting, it's reorganizingitself to sort of attack these buckets and themore that we change the payment for care over to risk, base models andultimaely full risk models. The more important efficiency price outcomeswill become, which will put some of the trinking which, as you know, wit someof the ways traditional ways that providers deliver care today at risk.You know you won't be able to get away with doing a crappy job and the gettingqoint Byou know paid more to fix it. So yeah core industries yeah, so one of the things that I talkabout often is this statistic that ninety five percent of innovations thatare brought to market fail to reach any adequate level of customer acceptanceor profitability, and that's really not in health care. That's just overallacross industries, and then you think about the additional complexity thatthet layers in health care. Why do you think some you know innovations failand some succeed. Yeah well, have you seen the you probably seen the curve of innovation? You got the early adoptersand yeah yeah and they're willing to...

...try everything and, and the tree is to get to about twentypercent market Shaire, with whatever the new innovation is yep and what'shard about. That is that next group is they're called pragmatists or earlyadoptors, and they have to have a business for the bheyre going to justdo it because it's cool to do. They have to have a business reason to do it,and so most companies that fail tend to fail in what they call that trough ofdisillusionment. You know where they can't criss in thecasm yeah, you gottaCrossim Yea, so you just can't get there. so that's writ large in in youknow, society across industries. I think in healthcare in some ways it's even tougher, because we don't necessarily have companiesthat are purchasing based on value they're purchasing based on how do Ioptimize revenues and a fefer service system right and so navigate. You knowcoming up with a better solution, even if it's the best solution doesn'tnecessarily mean io game acceptance. Now, having said that, Idid mention that record levels of private equity and venture money orflowing into the space and they're flying they're, still flyling intodevice and farmup like they always have, but the services and provider side aredisproportionately benefiting. So I I think the market believes there are all kinds of opportunities toimprove and one of the things I'm you know you look like you're a millennial, my daughters, twenty seven, okay. Well, I just have really really good genes.You are going to live to a hundred and two like soyour daughter's generation. Then youknow when you think about that group. Half of them don't have primary carephysicians, they think hospitals are only for really sick people yeah. They only want care when they need it,and only when they need it and they wanted to be on demand in a click awayand really convenient. So I think there are a number of sortof millennial entrpreneurs that are coming into fill that space, and thisis the generation that taught us to ride with strangers and to stay instrangers houses and I think, they're going to resate the way we docompletely so the digital natives, and so I think, there's a chance thathelpe her could become or could exceed those rates just because there's somuch room for improvement and the opportunity to take technologiesthat have worked in other industries for consumers and apply them to healthcare is so fast and people are doing it so and the current industry's not terriblygood at it. So so it's a disruptive moment, so I oneof the things hat think is really interesting. Is You just talked aboutthe the technology adoption carve, the difusion of innovation and IIS common as it is? It's very rarethat I come across a health innovator that is basing their targeting strategy on that market segmentation, so it'sstill usually more of the traditional sense that they might be segmentingusers versus you, know the buyer or the doctor versus the health plan or thepayer. But but I just I rarely see folks gothat step deeper. That really becomes a game, Changer and foundational to theirstrategy going forward of not looking at the earlie doctors, and so theyspend so much time with the pragmatist that you just talked about trying toarm twist them and convince them that they have a problem that they cansolve for them an and it's just kind of...

...a nic mismatch of o problem in solution or awareness, an interest to solve thatproblem. At that point of time, yeah there are two things I love about:capitalism. The first is the ability to createsomething from nothing, so you'R, RSIT's, probably one of the highestforms of human achievement, and it's it you know, and people obviouslygravitate to it. So so that's that's! That's great. I mean my company didn'texist six years ago and now it's you know a recently good little company YEP,hopefully gets bigger, and I'm that process of trying tofigure out what the marketplace is, what customers want, how to deliver it,how to price it, how to respond to setbacks, how toseise opportunity how ton not be overwhelmed by opportunity. All thosethings are remarkably invigorating, but they're also hard,and I think that one of the biggest things that entrepreneurs fail torecognize- and I see this a lot, particularly with engineers, D and people on the techside. The is it really doesn't matter how goodyour product or services. Ultimately, you got to convince somebody to buy it, and I, as I do a fair amount ofadvisory work for forearly stage companies and when I'm looking atcompanies, I'm now evaluating the CEO, not only on their ability to you know,produce a great product because I think most technically provision people are goodat design and their insicts are to make it better. But it's that marketingcomponent, you know, can you put yourself in the chair of the personacross the table really understand the problem they're trying to solve figure out whether or not you canactually help solve that problem and if you can get them to agree to roll uptheir sleves and work with you on that. You know too many people just say: YoLook at my great wigit and they have at thought about how it fits into so thosethat do that can canconvince people to buy whatthey're selling have really crossed the big threshold. So you know all thes,you know premoney companies or you know what they're gone at it they're working hard.But at some point you got to turn the potential into actual sales andthat's that's a hard thing to do, and I think that discipline is part of whatmakes capitalism more yeah yeah. Absolutely you know it's true. So many of thefolks that we work with you know think that, because their innovation istechnically or functionally superior t, the wints in the market right, it'sbetter, it's faster, it's more efficient or it's cheaper, and eveneven if they have demonstrated outcomes that it's better, it still doesn'tguarantee success right, no y way too many times. So this kind ofleads me to my next question. So how what are some of the strategiesthat you recommend for health ininvaders to rise above the noise,especially with earlyadoptors yeah? Well, I mean th. You just heard a doseof it, which is really try hard to put yourself in theposition of the person across the other side of thetable that you're trying to sell to and really understand what problem it is they're trying tosolve and whether you have a solicit so wen. Just I give ou an extent when Iwas a banker. I would for my first meeting, and maybe thiswas an indication that iltimately I was going to do turn more to journalism.But I would go to a first meeting with just a pad of paper and and a pencil,and I would interview the person and if...

...it was really important, I would write down what I thought thecurrent status was and what they're trying to do? Why they're trying to doit with what the goals were and then I would let that person readit and I could usually get it. Seventyfive, eighty percent of the way right and then get their input, and then atthat point we had a shared document that accurately reflected exactlybecause they had contributed and signed off on it whated it was. They were trying to doin terms of capital formation or acquisition or whatever it was, andthen I would go back and think hard about whether we could help and if wecould I'd, say well, here's what we've agreed on here's, what I think we can help. Idon't want to be adversarial. Why Don t we get on the same side of the table,roll up her sleeves and go at it yeah and you know ROK. I could not get otherbankers to do that. I mean they always wanted to take their pitchbork and well.You know, and I'd say, don't bring a pitchbook and they were recording to meright. Don't befor we're going to have a conversation? Well, just in case youknow, so I mean I almost can't overemphasizethat part enough. I think the other thing is is appreciate, particularly ifyou're trying to sell into a health system or not thut. Even if you got agreat point solution, somehow it's got ta integrate into everything else.That's going on. I believe, ultimately, we're going to move toward platformingand the same way Amazon does that these companies will be somewhat agnosticabout what they own and where they partner and where they outsource. Butwhat they'll have in common is ability to mix ad match attributes so that youcan they can design products that meet customer needs built around brand andcustomer experience. So you know having that narrowconversation without having a sense of how this could integrate into upbroaderservice platform. I think is also a mistake that many fall into yeah. Ithink so, especially for the latter part of the market, when the market isa little bit more ture that that whole product configuration- and I didn't youknow- you- don't- have to be the one to deliver the whole thing but being ableto have those partners and making sure that it's going to be able to be fullyintegrated is really really critical. So it sounds like you've worked with largeinstitutions that are trying to innovate within and then with someearly stage startups that are innovating externally. How would youdescribe the differences between those and the challenges that they face andhow they overcome them? Yeah? Well, I call the the smaller ones, the upstarts rightand then you geat Ombencs, and I like the title ofhe Boo, because thecustomer revolution so right. So we get upstar revolutionaries and incumbent revolutionaries and the thechallenge for the upstarts Ar what we've been talking about, which is getting access and sometimes resources. The incumbents you know are alreadymarket leaders. They have a whole different set of problems, usually related to the fact that what they're getting paid to do isdifferent than what they say they want to do so they want to. You say you want to putpatients first, but if I look at what you do rather than what you say, itstill takes a month to schedule an appointment. You don't have customerfriendly software, you don't follow up terribly well, youknow all the things that were very familiar with is consumal act of yoursystem. I very rarely see a disconnect betweenwhat what a small entrepreneurial company says it wantsto do and what it's doing that that...

...those are perfectly lyine. I often seeit disconnect in health care between what a big and company big incomingcompany says it wants to do a what it's actually doing: Soiy Rigt Ibeyeah, no, it's othere wasI used to Hav loved the show Dallas. He probably remember it and yeah. Therewas one episode. It was a long time ago. Obviously, where Jr the main characterwas was scheming with his brother, bobby back and forth and finally jared-and you know you know bobby once you give up your integrity. The rest is apiece of cake and I think in healthcare. We've got sortof this built in hypocrisy in a lot of what what happens because got this kind of artificial way ofpaying for things not rebllyted to value just related to volume and that'swhat everybody does to sort of keep the machine going and earn a great living.But they know that's not the right thing to do so. They talk about all thevalue stuff they're doing. But you know if your ninety eight percent Pfor service- and you got one person working on social determinants tohealth- that's probably not going to get the job done right right right, so I whent. I am on the incombant side.Woutd I've seen for really successful companies is this concept of dualtransformation. Have you heard of this? So you've got te just existing businessand then the new business- oh yeah, Havy, and so so call the existing a andyou run that as efficiently as possible and then B is the whatever the newbusinesses and I' say. Broadly speaking, and health, health care S, a and health is b. Youknow if you're going to try beat on health, that's very different thantrying to compete on health care. And yet, if we're going to go to populationhealth models and verticcal integration, Goan have to compete on health, andthen you got this sort of sea level up above which kind of settles the jump,balls and make sure resources, butessentially adoes a and you don't mess with that and beatUS B and you don't mess with that and let them go about their vusiness and you know an example that would be thefairviewhealth system very university Minnesota health system, which is justopened a system operation center. They used to have six hundred ways ofcalling into fairview now there's one center, so one CALLOF US at all they'vealso got some predicted analytics that sitsin this. This building with a bunch of screens they can anticipate where bottle nexts are going to occur andthen they can send a nudge to a nurse or to get a discharge out earlier andbringing down like the states improving that is kind of classic a busines. Youknow how do you run it better, yeah, yeah and simultaneously they've createdthis company within a company to handle all the risk business, so they got alittle bit of an insurance company. They've got physitian groups, so allthat care management activity isn't trying to succeed within thefever service to kind of treat en environment. So they really arecompeting on healthcare and a and competing on health and be differentbudget. Different culture, different goals, yeah, absolutely you completelyunderstand, and so it's really hard to do. I mean, butI don't, I think, if you try to do both inside the same company, it fails. It'sjust you know like when Kodak tried to do digital photography inside the film businessand they'rl make digital for lunch, and ultimately, you know choked on it soyeah. It's just one rod black after another, hey it's! Dr Roxy, here with a quickRak from the conversation, do you want...

...your innovation to succeed to changelives to shape the future of health care? I want that for every healthinnovator, which is why I invented coy Q, an evidence based framework to takeyour innovation from an idea to start up to the full market adoption, ifyou're, not sure where you are in the commercialization process, take thefree assessment. Now at Dr Roxycom Backfour, don't miss out on impactingmore lives just because you have a low coiq score. The free assessment is thatDr Roxycom XS, four, that's Dr Rox IECOM backslash score and now, let'sjump back into the conversation, so who are some of the healthinnovators out there? Both large are upstart that that you think are doing it. Well, ohthey're lost. There are lots of them, oarn crown yeah. Well, I and some some of the thepartnerships are kind of interesting too there's a company called GrandRounds Out of San Francisco, Silkon ballity funded, and they started as doing second opinion. So they collecteda network of top one percent specialists around the country. Theywould contract with employers who would pay per member for month. One of theiremployees would get sick, grandrounds would come in andlook at the diagnosis and the treatment pattern and about two thirds of thetime would change it and usually change it in ways that were less intensive and that that's a great service, butthey have now kind of migrated more into the primary carespace and theyhave an algorithm that literally ranks every primary care physician in thecountry and what they've discovered is thathigher performing primary care? Physicians get the referral patternsright the first time and get the prescriptions right thefirst time so, for example, seventy percent less OPIA prescription WHOPIprescriptions, so they grand rounds is now partneringwith Walmart and theywere going to roll out this service. So when a walmartassociate needs primary care, they will have their ability to look at all ofthe primary care. Physicians in that region and direct the associate thesehigher performing primary care. Physicians and the belief is- and it'salready started to prove itself out- that they will get better care. What weall want. You know better. Ou veis lower cost better customer experience. Comcast is doing something with with asimilar company what different from Grand Roumds, but another upstarcompany called Crossover that does onsite clinics nearby clinics andalvirtual clinics and comcast says a hundred eighty thousand peoplenationwide, so they're going to run all of their employes wo. These crossoverclinics, where they have a lot of people whill have it. You know on sigtwhether our reasonable number it will be nearby and otherwise well be virtual,but only one platform integrated great care- and you know codcast for a long time-has had some of the best outcomes of any of the corporate bioursof. Part ofwhat I think is happening is that the people that buy healthcare,government and selfinsured employers are starting todemand more value from the system. You know demand driven change, superhairforresults I 's at like you know: McDonald's is experimenting with CalSalads, not because they don't want to sell you more burgers. It's becausesome of their customers want some...

...healthier options. Yeah and I've beenwaiting for this for a long time, but I think the buyers are getting smarter and the only response many of the bigsystems have is to really use. You know: Market Leverage on pricing tokeep them in network. So as we get these new types of services like thetwo I just described, that starts to break down. You know your daughter'svirtual care, companywell get her generation, and you know I think the boomers to people more like me than you, butyou'll get there eventually are not going to go quietly into that goodnight, so theyre, star, theyre, disproportionally buying Medicareadvantage, which is a capitated payment lovel and ultimately, when you kind ofget through it, you got to take care of a group of people for a certain amountof money that changes everything. You know these MAA plans you get freehearing AIDS, gym membership,stanvil care all this other stuff coming in, and I think the boomers willalso redefine end of life care and I could go to any of these segments, andI you know if you want to know a creative houseless company. I cund giveyou the handful of those if you wanted to know a company that was thinkingabout patient navigation in a coherent way. I could talk about that. If youwanted to know about a company that was figuring out how to pull data and putit on a platform so that innovative companies can write outs S, I can tellyou about that they're all over the place. What's the pattern Dave t whatwhat is the if there is any, because what I thinkis interesting is the first two that you described and detailed. You knowtheir business model involves the self insured employer group. As the buyer.You know so they're able to circumvent a lot of the barriers that they mighthave to face if they were going into the traditional health care system. Sowhat Aryou know is kind of you think about it? Are there any patterns tothose examples that come to mine that we can? We can glean yeah well Roxi alittle slogan for my company or the Big Slovan for my little company. You knowlike the Little Engin that could is outcomes matter, customer count andvalue rules. So I think what all these companies have in common is are thosethree things that they are focused on outcomes not on process they're focused on customers, not on on any number of other things that youcould worry about and specifically on driving, better outcomes and improvingcustomer experience and value. You know getting better outcomes from lower cost,so I would say every company that I would point you to is contributing tothat in some way or another. I sometimes, if you can, you can tellyou like two bi two grips. If you can imagine one this one will be easierthan the last one wher you do it yeah. He got sort of market on the bottom, so yougot bad market and good market, and then he got medicine on the on the Yaxis and bad medicineand a good medicine. So, in the lower left bad market, bad medicine, you gotfragmentation you're, paying too much. You know it'sawful if you're on the lower right, whereyou've got good market but bad medicine. That's like a reasonably price Emaithat you don't need, even if it's just five hundred bucks, you don't need itthis bad for you Yeph Y, so that would be over treatment. If you go upward left so 's, it's badmarket, but good medicine. That's you need an Ri with you know: You're,paying fiveosand bucks for it, and those three over payment fragmentation and overtreatment...

...are the three faces of modern Americanmedicine right now: good medicine, good market convergence,what I call revolutionary healthcare right, careright time right place andright price. There are pockets of that in the country, but it's it's my farthe exception ot the rule. So again, if you kind of come back to that outcomes,matter, customers, cind of value, rules that you're driving up into thatupperright quadrant. You know we cannot. Healthcare, cannotdefy gravity forever and we're not going to continue as thesociety to pay for care that doesn't generate the type ofreturn it should and has enormous wayt associated with it. So I think this isthe way the marketplace is a attacking it. The other thing that's happening is on the regulatory side. We've got avery progressive regulatory set of of leaders at cms right now,Sima, Verma and Alexeys AR, and they are doing everything they canto push transparency to level accamative l you may have seen lastweek. They just came out with a new policy that says insurance companiesand hospitals are going to havetow. You know make it very easy to see what theycharge. What they're doing the industry's like having you know anatoplectic fit about it because they don't think they should have toreveal their prices. Well guess what, when you have pricing transparency,really empower people make better decisions or companies that act asproxies non behalf of people so again kind of a long answer yourquestion, but you know this is an industry. That's again focus really on pe fer servicepayment, turning volume, not really on outcomes on on value- and you knowthat's that's the old math. The new math is you're increasingly going to get kindof fixed payments for episodic care and capitation paymentsfor population health, and you got a fix amount. You got to work with, sohow do you take that money and and provide great care and profit at thesame time? So hell a yeah? So let's talk about outcomes a littlebit. You know thinking about a startup andthey're funding and their relationship with their investors or their board,and the amount of time that it takes to dmto develop a program thatdemonstrates outcomes, the resources that are needed to back that. Let's just talk about that a little bit.What's your perspective on the money and the time that takes in- and youknow in just this conversation of you know- could take me a year or twobefore I have some demonstrated outcomes. I got to get some cash comingin and check at right, yeah! No, it's well! My first advice to contrpreneurses food strap for as longas you humanly can that when you have to take the outsidemoney, it's very expensive and they get a Chunkyour company andthere've been too many cases where, because of the cash flow crunch, you know an entrereneur. That's reallycreated a company with a lot of valuents up with lot less of e the Pie than theyprobably should, if so, goods trap as long as possiblehusband resources, I think everybody's been a little bit kind of enammered of thes Silicon Valle,where you know they're, just seemd to hand out money like popsicles to tocompanies,...

...and you know sort of the attitude thatI will invest in ten ninill go bankkrupt, but the one that we will bea big winner and Yep so on. When I'm not sure those numbers are itos? So, like gambling, you know gamblers always tell you about the timethey have the big win. They don't tell you about the ten times they've lost,so I some call those people that said no to uber an Arbnv because theythought strangers were not going to ever come in someone's House Orenweren't getting in those cars, yeah wenlover still has at made any moneywhich is Tis kind of interesting. They. I was just out at the big healthconference in Vegas and which is kind of a got atech investor FOCUSD TI we're. Writing areport for the conference and just finishd the executive summary Fort andover and left were there in a big way. Lift was a five star sponsor left HellAna EA, so you know think about you know what lift could do to the pair of transit industry or even theambulance industry, to tell you the truth, ablutely yeah! So it's and they're already thinking aboutoutcomes, the customer and value that that something that they're endergyinyeah absolutely in their DNA yeah. So that'sso that's you know again you kind of keep comingback to these same concepts, demonstrating value, creating valueit's and then convincing others to pay you money to deliver it. It's reallyhard, but it's ultimately enormouslyrewarding and I think that's and- and you know, part of it is being lucky right, likefacebook was really lucky, because Yahoo was ayacht. No, who bougt my space, maybe was Fox and waysomebody bought my space and y kind of ruined it right right, and so they Zackerberg and there've beenmultiple attempts to try to do this type of social media connecting platform and facebook came Aron along right atexactly the right time. When you know if they've been earlier, they probablywould have failed. If they'd been later, there would have been somebody else, Oan facebook doing it, and timing is often as much a factor ashard work and Ingenodi, and so on absolutely yeah. I mean again, I have a lot of friends in Seattle and I wish more of them ould would justadmit that they got lucky when they worked for Microsoft and Licosof. Iwhatnot it's Junger, which isnt to say they weren't smart and didn't work hard,but there are a lot of Sarg people to work really hard, but not everybody.You know picks winter. That way, I still o Wer luck is there's luck is abig part of life and recognize I tryg to get it to come inyour favor. Although I have always liked that slogan, that the luck iswhere opportunity meets preparation, so you got to be ready to ready to getlucky right, hands down, not really onewithout the other e. So so dave just one last questionbefore wrap up today. Most of our listeners are healthinnovators, thatre in the trenches right now, with varying degrees ofsuccess and frustration. What what advice do you have for them? Well, Onheon the frustration side. I mean I'e Goa many recapsule, some of what I've said, which is bootstrap as long as you can. You know at some point you probably need to take some money,but hopefully that's when you got a product that works and you're going tobuild out a sales force that type of...

...thing Yep. The second is: You got to be really concerned aboutthe market, positioning and the market messaging and the sales process. Ican't spend all your time just making the product better and more beautifuland whatever so t what I said earlier about having some marketing chops sothat you can go out and convince somebody toput a piece of their business in your hands. It drives me in saying how manyinnovators spend millions of dollars on the product, and then they want toinvest about thirty fivesand dollars in their communications and go to marketstretch iyeah there you go, I so when I was abanker and we'd have these. You know beautycontests it. I used to call where you going Tand make a pitch yeah worldpresentation, and- and you know you be one o three or oneo five and somebody is going to win the others were going to lose yeah used toamaze me Roxy how how much time people would spend cultivating a clientwriting a proposal. You know doing all of that stuff andthen they would would wing it in the oral interview and hates to say to myteam. It should be exactly the opposite. If you're one o three finalists, you know your chance is a winning R atyou know all thet things being equat our third. If you over prepare for thatrehearse figure out with messageis going to be be tight on yourtransitions, have good graphics, all that stuff chance that you're going towin are going to be much better than if you go wel, you know just and people. Ican't tell you how many time is e Goin for the book like this tick and theyflip through pages and they lose coit N and wouldn't ask for the job Te Ani. You know that I think those samelessons apply in any company which is that's, got a product, a service in amarket and the point of sale of those moments. Yougot to have your a game on and you got to you know you got to look your bestand you got Ta Candy and hellow. You know it's! It's amatchmaking process and people that sort of don't either recognize that ordon't give it credence are just not going tobe as successful and they'll they'll be frustrated that others who are betterat that that don't have as good a product. Absolutely. How is this possible? My product is better it's moreefficient. It saves more money that they tell a better story to be harderSen. The world is not fair and he was right. So that's true. That's true!Well Dave! Thank you. So much for sharing your wisdom with our listenerstoday. OCAN folks get a hold of you. If you go to the website, ForsigdtHeltcom, that's the number for Oer. Like mynephew goes. He goes foresight so number four sight: HEA LTH, FORSIDThealthcom! You know you won, you can sign up. Wedo regular produce a ton of thought leadership,there's a huge backlog of stuff that we've written so there'sthere. You can also write to us there and, and so on and I'd encourage people.I hope we get a few new readers out of this. We also do podcast like you doand yeah well. This is, I do like the video thing here. We only do it audioso, but so that's that's the best way toget a hold of us and and we're always eager to get receivedfeedback, and also you know,...

...tell your tellike this. My editedversion right because you can see you gotta Commout, the Book Yeah by theCustomer Revolution in healthcare. It's it's doing reallywell and I think a lot of what we've been talking about is baked into that,and so people will enjoy that as well.Maybe use it. I've gotten lots of compliments unhisability to answer someof the questions that we've talked about today. That's great, that's awesome! Well,thank you. So much for joining me today. Thank you. Thank you so much for listening. I knowyou're busy working to bring your life changing innovation to market, and Ivawue your time and your attention to save kind and get the latest episodeson your mobile device automatically subscribe to the show on your favoritepodcast APP like apple podcast, spotify and stitcher. Thank you for listeningand I appreciate everyone. Who's been sharing the show with friends andcolleagues, see you on the next episode of coiq.

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